Taking Healthcare by Storm: Industry Insights with Chef Duane Sunwold

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Chef Duane Sunwold, a culinary arts instructor at the Inland Northwest Culinary Academy at Spokane Community College who also has chronic kidney disease (CKD).

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-032224-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.
 
 Subscribe now, and together, we can take healthcare by storm.
 
 Hello, everyone, and welcome back to Taking Healthcare by Storm.
 
 I am Dr.
 
 Jean Storm, the Medical Director of Quality Insights.
 
 Today, I am very excited about the guest who is joining us, and I feel he brings a unique perspective to chronic disease management, something that many of us really don't think about in chronic disease management.
 
 So I'm so excited to hear his perspective today.
 
 We are joined by Duane Sunwold, who's a culinary teacher and a chronic kidney disease educator.
 
 Chef, thank you for joining us.
 
 Well, thank you for having me.
 
 I'm always excited to talk about kidney disease and nutrition.
 
 Fantastic, because we are as well.
 
 So tell us about your background and how you came to do what you do.
 
 Well, my grandmother was actually my first babysitter and she was a very good cook.
 
 And since I've been two years old, I've been playing in the kitchen and haven't stopped, really.
 
 So I always wanted to be a teacher and I like to cook.
 
 So I went off to cooking school thinking I would get trained and then I could work while I go to university to become a teacher.
 
 And my very first culinary class, I was sitting in there going, this is it.
 
 I love this industry.
 
 I love to cook and I want to teach.
 
 I can do this all at a cooking school.
 
 So really early on, I knew exactly what I wanted to do with my career.
 
 And you're lucky that you found it so early.
 
 Yes.
 
 So where do you live now and have you always lived there?
 
 So I live in Washington state.
 
 I'm on the east side of the state, very close to the Idaho-Washington border.
 
 And I've lived here most of my life.
 
 I've lived in the Pacific Northwest almost my entire life.
 
 I did go off to school in Calgary, Alberta, Canada for two years.
 
 And both winters got 40 below.
 
 So I moved to Maui for a few years after that and enjoyed the sunshine.
 
 Oh, fantastic.
 
 So tell us about your own health challenges.
 
 I know you've had some challenges around chronic kidney disease.
 
 So tell us about those.
 
 So when I turned around 40, I started losing energy and I don't have a medical degree.
 
 I just thought that's what happens at midlife.
 
 So I didn't do anything about it.
 
 And over the two-year period, I just lost a lot of energy.
 
 And after those two years, I started having high blood pressure, hypertension, and migraine headaches, which I had never had before in my life.
 
 So I went to my general practitioner and it took his team three months to diagnose I actually have what they call minimal change disease.
 
 I was spilling a ton of protein in my urine.
 
 So before I could even get to my first kidney doctor, I crashed, was admitted into the hospital, and the next day they did the kidney biopsy and proved that I did have minimal change disease, which was causing the spilling of the protein.
 
 So my first kidney doctor never ever talked to me about diet, and he put me on an immune-suppressive regime with steroids.
 
 So I had a lot of side effects from the medications I was on.
 
 I gained an extra 75 pounds from the steroid treatment, and I had two other consults with a couple other doctors, and only one of the other doctors in the consult ever even talked to me about diet and nutrition and kidney disease.
 
 And she told me that my kidneys were obviously stressed out and that animal protein for some reason is kind of hard on kidneys and you should cut back.
 
 And like a good patient, I didn't listen to her for another six months.
 
 So while this was going on, I was also transitioning to what we call focal segmental glomular sclerosis or FSGS, which is the scarring of that really the tiny little filters inside our kidneys.
 
 And cooking or teaching here at the cooking school, we had a registered dietitian at the time teaching our students nutrition, and she was following my case.
 
 And she came in my office one morning and said, I want to do a challenge.
 
 I want to see what would happen to you, Duane, if we just take animal protein out of your diet for 90 days.
 
