June 2, 2022 – Current statistics on food and our health paint a grim picture.
Deaths linked to poor nutrition have increased by 15% since 2010. Malnutrition now accounts for a quarter of adult deaths worldwide each year. This includes people who don’t have enough to eat and people who are obese.
“We are facing a global pandemic far deadlier than COVID-19, but it is unfolding in slow motion and receiving too little attention and too little collective action,” says Scott Bowman, co-founder of The FEED movement. “Our diets are killing us.”
But food itself isn’t deadly – bad 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 foods we eat. let’s eat. Over the next few decades, discoveries and food-as-medicine programs have the potential to save millions of lives.
Envision the future
Currently, dozens of programs around the world are exploring ways to prescribe foods for people with diet-related illnesses such as obesity, type 2 diabetes and heart disease. Most of the research is done here in the United States, but the reach is global:
- In Canada, a new study examines the effects of dietary prescriptions on people with both food insecurity and high blood sugar.
- In Iran, researchers have developed a mobile app that uses artificial intelligence to recommend specific snacks for people with diabetes.
- In Italy, a menu recommendation prototype takes into account user 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 on how doctors are already using food as medicine, check out this companion story.)
“We still have a lot to understand when it comes to nutrition. We know a lot, enough to start taking action, but we also need to advance the science,” says Dariush Mozaffarian, MD, dean of the School of Nutrition Science and Policy at Tufts University.
No one expects life to get less busy over the next few decades. Solutions must therefore take into account our current way of life, in particular our dependence on convenience products.
“Most of us will still need prepared, convenient, packaged and processed foods in addition to fresh foods. So we need to advance the science to understand what is harmful in highly processed foods and what is beneficial in most natural foods,” says Mozaffarian. “I haven’t seen that yet.”
Food for treatment or prevention? Yes
While some scientists are thinking about how to treat disease with food, others are looking to use it to completely prevent disease. Plant-based diets take center stage here, as researchers search for ways to make the plants themselves more nutrient-dense.
“The first generation of agricultural technology companies were directed at growers, looking for higher yields and resistance to pests,” says Todd Mockler, PhD, principal investigator at the Donald Danforth Plant Science Center in St. Louis. . The new generation is still working on that, he says, “but also on innovations that are more consumer-oriented, like better nutrition.”
An example is HarvestMore. The organization uses a crop breeding process called biofortification to increase the iron, zinc and vitamin A content of staple crops in low- and middle-income countries around the world. Nearly 13 million small farms cultivate them.
Another is a private company called shiny seed, which uses artificial intelligence to map the universe of phytonutrients, compounds in plants beneficial to human health. It identified 1.5 million — more than 10 times what was previously known — says Mozaffarian, the company’s scientific adviser.
“If I want to optimize a food for a specific health condition, or interact with the body in a certain way, or reduce inflammation or respond to the microbiome,” says Bowman, “in the future, I might look to an organization like Brightseed and they will tell me exactly where to find these bioactive compounds in the plant kingdom.
And then there is the concept of precision nutrition. Researchers are finding that because each person has both a unique genetic makeup and microbiome, eating the same food affects you differently than anyone else, even close relatives. Your genes influence how your body uses nutrients (this is called nutrigenetics); and at the same time, the foods you eat can change the way your genes are expressed (this is nutrigenomics). Nutrigenomics means that if your genes make you more likely to have diabetes and you eat foods that turn on the genes, it can pave the way for the disease to develop. Meanwhile, the gut bacteria that make up your microbiome also work to individualize your body’s response to food.
“That’s going to be a big factor in optimizing health,” says James Marcum, PhD, of Baylor University, who wrote a review of the literature on genetic-based diets. “Given your genetic makeup, you might want to follow this particular diet to optimize your health, so you don’t turn on cancer genes, obesity genes, genes that lead to chronic disease.” The research is still in its early stages, he says, but he is optimistic.
The National Institutes of Health also see personalized diets as a promising area. Holly Nicastro, PhD, coordinator of a major NIH research project focused on precision nutrition, says it’s even more important than genetics and the microbiome.
“We need to study how all of these things work together with other systems in the body,” she says. “We want to take into account psychosocial factors, demographic factors, other things that really haven’t traditionally been taken into account in nutrition studies.”
On the business side, Bowman sees the many approaches coming together in the products we’ll find on future shelves.
“Over the next few decades, I think there will be huge leaps and bounds, especially when you combine things like artificial intelligence capabilities with the microbiome world,” he says.
Understanding how the body processes food, combined with science from a company like Brightseed, can help us understand how to get the right nutrients to the right people. It could change the way we think about food design, Bowman says.
How to get there
These advances all sound exciting, but solving the world’s diet-related health issues will take a shared global effort.
“If you look back, most of the industries that developed around the world were heavily supported by government – the industrial revolution, the railways, the green revolution that modernized agriculture. Now there is green energy,” says Mozaffarian. “The next big industry for government to focus on is food, with a focus on nutrition. If that happens, we can do all of that 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 accelerate the progress of the UN 2030 Agenda for Sustainable Development. Established in 2015, much of the program is based on healthier, more sustainable and more equitable food systems. While these actions are still at the proposal stage, many of them could have a direct impact on whether food is 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 primarily of shelf-stable starches, which do not provide much support for human health.
- Ensure that social protection programs, which provide food to food-insecure households, focus more on nutrition rather than calories.
- Create a global food innovation center to accelerate the development of convenient, easy-to-prepare and nutritious foods.
- Work together to centralize research on the microbiome and food as medicine, to promulgate guidelines and develop new strategies.
- Establish government targets for sodium, sugar and trans fats in packaged foods – many countries around the world do not yet.
- Diversify crops considered staple foods beyond the “Big 5”—wheat, rice, corn, potatoes, and soybeans—to provide a wider range of nutrients. Currently, wheat, rice and corn alone account for 42.5% of global calorie intake.
Put the medical in food as medicine
Before food can truly be treated as medicine, accompanied by prescriptions, doctors must acquire the necessary nutritional expertise. Yet, around the world, most medical students receive little or no instruction on the subject. In the United States, only 1% of teaching hours in medical schools focus on nutrition.
“We need to unleash the power of suppliers; otherwise they won’t know enough, they won’t be able to do these interventions,” Mozaffarian says. Late last year, U.S. Representative Jim McGovern (D-MA) introduced a resolution calling on American medical schools to use strong nutrition education programs.
In several countries, a movement towards “culinary medicine” is building, with doctors learning not only about nutrition, but also useful and practical culinary skills. Chief Medical Officer Robert Graham, MD, practices medicine and teaches health practitioners plant-based cuisine in New York City.
“You won’t take the medicine if it doesn’t taste good,” he says. “I’m in health care, not patient care, and it starts with food.”