Living with Dialysis

The Cooking Doc: Change Your Buds!


CS: An encore presentation. This is NephTalk. I'm Christopher Springmann, and Let's Get Cookin'. Dr. Blake Shusterman, MD: Hi, I'm Dr. Shusterman, The Cooking Doc. Now you've heard me say change your buds in my videos, but what does change your buds actually mean? It means learning to change your taste buds so they actually enjoy healthy food. But this doesn't happen quickly. It takes time. You have to teach your taste buds to like healthier things, whole grains, vegetables, fruit. And that's what The Cooking Doc is all about. It's about teaching you to make those things actually taste good. And once you make these changes, you won't have to fight as hard against your cravings for unhealthy food. Your cravings will actually go away over time.

CS: Dr. Shusterman, thank you for joining us on NephTalk from beautiful Greenville, South Carolina.

BS: Thanks so much for having me. Glad to be here.

CS: You are a nephrologist, and a great cook, too. And I've enjoyed your program The Cooking Doc on YouTube and Facebook. Let's discuss #changeyourbuds, which is part of your overall strategy, I believe, to enhance the effectiveness of dialysis for patients, and ultimately appeal to their families and the public buds as well. Am I on the right track there?

BS: It's really for anybody who has grown up or developed a taste for unhealthy foods over time. So the change your buds refers to your taste buds, of course, and it's a hashtag that I've used on Twitter, and also with all of my blog posts and videos.

And the whole point is that if you don't change your buds to enjoy healthier food, you're not going to eat healthier food. If you don't like healthy food, if you take a bite of broccoli or spinach or roasted chicken instead of a fried chicken, and you just say, oh, this is terrible, I don't like it, I'm not going to be able to convince you to eat in a healthier way.

CS: What are the specific dietary needs of a dialysis patient, and why is adherence to a dietary program crucial for dialysis to produce the best outcome possible?

BS: When you're on dialysis and you're not monitoring what you're eating very closely, it's easy to eat too much potassium or too much fluid or too much phosphorus that your kidneys aren't able to get rid of. And those levels can build up to levels in your body that are dangerous levels in your blood.

And one of the things that I tell my patients is that your diet on dialysis may be very different to the person who's sitting next to you in the dialysis chair.

CS: In fact, you really don't support the idea of a generic dialysis diet except as a base because it doesn't necessarily apply to all people who are on dialysis.

BS: Exactly. And the reason that that's so important is dialysis itself is a pretty difficult quality of life for a lot of people. And food comes with such enjoyment that if you apply a generic dialysis diet to everybody, you have people that don't need to give up things like a fresh summer tomato giving them up. Everybody really is different, and the fact that they have dietitians at the dialysis center really allows them to give an individual diet to each person.

CS: In reviewing your programs over the last six years, you've evolved the show The Cooking Doc from a strictly nephrologist conversation to be more inclusive, including creating very clever one-minute videos with no voiceover, onscreen cooking tips, and ideas about ingredients, as you did with the Healthy Pasta Salad show. Let's take a look at that program and discuss what inspired these changes.

BS: Four keys to a healthy pasta salad. Serving size. So no matter what kind of pasta salad you have, you want a smallish serving, especially if you're eating it as a side. You want a high vegetable to pasta ratio. So we've got tons of vegetables here that we're throwing in that pasta. Number three, you want a dressing that is healthy to hold the pasta salad together. We use an oil and vinegar-based dressing with a lot of herbs to really freshen it up. It's better than dumping a glob of mayonnaise on top of there.

Number four. You want to make sure you have a pasta salad that tastes good, obviously. So you want it a little crunchy, you want it a little salty, you want it a little sour, you want it a little sweet. And you want all those flavors in one bite. Even a little bitter. We're adding red onion today to make it a little bitter. So if you have all those flavors in there together, that's how you make a good pasta salad.

Thank you for watching The Cooking Doc, healthy cooking made simple and delicious.

So you've seen the old shows and the new shows. Do you think we've made progress?

CS: Oh, I think you've made tremendous progress. You're very creative, and going to a one-minute format for some shows when appropriate, I think, is very inspired. BS: Sometimes it's hard to capture people's attention for more than a minute unless your content is just unbelievable.

CS: Yes, I agree with that. There is an effort on your part to teach the family, or inspire the family on different ways to eat together. For example, you appreciate your audience's regional eating habits in South Carolina, which are often driven by culture, ethnicity, heritage, and traditions, especially around family getting together.

