Prescribing food could be as cost-effective – if not more so – than common drug treatments while delivering significant health benefits, according to research published in PLOS Medicine.
The study rides on a wave of interest in food as medicine – “farmacy” rather than pharmacy – by doctors, hospitals and insurers as drug treatments for food-related illnesses like diabetes, heart disease and cancer fail to fulfill their promise.
The researchers modelled the economic and health benefits of subsidising 30 percent of fruit and vegetable and 30 percent of wholegrains, nuts/seeds, seafood and plant-based oils.
Results showed that fruit and vegetable subsidies could avert nearly two million cases of heart disease while the wider incentive could prevent more than three million people from developing heart disease and 120,000 from getting diabetes.
The cost savings were also staggering – the resulting reduced use of health care services saved nearly US$40 billion and more than US$100 billion, respectively, confirming the cost-effectiveness of such an intervention.
“These new findings support the concept of Food is Medicine,” says lead author Dariush Mozaffarian; “that innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system.”
In reality, how likely are people to eat healthier food if it were subsidised?
One of the biggest barriers is access, and that’s where prescribing and subsidising food can make a difference.
Nutrition and cooking education might help as well – and is effective, as shown by research such as Australian studies Helfimed and SMILE.
These two interventions gave people suffering major depression food hampers and nutrition education, and in Helfimed they received cooking workshops. Both studies showed significantly improved diets in the treatment arm.
Depression symptoms decreased as well, suggesting that even psychiatrists could start prescribing diet.
Other research has found health benefits from food prescription programs, including lower blood sugar levels in people with diabetes, weight loss and increased intake of fruit and vegetables.
Having a GP validate and promote diet as a treatment could also be powerful.
“People may be more likely to make a behaviour change if the recommendation comes from their healthcare provider,” says Associate Professor Heidi Wengreen, “as part of a treatment plan for conditions such as diabetes, heart disease, high blood pressure, or obesity.”
Already, some doctors have started prescribing diet in the US, such as the Food Farmacy program at Nunnalee Pediatric Specialty Clinics in North Carolina.
Older adults, who often can’t afford healthy food, could derive even greater benefits from diet prescriptions. Poor diet has been linked to frailty with aging, associated with spiralling loss of strength, mobility and quality of life.
Even one extra meal a day could save lives.
Added to that, a healthy diet could displace the multiple medicines that are being prescribed to older adults, with many negative consequences.
Changing the culture of drug prescriptions could require an overhaul of the insidious and far-reaching influence that pharmaceutical companies have on clinical practice.
And although nutritional supplements might be a welcome alternative in some cases, nothing can replace a wholesome diet.
Our Cost of Malnutrition report outlines the problem of malnutrition and its various costs – both financial and physical – and offers a guide to its identification and management.
Download your free report HERE.
Posted by ProPortion Foods Blog on Jan 15, 2020 in Research
A group of experts, policy makers, clinicians and citizen representatives from around the world are tackling the pervasive financial conflicts of interest in health research, education and clinical practice, proposing a better way forward.
More than half of medical research in the US is industry funded. Time and time again, it’s been shown that industry-funded trial outcomes favour their products, exaggerating benefits and downplaying harm, compared to independent studies.
Editors of leading medical journals have been scathing of biased research for at least a decade, and yet little has changed.
Former editor-in-chief of the New England Journal of Medicine, Marcia Angell, stood down in 2000, famously saying, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”
Richard Horton, editor of The Lancet, similarly wrote that “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”
Big pharma’s tentacles spread to medical education with studies finding clear links between funding and promotion of sponsors’ drugs – their influence even extends to advocacy groups.
In clinical practice, sales representatives and direct payments are associated with greater prescribing of drugs from the company’s sponsors, and clinical guidelines are often written by people with financial interests in pharmaceutical companies.
These practices are leading to overdiagnosis and prescription of drugs, impacting people’s health and wasting money. Polypharmacy – taking five or more medicines a day – is common and has been increasing in older adults, with many detrimental outcomes.
Essentially, healthcare needs to become independent, they say.
“If we want to produce trustworthy evidence and tackle the epidemic of medical excess,” says lead author Ray Moynihan from Bond University in Queensland, Australia, “decision-makers at all levels within healthcare need to disentangle themselves from those profiting from that excess.”
To do this, they suggest governments call for independently funded research by scientists with no industry ties on new treatments, tests and technologies, and that public healthcare organisations accept no industry funding.
People and bodies involved in all aspects of medical education need to stop reliance on industry funding.
Marketing interactions between industry and decision makers also needs to be stopped, including healthcare professionals and clinical guideline authors.
The group suggests that research institutions could provide incentives for scientists to collaborate with public agencies and civil society groups.
They hope the reforms will reinstate public trust and improve healthcare outcomes.
“Patients and the public deserve evidence they can trust,” says Fiona Godlee, editor in chief of the BMJ.
“Commercial influence has no place in scientific research, nor in education and guidance of clinicians, nor in decisions about diagnosis and treatment. We hope that people around the world support our call for fundamental reforms.”
By accessing their paper, published online in the BMJ, concerned people can sign to support their call to action.
