Food as Medicine: Advocating for Food as Medicine
By Cherry Dumaual
Today’s Dietitian
Vol. 26 No. 2 P. 10
In this Q&A, RDs and other experts explain how to encourage widespread adoption.
There’s some dispute over whether Hippocrates said the famous phrase, “Let thy food be thy medicine and thy medicine be thy food.”1 However, there’s no doubt about the current interest in using food as a form of medicine, which research shows dates back to the ancient Egyptians.2 They used therapeutics derived from different plants.
In 2022, the White House Conference on Hunger, Nutrition, and Health delved into this topic with active participation from many organizations.3 One prominent advocate is the Food Is Medicine Coalition of nonprofit organizations dedicated to providing medically tailored meals, MNT, and nutrition counseling.
New research about the efficacy of food as medicine (FAM) is featured in a report from the Food is Medicine Institute at Tufts University. The report shows that food is medicine (FIM) interventions could save US lives and $1.1 trillion in annual health care spending.4
Yet, despite research and highly respected supporters, “food is medicine” or “food as medicine” faces challenges of being fully embraced across America.
HealthAffairs.org published an article stating that “Despite FIM’s growing popularity in health care, noncommunicable diseases (obesity, cardiovascular diseases, cancer, respiratory diseases, and diabetes) are responsible for 41 million deaths globally each year, expected to rise to 52 million by 2030.”5
To understand the current state of FIM, Today’s Dietitian (TD) interviewed the following three experts to find out what can be done to increase its adoption in the United States.
Kayli Anderson, MS, RDN, ACSM-EP, DipACLM, FACLM, is board-certified in lifestyle medicine and serves as lead faculty for the American College of Lifestyle Medicine’s FAM course. She’s the founder of the women’s health website PlantBasedMavens.com, a hub for women and the providers who serve them to get evidence-based guidance on nutrition and lifestyle medicine topics.
Lily Correa, MA, MPH, RDN, DipACLM, is the founding director of Education and Training, Office of Nutrition and Lifestyle Medicine, NYC Health + Hospitals. Since 2018, she has served as RDN for Bellevue Hospital’s renowned innovative Plant-Based Lifestyle Medicine Program in New York City.
Robert Graham, MD, MPH, ABOIM, FACP, Chef (aka Dr Rob the Chef), is a Harvard-trained physician who’s board certified in both internal and integrative medicine and cofounder of FRESH Medicine. He’s the chief health officer for a medically tailored meal company, Performance Kitchen, and is the director of integrative medicine for Catholic Health.
TD: How do you define FAM? What makes it different from MNT?
Anderson: I think of FAM as acknowledging that our food choices are an important part of treating and preventing many chronic diseases. MNT includes that same assumption as FAM that food has an important therapeutic effect on our health, but it’s more specific. It’s provided by an RDN, and it’s personalized to the individual.
Correa: MNT can seem more prescriptive or regimented in terminology, but in essence, just as FAM, it seeks to treat or manage chronic disease through nutrition. FAM seems like a more approachable term; placing food in the title highlights the power of our plates. When we think of the most vulnerable populations, many of whom have limited access to medical care, the FAM movement can really be empowering. It’s understanding that the food we eat has the power to help us attain our most optimal health and can put chronic conditions into remission. This really changes the way we look at our plates.
Graham: FAM sits at the intersection of food/nutrition and health care. Simply, it’s integrating healthful food and nutrition education into the health care system to help more Americans thrive. It may take many forms, including medically tailored meals, medically tailored groceries, produce prescription programs, and culinary/nutrition education. MNT is a form of FAM.
TD: What do you see as the key challenges to making FAM a long-sustaining movement? And what are key strategies to address these challenges?
Anderson: One challenge is education. While dietitians are very familiar with this concept, they also need buy-in from the rest of the health care team to truly move the needle with patients. Most health care providers spend very few hours learning about nutrition in their training. The American College of Lifestyle Medicine is working to change this with its educational offerings, including its FAM course, of which I am lead faculty.
Correa: There are people who disagree with FAM because an extreme view proposes that medications should not be used as a treatment and FAM should be the sole treatment. Instead, a balance of pharmacotherapy and FAM can and should be maintained in the treatment of chronic conditions. The barrier to access health-promoting foods, like fresh fruits and vegetables, is a challenge to make FAM a long-sustaining movement. In New York City, we’re lucky to have key initiatives like the Green Carts all over the city, which offer low-cost produce. I always tell my patients to carry a quarter in their pockets because you’re bound to run into a green cart and can buy a banana as a quick, healthful snack.
Graham: Sustained funding sources, execution of existing benefits by insurance companies, and integration into health care delivery are key challenges. They can be addressed by educating consumers about their insurance benefits and services and passing larger policy initiatives like the H.R. 6774, the Medically Tailored Home-Delivered Meals Demonstration Pilot Act and The Farm Bill.
TD: Is the growing interest in using food as a form of medicine reaching the general population? How can health care professionals reach this population?
Anderson: I think the FAM tide is rising for the general population. Many people feel helpless when it comes to health and are hungry for solutions that aren’t solely based on medical interventions like medications and procedures. Introducing the concept of FAM to patients empowers them. My specialty is women’s health, and I see so much misinformation about food and health targeted at the general population, especially women. It’s so important for people to hear the voices of health care professionals who are sharing evidence-based information.
