Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Shilpa Joshi ( Department of Dietetics, Mumbai Diet and Health Centre, Mumbai, India. )
Sambit Das ( Department of Endocrinology, Hi Tech Medical College and Hospitals, Bhubaneswar, India. )
Nutritional and dietary advice is the foundation of diabetes management. Unfortunately, such advice is seen in terms of intrusion and restriction of lifestyle, rather than as a health promoting intervention. This can be corrected by incorporating happiness into dietary modification. Culinary happiness can be defined as the process of sharing dietary, nutritional, and cooking advice, while ensuring the happiness associated with eating remains intact. The concept of culinary happiness includes all domains of culinary science: the procurement, preparation, plating and preservation of food.
Keywords: Diabetes, Dietary, Endocrinology, Person centred care, Type 1 diabetes, Type 2 diabetes.
Food and Happiness
Food and nutrition are associated with happiness and pleasure.1 The science behind happy foods and comfort foods is well known. Tryptophan, for example, can help build serotonin, which is a neurotransmitter than has a calming effect on mood. Tryptophan, found in milk, nuts and seeds, can cross the blood brain barrier directly, to produce serotonin, Docosahexaenoic acid (DHA), obtained from fish and shellfish, is linked to mood as well: DHA deficiency is associated with a higher prevalence of depression.
Food and Diabetes Care
Food and nutrition is the cornerstone of diabetes care.2 The diabetes care team, including nutritionists, educators, nurses and physicians, try their utmost to share appropriate dietary advice with their patients. While such advice is usually accurate, from a nutritional and scientific viewpoint, it may not always be welcomed with pleasure. Dietary advice, in fact, is viewed with distaste by most persons living with diabetes. Anecdotal experience sharing suggests that a diet prescription is considered to have greater intrusion into lifestyle than other aspects of diabetes care. Acceptance of and adherence to, suggested dietary rules and patterns, is far from optimal.
Person-Centred Medical Nutrition
What can be done to improve this state of affairs? As diabetes care professionals, we should focus not only on the content and complexity of the diet prescription, but the style of its delivery. As is true for all other spheres of chronic disease management, medical nutrition therapy (MNT) is a highly personalized interaction between patient and provider. The concept of person-centred diabetes care3 applies as much to MNT as to medical care. It is the responsibility of the nutritionist to share dietary advice that is appropriate, acceptable, and appealing to the patients. It is also her responsibility to do so in a manner which preserves the happiness associated with food and nutrition.
We term this concept as culinary happiness. Culinary happiness can be defined as the process of sharing dietary, nutritional, and cooking advice, while ensuring the happiness associated with eating remains intact. The concept of culinary happiness includes all domains of culinary science: the procurement, preparation, plating and preservation of food.
A nutritionist who incorporates culinary happiness into her routine work should be aware of local practices regarding purchase of foodstuffs (including seasonal variation in availability and cost), cooking styles and preferences, and taboos. Nutritional advice should be shared in a salutogenic positive way, which emphasizes the joy of life.4
Ensuring culinary happiness enhances the responsibility of the diabetes care team, including the primary care physician and nutritionist. One must be skilled in the art of communication, especially motivational interviewing. Behavioural modification should be addressed and encouraged while discussing details of diet and nutrition. Developing calmness and serenity in oneself helps foster the same emotions in the patient,5 and this creates a framework for acceptance and adherence to prescribed therapy. MNT should be portrayed as pro-active approach to health and happiness, rather than a restrictive intervention.
The Spectrum of Culinary Happiness
Prescribed foodstuffs should be described in positive terms. An example would be to encourage consumption of vegetables, salads and fruits using colours of national flags or favourite toys as a motivating factor. Suggesting novel recipes and plating ideas can also convert mundane foodstuffs to exotic dishes. The concept of culinary happiness can be approached as shown in the Table.
Nutritional and dietary advice is the foundation of diabetes management. Unfortunately, such advice is seen in terms of intrusion and restriction of lifestyle, rather than as a health promoting intervention. This can be corrected by incorporating happiness into dietary modification. This is what culinary happiness means.
1. Sucic I, Brkljacic T, Lipovcan LK, Glavak-Tkalic R, Lucic L. Happy Treat: Food and Drink as Important Parts of Daily Life and Happiness. Gastronomica. 2019; 19:79-92.
2. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KH, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019; 42:731-54.
3. Kalra S, Megallaa MH, Jawad F. Patient-centered care in diabetology: From eminence-based, to evidence-based, to end user-based medicine. Ind J Endo Metab. 2012; 16:871-2.
4. Kalra S, Baruah MP, Sahay R. Salutogenesis in type 2 diabetes care: a biopsychosocial perspective. Ind J Endo Metab 2018; 22:169-72.
5. Kalra S, Punyani H, Dhawan M. Creating happiness in the diabetes care clinic. J Pak Med Assoc. 2020; 70: 1099-1100.