Chef Mariana Orozco on Multiple Sclerosis and the Healing Power of Food

Episode Transcript

Dr. Correa:
Today we have a special announcement. Audrey, do you know that today is National Brain Health Day?

Dr. Nath:
Oh, that's right. It's September 15th. That's awesome. Improving the nation's brain health at every stage of life from a person's earliest years of development to their oldest years is the focus of a new effort by the American Academy of Neurology.

Dr. Correa:
We all know the COVID-19 pandemic has accelerated concerns about our brain health due to the many neurologic complications that can come, including long COVID and brain fog, as well as growing public interest in how to keep a healthy brain.

Dr. Nath:
To mark this effort, the American Academy of Neurology worked with US representatives to introduce a congressional resolution that designates September 15th, 2022 as National Brain Health Day.

Dr. Correa:
So what are we going to do to celebrate it? Well, on this inaugural National Brain Health Day, the top neurologist and health officials are gathering at the first-ever American Academy of Neurology Brain Health Summit in Washington, DC.

Dr. Nath:
Awesome. They're going to be discussing brain health over the lifespan and outlining current and future needs for research, education, and advocacy to achieve future optimal brain health for you, your family, friends, community.

Dr. Correa:
Today is truly a noteworthy first step because it also marks the beginning of National Hispanic Heritage Month, where we acknowledge and celebrate all Hispanic Americans that have contributed in our history, culture, here in the United States and around the world. What better way than to celebrate this day by welcoming our guest Mariana Orozco for our English episode and our accompanying Spanish episode today.

Dr. Correa:
Saludos and hello, I'm Daniel Correa

Dr. Nath:
And I'm Audrey Nath.

Dr. Correa:
We're two neurologists and fellow brain geeks hosting the Brain and Life Podcast. This show, the Brain and Life Magazine and website are all brought to you by the American Academy of Neurology.

Dr. Nath:
Now, let's get to today's show.

Dr. Correa:
Audrey, I am so hungry already after having talked with Mariana Orozco. She's a Mexican chef and really has an amazing story about her life with MS.

Dr. Nath:
Oh, wow. That's fantastic. I want to hear about the food.

Dr. Correa:
Do you cook?

Dr. Nath:
I cook some in my household. My husband does most of the cooking and I do the baking. But growing up, my mom made all kinds of Chinese food, and sometimes it would kind of end up being a fusion with whatever American food we wanted to eat too.

Dr. Correa:
Well, Mariana, so she actually started med school, and during med school started to have symptoms that she didn't really understand, was having issues, and also just decided that medical practice wasn't really for her. And so as a part of her whole experience trying to figure out what was going on with her medically but then also exploring her passions, she found her way to gastronomy and to being a chef. And then after a long battle of figuring out all the different symptoms, 11 years later, she got her diagnosis and finally was able to start care and treatment with a neurologist that she trusted and has been doing really well with her MS.

Dr. Nath:
What a journey. The symptoms and her disease process did affect a lot of her choices, but it sounds like she was able to make a really, really fascinating path out of it.

Dr. Correa:
And so I'm looking forward to everyone hearing about, even some of her thoughts about cooking and trying out Mexican cooking and the variety of Mexican cultural cooking that you can try at home. And then how she's found her way to treatment and managed with it over time.

Dr. Correa:
Today, I'm so excited, especially because I'm a little bit of a cooking geek, to be speaking with the acclaimed culinary teacher, author, food stylist, podcaster, and most importantly for us, MS patient advocate, Chef Mariana Orozco.

Dr. Correa:
Mariana, where did you grow up and how did you find yourself on a culinary path?

Mariana Orozco:
Hi, Dr. My culinary career was very bumpy. I live in Mexico City, I was born and raised in here. And first I attended med school for four years. And then I realized that I wasn't in that path, I wasn't really invested. I loved medical knowledge, but I didn't want to be a doctor. I was always worried. I was always making this relationships with the patients, and I was always feeling so bad. I was always so sad, and I thought that I couldn't change anything. Like this Mexican health system it's so complicated, it's really a tough thing to be involved with.

Mariana Orozco:
And then I decided to leave, and I always loved food. I always loved to eat weird things since I was a little girl. I didn't like pizza, I didn't like burgers. I love medium rare steak and duck and stuff like that. So I always loved food. I remember that I was traveling, actually, and I went to Spain and I fell in love with the food. And I fell in love with the attitude of people towards food. So I thought, I have to go back to Mexico and I have to change my life. And I came back and I changed careers. So I went to culinary school, and it was really tough for me because I always thought I was going to be a doctor, and all of the women in my family are doctors. So, I always thought that women were doctors by nature.