Correa: I’ve seen a growing interest among the population. Search trends also indicate a growing interest in FAM. During COVID, when access to health care was diminished, and entire health systems collapsed, people had to rely more on food and natural remedies. In my program in New York, we talk about FAM as a complement to traditional medicine. We don’t want people to think in extremes, like if you believe in one, you can’t believe the other. Lifestyle medicine can be a complement to pharmaceutical treatment or, in some cases, can stand on its own. We certainly want to communicate the power of our plates, but we don’t want to send the message that this negates use of pharmaceutical treatments, when warranted.
Graham: I believe the conversation and interest have changed in the past 10 years, largely driven by a desire to address the persistent and expensive problem of poor health arising from poor nutrition, which costs the US economy $1.1 trillion each year and is a leading cause of mortality. People are hungry for change and, I believe, are demanding more from their health care systems. I also believe that direct to consumer/patient marketing and education are vital for larger adaptation within health care.
TD: How can health care professionals effectively promote the idea of using FAM to help prevent chronic diseases?
Anderson: Showing vs telling is an effective approach. Share stories from your own experience or from patients who have given you permission. Show people how to make delicious and healthful meals. It’s important to maintain a positive tone when we talk about food and avoid language that’s shaming, alarmist, or negative. After all, we’re designed to derive pleasure from food, and there’s nothing wrong with that. FAM can and should include joy, pleasure, and fun.
Correa: The great thing about lifestyle medicine or using FAM is that seemingly small changes can have huge results and quick results, too. Something as simple as eating oatmeal for breakfast, which I tell all my patients is “the secret weapon,” can set you on a great path to prevent and help treat heart disease, diabetes, and fatty liver, among other conditions. The beta glucan in oats also can help alleviate conditions like constipation, which is something patients feel and experience fairly quickly after starting a routine of having oats with fruits and nuts for breakfast. Quick results mean higher motivation to maintain the lifestyle. It’s the evidence that people need.
Graham: Clinicians must start integrating food as the primary source of “medicine.” At the very least, doctors must start referring patients to RDs for nutrition services.
TD: What role does FAM play in hospitals to help patients get on a healthier track?
Correa: At NYC Health + Hospitals, our inpatient menu has plant-based entrees as the default entree. We offer chef-crafted, culturally attuned, delicious plant-based entrees like sancocho, arroz con gandules, and pad thai. When patients leave the hospital, they receive a recipe book of the entrees and, in some cases, a referral to our lifestyle medicine program to help them understand how to continue the practice at home.
Graham: Hospitals have an important role as examples of healthful, nutritious food delivery systems. We should not be feeding patients the same food that led to their medical issues and brought them to the hospital. Patients with chronic diseases should have, at the very least, an RD evaluation, as well as a follow-up in the outpatient ambulatory care service arena.
TD: What can the general public, especially people pressed for time, making low wages, or living in food deserts, do to incorporate FAM into their daily lives?
Anderson: This is a complicated question since many factors impact someone’s access to healthful foods, including systemic racism and other inequities. Although many of the healthiest foods like beans are inexpensive, they aren’t always accessible to all people. Much needs to be done at a societal and political level to make healthful foods more affordable and accessible, but individuals should not underestimate the power of small changes. Just one simple swap or healthful addition to a meal is an important step.
Correa: Start your day off with oats—cooked or prepared cold overnight. Add more legumes to the eating patterns. Use no-sodium-added canned beans, frozen veggies, and rice to make an affordable, plant-powered plate.
Graham: Food insecurity occurs when people don’t have enough access to food, whether fresh or processed. People must take the power back and not be passive recipients of the unhealthful food offered to them. Self-organizing is a vital community asset for building resilience and social sustainability. As such, policy responses to poverty should take a multiscale approach. This includes community advocacy and organizing local food co-ops that make nutritious food more accessible.
— Cherry Dumaual is a freelance health and wellness writer and communications consultant. She writes the monthly column about plant-based news and trends for Total Food Service. Dumaual has contributed food articles and recipes to major websites, such as Prevention.com.
References
1. Witkamp RF, van Norren K. Let thy food be thy medicine….when possible. Eur J Pharmacol. 2018;836:102-114.
2. Metwaly AM, Ghoneim MM, Eissa IH, et al. Traditional ancient Egyptian medicine: a review. Saudi J Biol Sci. 2021;28(10):5823.
3. White House Conference on Hunger, Nutrition, and Health. Office of Disease Prevention and Health Promotion website. https://health.gov/our-work/nutrition-physical-activity/white-house-conference-hunger-nutrition-and-health. Updated July 24, 2023. Accessed October 25, 2023.
4. News staff. Report shows food is medicine interventions would save lives and billions of dollars. Tufts Now website. https://now.tufts.edu/2023/09/26/report-shows-food-medicine-interventions-would-save-lives-and-billions-dollars. Published September 26, 2023. Accessed October 19, 2023.
5. Weinstein O, Badaracco C, Akabas S. Why current 'food is medicine' solutions are falling short. Health Affairs website. https://www.healthaffairs.org/content/forefront/five-food-problems-why-current-food-medicine-solutions-falling-short. Published May 12, 2023. Accessed October 27, 2023.