One in three hospitalised adults in the US is at risk for malnutrition, a major analysis has found. And patients’ poor food intake is having a significant impact on their healing and recovery, compounding their risk of death.
“Nutrition is easily overlooked as healthcare professionals often focus on a patient’s primary diagnosis,” lead author Abby Sauer told NutritionInsight.
“It may come as a surprise to some that when patients don’t get proper nutrition, it can significantly put their health and lives at risk,” she adds, explaining that nutrition is more important than ever when someone is sick or injured.
The researchers screened around 10,000 patients from 2009 to 2015 to assess malnutrition risk and links with mortality.
They found around one in two patients were eating half or less of their meals. This low food intake was linked to higher risk of mortality, and those who ate none of their food had a nearly six-fold higher risk of dying than those who ate at least some.
The findings support previous studies that have identified hospital malnutrition as a global public health problem, including Australian research which also found that this “silent epidemic” affects one in three hospitalised patients.
Despite this growing awareness, it is still not given the attention it deserves.
“Malnutrition can be invisible to the eye and is rampant in US hospitals because it’s not always top of mind,” said Gail Gerwitz, president of nutritionDay, an organisation which was involved in the study.
Loss of muscle mass and strength takes the brunt of poor nutrition, leading to sarcopenia, an age-related disease of accelerated muscle wasting that results in a downward spiral of poor health and mortality.
Some Australian hospitals are taking action by implementing basic malnutrition and sarcopenia screening tools. Relatives can also look for key signs of malnutrition.
These include unexpected weight loss, tiredness, low mood, poor appetite, unhealthy teeth and gums, listless hair and brittle nails, constipation and poor wound healing.
Hospitals and aged care facilities can take several measures to boost patients’ food intake, by using patient-centred service models, introducing mandatory nutrition standards, addressing obstacles to eating like poor dentition, and providing a choice of meals that are tasty and appealing.
High protein, high energy meals are the first line of defence to prevent or address malnutrition and promote healing. This can be achieved by adding extra cream or butter to food. Where necessary – especially with poor appetite – supplements can be used between meals to boost protein and calorie intake.
Posted by ProPortion Foods Blog on Nov 23, 2018 in Research
The number of people with food allergies is rising dramatically around the world. In fact, data suggest that peanut allergies have tripled over the past couple of decades.
Food allergy – an abnormal immune response to specific proteins – affects around 1 in 20 children. The most common triggers are egg, cow’s milk, peanut, tree nuts, seafood, soy, fish and wheat.
Most reactions aren’t severe, and many children will outgrow them. But peanut, tree nut, seed and seafood allergies are more likely to cause lifelong problems. And it is possible to develop an allergic reaction to a food that was previously safe to eat.
By adulthood, around 2 in 100 people suffer from food allergies. Symptoms can include swelling around the face, hives or skin rash, stomach pain and vomiting. In some they can cause anaphylaxis, a life-threatening reaction to suspect foods.
Not everyone with an allergy reacts to the common foods. More than 160 different foods have caused allergic reactions, including meat, sesame seeds, avocados, marshmallows (gelatin), corn, mango, dried fruit, and hot dogs.
Many less common food allergies are caused by oral allergy syndrome (OAS) or pollen-food allergy syndrome. People with OAS react to inhaled allergens like pollen from trees, weeds or grasses, and can develop “cross-reactivity” to foods with similar proteins.
For instance, many people with an allergy to birch and mugwort pollen also react to raw apple, and citrus fruit allergy can cross over to other citrus fruits, grass pollens, Timothy grass, birch and mugwort pollen.
Allergic reactions can impact quality of life. And because of serious and potentially fatal reactions in rare cases, common allergens must be listed on all foods.
Failure to list all ingredients can be tragic, like in the case of 15-year old Natasha Ednan-Laperouse, who died from an allergic reaction to a baguette in 2016. The culprit was sesame seeds, which was not on the ingredient list.
Hospitals and aged care facilities also need to be aware of new laws.
People who are allergic to peanuts (which are legumes, not nuts) might also be allergic to lupin, another type of high protein legume.
Australia’s food standards body, FSANZ, recently changed food labelling laws to require that lupin be declared as an ingredient – even if the food isn’t packaged.
Although lupin is not ordinarily used in Australian foods, it can be found in a range of common food items like bread, bakery products, pasta, sauces, beverages and even meat-based products like burgers and sausages.
Experts are not sure why food allergies are rising, but environmental influences are most likely.
A probable factor is the human microbiome – the 100 trillion bacteria and other microbes that coexist with us, mainly in our gut. These microbes play crucially important roles in immunity.
A host of modern practices has diluted our microbial diversity, including excessive use of antibiotics and disinfectants, and replacing diverse plant food diets with highly processed foods.
Another intriguing link is the higher incidence of food allergies in areas with less sunlight, suggesting a possible role for vitamin D.
Drawing from these observations, experts advise that we increase our exposure to green spaces, natural environments and sunlight, and regularly eat a broad range of plant foods.
Note that food allergies are different to food sensitivities.
Food sensitivities or intolerances are more prevalent than food allergy. They are not caused by an immune response, so the only way to identify them is by eliminating suspect foods then challenging to see if they produce a reaction.