Dr. Correa:
That's great.

Mariana Orozco:
So I thought that changing careers and going to culinary school was something that it was out of question and out of order of my life. So when I was there I fell in love with food even more. I learned a lot. I remember that my first day at school I started crying when I was wearing for the first time my chef coat, and I was so excited about that. And I started there and I thought that maybe teaching people would be a great way to spread the good news and to make people feel even better and to make people feel better with food, and feeling independent and feeling really powerful when you cook something that is really delicious. So I realized that I couldn't make a change in the world by being a doctor, but I thought that I could make a change by teaching people how to cook.

Dr. Correa:
I appreciate that. And when I was doing some reading that things took a different turn also for you in med school with your medical condition. So what changed for you that made you think that you needed to go see a doctor?

Mariana Orozco:
One day when I was 21 years old, I woke up and I couldn't see from my left eye and I couldn't walk and I didn't know what was happening. It was so, so frightening. I thought I was going to be blind forever, and I wasn't going to be able to walk ever again. I didn't know what was happening. I started thinking, what did I drink? What did I do? What's wrong with me? And then to make this long story short, I was started to being studied because a lot of neurologists thought I had a MS. But the thing is that they told me that because I was at med school, it was stress. That I was really stressed, that women didn't know how to cope with stress and that was it. So I was thinking how could I get so stressed that I turned myself blind and that I stopped walking properly?

Mariana Orozco:
It was when I was 21. I cannot remember it, it's a really foggy time for me, and I think that my brain is also protecting me from that trauma. But the thing is that I don't remember really what happened when I regained my eyesight and when I returned to walk properly again. I don't remember. But I did, I can see again perfectly. I walk like a "normal" person, air quoting normal. And then it was an 11 year quest for me to find a diagnosis. It was really, really complicated because I always felt that my body and my brain were not the same from that day forward. I always felt that there was something wrong with me, but I kept it quiet because I was really ashamed. Because in this world, health is a priority. So I wasn't healthy. I remember that I felt so many weird things. I felt this, my bones were made of ice. I remember that I was talking and then I couldn't remember what I was saying. I couldn't find the words for very simple things. I couldn't remember my brother's name.

Mariana Orozco:
There were so many things that happened and everyone was like, oh, it also happens to me. Don't worry. You're getting older, it happens. But I remember that I thought this is not getting older. I used to remember a lot of things from my childhood. And then now I don't remember so many things. I don't remember a lot of things that happened in my life. I don't have many memories. I do have some of them, but I used to have a really privileged memory, and I used to actually learn with this photographic memory. I don't know how you say it in English, but I used to see something and my brain remembered it, and then it stopped.

Mariana Orozco:
I used to have a really mathematical brain, but it stopped. Now I have to get a calculator to calculate tip when I go to a restaurant. It used to be my personality to have this memory and to have this mathematical ability, and I lost it. So, I remember that these little things were, for me really painful because I saw that I was losing things. I thought that I was losing my body's power. And then everyone was telling me that it was normal because I was getting older and it was normal because I was stressed and I thought, this is not normal. There's something wrong with me. And I saw a lot of doctors, a lot, maybe 10, 20. And all of them told me like, it's stress. You're a woman. Women don't know how to get this going on because you're so sensitive and you're so sensible. And then I was like, yeah, I'm not really like that but thank you.

Dr. Correa:
I'm glad that you were sensitive to pay attention to your own body and to paying attention to what was going on and I'm glad you really persisted and followed through listening to how it affected your vision, how it affected your memory. These are all many things that unfortunately and commonly can occur for patients with MS. And yeah, like you mentioned, I think some people, we have this idea of health and the way people "normally" function, as you said in air quotes. In reality, it's common for everyone to deal with changes in both their abilities and in their health throughout their life. Not everyone has that open openness and perspective about it.

Mariana Orozco:
I used to have a lot of activities in my week. I used to have this Monday I had one dinner, tomorrow I have a breakfast and I worked. But I also had this social life that was so bubbly. I had a lot of things going on. And when I started my medication, I was so tired. But I remember that I felt that my brain connected again, something move inside again. This puzzle was missing one piece and with my medication, I found it. And then it was complete. Even though I was tired, even though I had side effects, even though I had a lot of things. But I remember that my first week with the medication, I thought like, oh my God, I'm going to be okay. I'm going to get better. And I started changing a lot of things in my life. I started making it a little bit, not as speedy as it was, because I was doing a lot of things.

