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Neurology Today:
doi: 10.1097/01.NT.0000410292.41780.c3
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Meet New York's Most Acclaimed New Chef: Neurologist Miguel Sanchez Romera

Avitzur, Orly MD

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It's likely a first in the history of neurology. Although some of us display a talent for gourmet cooking, and even more of us consider ourselves foodies, Miguel Sanchez Romera, MD, is the only neurologist-chef who can claim successful careers in both fields. Indeed, he may be the only physician to have ever moonlighted his way to culinary fame. In 1996, he opened his restaurant, L'Esguard, outside Barcelona, continuing to practice neurology on weekdays at Hospital Policlínica del Vallès, and running the kitchen on weekends. In what can only be characterized as a' meteoric rise, the self-trained cook earned a Michelin-star after only two years, garnering both wide praise and bitter envy from fellow chefs who had earned their stripes traditionally by going to culinary schools and enduring arduous apprenticeships. (Imagine learning about a Nobel-winning neurologist who had skipped both medical school and residency!)

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In 2006, Dr. Romera was visited by Sant Chatwal — an Indian-born hospitality entrepreneur who runs the Hampshire Hotels & Resorts — and was ultimately convinced to relocate to New York. The result: the eponymous Romera New York, which debuted on Sept. 16 at the Dream Downtown Hotel in New York City's meatpacking district. According to W Magazine, it was the most anticipated high-end restaurant opening of the fall, as well as the most ambitious at $245 a plate (the tab for alcohol not included).

While most critics have lauded his food, describing it “rich tasting yet delicate,” and its artistry as “staggering to behold,” others have panned it as “Manhattan's newest culinary oddity,” often using bungled medical metaphors incongruous for a neurologist. New York Magazine complained that “he largely botched the operation,” and former New York Times restaurant critic, Frank Bruni dubbed the eleven-course menu “food psychosis;” quipping, “While blazers are optional at Romera, straitjackets would be a fine idea.”

Nevertheless, the chef is not short of fans, including one Wall Street Journal reviewer who raved after having been served nothing but Romera's famous Acqua Gourmands, an entire meal without food or calories, which nevertheless left her satisfied and full. The unique waters — infusions of fresh stocks and broths that vary in temperature, flavor, and scent— are intended to trick the satiety center in the hypothalamus.

Neurology Today spoke with New York's latest food sensation and asked him to explain his culinary point of view, among other things.

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I'VE HEARD YOUR APPROACH DESCRIBED AS APPLIED NEUROGASTRONOMY? CAN YOU TELL US MORE ABOUT THIS?

It's nothing more than my culinary style, the way that I see cuisine and how I structure my own concept of what I understand to be gastronomy. The word unites the two activities I've practiced professionally over the last thirty years. In any culinary experience there is a sensory response that triggers a link to taste and sentimental memories. The culinary and nutritional experience is perceived by the brain, whereas the digestive organ is just a passageway; it has no significance from a sensory perspective with the exception of being a trigger of information.

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WHAT INSPIRED YOUR COOKING?

I initially approached cuisine in an artistic manner. In time, I realized that there was a total union with neurology, and that my culinary style had to have a structure which represented the two things that I knew well. This ultimately developed into my entire concept and culinary style.

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HOW DOES YOUR MEDICAL BACKGROUND INFLUENCE YOUR MENUS?

Because I'm a doctor with 30 years of experience in the profession, I feel obligated to emphasize health and nutrition. As doctors, we have a responsibility to influence society, and the same is true of chefs. The second reason is culinary. When you have an eleven-course tasting menu of so many diverse forms of preparation, ingredients, and techniques, you're obligated to organize the courses considering not only the number of calories, but also the individual components of each dish. The idea is to create harmony, such that it doesn't become an unpleasant experience for the diner. In order to achieve spectacular culinary techniques, some chefs seek elements that are not good for our health, such as large amounts of fat, unnatural texturizers, chemicals, flavorings, fragrances and even colorants. None of this exists in my kitchen. I don't believe the company of excessive alcohol is a virtue of cuisine either. Everything in moderation.

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HOW DO YOUR ACQUA GOURMANDS FOOL THE BRAIN?

