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The Doctor is in… the Kitchen

MD Magazine®, Volume 1 Issue 1, Volume 1, Issue 1

Dr. Tim Harlan didn't come to medicine the traditional way. At age 22, when most of his colleagues were plunging into their first year of medical school and comparing their impressive pre-med resumes, Harlan was opening a restaurant.

How one physician transformed a passion

for food into a healthy

eating message real

people can swallow

Dr. Tim Harlan didn’t come to medicine the traditional way. At age 22, when most of his colleagues were plunging into their first year of medical school and comparing their impressive pre-med resumes, Harlan was opening a restaurant.

He’d grown up around food, washing dishes in his family’s Atlanta restaurant by age 11, so opening Le Petit Bistro seemed like the first step in a lifelong career in cuisine. By age 25, Harlan had sold the little French bistro to return to college at Georgia State. He wasn’t abandoning his career as a restaurateur, or so he thought. He was simply making a calculated move to boost his business skills.

“I’d been a chef-owner, and the chef part came naturally, but I needed to get the business ideas down that I didn’t have,” Harlan says. “And then I got to college and I was like, ‘I can do anything I want!’ The only thing I had ever really considered doing was being in the restaurant business.”

In one of those moments of inspiration that usually only strike in Hollywood film scripts, but seem to be a hallmark of Harlan’s career, he took a sharp left turn into medicine after watching a family member struggle in the wake of a kidney transplant. “I was walking across the hospital parking lot one day after visiting, and I thought, ‘I can do a better job than these guys!’ So I literally went across town to Emory and said, ‘I want to go to medical school.’ They said, ‘We think you’ll need an undergraduate degree for that.’”

In the fall of 1983, Harlan enrolled in pre-med classes at Emory, but even as he sat in lectures, did clerkships, and went on rounds, he was still a chef at heart. And he pictured good medicine and good food coming together in a unique way. Taking all of his recipes from Le Petit Bistro, as well as new ones he continued to develop, Harlan adapted them based on what he’d learned in medical school about nutrition. He didn’t yet know exactly what he planned to do with them, but when opportunity came calling, in the form of some of his old restaurant patrons who owned the Atlanta publishing firm that more or less created the patient education materials business, he was ready.

It’s Heartly Fare,

“They wanted to create a cookbook for heart patients, and they thought of me,” Harlan says. The book evolved into more than a cookbook—really, a healthy eating manual for people with cardiovascular disease. Published while Harlan was a second-year med student, now in its fourth printing, helped pay the rest of his freight at Emory.

More importantly, it helped to give birth to Dr. Harlan’s alter ego: Dr. Gourmet. Cooking shows were all the rage at the time, and Natalie Dupree was big in Atlanta. Harlan’s brother, Bruce, a television producer, kept pushing him to go into television. “I said, ‘Look, I’m kind of busy right now!’” But after he’d completed his residency and set up practice in rural northern Virginia, Harlan finally found the time. And he had more than enough recipes.

It’s Heartly Fare,

“Every time I’d come up with a new recipe, I’d do the nutritional breakdown on it, which I’d learned while writing ” he says. So the brothers shot a few episodes of the “Dr. Gourmet Show”—a name dreamed up by a neighbor of Harlan’s in Front Royal, Virginia—hoping to pursue what Harlan calls the “standard PBS model” of pairing a TV show with a popular book.

The first part of the plan worked—“Dr. Gourmet” aired in the southeast and even won a regional Emmy—but since Harlan wasn’t a celebrity chef or pushing a fad eating plan like South Beach or Shangri-La, publishing houses said no. “It’s a tough genre. Just eating great, healthy food? There’s no gimmick there,” he says.

Still seeking a venue to leverage a companion book-and-TV show deal, Harlan launched a website in 1998. Initially, it was just a PR vehicle for Harlan’s other work, such as a series of some 70 appearances on the DIY Channel. But somewhere along the way, DrGourmet.com became one of the Web’s most successful healthy-eating sites. Today, more than 30,000 unique visitors a month come to the site for daily newsletters, recipes, Harlan’s blog, and customized menus based on series of specialized diet plans Harlan has dubbed “eatTHISdiet.”

If it sounds like Harlan went Hollywood, we’re telling the story wrong. All along, as he built DrGourmet.com, he remained a classic country doctor in Front Royal, Virginia, seeing patients every day. In fact, he was a dinosaur in many ways, still making house calls, seeing patients in the hospital, in his office, and at nursing homes. “I always wanted to strike the balance between Chef Tim and Dr. Tim,” he says. Indeed, it was those daily visits with patients that created the eatTHISdiet plan in the first place.

