You know your diet plays a huge role in weight and energy, and even your mood. But did you know it could help save your life, too?
That’s the whole idea behind the “food as medicine” movement — a philosophy that has roots in the HIV epidemic and began in the 1980s, when public health advocates launched nutrition programs to aid management of AIDS.
Now, many people are catching on to the notion that certain eating styles have the potential to influence disease prevention, too, not to mention influence quality of life, health, and longevity.
“We have known for literally decades that 80 percent of all chronic disease and premature death that happens in the world around us is completely preventable just by routine physical activity, not smoking, and eating optimally. The only complicated variable in that is eating optimally,” says David Katz, MD, founder and CEO of DietID in Detroit, and past president of the American College of Lifestyle Medicine.
If you’re interested in the why and how of these benefits, look no further. Whether you’re hoping to help fend off a disease or manage one you already have, or simply eat healthier to look and feel better, these days there’s no shortage of resources that can enable you to take advantage of using food as medicine.
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How a Healthy Diet Can Help Keep Disease at Bay
What types of food usually fill your plate? The answer can play a major role in your risk for future chronic disease.
After all, each year poor nutrition is responsible for 11 million global deaths from ailments such as cardiovascular disease, certain types of cancer, and type 2 diabetes, according to a study published in April 2019 in The Lancet.
Meanwhile, in the United States, its estimated 900 deaths per day from heart disease, stroke, or type 2 diabetes could be the result of poor diet, according to a study analyzing the association of diet and heart-metabolic linked deaths published in March 2017 in the Journal of the American Medical Association. Young, Black, Hispanic, and relatively less-educated people are more likely to die due to poor diet, the authors wrote.
Generally speaking, the characteristics of a poor diet include consuming too much sodium, meat (especially the red or processed variety), and sugar-sweetened beverages, or not eating enough fruits, vegetables, nuts and seeds, whole grains, polyunsaturated fats, and seafood-based omega-3 fatty acids.
Certain diet plans are scientifically supported to help prevent many chronic diseases. Dr. Katz points to research on the heart-healthy DASH diet, which has been shown to lower blood pressure and LDL cholesterol, per the National Heart, Lung, and Blood Institute. He also cites the plant-based Portfolio diet, which when combined with a low-fat regimen has been shown to lower potentially harmful low-density lipoprotein (LDL) cholesterol and lower cardiovascular disease risk, according to a review published in the May–June 2018 issue of Progress in Cardiovascular Disease.
Similarly, some research, such as a study published in September 2015 in Alzheimer’s & Dementia, has shown that the MIND diet, which focuses on combining tenets of the DASH and Mediterranean diets, may play a role in warding off Alzheimer’s disease, the most common type of dementia. On its own, the Mediterranean diet — an eating approach that includes produce, whole grains, fish, olive oil, dark chocolate, and some red wine — may help lower your chances of developing conditions including Alzheimer’s and Parkinson’s disease, certain types of cancer, and heart disease, as the Mayo Clinic notes.
Katz further cites the Diabetes Prevention Program, which showed that a 7 percent weight loss, achieved through a low-fat diet and exercise, lowered blood sugar and reduced the rate of developing type 2 diabetes in individuals with prediabetes by 34 percent. “Diet truly is medicine, not just prevention, not just health promotion — literally treatment and reversal of disease,” says Katz.
In the same vein, healthy plant-based diets that are higher in whole grains, fruits, vegetables, nuts, legumes, including the Mediterranean diet are linked to numerous protective benefits. According to a 2019 study published in the Journal of the American Heart Association, this includes a lower risk of cardiovascular disease, as well as lowered risk of death from all causes.
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Using Food to Manage Disease Stems Back to Early Grassroots Efforts
As mentioned, the roots of the food as medicine movement on a grassroots level stem back to the ’80s. For these programs, food has primarily been used as a means to manage, not prevent, disease.
The members of the Food Is Medicine Coalition (FIMC) are among those who have been at this movement the longest. The FIMC is comprised of nonprofit food and nutrition service organizations that focus on providing “complete, evidence-based, medical food and nutrition intervention to critically and chronically ill people in their communities.”