Dr. Correa:
We have to reset our perspective on what is healthy and living with our own capabilities and abilities.

Mariana Orozco:
So, I thought that my whole life was in front of me, but there were things that I was going to have finding a partner, telling him I had a MS. It was really hard for me. I didn't know how to start that conversation. This is going to sound awful, but when you're sick with something like this, with a chronic disease, you think you're damaged goods. So I remember that I was thinking, why is someone going to buy damaged goods if you can find something that's new? So, I was more for the vintage market. So I was thinking about that. And then it was this psychological process with my psychoanalyst where I had to grieve. Also this thing, you have to quit to a lot of things when you have a chronic disease. Every single day for me, when I wake up I know if it's going to be a good day or a bad day, but you cannot plan ahead a lot when you have this disease and many of that are similar. It's very hard to not be able to plan ahead.

Dr. Correa:
It's developing a significant level of adaptability and adjusting to both your expectations and to living with your own capabilities. And I'm glad that you reached a point when you met your neurologist that you're working with now, that he empowered you in moving forward with your condition and thinking about and being able to spend some of that extra time also both grieving and coping with the changes in your life.

Dr. Correa:
Now, in your cooking classes, I felt like a little bit of a sense of that you have similar goals for the community. What is your main goal for us to learn in the kitchen when we approach taking care of ourselves?

Mariana Orozco:
In this world when you can start doing something new, when you get a new ability, you feel powerful, you feel empowered, you feel that you can conquer the world. So I have a lot of different students, it's been almost 12 years I have almost 7,000 students in my life, which has been an amazing opportunity for me. And I always have fun. I don't take myself seriously so I hope they don't take cooking so seriously that makes them feel like it's something unattainable. So, I want them to feel like cooking is fun, to make them adapt, to make them understand the process, because you have to understand what you're doing and what do you want to achieve so you can succeed. If you understand the process, you can make it work. And then you have to enjoy, and you have to understand that food is fun and that food is made to be shared.

Dr. Correa:
As you've developed this patience and forgiveness for yourself, how has your cooking and teaching changed over time with your MS?

Mariana Orozco:
When I cook at home, when I have the strength to cook, it has become happier. They are happier meals. I find them so indulging, I find cooking, giving me life again. So when I go and teach a class and when someone arrives, they don't even know what's parsley, and they leave my class making green risotto and they like, oh my God, I cooked risotto. I'm like, Yeah, you did. It's rice with liquid and parsley and you made it. So I love people feeling this joy that I feel when I cook. Because for me, every day that I cook something when I'm not feeling okay, for me, it's like I went to the Kilimanjaro. Even though I know how to cook, when I eat something that I made at home, I made it. I made it happen.

Dr. Correa:
Yeah, Unfortunately, so far we don't yet have really research that really says this certain diet for people with multiple sclerosis or different autoimmune conditions change their condition, but each person should listen to their own body. But more and more research has started to show significant benefits for plant-based diets for our bodies and for brain health. What would be your suggestions or a few tricks if more of our listeners are thinking about trying out more vegan, vegetarian, or plant-based meals?

Mariana Orozco:
You know what? I think that when people say that they don't eat veggies, it's because they've always eaten them badly cooked. They haven't been cooked properly. No, I promise. They're over-boiled. You have this carrot that looks almost yellow instead of orange. You have this zucchini that looks gray instead of green. So when you start cooking vegetables in the way they have to be cooked, when they're al dente they when they're in their prime, then you realize why I wasn't eating veggies.

Mariana Orozco:
So I think that we should start trying out recipes and then we should start eating some things raw. For example, I have this cauliflower tabouli recipe. It just cauliflower that's raw with olive oil and tomato and mint and parsley, and it's delicious. And it takes you about 10 minutes to make it. So everyone, is disappointed of cooking vegetables because they think it's going to take thing like the whole day. But you can have a plant-based plate on your table in 15 minutes. And vegetables are so amazing that you can roast them, you can boil them, you can fry them. I'm sounding like Forrest Gump, but you can boil them, you can fry them, you can do anything you want and they're delicious. They're so, so, so delicious.

Mariana Orozco:
So what I will tell the people that's listening is start trying one new vegetable a week.

Dr. Correa:
You made me hungry. It sounds delicious. Looking back, what would you tell yourself at those most difficult points of your journey?