“I spend more time than the average doctor talking about diet, lifestyle, and exercise, but I really wasn’t using the Web site with patients until a few years ago,” he says. “A lot of my patients didn’t even know I was Dr. Gourmet until they saw me on TV.”

Harlan started talking with a young patient of about 26 who had a body mass index of about 37. “She was otherwise pretty healthy, but she’s young. I told her, ‘This weight isn’t causing you any issues right now, but it’s going to, and you need to think about how you’re going to deal with it,’” Harlan says.

Tell me what to eat.’

He gave the patient simple handouts about diet and exercise, and she handed them right back. She didn’t want diet advice: she wanted her doctor to tell her what to eat. “She said, ‘No, you’re the guy, you know about this stuff. It was the closest to an epiphany I’ve ever had in my life.”

It’s Heartly Fare,

He told his patient to come back in a week, and when she did, he’d custom-designed a set of menus for her—in the middle of writing a new book, revising shooting a TV episode, and seeing other patients. “We did it a week at a time. She’d come in every week, after hours—I didn’t charge her for it—and tell me what worked and what didn’t,” Harlan says. Based largely on Mediterranean diet principles, the six-week cycle of menus he crafted for this patient evolved into eatTHISdiet. Along the way, his morbidly obese patient went through the six-week plan four times, and lost a pound every single week.

Today, there are three eatTHISdiet plans: the original one, which works for people with food allergies and special dietary needs; eatTHISdiet for Coumadin users, aimed at the unique food challenges of people on blood thinners, and eatTHISdiet-the Comfort Food Diet, which “healthies up” classic stick-to-your-ribs fare like meatloaf and macaroni and cheese. DrGourmet.com users can create their own meal plans online, featuring dishes like sage mustard pork tenderloin with mashed yams, halibut with seven spices, and leek and salmon fettuccine salad.

All along, Harlan continued his old-school country doctor practice in Front Royal, but he’d seen the writing on the wall: this kind of practice was becoming obsolete. With the growth of hospital medicine, it was becoming harder and harder for him to make a living as an ambulatory care doctor in a smaller town. “I went to Front Royal because I wanted to experience country doctor medicine, but I hadn’t expected to be able to do that kind of practice forever. I knew the model was changing, and it was going to be more difficult for me to make a living as an ambulatory care doc in a smaller town,” he says.

What’s more, he was getting married, and it was time to move from Buckhead, the farm he’d renovated in Front Royal, to a place that was “theirs.” But where? Harlan could have moved closer to Washington, D.C., and been a successful ambulatory care internist, but he didn’t feel drawn in that direction.

Shortly before his wedding, at a dinner party thrown by a cardiologist mentor of his from Atlanta, Harlan met a doctor from Louisiana in town for a fellowship. She was more than a little surprised to learn that Harlan and his fiancée were planning a honeymoon in New Orleans, barely a year after the devastation of Hurricane Katrina.

“My wife and I both love New Orleans. It’s a magical place,” he says. “I thought, they need our money more than Paris. In fact, I snapped my fingers and said, ‘I’d move to New Orleans like that.’ My wife said, ‘I know someone you should talk to.’”

At the time, Karen DeSalvo, chair of the internal medicine department at Tulane University School of Medicine, was struggling to rebuild her department, which had dropped from a high of 30 faculty members to 15 at its nadir. She’d finally begun to bring new physicians on board, mostly talented, idealistic young people who might have gone into the Peace Corps in the 1970s. They brought drive and devotion, but lacked experience. To help bring them together, she needed someone with years of practice and seasoning. A mentor.

“I reached out to [Harlan] because we were looking for help, and I liked him immediately,” she says. “He knows what he wants, he’s very clear about what he brings to the table, and he understands quickly what needs to be done. He’s a great fit. It was one of the easiest recruits I’ve ever done.”

Harlan interviewed for the position at Tulane on his honeymoon. He met with DeSalvo on Thursday, with the school’s acting dean on Saturday, and then he and his new wife, Morgan, had dinner at the venerable Commander’s Palace, which had only reopened four days before. “They were incredible. They brought us a bottle of champagne and every dessert on the menu,” he says. “I later learned that they just don’t do that at Commander’s! But they were so happy to have people back.”

Harlan and his wife spent their honeymoon wandering the streets of the reviving city, visiting open houses, watching how people lived in the “new” New Orleans, and wondering what it would be like to be among them. Nearly four months later, they moved.

“I’m an internist—I don’t make decisions quickly,” Harlan says. “We stick our hands in our pockets and scratch our heads and look at the data. If I had to analyze it, I might not have done it. But we decided it was the right thing to do, and it has been.”

