June 2, 2022 – The current statistics about food and our health paint a gloomy picture.
Deaths related to poor diets have grown by 15% since 2010. Malnutrition now accounts for one-quarter of adult deaths worldwide each year. That includes people who don’t have enough to eat and people living with obesity.
“We are facing a far deadlier global pandemic than COVID-19, but it’s happening in slow motion and it receives too little attention and too little collective action,” says Scott Bowman, co-founder of The NOURISH Movement. “Our diets are killing us.”
But food itself isn’t deadly – the wrong food is. A movement is growing to approach food as if it were literal medicine by tailoring meals to treat specific conditions, providing prescriptions for fresh fruits and vegetables, and improving the nutrient content of the food we eat. Over the coming decades, food-as-medicine discoveries and programs have the potential to save millions of lives.
Envisioning the Future
Right now, dozens of programs around the world are exploring ways to prescribe food to people who have diet-related conditions like obesity, type 2 diabetes, and heart disease. The bulk of the research is being done here in the U.S., but the reach is global:
- In Canada, a new study is looking at the effects of food prescriptions on people with both food insecurity and high blood sugar.
- In Iran, researchers developed a mobile app that uses artificial intelligence to recommend specific snacks to people with diabetes.
- In Italy, a prototype menu recommender considers users’ preferences as well as their conditions and prescriptions.
- In Australia, a study is underway to develop a medically tailored meal program aimed at reducing heart disease.
Each of these efforts contributes a little more to our understanding of how food can be used as medicine.
(For more about how doctors are using food as medicine already, see this companion story.)
“We have much more left to understand about nutrition. We know a lot, enough to start acting, but we also have to advance the science,” says Dariush Mozaffarian, MD, dean of the School of Nutrition Science and Policy at Tufts University.
Nobody expects life to get any less busy over the coming decades, so solutions need to acknowledge the way we live now – especially our reliance on convenience products.
“Most of us are still going to need prepared, convenient, packaged, and processed foods in addition to fresh food. So we need to advance the science to understand what is it that’s harmful about highly processed foods, and what’s beneficial about most natural foods,” Mozaffarian says. “I haven’t seen that yet.”
Food for Treatment or Prevention? Yes
While some scientists are considering how to treat disease with food, others are looking to use it to prevent disease altogether. Plant-based diets take center stage here, as researchers look for ways to make the plants themselves more nutrient-dense.
“The first generation of ag tech companies were directed towards growers, looking for higher yields and pest resistance,” says Todd Mockler, PhD, a principal investigator at the Donald Danforth Plant Science Center in St. Louis. The new generation is still working on that, he says, “but also innovations that are more consumer-facing, like improved nutrition.”
One example of that is HarvestPlus. The organization uses a crop breeding process called biofortification to boost the iron, zinc, and vitamin A content of staple crops in low- and middle-income countries around the world. Almost 13 million small farms are growing them.
Another is a private company called Brightseed, which is using artificial intelligence to map the universe of phytonutrients, the compounds in plants that benefit human health. It has identified 1.5 million – more than 10 times what was previously known – says Mozaffarian, a scientific adviser for the company.
“If I want to optimize a food for a specific health condition, or interacting with the body in a certain way, or reducing inflammation or responding to the microbiome,” Bowman says, “in the future I could turn to an organization like Brightseed and they’ll tell me exactly where to find those bioactive compounds in the plant kingdom.”
And then there’s the concept of precision nutrition. Researchers are finding that because every person has both a unique genetic makeup and a unique microbiome, eating the same food affects you differently from anyone else, even close relatives. Your genes influence the way your body uses nutrients (that’s called nutrigenetics); and at the same time, the foods you eat can change the way your genes are expressed (that’s nutrigenomics). Nutrigenomics means that if your genes make you more likely to have diabetes, and you eat food that activates the genes, it can open the pathway to developing the disease. Meanwhile, the gut bacteria making up your microbiome also work to individualize your body’s response to food.
“This is going to be an important factor in optimizing health,” says James Marcum, PhD, of Baylor University, who wrote a review of literature on genetics-based diets. “Given your genetic makeup, you might want to eat this particular diet to optimize your health, so you don’t turn on cancer genes, obesity genes, genes that lead to chronic diseases.” The research is still in its early stages, he says, but he’s optimistic.
The National Institutes of Health also considers personalized diets a promising area. Holly Nicastro, PhD, coordinator of a major NIH research project focused on precision nutrition, says it’s even bigger than genetics and the microbiome.
“We need to be studying how all these things work together with other systems in the body,” she says. “We want to consider psychosocial factors, demographic factors, other things that really haven't been traditionally captured in nutrition study.”
On the commercial side, Bowman sees the many approaches uniting in the products we’ll find on future shelves.
“Over the next several decades, I think there will be huge leaps and advances, especially when you combine things like artificial intelligence capabilities with the world of the microbiome,” he says.
Understanding how the body processes food, coupled with science from a company like Brightseed, may help us understand how to get the right nutrients to the right people. That could change how we think about food design, Bowman says.
How to Get There
These advances all sound exciting, but to solve the world’s diet-related health problems will require a shared effort on a global scale.
“If you look back, most industries that have grown in the world, they’ve been heavily government supported – the Industrial Revolution, the railroads, the Green Revolution that modernized agriculture. Now there’s green energy,” says Mozaffarian. “The next major industry government has to focus on is food, with a focus on nutrition. If that happens, we can do all this pretty quickly, in 10 to 20 years.”
To that end, last fall, the United Nations convened a Food Systems Summit. Its goal: to launch bold new actions to boost progress on the U.N.’s 2030 Agenda for Sustainable Development. Set in 2015, much of the agenda relies on healthier, more sustainable, and more equitable food systems. While those actions are still in the proposal phase, many of them could have a direct impact on food being treated as more than just calories:
- Invest in infrastructure, to make nutrient-dense foods like fresh produce more affordable. Currently, in many low-income parts of the world, diets consist mostly of shelf-stable, starchy staples, which don’t offer much support for human health.
- Make social protection programs, which provide food to food-insecure households, more focused on nutrition rather than calories.
- Create a global food innovation hub to speed up the development of convenient, easy-to-prepare, and nutritious foods.
- Work together to centralize research into the microbiome and food as medicine, to enact guidelines and develop new strategies.
- Establish government-set targets for sodium, sugar, and trans fats in packaged foods – many countries in the world don’t do this yet.
- Diversify the crops considered staples beyond the “Big 5” – wheat, rice, maize, potatoes, and soy – to provide a broader array of nutrients. Right now, wheat, rice, and maize alone account for 42.5% of the world’s calorie supply.
Putting the Medical in Food as Medicine
Before food can truly be treated as medicine, complete with prescriptions, doctors must get the needed nutrition expertise. Yet around the world, most med students receive little to no instruction in the subject. In the U.S., just 1% of medical schools’ lecture hours cover nutrition.
“We need to unleash the power of the providers; otherwise they won’t know enough, won’t be able to give these interventions,” says Mozaffarian. Late last year, U.S. Rep. Jim McGovern (D-MA) introduced a resolution calling on American medical schools to use robust nutrition education programs.
In several countries, a movement toward “culinary medicine” is building, with doctors learning not just about nutrition, but also useful, practical cooking skills. Doctor-chef Robert Graham, MD, practices medicine and teaches health care practitioners about plant-based cooking in New York City.
“You won’t take the medicine if it doesn’t taste good,” he says. “I’m in the business of health care, not sick care, and it starts with food.”