You consequently have a very positive attitude about change versus saying, no, don't eat this, don't eat that, that's bad for you. That is not your perspective on the world.

BS: It's about keeping the family bond strong. And so keeping those things at the forefront of any kind of discussion about a healthy diet, I think, is very important. My patients have stories that I don't understand. Their families have stories, and they have history together. And I really want to try to work within the context of their family and what they know and love, and try to get them all to change together so they're keeping these celebratory meals, just with a little bit of a different focus on healthier food.

CS: When I first looked at your site, I thought aha, this is all vegetarianism. In reality, it's important for you to be inclusive, not exclusive and exclusionary. What are your thoughts about that?

BS: I do believe that vegetables and grains and fruits should be the staple of a healthy diet. There are so many people who have an unhealthy diet focused on meat, and red meat especially, that going from a red meat-heavy diet to a vegetarian diet is nearly impossible. You might as well not even give any dietary advice if you're telling somebody to give up all of their red meat and just go strict vegan.

It is a tough sell, and you can learn to be healthy. There are ways, even, to include meat in a healthy diet. So if you sit down, and your meat meal is a bacon double cheeseburger, that's not going to work. Over time, that's going to lead to health problems. If you absolutely have to have that red meat occasionally, you sit down for a single burger. You leave off the cheese. You leave off the bacon. You have only one burger instead of two. Maybe you leave off the bread if you're trying to make it a little bit healthier. So there are ways to be inclusive and encourage people to do things that are within their ability.

CS: I looked at your work on Facebook, and also, of course, on YouTube with The Cooking Doc. You have a Pro Tip Tuesday on Facebook. And this one says, layer salt throughout the cooking process. A little salt at the beginning of the cooking process will get absorbed as the food cooks, providing a depth of flavor and allowing you to taste the salt without using a heavy-handed salt shaker at the table. First of all, I don't have a salt shaker at the table. And the truth be known, I don't have sugar in the house, either.

But let's talk about that because you're really talking, to some extent, about incrementally changing people's behavior with tips and techniques that are attainable and sustainable. And over a short period of time, people will change their buds.

BS: That is my belief. And I have seen that in some of the medical research, and also with some of my patients, especially when it comes to salt. So most of the salt that people get in their diet actually come from two places, from processed foods or from eating out at restaurants. That's the first thing I have them give up or cut down on because I think that kind of gives them an easy way to start without getting rid of the salt shaker at home.

And over the course of a few months, six to 12 months, they'll be able to appreciate a lower sodium diet and actually like food that doesn't have as much salt in it.

CS: Let's go into the Instapot Chicken recipe, which, by the way, has over 20,000 views on YouTube. Congratulations.

BS: Thank you.


CS: What is it about the Instapot chicken recipe that really supports your ideas here in terms of, for example, using olive oil, vegetables, of course, onion, carrots, artichoke hearts, and garlic, and no sodium or low sodium chicken stock? These are all very, very subtle ways to work towards that ultimate goal. Would you agree with that?

BS: I would. So the thing about the Instapot chicken recipe is it's a really nice family recipe, and it's really easy to make if you have an Instant Pot.

CS: This reminds me of the discussions I've had on cardiac rehab, where the whole family gets together as a support group and makes cooking a team sport. If the person, in this case, who is on dialysis is somehow singled out, they feel that they're not-- well, that they're having a different eating experience.

But being inclusive with, in this case, the Instapot one-pot cooking of chicken, cooking becomes a family sport again.

BS: One of the things that I hear often from patients when I talk about whether or not they're eating a diet that's conducive to good health at home is they say, I live with my kids. And so I am reliant on them to make dinners that I can eat, and they just love fried food. So what am I supposed to do?

CS: What are they supposed to do?

BS: This is especially what I hear from people in their 60s and 70s who may have moved in with their son or daughter. What are they supposed to do? Their son or daughter is in charge of the cooking. They don't want to change. They're making the food. And so they are at a loss at a way to improve their diet.

And so just by bringing in the family and talking to them, and getting everybody to work together, just as you were saying, we can make much better strides.

CS: The kids, perhaps because of mobility issues on the part of the parent or the relative with dialysis, may be doing the shopping.

BS: You got it.