Many coalition members started as HIV service organizations during the early days of that epidemic, says Lisa Zullig, RDN, director of nutrition services for the New York City–based coalition member God’s Love We Deliver. Her organization and others evolved to serve other people with chronic and serious diseases that come with special nutrition requirements. God’s Love We Deliver alone cooks and home-delivers more than 2.2 million medically tailored meals each year for people whose diseases prevent them from shopping or cooking for themselves.
Altogether, coalition member organizations serve over 12 million meals to 57,000 people across the nation, according to an FIMC press statement. Of those served, 35 percent are living with HIV or AIDS, 18 percent with cancer, 12 percent with cardiovascular disease, and 11 percent with diabetes as their primary diagnoses. Many live with more than one diagnosis, though.
A wealth of research suggests using food in conjunction with traditional care, such as medication and surgery, to help manage disease is a worthwhile effort. Diseases that you can improve with diet changes include everything from diabetes and chronic kidney disease to cancer and gastrointestinal diseases like ulcerative colitis and Crohn’s, notes the National Institute of Diabetes and Digestive and Kidney Diseases.
Fad Diets for Medicine: Yay or Nay?
That said, not all eating styles are created equal. These days, more people are trying fad diets on their own in hopes of improving a health condition, losing weight, or promoting general well-being, like increasing energy, improving sleep, or eliminating so-called brain fog.
But unlike with the aforementioned programs run by FIMC, there isn’t always rigorous scientific research to support trying a given diet plan for the desired result. And many people are going it alone when making diet changes, which may offer the desired result in some cases, while in others it may do nothing or pose harm.
For example, the number of people in the United States who adhere to a gluten-free diet without having celiac disease — an autoimmune condition that disrupts the digestion of proteins found in certain cereal grains, such as wheat — tripled between 2009 and 2014 to 2.7 million, according to a 2016 research letter published in JAMA Internal Medicine. This is despite that there isn’t much evidence that the diet helps people who don’t have formally diagnosed celiac disease, according to an article published in February 2018 in Gastroenterology & Hepatology.
Likewise, the ketogenic diet remains one of the most popular diets for weight loss, and it has gained a reputation online for treating certain diseases as well. While it’s been shown effectiveness for treating epilepsy in children, and is now being used in some adults, as January 2019 research in Frontiers in Neuroscience shows, other health uses are more controversial. Still, some programs, such as the Cleveland Clinic’s therapeutic ketogenics program and the telemedicine company Virta’s individualized nutritional therapy program, argue that with medical supervision, the ketogenic diet can be a sustainable way to help individuals better manage type 2 diabetes.
If restrictive diets like these are helpful for you and your doctor okays them, great. However, Katz emphasizes that it’s important not to get too drawn in by the idea that specific food (or food group) or the lack of it is a magic bullet. “This is a classic instance of missing the forest for the trees. You know, inevitably what gets the most marketing is somebody’s tree. So, just eat this superfood and all will be well. The reality is the really strong predictions come from dietary patterns.”
Instead, for optimal health, he says, “All of the best themes, or rather, all the best variants on a theme of optimal diet share the following: They are mostly made up of unprocessed or minimally processed whole plant foods. So, lots of vegetables, fruits, whole grains, beans, lentils, nuts, seeds, and plain water, preferentially, for thirst. And that’s pretty much, full stop.”
Resources Involving Use Food as Medicine Are Exploding
New generations have become increasingly aware of the potential medicinal power of food, according to the consumer research firm NPD Group. “While it is commonly understood that good nutrition promotes general health, consumers are becoming increasingly aware of how their food and beverage choices can help them manage and, in some cases, reverse certain medical conditions,” the company said in an August 2019 press release.
“Younger adults, ages 18 to 24, are particularly interested in using foods to improve their health,” the company further states. “For example, 9 percent of adults say a top nutrition goal is protecting brain health and when asked about foods that promote brain health, young adults were 45 percent more likely to express an interest in these products compared with 35- to 44-year-olds.” NPD Group says that the so-called “superfoods,” (an oversimplified nutrition concept that Katz cautions against) that consumers are expressing the most interest in include elderberry, cannabidiol (CBD), and manuka honey.