 And I'm like, okay.
 
 I've certified the rules that meant no meat, no cheese, as little eggs and baked goods as possible.
 
 And she said, let's just see what happens.
 
 And I said, okay.
 
 So Monday morning, I became what we call a wannabe vegan.
 
 And I have to tell you, I approached this as a very egotistical shop.
 
 I've been around food all my life.
 
 This is going to be a piece of cake.
 
 And I hadn't thought about the process of I'm changing a 40-year eating pattern.
 
 And it was much more difficult than I thought.
 
 But what was so amazing was within two weeks of taking as much animal protein out of my diet as possible, I actually started feeling better.
 
 And a year and a half of medication never made me feel that good.
 
 That is amazing.
 
 That diet did that made that big of a difference.
 
 So you talked a little bit about your diagnosis.
 
 Do you do you feel like you received adequate education and communication about your condition that you kind of you understood it well?
 
 No, in my case, I didn't.
 
 And I don't think that's true for all patients.
 
 Based on some of their diseases, I think the doctors are really good at explaining, you know, here's how your disease is going to progress.
 
 For me, I didn't realize how sick I was until we track our kidney function with a scale called the GFR.
 
 And once you drop down to 15 or lower, you're considered a dialysis or a transplant patient.
 
 And I actually got as low as 13 on the GFR scale.
 
 And I will never forget how that feels.
 
 And that's when I really got a reality check.
 
 And they said, look, you know, at 15, you're a dialysis patient.
 
 You're now dropped to 13.
 
 We have to make some major changes.
 
 And I really believe if I had not changed my diet, I would definitely have been on dialysis for the last 20 years.
 
 Yeah, that's a scary proposition.
 
 So tell us about your interest in kidney disease and obesity, because a lot of people don't really think about them as being connected.
 
 Well, you know, they don't.
 
 And it's interesting.
 
 I feel kind of guilty because, you know, I teach future chefs, and I think our industry is partially responsible for this obesity crisis in our country.
 
 People want good food, and I understand that.
 
 But it takes a little bit of work to make good food healthy.
 
 And I just think we've been lazy about that.
 
 And, you know, I think we're just now, medicine and science is just kind of doing the research to prove that obesity does have an impact on our kidney function.
 
 So I was actually one of just a few patients that was got the honor to actually attend the first conference ever with obesity experts and kidney experts in the medical field.
 
 And it was fascinating to learn from the obesity doctors how our bodies, people that can be very sensitive and react very differently to how our body wants to store and save fat rather than use it up as an energy source.
 
 Yes, it is a very controversial subject.
 
 So you kind of, I think you alluded to, you participated in a conference.
 
 And was it a study looking at a link between obesity and CKD?
 
 It was actually a conference where for the first time they brought these two groups of doctors together to even talk about it and make suggestions and recommendations on what kind of future research needs to be done on obesity and kidney disease together.
 
 So I'm sure your input was just valued and unique at that forum.
 
 Yeah, I do have a very unique perspective.
 
 And, you know, the other thing I want people to know is, you know, because I've stayed on my diet, I've been in remission for 20 years, which is really unheard of for kidney disease.
 
 Oh, it absolutely, yes, it definitely is.
 
 Now, we talked a little bit about chronic kidney disease and communication about that diagnosis.
 
 Do you think physicians do a good job at discussing obesity with patients?
 
 I don't think so.
 
 First of all, it's a really sensitive issue.
 
 How do you bring up the topic when even if the patient knows they're overweight, they may not want to talk about it, they may not want to hear it about it.
 
 I think we need more training in how to have that conversation about obesity with patients.
 
 I'm happy to see more research coming down the pike on the effects of obesity on our bodies.
 
 I just was reading a summary of a study done in Israel where they're actually proving teenagers with obesity have a higher chance of getting kidney disease.
 
