Diet and lifestyle behaviors can affect health status and the development of disease. Large research studies have shown making healthy choices, such as improving diet, regular exercise, managing stress, sleeping well, avoiding smoking, and moderating alcohol, can add over a decade of disease-free years to our lives (Li et al. 2020; Li et al. 2018). In fact, organizations like the American Heart Association highlight reductions of diet and lifestyle risks as first-line approaches for treating disease (Arnett et al. 2019; Mach et al. 2020). These professional organizations and clinical practice guidelines show how food can be used as medicine, such as through produce prescription programs, personalized nutrition education, medically tailored meals, and medically tailored groceries. The importance of nutrition in healthcare is especially relevant as one in five deaths globally can be connected to poor diet (Afshin et al. 2019). The “Food as Medicine” method and programs stress how food can be an integral part of preventing, managing, and treating disease. This publication, intended for general learners, dives into how nutrients connect to disease and how to use “Food as Medicine.”
Nutrients and Disease 101
The nutrients that make up food can influence health in extensive ways—both positively and negatively. Each cell in the body needs a supply of nutrients from food to maintain and carry out functions. This starts with breaking large nutrients in food into smaller units (digestion), which then move from the digestive system into the blood (absorption) to travel to all parts of the body. Nutrients in food become part of the body, available to use wherever they are (or perhaps are not) needed. Beyond basic needs, nutrients and nutrient deficiencies can alter many metabolic pathways (i.e., all the reactions that happen in cells). When factors are out of normal ranges (such as having too high or too low fats or sugar in your blood), risk for disease can increase. When factors are optimal, you can lower the risk for a condition.
For example, researchers looking at the relationship between nutrition and disease found specific diet factors, including low fiber intake, were associated with nearly half of all cardiometabolic deaths related to heart disease, stroke, and type 2 diabetes in 2012 (Micha et al. 2017). Diets high in fiber, which is found in fruits, vegetables, legumes, and whole grains, may lower disease risk.
How Can Food as Medicine Be Used?
Uses of Food as Medicine are evolving every day, with evidence suggesting they can be effective. These practices may promote general well-being or target a certain disorder. While it is common to receive prescription medications, nutrition prescriptions can also be part of improving health. For example, your doctor or dietitian may work with you to “prescribe” meals or talk about cooking techniques and recipes based on an eating plan that supports your health (Hirsch. et al. 2019). Other resources such as food vouchers and education are often given to help with making lifestyle changes. Food as Medicine includes produce prescription programs, personalized nutrition education, medically tailored meals, and medically tailored groceries (Downer et al. 2020; Yoder, Proaño, and Handu 2021).
Produce prescriptions give vouchers for free or discounted fruits and vegetables, and they have shown promising improvements in accessing and eating healthy foods (Little et al. 2019; Bhat et al. 2021). Fresh “Food Farmacies” or other incentive programs, such as matching dollars for healthy foods at a farmer’s market, have also led to better diet intake and food access (Savoie-Roskos et al. 2016). Food pharmacies prepare and dispense healthy foods. In a study of 97 adults with type 2 diabetes, a fruit and vegetable prescription program (Veggie Rx) resulted in significantly lower HbA1c (a long-term measure of blood sugar control as an average over the past two to three months) levels (Veldheer et al. 2021). The Geisinger Fresh Food Farmacy, another produce prescription and fresh food program, has also shown cost and clinical benefits, including an average 2-point reduction in HbA1c and lower low-density lipoproteins, triglycerides, and blood pressure (Feinberg et al. 2018; Hess, Passaretti, and Coolbaugh 2019).
