Can Food Really Heal?

Greek philosopher and physician Hippocrates made his often-repeated proclamation, “Let food be thy medicine, and let medicine be thy food,” more than 2,000 years ago. He was far from alone in his belief that the foods one eats have the power to optimize health and well-being: ancient medical texts in the Egyptian, Ayurvedic, and Chinese traditions also noted different foodstuffs that were believed to prevent or treat illness.

It would seem that what is old is new again: over the past decade, the Food as Medicine (sometimes referred to as the Food Is Medicine) movement has made significant strides, with the Biden-Harris Administration publishing a National Strategy on Hunger, Nutrition, and Health in 2022 with a push to increase access to whole fruits and vegetables, and other healthy food options, to “make America truly a stronger, healthier nation.”

“Food as Medicine received a lot of attention at the White House conference that preceded that strategy,” says Lisa Sanders, owner and principal scientist at Cornerstone Nutrition and a consulting nutrition scientist for IFT. “We have now moved into a new administration, of course, but I still see a lot of energy around Food as Medicine efforts, especially as new trials have been published to show its benefit on a potentially larger scale.”

Tambra Raye Stevenson, founder and CEO of Women Advancing Nutrition, Dietetics, and Agriculture, a nonprofit organization focused on building a platform for women and girls of African descent to lead in the food system as advocates, educators, and entrepreneurs, added that the Biden-Harris plan framed a greater investment in Food as Medicine as a “public health and equity issue.

“From investments in local food systems and school meals, to supporting the National Institutes of Health (NIH) nutritional research agenda, the policy winds have started to shift,” she says. “But we are at an inflection point. We’re at risk of losing a lot of ground.”

I still see a lot of energy around Food as Medicine efforts, especially as new trials have been published to show its benefit on a potentially larger scale.

Lisa Sanders

Cornerstone Nutrition

How Food as Medicine Works

Simply defined, Food as Medicine is the use of nutrients in foods to support overall health. With obesity rates (and prevalence of related diseases) skyrocketing across the globe, physicians are increasingly relying on dietary interventions to prevent, manage, and treat a variety of illnesses. Drew Ramsey, MD, a board-certified psychiatrist and author of the book, Eat to Beat Depression and Anxiety, says that, more and more, physicians from all specialties understand that food needs to be a part of any prescribed health solution.

“We know that when people engage in lifestyle alterations, including improving their diet, we see better outcomes,” he says. “As a clinician, it’s a very exciting time. Not only do we understand that the right dietary pattern can help people improve their metabolic and cardiovascular health, but good food can also be an intervention in mental health, shifting the risk of mental health conditions and helping people better manage disorders like depression and anxiety.”

These kinds of “lifestyle alterations” now involve more than your doctor offhandedly telling you to cut down on salt or fatty foods while walking out the door at the end of your annual physical. Many health-care organizations are actively working toward providing patients with medically tailored meal plans and produce prescriptions.

“There are different tools in the Food as Medicine tool kit,” says Sarah Ohlhorst, chief science policy officer at the American Society for Nutrition. “And, as these programs have gotten off the ground, we see that they can be impactful for health.”

Yet, why they are so impactful remains a bit of an open question. Many studies have shown that dietary interventions can be helpful in preventing and treating a wide range of diseases. Thanks to the Framingham Heart Study, a multigenerational longitudinal study with the goal of identifying common contributors of cardiovascular disease, we’ve known about the importance of reducing salt and fat to decrease heart attack and stroke risk for decades. Today’s research suggests that food also has the power to lower the risk of dementia, as well as several types of cancer.

But now, studies are also showing the importance of diet to mental health. The 2017 Supporting the Modification of Lifestyle in Lowered Emotional States (SMILES) study, a randomized controlled trial that looked at dietary changes as a treatment for depression, for example, found that changing one’s diet could reduce depressive symptoms. A further analysis of the data from that trial also showed a correlation between ultra-processed foods (UPFs) and mood: the patients who saw the greatest improvement in their depressive symptoms were the ones who ate the fewest UPFs.