CS: And there's nothing like having someone walk in the door with grocery bags and hearing a groan on the other side of the table, oh, no, are we going to eat blank again? So working together can change the level of participation and acceptance. Part of the plan here is to change everyone's buds.

BS: Dialysis patients have a lot of medical problems. And that's why I hate to tell them all the time that you cannot eat this or you cannot eat that. I look at the traditional renal diet or dialysis diet, and it's no sodium, diabetic friendly, no phosphorous, fluid restricted, low potassium, low sugar. And then you have to make it taste good. And if you're following all those rules, there is basically nothing left to eat. So we really have to work to make it taste good within those confines, or just expand the ability of people on dialysis to eat different foods. CS: Well, that reminds me of a sign I saw the other day in the supermarket for a snack food. It said, no sugars, no fats, no calories, under which someone had written in magic marker in big letters, No Fun! BS: But you know what it should say under there? Under that black marker where it says no fun, it should also probably say no taste, right? CS: That goes without saying, doctor.

BS: It goes without saying. I mean, foods that are labeled like that makes me just take a step back and think, why are people eating those foods? And I think about that whenever I try to eat any food or recommend a food to somebody. Is it at least nourishing? Are we eating it because it's nourishing? Are you eating it because it tastes delicious?

I do not want people to have that kind of relationship to food. I think it's inherently negative. And food should be a positive thing, an enjoyable thing. I love to eat. We all love to eat.

CS: I really admire your strategy here.

BS: There has been significant improvement over the last five to 10 years, I think, in the South. I've noticed that in Greenville. More and more healthy options to eat, and more and more people embracing a diet that doesn't focus on the fat, salt, and sugar. I think as time goes on, changing individual people's buds, their taste buds so that they enjoy food that's not shrimp and grits, fried chicken, I think will have a tremendous impact.

CS: What kind of response have you received from your patients and friends, fans, followers on social media, on Facebook and YouTube?

BS: I do have regular watchers and fans. There is this one person who watches my cooking video every time, and he always comments on my knives not being sharp enough. And so I've really made a point to sharpen my knives before I do my shoots, and he's actually been appreciative for that. Most of the response that I've gotten a chance been very, very positive. I get people inspired to find a way to incorporate healthy eating into their life in a way that they enjoy. I've really gotten a tremendous response from my patients here in Greenville, and also from the internet.

CS: You've mentioned that some of the segments, and I'm quoting now from this wonderful article in The Greenville Journal by Ariel Turner, that some of the segments focus on healthier versions of a typically unhealthy dish, such as Fettuccine Alfredo substituting cauliflower for the heavy cream, or Buffalo Chicken Dip made with low fat cream cheese and tofu. Other times the recipes are naturally low fat and low sodium dishes, as we've been discussing.

You are reaching an audience with a very, very important message. How has this affected and touched not only your practice in Greenville, but also your relationships with patients? BS: One of the things that I've found with my specific patients-- I get this with new patients and with people that I've been seeing for a long time-- is everybody wants to talk about food now, and it's just a great thing. We will spend a few minutes talking about high blood pressure and diabetes and how they're doing. And then if I forget to bring it up, they invariably say, OK, what should I eat? I know you're the expert on cooking. What should I make?

CS: Oh, really?

BS: It surprises me, but it's wonderful. It really helps us, as a practice, show that we are engaged in improving our patients' care in the upstate of South Carolina.

CS: You're also meeting people where they're at, on their device of choice, at their time of choice, perhaps, and also so they can share information with family members and other friends who are concerned about their health. But that's really crucial. You've reached over 20,000 people with the InstaPot chicken video alone. You must be very pleased with that.

BS: I'm very happy that we've reached so many people. But I really think we are only scratching the surface of the amount of people that we can reach with this kind of information. There is millions of people in the United States who are struggling with a healthy diet, all kinds of information on the internet about what to eat and what not to eat. And I think that we can reach even more people, and I really want to spread the word.

CS: Well, to help you spread the word, Dr. Shusterman, where can people see your videos and learn more about your practice as a nephrologist?

BS: The website for my cooking show is We also have a Facebook page, The Cooking Doc, Twitter @TheCookingDoc, and an Instagram page the same. My practice is called Carolina Nephrology, and you can reach us at, and we serve the upstate of South Carolina in about a 100-mile radius.

CS: Dr. Shusterman, thank you so much for joining us today on NephTalk. BS: Thanks, Christopher. It's a pleasure to be here. It was a lot of fun.