Personalized nutrition education may not provide foods, but it tailors messages to you—through one-on-one support, group classes, grocery store tours, websites, handouts, or recipe cards. To support medical conditions, personalized nutrition may apply Medical Nutrition Therapy (MNT), the individualized nutrition-based process provided by a registered dietitian nutritionist (RDN) for a disease (Academy of Nutrition and Dietetics n.d.). Medically tailored meals are ready-to-eat, prepared foods crafted (usually by an RDN) specific to an individual’s medical needs. According to the Food is Medicine Coalition, medically tailored meals translate evidence-based nutrition standards into meals for a range of conditions, such as heart disease, kidney disease, and diabetes (Food Is Medicine Coalition n.d.). In a study of adults with type 2 diabetes, medically tailored meals enhanced intake of healthy foods and blood sugar control (Berkowitz, Delahanty, et al. 2019). Another study of over 1000 patients showed medically tailored meals were associated with about half the number of hospital admissions compared to nonrecipients (Berkowitz, Terranova, et al. 2019). Improvements in quality of life, mood, and medication use have also been connected to medically tailored meals (Downer et al. 2020; Hirsch et al. 2019).
Similar benefits that regulate blood sugar levels and improve fruit and vegetable intake have resulted from medically tailored groceries of non-prepared foods (Seligman et al. 2015). Medically tailored groceries or food boxes are often paired with clinic or hospital-based food pantries, with a set of disease-friendly ingredients (Oronce et al. 2021).
The foods you choose at the grocery store and how you make them into meals are both strategies for changing risk factors. Healthy cooking can be a key way of implementing Food as Medicine in your daily habits and may be combined with other programs. Connecting foods that are both good for you and tasty to eat has led to using culinary medicine as part of Food as Medicine.
Culinary Medicine: Kitchen Prescriptions
Culinary medicine is a growing field that blends the art of preparing and presenting food with the science of medicine to target disease processes or overall health (Hirsch et al. 2019; La Puma 2016). Along with medically tailored meals, meal kit delivery services, and health apps, culinary medicine includes culinary therapy, teaching kitchens, and cooking classes. Teaching kitchens are emerging in many communities and clinics for hands-on guidance through a “kitchen prescription” to make nourishing meals together and talk about other lifestyle habits. In most teaching kitchens, a trained dietitian or doctor will teach you culinary skills and food access strategies to take nutrition research to the kitchen (Eisenberg and Imamura 2020; Teaching Kitchen Collaborative n.d.). Recent evidence has shown culinary medicine can help people develop cooking skills and knowledge, improve diet intake, and manage risk factors (Hasan et al. n.d.; Reicks, Kocher, and Reeder 2018; Monlezun et al. 2015; Eisenberg et al. 2019). Virtual culinary coaching by a healthcare provider has also shown similar benefits (Polak et al. 2017; Silver et al. 2021; Polak et al. 2014). In one study, participation in a clinic-led virtual food prescription and culinary medicine program resulted in significantly better blood sugar control in patients with diabetes (Sharma et al. 2021).
A central part of culinary medicine is integrating delicious food with healthy food—bringing both the flavor and the wholesome nutrition. The influence of food on health extends beyond the nutrient compounds that make up its structure. Sensory and emotional pleasure, from the tastes and textures to memories with friends and family, are also important to encourage healthy food choices and manage stress levels, preventing and managing disease (Bédard et al. 2021; Hirsch et al. 2019).
The Future of Food as Medicine
While nutrition can be a powerful tool for your health, learning what works for your body within a healthy pattern and maintaining a positive relationship with food are important. Enjoying meals without excess fear or stress is another vital part of health. Every person responds differently to food (due to genetics, environment, and lifestyle, among many factors), and the “Food as Medicine” term can provoke nutrition myths about what researchers have allegedly found to lower disease risk. It is not uncommon to find false nutrition claims promising quick fixes or cures to disease on websites and social media, sometimes even from “medical experts.” Relying on trained health professionals and credible sources of information, such as professional, government, or academic sites, can help lower the chances of falling prey to nutrition fads. Food as Medicine is meant to support, rather than replace, other forms of medical care.
The role of a healthy diet and lifestyle in preventing and managing many diseases is evident. Promising research shows the possibilities of healing through food, with meaningful connections from the soil to our plates to our health. Hospital systems are already beginning to adopt rooftop farms, teaching kitchens with cooking classes, preventive food pantries, and gardens as a routine part of patient care (Fitz et al. 2017; Musicus et al. 2019). As healthcare evolves, diet is becoming a vital sign—that is as essential in assessing health as heart rate and blood pressure—to complement medicine with new kinds of nutrition prescriptions.
