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The idea of food as medicine dates back to the ancient Greek physician Hippocrates, and a new study adds to the evidence that a diet rich in fruits and vegetables can help improve heart health. The research comes amid an epidemic of diet-related diseases that competes with smoking as the leading cause of death.
The researchers assessed the impact of “product prescriptions,” which provide free fruits and vegetables to people with diet-related illnesses, including diabetes, obesity, and hypertension. The study included nearly 4,000 people across 12 states who struggle to afford healthy food. They received vouchers, worth an average of US$63 per month, for up to 10 months, which could be redeemed for products at retail stores or farmers’ markets, depending on location.
Health care providers tracked changes in weight, blood pressure and blood sugar among participants. “We were excited to see improvements,” says study author Kurt Hager, instructor at UMass Chan Medical School.
“Among adults with hypertension, we saw that systolic blood pressure decreased by 8 mm Hg and diastolic blood pressure decreased by about 5 mm Hg, which could have a significant impact on health outcomes,” says Hager.
Among people with uncontrolled diabetes, their A1C levels, which is a 2-3 month average of blood sugar, also dropped significantly, by about 0.6 percent. “The reductions we saw in blood sugar were approximately half that of commonly prescribed medications, which is really encouraging for a simple dietary change,” says Hager.
“I felt great,” said Joann Erickson, 60, who participated in the Sacramento County Health Center’s prescription pilot initiative in Sacramento, Calif. The program was organized by Wholesome Wave, a non-profit organization at the forefront of initiatives to make healthy eating cheaper and more accessible. Approximately 85% of participants reported that participation in the program improved their health.
“As a chef and father of two who live with diabetes, I’m not surprised,” says Wholesome Wave co-founder Michel Nischan. “Our dietary strategy included significantly increasing Chris and Ethan’s fruit and vegetable consumption,” he says, noting that their children’s A-1C decreased and, as a result, their insulin use was reduced. “We knew we needed evidence to make the case for policy change,” he says.
“Being able to buy healthy food made me feel like a millionaire,” says Erickson. She loaded her cart with strawberries, blueberries, cherries and salad greens, items she normally can’t afford. “It was a huge thrill for me,” she says. After six months on the program, her doctor was able to reduce her blood pressure medication. Their blood sugar levels also dropped. “I had more energy,” says Erickson.
“Anything that lowers hemoglobin A1C and improves blood pressure control is beneficial,” says Dr. Dariush Mozaffarian, a cardiologist and professor at Tufts University’s Friedman School of Nutrition, where the research was conducted. The challenge is to maintain these reductions. “Improvements in blood glucose can significantly reduce the risk of diseases such as eye, kidney and nerve diseases,” he says, which happen frequently among people with uncontrolled diabetes.
A year ago, following a White House conference on hunger, nutrition and health, the Biden administration announced a national strategy aimed at improving healthy eating and incorporating nutrition into health care. This has created momentum to strengthen the evidence as more health care providers connect the dots between diet and disease. “I think our study really provides a strong foundation for the next investment step,” says Hager. It’s time to move beyond pilot programs, “to invest even more in larger trials with comparison groups,” says Hager.
As evidence continues to mount, “it’s important that we simultaneously invest in the infrastructure needed to scale up food and drug prescriptions,” says Holly Freishtat, director of the Feeding Change initiative at the Milken Institute. Her team outlined market solutions that could help support implementation, such as technology-based systems that would help patients participate in food assistance programs, including SNAP (food stamps) and these newer approaches.
“With the growing burden of chronic food-related illnesses in the US, we cannot afford to [to] backlog,” says Freishtat. “We need to find a way to make it easier for individuals to know their eligibility for benefits, track benefit amount status, and understand where and how to utilize those benefits,” says Freishtat.
For now, prescription product programs only offer short-term assistance. Since Joann Erickson’s production vouchers ended, her monthly SNAP benefits have also been significantly reduced. Now, once again, she cannot afford healthy food. “After I stopped the program, I saw my blood pressure go up,” she says. “I would say there’s a direct correlation,” says Erickson.
For the food is medicine strategy works, it is clear that people will need long-term support.
“We need to get to a point where these benefits are persistent,” says Mozaffarian. “If you take a blood pressure lowering drug, you are not going to stop taking the drug in six months,” he says. The same happens if a healthy diet is prescribed. He says more research is needed to establish which patients benefit from which food assistance programs, whether personalized meals or prescriptions, and just how much they need to manage their conditions. But he says the ultimate goal is to get to a point where those benefits are covered for the people who need them.
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