Less than four years after moving to New Orleans, Harlan has planted his clinical practice flag at a downtown clinic attached to the hospital that treats everyone from bankers and lawyers to guys who work the grill at the local deli. He’s crafted a curriculum on nutrition for a first-year course called “Foundations in Medicine.” He’s working on a series of healthy eating videos for a pilot program offering educational materials on a computer kiosk in a senior center serving about 400 patients.

Karen DeSalvo calls Harlan “a rare beast.” “He’s always cheerful and brings laughter to the room, and does it with his patients,” she says. “This is a stressful environment, whether you have a lot of means or little means, and he’s role modeling this positive attitude. You can care, be engaged, work really hard, and it can be fun. There just aren’t that many primary care doctors who feel that way anymore. I can’t get him around enough students or residents.”

Harlan believes that the post-Katrina world has brought a new ethos to Tulane. “A real sense of place, a real sense of belonging to New Orleans within the medical students, and a great sense of community service,” Harlan says. In fact, it’s now a requirement that all Tulane students must fulfill community service obligations.

Even the school’s mission has changed. “Before, it was one of those stupid things like ‘We will improve health care with research, education and clinical care.’ The same thing every medical school has,” says Dr. DeSalvo. Today, Tulane’s mission is short and focused: “We heal communities.”

That fits right in with the Dr. Gourmet model. Dr. Gourmet’s message—delicious food can be healthy, and healthy food can be delicious—is much needed in New Orleans, which is consistently ranked in the top 10 “fattest cities in the nation.” Harlan is mentoring medical students who’ve created Don’t Weight to Lose, a community-based program offering nutritional advice, health screenings, lectures on health and wellness topics, and individual counseling.

“They do it in the medical school auditorium, and there’s always a line of people outside the door waiting to sign up,” says DeSalvo. “They make healthy eating attractive, with a realistic approach to eating the food we all love. It’s not about eating asparagus all the time, but here’s a way to make fried chicken healthier. Here’s what you can choose at a fast-food restaurant that’s better for you. Unlike some other doctors, Tim doesn’t make the mistake of assuming that low-income people aren’t smart enough to understand these messages. We know they’re smart enough, we just have to give them the tools to act.”

Despite New Orleans’ fame as the home of overindulgent food (beignets and deep-fried everything, anyone?), making simple, healthful changes to the local fare—without doing violence to flavor—isn’t hard to do. “The recipes here are easy to adapt because much of it grows out of a Mediterranean tradition with a bit from Spain, a bit from France, a bit from Italy, some from Northern Africa, and a pinch from northern Europe. Most all of those cuisines are healthy,” Harlan says. “Good food is not full of butter or deep fried. Good food is a well-made gumbo that starts with browning the flour in a pan dry. To that is added the veggies, lean sausage, beans, seafood, and spice. Simple and healthy. Remember that on the plantation, fat, salt, and sugar were expensive and kept locked up. Real great New Orleans food gets along fine without them.”

In between treating patients, teaching medical students, testing recipes, and renovating a house in the Garden District (oh, and did we mention he’s training for “century” bike rides?), Harlan has also taken on a new role: nutrition guru for Lance Armstrong’s Livestrong.com. The site aims to challenge visitors to set health goals that it calls “Dares” (lose weight, exercise regularly, spend time with family), and then track and achieve them with a variety of tools. Harlan is a featured expert and a member of the five-person advisory board (along with Armstrong himself and CNN celebrity physician Sanjay Gupta).

“Initially they wanted to buy us,” Harlan says. “I think a lot of Web publishers create projects like Dr. Gourmet wanting to sell them for a whole bunch of money. But the main motivation for us is not profit. The goal is to create the definitive evidence-based nutrition website. So instead, we reached an agreement that I’d provide them with content—recipes, menus, meal plans, Q&A sessions, articles, and eventually things like live chat.”

As one of the Livestrong.com’s most active “experts,” Harlan has played a big role in the site’s success. He even blogged all the way through Spain while celebrating his 50th birthday at the running of the bulls in Pamplona.

“He’s the epitome of what we would want for an expert on the site,” says Joe Perez, Executive Vice President of Product and Community for Demand Media, which developed Livestrong.com. “By combining his medical expertise with his love for food, he really takes it to the next level. We’re passionate about Livestrong, and he’s equally passionate about what he does.”

“Passionate” is a word that comes up a lot in connection with Harlan. Recently, he and Morgan visited the Abita Brewing Company, which brews its popular beers in the piney woods north of New Orleans. “They said, ‘We got through the storm because we’re really passionate about what we do,’” Harlan recalls. “That’s me. I love being an internist, I love cooking, and it’s really cool to be able to do both of them and reach people with that message.”