Learn More
Diet and Health Conditions: https://www.nutrition.gov/topics/diet-and-health-conditions
Nutrition and Health: https://www.niddk.nih.gov/health-information/diet-nutrition
Culinary Medicine and Teaching Kitchens: The Teaching Kitchen Collaborative Food as Medicine map shows where you can find Teaching Kitchens, medically tailored meals, and produce prescriptions across the nation. https://teachingkitchens.org/map-fim/
Food as Medicine from the Academy of Nutrition and Dietetics: https://www.eatrightfoundation.org/resources/food-as-medicine
Food is Medicine Coalition Medically Tailored Meal Providers: http://www.fimcoalition.org/partners
References
Academy of Nutrition and Dietetics. n.d. “MNT Versus Nutrition Education.” Archived at the Wayback Machine, June 30, 2022. https://web.archive.org/web/20220630171233/https://www.eatrightpro.org/payment/coding-and-billing/mnt-vs-nutrition-education
Afshin, A., P. J. Sur, K. A. Fay, L. Cornaby, G. Ferrara, J. S. Salama, E. C. Mullany, et al. 2019. “Health Effects of Dietary Risks in 195 Countries, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet 393 (10184): 1958–72. https://doi.org/10.1016/S0140-6736(19)30041-8
Arnett, D. K., R. S. Blumenthal, M. A. Albert, A. B. Buroker, Z. D. Goldberger, E. J. Hahn, C. D. Himmelfarb, et al. 2019. “2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Circulation 140 (11). https://doi.org/10.1161/CIR.0000000000000678
Bédard, A., P. O. Lamarche, L. M. Grégoire, C. Trudel-Guy, V. Provencher, S. Desroches, and S. Lemieux. 2021. “Can eating pleasure be a lever for healthy eating? A systematic scoping review of eating pleasure and its links with dietary behaviors and health.” PLoS ONE 15 (12): e0244292. https://doi.org/10.1371/journal.pone.0244292
Berkowitz, S. A., L. M. Delahanty, J. Terranova, B. Steiner, M. P. Ruazol, R. Singh, N. N. Shahid, and D. J. Wexler. 2019. “Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: A Randomized Cross-over Trial.” Journal of General Internal Medicine 34 (3): 396–404. https://doi.org/10.1007/s11606-018-4716-z
Berkowitz, S. A., J. Terranova, L. Randall, K. Cranston, D. B. Waters, and J. Hsu. 2019. “Association Between Receipt of a Medically Tailored Meal Program and Health Care Use.” JAMA Internal Medicine 179 (6): 786–93. https://doi.org/10.1001/jamainternmed.2019.0198
Bhat, S., D. H. Coyle, K. Trieu, B. Neal, D. Mozaffarian, M. Marklund, and J. H. Y. Wu. 2021. “Healthy Food Prescription Programs and Their Impact on Dietary Behavior and Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis.” Advances in Nutrition (Bethesda, Md.) 12 (5): 1944–1956. https://doi.org/10.1093/ADVANCES/NMAB039
Downer, S., S. A. Berkowitz, T. S. Harlan, D. L. Olstad, and D. Mozaffarian. 2020. “Food Is Medicine: Actions to Integrate Food and Nutrition into Healthcare.” The BMJ 2020 (369): m2482. https://doi.org/10.1136/bmj.m2482
Eisenberg, D. M., and A. Imamura. 2020. “Teaching Kitchens in the Learning and Work Environments: The Future Is Now.” Global Advances in Integrative Medicine and Health 9 (January-December): 216495612096244. https://doi.org/10.1177/2164956120962442
Eisenberg, D. M., A. C. Righter, B. Matthews, W. Zhang, W. C. Willett, and J. Massa. 2019. “Feasibility Pilot Study of a Teaching Kitchen and Self-Care Curriculum in a Workplace Setting.” American Journal of Lifestyle Medicine 13 (3): 319–330. https://doi.org/10.1177/1559827617709757