 I think that's the kind of information the medical team needs, but we've got to find a way that patients and doctors can communicate this in a way that's going to be motivational for the patient.
 
 Yeah, I agree.
 
 I think it's very challenging.
 
 If we're not doing a good job at discussing obesity, now I don't think your physician did a very good job at perhaps explaining the progression of chronic kidney disease and if that progression can be stopped or even reversed in your case.
 
 True.
 
 I have to remember this was 20 years ago, and now they're finally doing research and showing that plant protein is more gentle on our kidneys.
 
 And I think we're all going to see more research done in that field, where the other thing about kidney disease is our body compensates for our dysfunctional kidneys for so long.
 
 A lot of patients, they reach that GFR of 18 before they ever go see the doctor or even the crash into dialysis.
 
 Where they've already dropped below 15 on a GFR.
 
 And I think we, the medical community as a whole, has got to start diagnosing kidney disease way earlier on.
 
 Yeah, I would agree.
 
 So you were, I think you said you worked with a dietitian initially.
 
 Can you tell us about your experience working with that dietitian?
 
 And do you still work with a dietitian?
 
 So, one of the things I actually love about my kidney disease is I get to work with dietitians across the United States and like for foreign countries.
 
 So I think dietitians are invaluable to a patient.
 
 They know so much about the science of food and how those nutrients interact with our body.
 
 So I love working with dietitians.
 
 Every project I can, I work with the dietitians so that I know I'm going to come away and learn something from them.
 
 I also think there is a small handful of dietitians that have been trained on flavor, but most dietitians, they understand the science of nutrition, but they don't understand how do we get food to taste good.
 
 Because if you want patients to comply, you're going to have to get food that the patient's going to enjoy eating.
 
 So I always love working with a dietitian and I approach it totally as a team.
 
 It's like, look, we're in this as a team and together our two expertise are going to make a much better outcome than just one of us.
 
 Yeah, I would agree.
 
 It's definitely a team effort with chronic disease.
 
 We talked a little bit about your own communication challenges with your healthcare team.
 
 And I read an article about your perspective and it mentioned motivational interviewing.
 
 So what do you think the role is in motivational interviewing and talking about a chronic disease like chronic kidney disease?
 
 I think motivational interviewing is very crucial.
 
 And the key to motivational interviewing obviously is to get the patient to bring up and discuss what the problem is or what the hurdle is they need to learn to overcome to be healthier.
 
 So I think motivational interviewing is a great technique.
 
 It does take a little bit of time, but the patient usually is so much more receptive to hearing.
 
 And I know one of our problems with our health care system is that, you know, it's a business and they want you to see as many patients as possible in the shortest amount of time.
 
 And in that kind of format, it really becomes the poor dietitian is just shooting information at you.
 
 Boom, boom, boom.
 
 And it's not the dialogue where I think if doctors and dietitians, you have to start wherever the patient is at.
 
 And you really need to know is what do they normally eat and work from there.
 
 And then try to figure out, you know, what's the first thing I can change in a patient's diet that's going to cause the biggest impact and that they're going to be receptive to making that change.
 
 I had an incredible mentor in the education field who said, look, every adult has this five-year-old child inside of us, and you're going to have to teach to that five-year-old child.
 
 So when the day the dietitian took me off of animal protein, I remember my five-year-old child throwing a temper tantrum inside my head.
 
 But I'm so thankful that I listened to her and followed her advice.
 
 Yeah, that's a great tactic, listening to the five-year-old child.
 
 So switching gears a little bit, there's been a lot of talk about food deserts, those areas of the country where individuals don't have access to a grocery store to get fresh fruits and vegetables, fresh foods.
 
 Maybe they're getting their food from convenience stores, gas stations.
 
 So do you feel that these food deserts are playing a role in the incidence of obesity and chronic kidney disease in the country?
 
 I definitely think this is a very serious issue for our country.
 
 Yes, these food deserts are supplying really cheap, inexpensive food that's not highly nutritious.
 