Despite these powerful studies, other large-scale trials have found more mixed results when examining the effects of different dietary interventions. A recent trial looking at Food as Medicine interventions to manage type 2 diabetes did not see improvements in participants’ HbA1c levels, surprising many who expected a strong positive effect. And, as noted in a recent meta-analysis of trials, many of these studies, when they show positive outcomes, aren’t always statistically significant. There could be many reasons for these negative results: there may be some flaws in trial designs, people may not be honest about what they are really eating, or it’s possible the researchers aren’t testing the most effective interventions.

No matter the reason, contradictory results present a challenge to Food as Medicine champions—and demonstrate a need for further research. Even as more physicians, like Ramsey, are already prescribing whole foods or other dietary interventions, moving from a basic food prescription to a precision medicine food prescription will require a lot more study. For example, do specific conditions require specific foods? While oranges and tomatoes can do wonders for scurvy, using food to prevent cancers may prove to be a bit more complicated than just upping one’s vitamin C. There may be other vitamins or nutrients involved with keeping tissues healthy. Today, researchers continue to investigate different factors that can explain why foods can promote health, including microbiome changes or patients’ specific DNA or epigenetic profile. The insights revealed in such studies will help the medical community create more effective food prescriptions to combat disease at both the population and individual levels.

“Understanding the mechanisms of why [Food as Medicine] is helpful and in what cases it’s helpful is still a bit of an open question,” says Ohlhorst. “Now, we are seeing more research to try to elucidate the true health benefits of these prescriptions and where they can have the most impact.”

Understanding the mechanisms of why [Food as Medicine] is helpful and in what cases it’s helpful is still a bit of an open question.

Sarah Ohlhorst

American Society for Nutrition

Food Prescription Programs

The National Strategy on Hunger, Nutrition, and Health provided a Medicaid section 1115 demonstration waiver to help pay for produce prescriptions, expanding access to whole fruits and vegetables in vulnerable patient populations. Luisa Furstenberg-Beckman, produce Rx manager for DC Greens, a nonprofit organization that works to improve access to quality, affordable, healthy food in the Washington, D.C., area, says there are many produce prescription programs across the country—and they’ve been effective in helping improve both food security and health status for many underserved populations.

“Many programs are run by local nonprofits, like ours, or local clinics, and they do so much with so little to support the communities that need these programs the most,” she says. “Many states, like New York, California, Massachusetts, and North Carolina, have already passed and started to implement waivers that cover food and nutrition services like produce prescriptions. It’s one step in the overall goal of embedding Food as Medicine interventions into health-care delivery.”

Other organizations, like the Kroger grocery chain and Kaiser Permanente, an integrated managed health-care consortium, have also implemented produce prescription programs on a regional basis. Stacy Bates, director of wellness nutrition strategy for H-E-B, a Texas-based grocery chain, says, however, that with expected cuts to Medicaid and funding for community-based organizations, people are “holding their breath” to see what happens next.

“You’re seeing retailers, food companies, and health-care payers having to get creative as they think about the future of these programs,” she says. “It’s not just cuts to Medicaid that we are concerned about. We also see that the federal government has released so many jobs and roles where individuals were working on both the research and the implementation of programs to help promote healthier diets.”

This is of significant concern to many in the Food as Medicine movement. Several university researchers declined to be interviewed for this article because they are waiting to see what will happen to grants and other funding from institutions like the NIH and the U.S. Department of Agriculture. The Make America Healthy Again (MAHA) agenda heralded by Secretary of Health and Human Services Robert Kennedy Jr. has “significant alignment” with the Food as Medicine movement, says Furstenberg-Beckman, so she remains optimistic.

“My hope is that the new administration will work with organizations like ours to increase access and consumption of fresh and nutritious food that people both want and need to support and improve their health conditions,” she says.

Devon Klatell, vice president, food, with The Rockefeller Foundation, says she is seeing heightened interest and dialogue about the connection between food and health across the country—even as the fate of such programs remains up in the air. She noted recent research conducted by The Rockefeller Foundation that found four out of five Americans surveyed believe U.S. health care should offer more food and nutrition programs to treat and manage illnesses—and that Food as Medicine programs should be covered by both public and private insurance.