Meanwhile, there’s evidence of a recent bump in interest in books and media about food as medicine. Entering the search terms “food is medicine” and “food as medicine” on Amazon yields 29 results for 2018, 44 results for 2019, and 31 results for 2020, suggesting that while interest has fluctuated, it hasn’t waned.
Meal Delivery Services
What’s more, a growing number of meal delivery services distributed commercially are rooted in the idea of using food as medicine. Here are some examples and details on how they work:
Remember the healthy frozen food brand Luvo? In 2019 it was rebranded as Performance Kitchen, with an all-star roster of former pro athletes, such as co-owners and Major League Baseball’s David Ortiz and Tori Hunter. Performance Kitchen also has a meal delivery service states with the stated goal to “to make ‘Food is Medicine’ an easy and accessible solution for everyone no matter what your unique needs.” In particular, their “Performance Kitchen Crafted” line is prepared in small batches that minimize sugar and sodium, and can be ordered for specific diets, such as maternity health (in first to third trimester plans), dairy-free, gluten-free, keto, low FODMAP, renal (for kidney disease), vegan, Whole30 and Mediterranean. You can order them in seven-day meal plans that range between $130 and $250 in price weekly, or a la carte for roughly $7 to $10 per single serving frozen meal.
This meal delivery service focuses on the low FODMAP diet, which is tailored to reduce symptoms of irritable bowel syndrome such as gas, bloating, cramping, diarrhea and constipation. All of Modify Health's meals are fresh and free of gluten, wheat, refined sugars, and peanuts, as well as artificial colors and flavors. You also have the option to exclude ingredients such as dairy, red meat, poultry, fish, shellfish, and soy. Seven-day meal plans start at $165 per week, with optional dietitian support for an additional one-time $99 fee for three consultations. Single meals start at $8.
Catering to gluten-free eating (the only treatment for people with celiac disease, according to the Celiac Disease Foundation), as well as the low FODMAP diet needs, this service delivers fresh meals (not frozen) that are free of hormones, preservatives, and antibiotics. Rather than choose meal plans, you simply order a la carte dishes that cost an average of $15 each, for as many as a month’s worth at a time. Epicured also has vegan and dairy-free options on the menu.
Marketed primarily to seniors, Magic Kitchen delivers frozen meals that follow a broad array of diets including those for people who have diabetes and kidney disease (renal and dialysis), and those who need to minimize fat and sodium or exclude dairy. Gluten-free eaters and vegetarians are in luck, although vegans must look elsewhere for their culinary needs. Meal plans range from $82 to $275 per week for one to three meals per day. A la carte meals range from $10 to $35 each for two servings per meal.
Telemedicine Platforms and Apps
Digital resources, including telemedicine and apps, can also help you use food as medicine.
“Telemedicine is increasing the access to nutrition professionals,” says Lauri Wright, PhD, RDN, who is based in Jacksonville, Florida, and is a national spokesperson for the Academy of Nutrition and Dietetics. “So, you don’t necessarily have to go to a clinic anymore. You can have a telemedicine visit with a registered dietitian.”
There are many ways you can connect with an RDN online using a computer, tablet or phone, but Dr. Wright says the best approach is to ask your healthcare provider to make a referral or to check your insurance company’s directory of nutrition professionals and then use whichever telemedicine platform the provider you have chosen is using.
Some people are going a step further and using apps and platforms to make diet changes for health results, like disease management or weight loss. Examples of platforms that encourage using food as medicine include:
Virta is a medically tailored, nutrition-based program that aims to help people with type 2 diabetes manage their blood sugar without medications or insulin. It is based on an individualized version of the keto diet, a low-carb, high-fat regimen that reduces the need for insulin by placing your state in a ketosis, during which it burns fat for fuel. For $249 per month, plus a $250 initiation fee, you’ll receive remote care via a desktop or mobile app that enables telehealth visits by doctors and health coaches, as well as tools to track your biometric data. The service also comes with supplies for measuring blood sugar, ketones, blood pressure, body weight, and the weight of food you consume.
