Food as medicine? It is not as simple as it seems.


Since I am a recent medical residency graduate, I have prescribed food to my patients to prevent and treat chronic health issues, such as diabetes and heart disease. But health insurance never covered the cost of a healthy meal, which meant that some patients could not afford the healthy diet I gave them.

That recently changed in California and a handful of other states, where Medicaid now covers some foods targeted at patients with diet-related conditions. As a result, I now prescribe “medical supportive food” to some patients—a weekly bag of groceries, or up to three daily meals—that insurance pays for as if it were medicine.

This move to embrace “food as medicine” reinforces it Research Showing that nutritional prescriptions by medical professionals can reduce healthcare costs and improve well-being, especially for those who do not have the resources to access healthy food.

lately studyResearchers estimated that offering a nationwide “medical designed meal” benefit to individuals with diseases such as heart disease, cancer and diabetes could save $185.1 billion in medical costs and avoid more than 18 million hospitalizations over 10 years.

For those who see food as an integral part of treatment, this is a huge step forward. But describing food is not as easy as it seems.

Food is more complex than any grain. This makes it difficult for doctors and patients to know which medically designed foods are the best medicine and which suppliers can provide the best edible remedies.

First, there is a real challenge in identifying suppliers that offer the most nutritious foods. A pharmaceutical drug, whether generic or brand name, has a near-identical make-up no matter who makes it. But food varies greatly in nutrient content depending on the diet Seeds, season, planting And the method of processing and how long it is stored before eating it. Combine foods to make a meal and the variety of nutrients will increase even more.

The lack of standardization made it difficult, for example, for Dennis Hsieh, a physician and chief medical officer for the California-based Contra Costa Health Plan, to choose among the bidding food vendors to fill prescriptions for those enrolled in his plan.

Hsieh has extensive experience contracting with medical supply companies for medicines and other healthcare products, but this is his first foray into the food sector. He said he received little guidance from the California Department of Health Care Services about what he should buy. It Policy The guide only suggests that it offers “appropriate nutritional remedies based on evidence-based dietary practice guidelines.”

“At the end of the day, my primary benchmark [for vendors] It’s that they get food for the sick and they don’t give them McDonald’s and charge us for it.”

In the end, Hsieh signed with six vendors. He said he hopes these vendors will offer meals and groceries that result in cost savings and the health benefits of “food is medicine He studies, but he doesn’t have the “experience” to judge which vendors will get it done.

Michelle Kubis, registered dietitian and director california food is medicine alliance, Concerns are also about the quality of some of the foods entering this growing medicinal market.

“There are so many new companies coming into this space because there is money involved and people want health care money,” Kubis said. She said she suspected some of them “started selling ready-to-eat weight loss meals and then rebranded”.

Kuppich found it difficult to obtain information about the nutritional value of some of the foods being sold. “There is a lack of transparency in terms of ingredients,” she said.

Some vendors offer food just like that Ultra processed As fast food, Hsieh hopes to avoid it. Ultra-processed foods have been linked to chronic disease and an increased risk of premature death.

What are ultra-processed foods? What should I eat instead?

For example, GA FoodsFlorida’s medically fortified food retailer, offers more than 50 “nutritionally balanced” meals. that Contains additives, including corn syrup and other sweeteners, food colorings, flavor additives, hydrolyzed protein and preservatives. “We follow the guidance issued by the top organizations for each disease condition and update the guidance as it is released,” said Mary O’Hara, senior director of marketing for GA Foods. “Our portfolio of clinically designed meals is constantly evolving to meet patient needs and new innovations around health and wellness.”

and Tracy Smith, Vice President of Marketing for mother meals, The Iowa-based company that serves more than 1 million meals a week nationwide said some of its meals include a blend of micronutrients magnesium, zinc, iron, calcium and vitamins C, B1 and B6 “to ensure that a meal fully meets one-third of a person’s needs.” Reference dietary intake. We do that instead of including additional servings of food that would take that meal above the recommended calories, sodium, or carbohydrates per serving, for example.”

Fortifying foods with vitamins and minerals can prevent anemia and other diseases associated with deficiencies of specific nutrients, but it cannot reproduce the most complete nutrition available in a whole food. A carrot, for example, contains all the nutrients found in a mother’s meal mix Dozens of additional disease-fighting compoundswhich work together to influence our health.

Catherine Koch, Founder and CEO, Inc Ceres Community Project, a nonprofit MSF supplier based in Sonoma County, California, said, “We use high-quality, nutrient-dense food and don’t need to add anything to meet our customers’ nutrient requirements.” Getting food regionally and reducing storage and transit time helps ensure higher food quality, Koch said. (It can also help support the local economy and reduce your environmental footprint.)

Healthcare providers also face the challenge of identifying vendors that serve food that appeals to the taste buds — and the soul.

said Seth Berkowitz, a researcher who led some of the experimental studies of medicine and is now an associate professor of general medicine and clinical epidemiology at the University of North Carolina School of Medicine. He described the food as offering gastronomic pleasure, cultural connection and family memories.

Berkowitz said national vendors offer an “economy of scale” that keeps costs down, but pilot studies he’s been involved with in Boston that show positive results are receiving their food from a nonprofit group that says it offers “prepared” meals and purchases from local farmers.

“Task-driven organizations may offer benefits,” Berkowitz said. “It remains to be seen if the secret sauce that made those small efforts work can be scaled up.”

Nutrition and lifestyle training

In addition to providing food, MSF California vendors are expected to provide nutrition and lifestyle training to their customers from then on. Research It shows that coupling nutritional assistance with education is likely to promote healthy eating patterns.

As with food, these services vary. Some registered vendors give access to a brief nutrition consultation or a healthy food app, while others offer cooking lessons and real-time shopping.

Sarah Nelson, CEO, said 18 reasons, An MSF provider in the San Francisco Bay Area. She has found that her clients are more likely to try a new vegetable if they are given a recipe and practice preparing it in a group setting.

“Nutrition education and counseling is just as important as food, so that people can prepare healthy meals as soon as the prescription is over,” Kubis said.

How does it work in the doctor’s office

Recently, I wrote a nutritional recipe for a 50-year-old woman with poorly controlled type 2 diabetes. She was enrolled in MediCal, California’s health insurance program for children and adults with limited incomes and resources.

I did my best to point it to the vendor who would offer the tastiest, most nutrient-dense and culturally relevant food. But even with my nutritional knowledge, I found it hard to know which might be which.

She eventually opted for a nonprofit group that sources most of her food locally and has meals delivered to her doorstep. Two months after her prescription, her blood sugar improved, and I called her to give her the good news. I asked her what she thought of the meals. “They’re so cute, it’s really good to see them,” she said.

It took me a while to realize she was referring to the delivery person, not the food.

Her comment left me wondering what led to the positive change in my blood sugar. Was it the food? social contact? Both?

Regardless, it was a powerful reminder that food isn’t a pill, it’s a much more complex medicine.

At any age, a healthy diet can extend your life

Daphne Miller, MD, is a family physician and clinical professor at the University of California, San Francisco, and a research scientist at the University of California, Berkeley School of Public Health. She is also the founder of the Health From the Soil Up Initiative.

Leave a Comment