 It's usually very highly processed.
 
 What's interesting is they're doing more and more studies now on our whole GI track.
 
 What we're finding is that these highly processed foods, that they're usually high in fat, they're high in salt, they could be high in sugar, and we digest them much earlier into our GI track.
 
 So it changes all of those biotics that have been growing in our intestines.
 
 So if you eat a whole foods diet, whole fruits, vegetables, you actually change what's living in our GI track and it's a much healthier for our whole body.
 
 So people have to have access to whole fruits and vegetables.
 
 One of the challenges the renal nutrition group gave me was, they asked me when you're to give a cooking demonstration only using food from a food pantry.
 
 So I went to our largest food bank and said, what are the main ingredients usually given to your clients in a box, and then I had to take that box of canned foods and say, okay, how do I make this as healthy as possible?
 
 It was a fascinating project because I learned so much that a lot of food banks, the big food banks, all have dieticians now, and they try to accommodate clients' dietary constraints.
 
 So I think it's really important that patients, if you are in a desert, to look, expand outside of your local convenience store.
 
 If there is a food pantry, food bank close by, I would recommend checking it out.
 
 I also teach patients, I said, create a little card that has your nutritional guidelines that your doctor and your medical team want you to follow.
 
 Because I use that card all the time.
 
 If I was a patient getting food from a food bank, I would hand the person there and say, here's what I'm supposed to be eating.
 
 Because if they have low-sodium canned vegetables, they're going to pick those out for you.
 
 They try to accommodate your health needs as best as possible.
 
 That is wonderful guidance to give individuals.
 
 Now, I know you teach, so tell us about your course, Nutrition for Chefs.
 
 Yes, we have the American Culinary Federation, which is the program that accredits our cooking program or school.
 
 They require us to teach 30-hour minimum nutrition class for chefs, and certified chefs are required every five years to take a nutrition class.
 
 I love this class because first of all, I'm working with people who've had what I call the 32nd nutritional education.
 
 Whatever the commercials they've listened to, that's what they know about nutrition.
 
 I literally start with a clean slate and we talk about just the macronutrients, protein, carbohydrates, fats.
 
 We explain why we need vitamins and minerals and why water is so important.
 
 Then from there, I take it and we break it down even more.
 
 Like carbs, we literally talk about what are the good carbs, those complex carbs that are slow to digest.
 
 The problem is processed foods are high in simple carbs.
 
 They're high in sugar, they're easily absorbed into our bloodstream, which causes our blood sugar to spike.
 
 It really helps chefs understand, it's not just putting really good flavored food on a plate.
 
 Because the other thing I want them to know is, I said, we want our customers for a long time, which means we have to help keep them healthy.
 
 We've got to be able to make food taste good, but you also have to think about how do we make it healthy?
 
 In today's world, there's so many dietary constraints that you have to know how to modify recipes.
 
 How do you make something gluten-free?
 
 How do you make something that someone can't have lactose?
 
 Or chefs are really famous for where we use too much salt, so how do we make food taste good with lowering the sodium?
 
 Human beings, our tongue just naturally loves the taste of fat.
 
 If you want something to taste good, it's easy to add more fat.
 
 I'm always challenging my students, how do you take out the salt?
 
 How can you lower the fat?
 
 Really, how many simple carbs are on this plate?
 
 Can we make them more complex by adding whole grains rather than doing something with just processed flour as an example?
 
 You can always add more butter to make things taste better.
 
 Julia Childs loved her butter.
 
 Do you feel that it's more of a challenge to cook with plant protein compared to animal protein?
 
 I find it more creative.
 
 Obviously, I do 90-some percent of the cooking in my house at home.
 
 For me, I love being able to walk through an average grocery store and go to the produce section and see what's in season and I find my dinners are much more creative and they're much more colorful, because I'm using foods that are in season, which usually means they're at the highest quality and they're also at the lowest price.
 