DayTwo also uses medically tailored nutrition to treat type 2 diabetes, but with a twist on the traditional low-carb approach. The service analyzes the microbes in your gut, which are involved in digestion, to determine how you will uniquely respond to food. A growing body of research indicates that imbalances in gut microbes are linked to insulin resistance, the hallmark of type 2 diabetes. For $499, DayTwo will analyze a stool sample that you provide and then make personalized recommendations through its app for what you should eat to keep your blood sugar under control. You’ll also get a 30-minute consultation with a nutritionist.
Zoe promises to help optimize your health and weight, and boost your energy, by testing your gut microbiome and level of dietary inflammation after eating. Its algorithms are based, in part, on data from an ongoing U.K. trial, published in June 2020 in Nature Medicine, involving identical twins. The app is designed to predict a person’s response to food in terms of blood sugar and triglyceride, or blood fat, levels. Program subscriptions start at $59 per month for a test kit, meal recommendations, and telemedicine chat sessions with a nutrition coach. There is a six-month commitment, meaning the cost is $354 before tax.
If you are managing gastrointestinal conditions such as irritable bowel syndrome, Crohn’s disease, ulcerative colitis, celiac disease, diverticular diseases, and gallstones, see if your employer or health plan offers Vivante Health’s GI Thrive. The integrated digital platform and telemedicine service includes gut microbe analyses, apps for monitoring and managing your condition, personalized nutrition counseling from a registered dietitian, and 24/7 support from a team that also includes nurses and a health coach. Check with your employer or health plan for any associated costs.
Katz’s app DietID takes a user’s biometric data and a user-friendly, image-driven way of detecting their diet preferences to help their nutritionist or healthcare provider prescribe an individualized diet for their optimal health. It takes about two minutes. “We can do this on any patient’s smartphone or an iPad in a doctor’s waiting room,” says Katz. While the app is not available directly to consumers, DietID has struck recent deals with companies such as the vitamin provider Nature’s Bounty, who will use their technology to help consumers select vitamins.
If you decide to follow the advice of a “food is medicine” service or app, remember that it’s still important to connect with a registered dietitian who knows you and your medical needs, Wright cautions. They will know if the advice you are receiving is truly appropriate for you — not just from a health standpoint, but also based on what you can afford, your environment and even your cultural traditions.
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Using Food as a Complement to — Not a Replacement for — Medicine
While food can help prevent or even treat disease, it’s important to keep your expectations in check.
You can think of food as a complementary, not alternative, form of medicine, says Dylan Mackay, PhD, a nutritional biochemist at the Rady Faculty of Health Sciences at the University of Manitoba in Canada.
Too frequently, he says, “it is presented as a one versus the other scenario. If you eat the right foods, you never need medicine.” Dr. Mackay’s own experience as someone living with type 1 diabetes (and therefore dependent on both insulin and controlled diet) has left him believing that food and medicine are each important to living, but should not be conflated.
He points to the way people can fall for claims about cancer-cure diets, which, as UT Southwestern Medical Center notes, are false. Balanced, healthy diets can help to lower cancer risk or supply energy that you need to fight the disease, but no single food or diet will starve or cure it. “There are many stories of people delaying or not getting conventional cancer treatments because they wanted to use food-based treatments,” notes Mackay.
“What we eat, or don’t eat, has a profound impact on our health, but the effect happens over a much longer time than when what most people think about as ‘medicine.’ Calling food ‘medicine,’ can set food up for failure, because people will want those big, fast results.” Furthermore, “If you see every meal as a potential preventative medical treatment, it can change your relationship with food,” making it stress-inducing. For those who are struggling with eating disorders, that can be yet another way to have an unhealthy relationship with food.
While Katz unabashedly says, “food is medicine,” he, too, cautions against singling out any one food for its medicinal power or believing you can replace medicine with food. “There are absolutely times when the best medicine is medicine. If you need an antibiotic, you need an antibiotic. If you need a chemotherapeutic agent, you need a chemotherapeutic agent. If you have atrial fibrillation then you need to take a drug to control that. There are things diet cannot do. You need to take a step back and see the big picture and try to derive maximal benefit from both.” A healthy balance is important to this approach, in his view.