Mariana Orozco:
Ooh, that's a very tough question. You should trust your gut because we are the ones that know our bodies. We know how we feel. We know when there's something wrong. We always know. We always, always know. Even though we want to listen to it or not, but we always know that there's something wrong. That life is going to get better. That life is going to get better. That you're going to be loved, that you're going to be heard, and that you're going to get better. And that even though the world is a very difficult place to live in, that these people that you will meet will make you feel so, so much better. I think that I would tell myself that.

Dr. Correa:
That's good. That's good for all of us to remember. Mariana, it's been an honor to speak with you, to be inspired by your perseverance and the love for your craft. I hope we get a chance to cook some of your brain-healthy recipes together. If our listeners would like to find some of your recipes or follow you on social media, where do they find you?

Mariana Orozco:
Okay, I'm on Twitter as MarianaOE and my Instagram is Mariana, well, the same Mariana, M-A-R-I-A-N-A-O-E_.

Dr. Correa:
We will include links to Chef Mariana Orozco's website, accounts in our show notes. I encourage you all to check out her vibrant and delicious recipes, even if you don't speak Spanish. Thankfully, many of our internet browsers for anything that's other languages will translate her website and recipes automatically or reach out to her. Chef, saludos.

Mariana Orozco:
Muchas gracias.

Mariana Orozco:
Thank you so much.

Dr. Correa:
Oh, thank you.

Dr. Correa:
Are you or a loved one living with a neurologic condition? Are you seeking answers about what it all means and how to adapt to new changes in your life?

Dr. Nath:
Look no further than the Brain and Life book series from the American Academy of Neurology. These books combine the expertise of highly respected neurologists with valuable insights from patients and caregivers to help you navigate life with a brain condition.

Dr. Correa:
Our titles cover conditions such as Parkinson's disease, multiple sclerosis, ALS, stroke, migraine, epilepsy, brain tumor, and more.

Dr. Nath:
To purchase your book today, visit Brainandlife.org/books.

Dr. Correa:
I'm so honored to have the pleasure to talk with Dr. Lilyana Amezcua. She's a neurologist and multiple sclerosis specialist based out of Los Angeles at USC and the Keck School of Medicine. In addition to her care for the community, she has also dedicated herself to research about the genetic and ethnic contributions in MS, with an emphasis particularly on how the differences in disease expression or the condition affects those from Hispanic descent. She's also done extensive work to identify the racial disparities and barriers in getting MS care. Lilyana, thank you so much for taking the time to talk with us and the Brain and Life community.

Dr. Amezcua:
Thank you for having me.

Dr. Correa:
Now, in the story when we were talking more recently with Mariana, she told us in this inspirational background, she actually started to train as a physician and then changed her direction because she wasn't really happy with it. But already at that time, she was having issues impacting her vision and her walking. When you meet with your patients and they're coming to you talking about episodes of changes in their vision, changes in their ability to walk or sensation, how do you approach that early discussion with them?

Dr. Amezcua:
Yeah, it's a very good and important question because what you are referring to these episodes, we call them attacks or relapses, and they usually are episodes of what we call inflammation that is happening. And sometimes it correlates with specific lesions that we can see in the brain or spinal cord or optic nerve. And so these are really important to certainly relate to your physician because again it may be associated with new attacks, new areas of inflammation that need to be controlled.

Dr. Amezcua:
The ones that Maria talks about are certainly a very typical signs and symptoms of multiple sclerosis, particularly the visual or sometimes which is associated with optic neuritis, which means inflammation of the optic nerve, of the nerve that is important for vision. That is a typical location for MS to attack. Certainly the parasthesias can represent other areas in the brain or spinal cord, which may be associated with what we call sometimes a partial myelitis. So meaning, again, inflammation, the -itis part and the myelitis part of the spinal cord, and partial because it's only certain parts of the spinal cord and not a complete or transverse myelitis.

Dr. Correa:
So people can have the multiple sclerosis or these inflammation attacks affecting their eyes, their brain, or their spinal cord. And when they have symptoms, we know that inflammation can go away, but how do we know whether or not their vision or their walking is going to get back to normal?

Dr. Amezcua:
We try to better understand the timing of when that symptom or attack started. And if they're in the midst of it's usually what we say, a relapse. It's the symptoms that are lasting longer than 24 hours and things are not making it better. As opposed to sometimes we see worsening symptoms that are related to something else happening. So for example, a urinary tract infection sometimes worsens symptoms of MS, and one can feel there's worsening of their walking, but it kind of gets better once the urinary tract infection gets treated. And so we commonly may call that a pseudo relapse. Something that's looking like a relapse, like an attack, but it's not a true attack.

