Food as medicine for chronic disease care

What we eat, and how we eat it, is a fundamental part of what makes us human. Food is deeply ingrained in every global culture, helping us mark special occasions and provide comfort in times of need. However, while food is an essential component of our social lives, it isn’t anywhere near as central to the Western medical tradition as it is to Eastern traditional medicine, where food as medicine is foundational.

Only recently have healthcare providers started to closely examine the impact of diet on population health—and only after the Standard American Diet, appropriately abbreviated as SAD, has already taken a devastating toll on many communities.

In 2012, up to 45 percent of deaths from heart disease, stroke, and type 2 diabetes were directly attributed to poor diet, according to recent research. Overconsumption of salty, fatty, and sugary foods, paired with underconsumption of fresh produce, whole grains, and lean meats, dramatically increase the risk of mortality from these common chronic diseases.

“Despite progress over the past few years, Western medicine still largely underappreciates the role of nutrition in health,” asserted Colin Zhu, DO, DipABLM, a primary care provider, culinary instructor, and lifestyle activist. “And we don’t do enough to train physicians to address these issues.”

“As a new doctor, I found out very quickly that no matter who came through my door for what reason, there was nearly always a lifestyle risk that could be tied back to their relationship with food. And yet, I felt poorly prepared to have conversations with my patients about these challenges because we never really talked about how to do so in medical school.”

The gaps were frustrating for Zhu, whose mother was a Chinese medical doctor and acupuncturist.

“In many other traditions, including Chinese culture, medicine is much more holistic. Food is a major part of how physicians address health concerns,” he said. “We need to bring that whole-person approach into our clinical care, especially with the rising rates of chronic diseases with very clear ties to lifestyle choices.”

Preparing providers to take a holistic view of nutrition and health

The CDC estimates that around 60 percent of US adults have at least one chronic disease and 40 percent live with two or more long-term conditions, such as diabetes, heart disease, cancer, or kidney disease.

Despite the CDC prominently highlighting poor nutrition as a main contributor to these conditions, medical schools don’t spend nearly enough time training graduates on how to discuss these issues with their patients.

Medical schools are recommended to devote at least 25 hours of education to nutrition—a relatively low number across four years of intensive education. Yet many institutions fail to clear even this modest bar: researchers in 2015 found that 36 percent of medical schools provide less than half of the recommended hours, and the majority of instruction is delivered in pre-clinical courses instead of a higher-level context.

“As physicians, we just don’t have the confidence to talk about it,” said Zhu. “The education isn’t where it needs to be.  Typically, a physician will just say, ‘you have to eat healthier,’ and then send the patient out the door, but that doesn’t provide any tools or information to make better real-world decisions.”

“Patients are coming to their physicians as their primary source of support for diet and lifestyle, but we fall short in our ability to help them. The change has to start in medical school so we can equip physicians with standardized, evidence-based knowledge about nutrition to share with patients on a consistent basis.”

Overcoming barriers in cultural communication

Each culture has its own way of looking at food and its impact on health. In highly diverse communities, physicians may find it challenging to learn about the unique traditions of every group and provide tailored, culturally sensitive advice accordingly.

“I worked in Seattle for a period of time, which is a very diverse city,” Zhu recalled. “There were people from all over Africa, Asia, and Central and South America, all of whom had their own perspectives about the intersection of food and health.”

“Not all of these people were incredibly open to conventional Western medicine, so it’s important to understand their history with the health system and meet them where they are in terms of their beliefs, customs, and expectations.”

Food can be an effective way to catalyze positive conversations about lifestyle and self-care, he added. “Some people are afraid that we’re going to take away all the foods that are important to them, but it’s a great opportunity to show how a few ingredient swaps or technique changes will allow them to keep the recipes they love, but just make them healthier.”

Bridging the communication gaps and building trust are essential for having more detailed conversations about necessary treatments. “If they don’t trust you, and if they don’t understand you, it doesn’t matter what new diet or medication or surgical procedure you recommend to them. You have to make a real effort to learn about your patients and find ways to connect with them so that you can collaborate on making a difference in their life.”

Zhu recommends connecting with the community through classes and demonstrations that celebrate traditional approaches to cooking while prioritizing healthy choices.

“If you can invite people in your space, or into a community space, and show them that you value food-based traditions as much as they do, you’re much more likely to get engagement and leave the participants with some valuable knowledge. That has to be the entry point into using food as a healing tool.”

“The way we have been addressing nutrition in medicine hasn’t been helpful enough for our patients. If we can overcome some of these fundamental challenges and start having meaningful conversations about the role of food in chronic disease, we’re going to see much more positive results across communities that need some extra support and information from their providers.”

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.