Feinberg, A. T., A. Hess, M. Passaretti, S. Coolbaugh, and T. H. Lee. 2018. “Prescribing Food as a Specialty Drug.” NEJM Catalyst. Accessed February 27, 2022. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0212
Fitz, E., J. Warner, A. Braun, E. Hill, K. Wolf, and C. Spees. 2017. “Development, Implementation, and Evaluation of Evidence-Based Cooking Videos for Cancer Survivors.” Journal of Nutrition Education and Behavior 49 (6): 525–526.e1. https://doi.org/10.1016/J.JNEB.2017.03.012
Food is Medicine Coalition. n.d. Home page. Accessed March 26, 2022. http://www.fimcoalition.org/
Hasan, B., W. G. Thompson, J. Almasri, Z. Wang, S. Lakis, L. J. Prokop, D. D. Hensrud, et al. 2019. “The Effect of Culinary Interventions (Cooking Classes) on Dietary Intake and Behavioral Change: A Systematic Review and Evidence Map.” BMC Nutrition 5: 29. https://doi.org/10.1186/s40795-019-0293-8
Hess, A., M. Passaretti, and S. Coolbaugh. 2019. “Fresh Food Farmacy.” American Journal of Health Promotion 33 (5): 830–832. https://doi.org/10.1177/0890117119845711d
Hirsch, I. B., A. Evert, A. Fleming, L. M. Gaudiani, K. J. Guggenmos, D. I. Kaufer, J. B. McGill, C. A. Verderese, and J. Martinez. 2019. “Culinary Medicine: Advancing a Framework for Healthier Eating to Improve Chronic Disease Management and Prevention.” Clinical Therapeutics 41 (10): 2184–2198. https://doi.org/10.1016/j.clinthera.2019.08.009
La Puma, J. 2016. “What Is Culinary Medicine and What Does It Do?” Population Health Management 19 (1): 1–3. https://doi.org/10.1089/pop.2015.0003
Li, Y., A. Pan, D. D. Wang, X. Liu, K. Dhana, O. H. Franco, S. Kaptoge, et al. 2018. “Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population.” Circulation 138 (4): 345–355. https://doi.org/10.1161/CIRCULATIONAHA.117.032047
Li, Y., J. Schoufour, D. D. Wang, K. Dhana, A. Pan, X. Liu, M. Song, et al. 2020. “Healthy Lifestyle and Life Expectancy Free of Cancer, Cardiovascular Disease, and Type 2 Diabetes: Prospective Cohort Study.” BMJ 2020 368 (January): 16669. https://doi.org/10.1136/BMJ.L6669
Little, M., E. Rosa, C. Heasley, A. Asif, W. Dodd, and A. Richter. 2021. “Literature Review Promoting Healthy Food Access and Nutrition in Primary Care: A Systematic Scoping Review of Food Prescription Programs.” American Journal of Health Promotion 2022 36 (3): 518–536. https://doi.org/10.1177/08901171211056584
Mach, F., C. Baigent, A. L. Catapano, K. C. Koskinas, M. Casula, L. Badimon, M. J. Chapman, et al. 2020. “2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS).” European Heart Journal 41 (1): 111–188. https://doi.org/10.1093/EURHEARTJ/EHZ455
Micha, R., J. L. Peñalvo, F. Cudhea, F. Imamura, C. D. Rehm, and D. Mozaffarian. 2017. “Association between Dietary Factors and Mortality from Heart Disease, Stroke, and Type 2 Diabetes in the United States.” JAMA - Journal of the American Medical Association 317 (9): 912–924. https://doi.org/10.1001/jama.2017.0947
Monlezun, D. J., E. Kasprowicz, K. W. Tosh, J. Nix, P. Urday, D. Tice, L. Sarris, and T. S. Harlan. 2015. “Medical School-Based Teaching Kitchen Improves HbA1c, Blood Pressure, and Cholesterol for Patients with Type 2 Diabetes: Results from a Novel Randomized Controlled Trial.” Diabetes Research and Clinical Practice 109 (2): 420–426. https://doi.org/10.1016/j.diabres.2015.05.007
