As the leading cause of death in America, poor diet is driving development of chronic diseases, 80% of which are preventable. Today, the concept of food as medicine has an avid fan base going all the way to the White House. What is “food as medicine”? Why should the average person care? Why is it especially important now—despite being a concept that has been around a very long time?
By Dexter Shurney, MD, MBA, MPH
Everyone loves good food. But “good food” often means junk food to Americans loyal to fast food, fries, and milkshakes.
Such food may be cheap—both in dollars and nutritional value—but its long-term price is incredibly high. A shocking 80% of chronic diseases such as diabetes, high blood pressure, cancer, and obesity are diet-related and, thus, preventable. The problem is so bad that diet has surpassed tobacco use as the nation’s leading cause of death.
Enter the concept of “food as medicine” (FAM). Using diet to prevent, treat, and even cure health conditions can be traced as far back as early-day practices of Indigenous tribes, Hippocrates (the father of modern medicine), and Seventh-day Adventists. Adventist heritage is steeped in a general health message and in the biblical principles of how we should treat our bodies through proper diet.
Today, though, only 2.7% of Americans live a healthy lifestyle, concludes a Mayo Clinic study. “Healthy lifestyle” is defined as a diet score in the top 40% on the Healthy Eating Index, body fat under 20% for men and 30% for women, seven hours of sleep each night, and consistent moderate to vigorous exercise for 150 minutes a week.
Instead, the standard American diet (appropriately known as “SAD”) fuels our bodies into a constant dangerous state of quiet inflammation, setting the stage for chronic disease development. The combination of high-sugar, impoverished-flour, ultra-processed meals and snacks—ubiquitous in our modern diet—raises insulin levels and inflates blood sugar.
We also consume large amounts of artificial and highly inflammatory foods—dyes, hydrogenated oils, trans fat, and artificial sweeteners. Often, food is cooked or overcooked at high temperatures, destroying nutrients that would be beneficial if consumed raw and producing changes to protein structure that can spark even more inflammation.
People routinely overestimate how healthy their diets are, but data from the Centers for Disease Control and Prevention (CDC) show that only 10% of adults eat the recommended servings of vegetables, while 12.3% eat that of fruit.
These realities contribute to the fact that type 2 diabetes, found in one in 20 people 30 years ago, now strikes one in seven Americans today. Sadly, a growing number of these patients are as young as teenagers, 40% of whom will develop the disease in their lifetimes, according to a recent New York Times article.
The shift in food attitudes
Attitudes about food are changing. According to one study, the primary foods marketed online by grocery stores are of poor nutritional value and resemble candy and treats rather than fresh or highly nutritious foods.
Moreover, ingredient labels can confuse consumers who are more familiar with teaspoons than grams. And manufacturers often “hide” ingredients such as sugar and salt in unsuspected foods such as spaghetti sauce to appeal to—and thus support—America’s renowned sweet tooth and salt cravings.
Portion sizes are wildly out of whack, especially in restaurants and fast-food outlets, resulting in excessive calories even when the food—such as monster salads loaded with dressing, cheese, and bacon bits—may be viewed as a healthy choice by consumers.
Increasingly, though, consumers are connecting diet to health and realizing that food affects their energy, mood, performance, and productivity. Gen Z, in particular, has embraced FAM. Nearly 80% of those born between 1997 and 2012 go meatless at least one day a week, and 65% want a more plant-slanted diet. For demographics overall, 62% of U.S. households buy plant-based products, with just under half (42%) purchasing plant-generated milk. Food industry leaders note that “flexitarian,” with a heavy emphasis on plant-based products, is a growing trend, versus vegan or vegetarian.
In addition, a September 2022 survey revealed that 80% of respondents think fresh foods are better for you than packaged or processed “healthy” foods. And most respondents agreed that certain foods bring “functional wellness benefits such as boosting mental or physical performance (79%), providing preventive (78%) or therapeutic health properties (76%), or serving as the best medicine (75%).”
Those surveyed reported they made food choices around their goals of building immunity (35%), losing or maintaining weight (43%), managing medical conditions (32%), preventing diseases (39%), improving emotional or mental health (34%), protecting brain health (21%), and improving sport performance (13%). Those are high expectations while walking an average grocery aisle.
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In response, the mainstream grocery industry has been transforming. Sales of plant-based foods—especially milk and plant-based “meat”—totaled a record $7.4 billion in 2021, the fastest of any grocery category, according to the Plant-Based Foods Association, The Good Food Institute, and data company SPINS.
With such high demand, grocers are committing more shelf space to plant-based foods, testing and adding new products, and offering in-store education about plant-based options such as almond milk, baked chickpeas, and vegetable-infused pasta.
Simultaneously, grocers have found a heartier customer appetite for local sourcing from nearby farms, agricultural facilities, beekeepers, and other healthy-food vendors, thus strengthening the local economy. Large grocers such as Kroger have partnered with farmers to create “locally grown” displays throughout their produce sections; added calorie and nutritional information to on-floor signage, websites, and apps; and established staffed kiosks so customers can sample unfamiliar produce and ask questions about proper preparation.