“We are seeing a lot of discussion, dialogue, and aspiration to better integrate food into the health-care system to help improve patient health,” Klatell says. “But right now, most of these programs are working on a pilot basis or through regulatory loopholes … we need the kind of consumer and patient demand that will move the health-care system and policy makers to make the changes needed to support more programs.”

Stevenson agrees. She says most Food as Medicine programs, whether they are produce prescriptions or programs that support other forms of increased food access, have limited sustainability as it stands.

“We need to move from pilot to policy, embedding these interventions into the standard of care and into the health-care reimbursement system,” she says. “Public-private partnerships are critical here, especially those that include trusted community-based organizations, who know how to engage people and communities outside of clinical walls.”

She added that MAHA proponents, as well as government agencies, need to ask themselves an important question: will they double down on a future where food is seen as a right and a remedy, or retreat to business as usual?

“The question is how you get Food as Medicine done, especially if we are now ignoring social determinants of health, where there is so much vital evidence showing that we all need good food to be healthy,” Stevenson says. “So, if you’re busy cutting Supplemental Nutrition Assistance Programs and Medicaid programs, it becomes problematic,” she continues. “We have a lot of communities who don’t have access to good food, and we need the efforts of MAHA to include them if those programs are to be truly impactful for all of America.”

We need food brands that go beyond labels and lean into legacy.

Tambra Raye Stevenson

Women Advancing Nutrition, Dietetics, and Agriculture

Seeking Industry Support

With so much uncertainty, both in terms of research outcomes and program futures, it is clear there is an important role for the food industry to help bolster the Food as Medicine movement. Many food developers are actively working on simplifying ingredient lists and creating more nutrient-dense foods through the promotion of regenerative agriculture practices and new product formulations. Ramsey, for his part, would like to see the food industry working to enhance the growth and distribution of more “real” food.

“We want to see Big Food respond to our concerns about ultra-processed foods and create simpler products with greater access,” he says. “To have foods that can help with health, we need to see more nutrient density, more fiber, and less fillers so we can more easily direct our patients to the foods they need to stay healthy.”

Klatell says she is buoyed by the fact that so many food and beverage companies have started pushing toward not just healthier products—but more affordable ones.

“That work ties closely to the Food as Medicine movement. I hope the industry will embrace innovation around healthy foods that use whole ingredients, but I also hope they will work more to ensure that they can get those healthy, whole foods to more people,” she says. “In our experience, the health-care system and the food and beverage industry are separate giants in their own spaces that don’t talk to each other about how they can collectively serve patients. I would love to see more dialogue between these two spaces to help move us forward.”

If nothing else, many in the Food as Medicine movement would like to see the food industry join their advocacy efforts to help shape the future policies and regulations needed to offer accessible and affordable healthy foods for all.

“We really need the support of the food industry, as this movement is cross-sector and will only thrive and succeed if it remains that way,” says Furstenberg-Beckman. “We need health-care, government, community-based organizations, the food industry, grocery retailers, and more to be a part of this. And since the food industry has a lot of power in the food world, their support in pushing policy forward that makes food more accessible, and incorporates nutritious food into health care, is important.”

Stevenson says that, ultimately, the food industry has a choice: evolve or be left behind. Studies showing that even the wealthiest Americans still have poorer health outcomes than Europeans enrolled in their national health systems illustrate that we, as a country, need to make some changes. She says that Food as Medicine is not a trend—it is crossing political lines and being embraced by consumers across the United States.

“We see a tectonic consumer shift in how people value health care, food, and community. The companies that prioritize transparency [and] regenerative sourcing and are willing to collaborate with public health and community leaders will be ahead of the curve,” she says. “We need food brands that go beyond labels and lean into legacy. We need them to honor the cultural intelligence of food and commit to healing both the people and the planet. The future of food is functional, flavorful, and hopefully rooted in food justice. Companies that feed the body, soul, and the story are going to be the ones that thrive.”ft