Dr. Amezcua:
So, really the timing of how long these symptoms are lasting, how long they're progressing. Most attacks relapses where they're going to get worse over time for several days, not like a stroke where it is sudden and climaxes rapidly. Here in MS they can take days, but it's taking longer than 24 hours for it to again become either going to get worse or going to get better in a few days. Commonly, we always think about it almost like a two week or one week type of climaxing since the start of the attack.

Dr. Correa:
And Mariana talked about that for her when she was younger. She started kind of bouncing around to different doctors trying to figure out what was going on. She had some of the tests or parts of them done at different places. For a while they didn't know what was going on and what she was having. And in a way, she felt ashamed and she felt bad. And how do you talk about that challenge and that trauma of going through the diagnostic process with some people and maybe some of the mental health issues that can come with multiple sclerosis or having impairments.

Dr. Amezcua:
Mariana is Latina, Hispanic female and multiple sclerosis in these populations is less frequent, so there is less of a cognitive awareness of this disease. So, there might be some implicit biases that might have played in the delayed of the diagnosis, but also even just, and not just implicit bias, but just again, cognitive awareness that MS can affect anyone. Certainly over the last 10 years, we've learned that Hispanics and Latinos do get multiple sclerosis, as well as African Americans and Asian background. It's Asian at a much rare frequency but in the African American, we're starting to learn that this may even be much more frequent than we think.

Dr. Amezcua:
So, certainly these changes may not necessarily be out there yet for every physician to know a neurologist, and we don't have that many MS specialists around the nation or the world. And so it is a complex disease to present with, but also it's a complex disease for the neurologist to diagnose. So, that could have all contributed to her delay. We're certainly trying to do better in communicating and educating, not just patients to be aware of but also neurologists to consider MS in their diagnostic, in their differential in these populations as well.

Dr. Correa:
Tell us some about the work that you've done to look at the racial disparities within the communities you've worked with.

Dr. Amezcua:
There are disparities, and these are health disparities and health inequities that what we've found are likely related to these social determinants of health. These factors that we are born to live and grow to and are constantly being impacted by. And at the highest level, it could be also influenced by the imbalance of power and imbalance of distribution of resources and highest racism. So, what we have seen, and this was a recent review we published in JAMA Neurology describing what we have found within multiple sclerosis, that there are these health disparities, and in some aspects they're related to differences in educational levels, income and how they affect multiple sclerosis. And we find that African Americans, as well as Hispanic and Latinos are more likely to suffer from these social determinants of health compared to white populations. So they are more likely to have lower health literacy. And again, MS is a complex disease, so health literacy is important to understand the disease, but also to engage in treatment.

Dr. Correa:
And for all of our listeners, whether or not they're living with MS or some neurologic symptom they're not sure about, if they're preparing themselves, maybe they go to the ER because they have a symptom they're not sure about and they don't have access to a neurologist, or maybe they're going to go to a neurologist and see them in clinic. What types of things would you suggest that they do that could help them organize what symptoms they have, what's going on, the story of their symptoms and help them being empowered to work with the doctors that they're seeing to make sure they're getting all the tests that they need?

Dr. Amezcua:
It is important to be able to, as best you can, describe the symptom, describe its location, I mean describe where it started. And if there was something that they're considering because they read somewhere the possibility of, let's say MS, then mention it. Mention it, or not be afraid to say, he's like, well, why am I not getting an mri? Why am I not getting an x-ray? It's okay to bring that up, and certainly I've seen this across different cultures, but sometimes it's a cultural part where they feel that they don't want to question the doctor. No, we want to be questioned. So the more you have information or bring someone with you that if you do have someone that knows the healthcare or is a bit more literate in the health, then bring them with you to the visit so they can help you describe your situation.

Dr. Correa:
Thank you very much, Dr. Amezcua for joining us today. This has been very helpful and we look forward to hopefully having some follow up discussions with you more about other types of conditions that affect inflammation in the brain and spinal cord. And we are also looking forward to our complimentary Spanish episode, so anyone who wants to listen to this podcast, similar topics with both Mariana Orozco and Dr. Amezcua en español we will be on also on the same podcast.

Dr. Correa:
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Chef Mariana Orozco on Multiple Sclerosis and the Healing Power of Food

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