Farmers markets have exploded to 8,000-plus nationwide, growing by 63% from 1994 to 2000, according to 2019 National Farmers Market Managers research and the U.S. Department of Agriculture, respectively. Such markets connect rural to urban communities and increasingly serve people in “food desert” zones where access to grocery stores with affordable, healthy options is minimal or nonexistent.
Another trend is that some folks are “micro-farming” themselves. Spurred by 24/7 Food Network programs and health podcasts, they’re creating budget-friendly, container-based “porch gardens,” growing herbs on kitchen counters, and tucking indoor horizontal greenhouses into corners or on balconies. These are great ways to grow high-value foods such as tomatoes, rosemary, and microgreens.
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Innovations in food access also are opening new paths for FAM adopters. Online grocery ordering, for example, skyrocketed during the COVID-19 pandemic and is expected to double in the next five years. Cook-at-home meal subscription companies such as Hello Fresh and Blue Zones offer healthy meals delivered straight to consumers’ doorsteps, with how-to instructions and chef hotlines.
Even food pantries have adopted food-as-medicine strategies. Working with corporate sponsors, hunger nonprofits, and government agencies, food banks are encouraging healthier food donations, distributing client education on healthy eating, and adding color-coded labels to products based on nutritional value.
They’re also getting creative about partnerships to reach vulnerable, often minority populations with information about the most prevalent diet-based chronic diseases, such as diabetes and heart disease.
DoorDash, for instance, recently announced it would donate $1 million in gift cards to food banks in 18 cities, plus pay dashers to deliver nutritional food to low-income communities in food deserts. Food banks subsidize costs, but the company foots most of the bill.
Amazon, meanwhile, has given major donations to school-based pantries in communities where it has offices or facilities. The goal is to ensure children can access healthy food and produce during the weekends when they are away from free meal programs at schools.
Many such corporate employers also are looking internally to improve the health and, increasingly, the diets of their own employees. As the largest private provider of healthcare insurance in America, companies are revising worker wellness programs to expand nutritional coaching, discount weight management programs, offer fruits and vegetables onsite, and share nutrition education through their communications.
Research shows these types of investments yield positive health and financial outcomes for both the employer and worker by nudging and empowering the latter to adopt and maintain healthier lifestyles. Recognition is growing that health is produced at home, the office, or in school—not in an hour or two at a physician’s office.
Technology is playing a role in advancing FAM, too. Many employer wellness programs offer apps or wearable devices that can track food and water intake, nutritional values, sleep, and movement. These wearables combine convenience, education, and even gamification as reinforcement and motivation for healthy choice-making each day.
One barrier to more widespread adoption of FAM, though, is lack of training around food preparation. People won’t buy food if they don’t know what to do with it; they must learn how to prepare it correctly to optimize taste and nutrition. The pandemic jolted many people stuck at home into experimenting with cooking, often relying on YouTube or TikTok to inspire and teach.
With COVID increasingly manageable, in-person cooking classes have proliferated, and “teaching kitchens” have gone mainstream at entities ranging from large companies to universities, community centers to online health channels, community colleges to local culinary shops and grocery stores.
All of these trends solidify the need for government, healthcare providers, employers, and individuals to commit to widespread adoption of FAM. Our nation cannot sustain high-cost, low-result healthcare systems, and neither can companies. Families already pay an average one-third of their median household income for employer-sponsored healthcare insurance ($22,221 in 2021).
The country also cannot allow health disparities to go unchecked in terms of dollars and lives. America’s most common (and expensive) chronic diseases are each experienced more prevalently by communities of color, people in rural areas, and low-resource individuals. This is due to social determinants of health—barriers such as poor diet and food access, inadequate medical access and care, lack of education, and poverty.
Worse, the expensive status quo is unnecessary. While 45 medications treat type 2 diabetes, for instance, not one is a cure. But if you’re one of the 12% of Americans with this disease or among the 27% of adults with hypertension, adopting FAM habits such as a plant-slanted diet can stall progression, reduce complications, and even move it to remission.
Almost 60% of America’s adult population experiences at least one chronic health condition. Imagine the impact if FAM is adopted and supported by them and their providers. Now imagine it as a disease prevention tool for all Americans. The potential is mind-boggling—and, as President Biden said recently, achievable.
We won’t get healthier collectively or individually unless we change our lifestyles, policies, and practices that support good health. Adopting a FAM approach to everyday eating choices will improve the quality—and length—of your life.
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Dexter Shurney, MD, MBA, MPH, is Adventist Health’s chief health equity, diversity, and inclusion officer, and president of the Blue Zones Well-Being Institute. He is responsible for creating innovative solutions that have broad impact on health, well-being, health equity, and diversity. Dr. Shurney is the immediate past president of the American College of Lifestyle Medicine. He is a fellow of the American College of Lifestyle Medicine and is board certified in preventive medicine and lifestyle medicine. He attended Loma Linda University for his undergraduate training and Howard University College of Medicine, where he received his degree in medicine. He also holds master’s degrees in business and public health from the University of Detroit/Mercy and the Medical College of Wisconsin, respectively.