Musicus, A. A., K. A. Vercammen, A. P. Fulay, A. J. Moran, T. Burg, L. Allen, D. Maffeo, A. Berger, and E. B. Rimm. 2019. “Implementation of a Rooftop Farm Integrated with a Teaching Kitchen and Preventive Food Pantry in a Hospital Setting.” American Journal of Public Health 109 (8): 1119–1121. https://doi.org/10.2105/AJPH.2019.305116
Oronce, C. I. A., I. M. Miake-Lye, M. M. Begashaw, M. Booth, W. H. Shrank, and P. G. Shekelle. 2021. “Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-Analysis.” JAMA Health Forum 2 (8): e212001–e212001. https://doi.org/10.1001/JAMAHEALTHFORUM.2021.2001
Polak, R., D. Dill, M. J. Abrahamson, R. M. Pojednic, and E. M. Phillips. 2014. “Innovation in Diabetes Care: Improving Consumption of Healthy Food through a ‘Chef Coaching’ Program: A Case Report.” Global Advances In Health and Medicine 3 (6): 42–48. https://doi.org/10.7453/gahmj.2014.059
Polak, R., D. M. Pober, M. A. Budd, J. K. Silver, E. M. Phillips, and M. J. Abrahamson. 2017. “Improving Patients’ Home Cooking - a Case Series of Participation in a Remote Culinary Coaching Program.” Applied Physiology, Nutrition, and Metabolism 42 (8): 893–896. https://doi.org/10.1139/apnm-2017-0053
Reicks, M., M. Kocher, and J. Reeder. 2018. “Impact of Cooking and Home Food Preparation Interventions Among Adults: A Systematic Review (2011–2016).” Journal of Nutrition Education and Behavior 50 (2): 148–172.e1. https://doi.org/10.1016/j.jneb.2017.08.004
Savoie-Roskos, M., C. Durward, M. Jeweks, and H. LeBlanc. 2016. “Reducing Food Insecurity and Improving Fruit and Vegetable Intake Among Farmers’ Market Incentive Program Participants.” Journal of Nutrition Education and Behavior 48 (1): 70–76.e1. https://doi.org/10.1016/J.JNEB.2015.10.003
Seligman, H. K., C. Lyles, M. B. Marshall, K. Prendergast, M. C. Smith, A. Headings, G. Bradshaw, S. Rosenmoss, and E. Waxman. 2015. “A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control among Clients in Three States.” Health Affairs 34 (11). https://doi.org/10.1377/hlthaff.2015.0641
Sharma, S. V., J. W. McWhorter, J. Chow, M. P. Danho, S. R. Weston, F. Chavez, L. S. Moore, et al. 2021. “Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program.” Nutrients 13 (12): 4492. https://doi.org/10.3390/nu13124492
Silver, J. K., A. Finkelstein, K. Minezaki, K. Parks, M. A. Budd, M. Tello, S. Paganoni, A. Tirosh, and R. Polak. 2021. “The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and Emotional Well-Being during the COVID-19 Pandemic.” Nutrients 13 (7): 2311. https://doi.org/10.3390/NU13072311
Teaching Kitchen Collaborative. n.d. Home page. Accessed September 6, 2021. https://teachingkitchens.org/
Veldheer, S., C. Scartozzi, C. R. Bordner, C. Opara, B. Williams, L. Weaver, D. Rodriguez, A. Berg, and C. Sciamanna. 2021. “Impact of a Prescription Produce Program on Diabetes and Cardiovascular Risk Outcomes.” Journal of Nutrition Education and Behavior 53 (12): 1008–1017. https://doi.org/10.1016/j.jneb.2021.07.005
Yoder, A. D., G. V. Proaño, and D. Handu. 2021. “Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review.” Journal of the Academy of Nutrition and Dietetics 121 (9): 1866–1880.e4. https://doi.org/10.1016/j.jand.2020.08.080