There is no doubt that there are well-defined areas linked to hunger, to satiety, and thirst in the hypothalamus. With information that originates in the digestive tract and the rest of the body, the brain organizes a response either to eat, to stop eating, or to drink. When we're hungry, the body begins secreting substances through the digestive organs. The process of taste and smell, together with the food passing through the digestive tract, begins to send information to the brain so that it can start structuring the response that hunger is being satiated. With the waters, we pull a “trick” on our satiety system in the hypothalamus by having incorporated a liquid in place of a solid and associated the work of our taste buds and our olfactory system. This is very similar to what happens with solid food, and achieves a complete gastronomic experience, with very few calories, without incorporating fats or sugars, and using a very small quantity of proteins.

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DO YOU IDENTIFY YOURSELF MORE AS A NEUROLOGIST OR AS A CHEF?

I've always said that I'm a doctor who cooks and not a chef who's a doctor. This says it all. I cook as many of my neurologist colleagues would if they were to devote themselves to cooking. My training, the richness of the experience I've acquired, the effort that I've put in, and the link to the world of health and to my patients are impossible to replace.

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HAVE ANY NEUROLOGISTS YET DINED AT ROMERA NEW YORK?

In just two months we've received visits from between twelve and fifteen neurologists from the United States, Spain, Argentina, Cuba, Mexico and others. The reception among neurologists, both in Spain and here in the United States has always been the same. They are fantastic guests. Every time neurologists visit they contribute something new to my vision of neurogastronomy. They are the people who best understand, perceive, experience and explain what they've eaten. Their level of taste is worldly and they have access to different cultures and different ways of seeing cuisine.

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DO YOU MISS PRACTICING NEUROLOGY?

Without a doubt. Leaving practice has been one of the most difficult things I've had to endure. I'd like to return to neurology and the neurosciences again in the future, yet in a way distinct from a patient's clinical record. I would be very excited to form part of a multidisciplinary team covering the neurosciences in conjunction with cuisine and human nourishment. As of this moment my kitchen can be utilized as a “true laboratory of neurosensory perception and food.”

Neurology Today Associate Editor Dr. Avitzur, a neurologist in private practice in Tarrytown, NY, holds academic appointments at Yale University School of Medicine and New York Medical College. She is the editor-in-chief of the AAN Web site, AAN.com, and chair of the AAN Practice Management and Technology Subcommittee.

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WHAT IS NEUROGASTRONOMY?

In an interview with Neurology Today, Gordon M. Shepherd, MD, DPhil, professor of neurobiology at the Yale School of Medicine, former editor in chief of the Journal of Neuroscience, and the author of Neurogastronomy: How the Brain Creates Flavor and Why It Matters (Columbia Press, December 2011), provides insight into an area of study referred to as neurogastronomy.

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In this book, Dr. Shepherd focuses on brain mechanisms that are involved in creating flavor perceptions and preferences. He describes research that has shown that smell molecules give rise to spatial patterns of activity in the olfactory bulb, which function as various Iodor imageso representing different stimulating molecules. These images are processed by microcircuits in the olfactory bulb and olfactory cortex, the latter of which projects the processed images to the orbitofrontal cortex of the prefrontal cortex. These areas are highly developed in humans, giving smell and flavor privileged access to the highest level of cognition in the human brain. Other systems engaged by smell and flavor include limbic regions involved in emotion, memory, consciousness, and dopaminergic reward systems, which together constitute what he calls the “human brain flavor system.”

Normally this system provides for eating healthy diets, but when craving flavors becomes irresistible it activates many of the same brain systems as craving drugs. Understanding this is a critical step toward attacking the current obesity epidemic.

Dr. Shepherd explains that most of flavor is smell — mostly retronasal smell, due to breathing out the volatiles at the back of the mouth so that they stimulate the olfactory receptor cells when we exhale during chewing and after swallowing. We are under the illusion that this sensation is due to the taste system because the mouth Dcapturesc our attention so that the smell is referred to the mouth. He suggests that you prove this for yourself by pinching your nose while putting a small bit of candy on your tongue. The sensation will be mostly the sweet of the candy until you unpinch your nose and breath out, releasing the full flavorf of the candy due to the retronasal smell. While tastet modalities give us universals of sweet, salt, sour and bitter (and umami), the smell qualities vary enormously, due to the different patterns set up in the brain, accounting for much of the variety of cultural cuisines and the individual variations within them. Understanding how flavor establishes our food preferences is therefore a key to healthy diets.

©2011 American Academy of Neurology

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