Food as Medicine is No Longer a Fringe Idea

Dr. Daniel Nadeau gives Allison Scott a few tips on getting kids to eat healthy, at Ralph's Supermarket in Huntington Beach. (David Gorn/KQED)

Several times a month, you can find a doctor in the aisles of Ralph’s market in Huntington Beach, wearing a white coat and helping people learn about food. On one recent day, this doctor was Daniel Nadeau, wandering the cereal aisle with Allison Scott, offering ideas on how to feed kids who studiously avoid anything that tastes healthy.

“Have you thought about trying smoothies in the morning?” he asks her. “The frozen blueberries and raspberries are a little cheaper, and berries are really good for the brain.”

Scott knows about smoothies, actually. She's been cooking a plant-based diet for her family for about nine months, a decision prompted by her husband being diagnosed with systemic inflammation. Scott cooks a couple of hours a day to prepare meals from whole foods. So when she saw a doctor in Ralph's, Scott says, she was delighted to find someone talking about the very thing that has been consuming her life: food as medicine.

Nadeau is program director of the nearby Mary and Dick Allen Diabetes Center, part of the St. Joseph Hoag Health alliance. The Center's Shop with Your Doc program sends doctors to the grocery store to meet with any patients who sign up for the service, plus any other shoppers who happen by with questions.

“In America, over 50 percent of our food is processed food,” Nadeau says. “And only 5 percent of our food is plant-based food. I think we should try to reverse that.”

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It can be hard work, as anyone who's tried to eat more vegetables or quit sugar knows. Part of the work is learning about nutrition and making time to cook, says Scott, who in the beginning ran all her menus past a nutritionist, and sometimes uses a service that delivers her a box of organic food and recipes to prepare it. And for her, another part is getting her two boys, 5 and 8, to make the same changes.

"I always make them try a bite of every single thing I make," she says. "The kids get so mad at me, still, even though they're starting to eat better."

A Small Revolution Brewing

Scott and Nadeau are part of a small revolution brewing across California. The food-as-medicine movement has been around for decades, but it's making new inroads as physicians and medical institutions make food a formal part of treatment, rather than relying solely on medications. By prescribing nutritional changes or launching programs such as Shop with Your Doc, they're trying to prevent, limit or even reverse disease by changing what patients eat.

“There’s no question people can take things a long way toward reversing diabetes, reversing hypertension, even preventing cancer by food choices,” Nadeau says.

Clients in a pilot program for pregnant women with diabetes choose from an array of fresh fruits and vegetables, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital.
A client in a pilot program for pregnant women with diabetes chooses from an array of fresh fruits and vegetables, with help from a volunteer, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital. (UCSF)

In the big picture, says Dr. Richard Afable, CEO and President of St. Joseph Hoag Health, medical institutions across the state are starting to make a philosophical switch to becoming a health organization, not just a health care organization.

That sentiment echoes the tenets of the Therapeutic Food Pantry program at Zuckerberg San Francisco General Hospital, which completed its pilot phase and is about to expand on an ongoing basis to five clinic sites throughout the city. The program will offer patients several bags of food prescribed for their condition, along with intensive training in how to cook it.

“We really want to link food and medicine, and not just give away food," says Dr. Rita Nguyen, the hospital's medical director of Healthy Food Initiatives. "We want people to understand what they’re eating, how to prepare it, the role food plays in their lives.”

In Southern California, Loma Linda University School of Medicine is offering specialized training for its resident physicians in Lifestyle Medicine—that's a formal subspecialty in using food to treat disease.

Research on the power of food to treat or reverse disease is beginning to accumulate, but that doesn't mean diet alone is always the solution, or that every illness can benefit substantially from dietary changes. Nonetheless, physicians say they look at the cumulative data and a clear picture emerges: that the salt, sugar, fat and processed foods in the American diet contribute to the nation’s high rates of obesity, diabetes and heart disease. According to the World Health Organization, 80 percent of deaths from heart disease and stroke are caused by high blood pressure, tobacco use, elevated cholesterol and low consumption of fruits and vegetables.

“It’s a different paradigm of how to treat disease,” says Dr. Brenda Rea, who helps run the family and preventive medicine residency program at Loma Linda University School of Medicine.

Choosing What Foods to Prescribe

The lifestyle medicine subspecialty is designed to train doctors in how to prevent and treat disease, in part, by changing patients' nutritional habits. The medical center and school at Loma Linda also has a food pantry and kitchen for patients.

St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices.
St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices. (David Gorn/KQED)

Many people don’t know how to cook, Rea says; they only know how to heat things up. That means depending on packaged food with high salt and sugar content. So teaching people about which foods are nutritious and how to prepare them, she says, can actually transform a patient’s life. And beyond that, it might transform the health and lives of that patient’s family.

“What people eat can be medicine or poison,” Rea says. “As a physician, nutrition is one of the most powerful things you can change to reverse the effects of chronic disease.”

Studies have explored evidence that dietary changes can slow inflammation, for example, or make the body inhospitable to cancer cells.

In general, many lifestyle medicine physicians recommend a plant-based diet—particularly for people with diabetes or other inflammatory conditions.

“As what happened with tobacco, this will require a cultural shift, but that can happen," says Dr. Nguyen. "In the same way physicians used to smoke, and then stopped smoking and were able to talk to patients about it, I think physicians can have a bigger voice in it.”

From her own experience, Allison Scott suggests that anyone making the switch to a plant-based diet have support, because "it's a complete lifestyle change."

"You  have to stop buying what's on sale," she says. "You have to go into the store knowing what you want to buy."

And if you're cooking for a family, she says, plan all your food in advance and have it already on hand.

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One more tip for people who want to quit sugar: read labels. Most salad dressings, soups and breads contain sugar. Even Amy's organic tomato soup. Go figure.

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