 Whereas, if you're dealing with animal protein, you run to the butcher shop area and you're deciding, are we having beef, pork, chicken, fish?
 
 What is it?
 
 Then we've designed the meal around our animal protein.
 
 Whereas, if you go plant-based, it's really just a variety of plants.
 
 People forget that even broccoli has three or four grams of protein in it.
 
 Potatoes actually have a couple grams of protein in it.
 
 Portobello mushroom cap has eight grams of protein.
 
 I don't feel deprived at all on a plant-based diet.
 
 I just feel it's so much more creative.
 
 Yeah, I would agree.
 
 We're talking a lot about food.
 
 What is your favorite meal to cook?
 
 I have to say, fate has put me right where I need to be because I don't have a favorite meal.
 
 I love the challenge of a new recipe.
 
 Once I've conquered the new recipe, it's time to move on to the next.
 
 I'll give you a couple of examples here.
 
 The National Kidney Foundation is working on upgrading some of their recipes and videos coming out this spring.
 
 They asked me to do some recipe development for them.
 
 I just made a African peanut stew.
 
 What's interesting is one of our students in our cooking school is from Trinidad.
 
 I gave him some and I said, I want you to take this home and taste it and critique it.
 
 We're going to reverse roles.
 
 You're the chef now, I'm the student.
 
 He came back to me and he goes, Duane, this tastes just like I had in Nigeria.
 
 I said, oh, perfect.
 
 I love this challenge of taking a recipe that is from a culture.
 
 How do we make it healthier and still keep it very flavorful?
 
 I agree.
 
 Then people don't feel deprived.
 
 They feel like they're eating what they want without feeling deprived and eating healthfully.
 
 Right.
 
 I think we have to look at the different ethnic cultures around the country because that's what their comfort foods are.
 
 When people don't feel well, they're going to eat comfort foods.
 
 Yes.
 
 I agree.
 
 Last question.
 
 If you were in charge of health care in the United States, what is the first thing that you would do?
 
 Well, probably two things.
 
 I think everyone needs their kidney function checked, just in my case.
 
 But number two, I really think doctors need to recommend patients have some nutritional consultations.
 
 There's so much misinformation out there through commercials, through the Internet, that I don't think people truly have a strong foundation of nutrition so that they can make healthy choices.
 
 And the other thing, when I do a healthy cooking class, one of the things I also tell the class is when you walk into a grocery store, it's game on, it's you against those professional marketers.
 
 And their goal is to get you to buy whatever they're selling.
 
 And your goal should be, how do I get food that tastes good but is healthy when I come out of the store?
 
 And so I always think shopping is a crucial part of that.
 
 And I think, I don't think doctors get enough nutritional education.
 
 And I don't expect my doctor, in fact, we have a joke.
 
 I tell my doctor, you don't have to practice cooking and I won't practice medicine and we'll get along just great.
 
 But, and I could tell her, I said, you're too talented as a doctor.
 
 I don't want you wasting your time in the kitchen.
 
 So, but, you know, I think doctors don't have enough information about nutrition.
 
 But I think we're getting doubt.
 
 I mean, this is such an exciting time to live with medicine or research right now, because we're finally getting, we're getting the researchers into the kitchen.
 
 They're really diagnosing food and how food really is part of our medicine, which, you know, in ancient Greece, they said that years ago, and now we're just finally proving it again.
 
 Well, chef, thank you so much for joining us.
 
 You really provided us a unique perspective and some wonderful guidance.
 
 So, thank you very much.
 
 Well, thank you.
 
 Like I said, this is a great opportunity, and I love talking about kidney disease and nutrition, so thanks for this opportunity.
 
 Fantastic.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
 We hope that you enjoyed this episode.
 
 If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.
 
 If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website.
 
 We would love to hear from you.
 
 So until next time, stay curious, stay compassionate, and keep taking healthcare by storm.