Congestive heart failure is a disease notoriously difficult to treat.
The condition, which affects more than 6 million Americans, results from the heart’s inability to pump blood to the rest of the body, leading to fluid buildup in the lungs. The mainstay of treatment is medication that removes the excess fluid, but striking the right balance is challenging and often thrown off by something as simple as the wrong meal. (Heart failure hospitalizations tend to spike after major holidays.)
Too much fluid and patients are gasping for air. Too little, they’re dehydrated and lightheaded. Either way, they’re back in the hospital.
As a physician who cares for hundreds of patients with heart failure every year, I’m frequently humbled when, despite my best efforts, patients shuttle between hospital and home. I track the emergence of new drugs and telemedicine programs that promise to break the cycle, but recent research suggests that doctors like me should consider a tastier and potentially more cost-effective treatment: food.
Despite widespread recognition that diet is a primary driver of illness in the United States — two-thirds of Americans are overweight and obesity-related illnesses consume nearly 10 percent of U.S. gross domestic product — our health-care system hasn’t traditionally done enough to intervene. Too often, nutrition counseling at the doctor’s office has consisted of little more than advice to eat less and move more — followed by a physician offering a stern look and higher dose of insulin at the next visit.
But that’s starting to change amid mounting evidence that crafting the right diet for patients can improve outcomes and reduce costs. Consider a recent program in Massachusetts designed to support the nutritional needs of low-income patients with heart failure and other conditions for which diet plays an important role, such as diabetes, kidney disease and HIV.
Each week, an organization called Community Servings delivers 10 ready-to-eat meals to patients’ homes, each tailored to individual patients’ medical needs by a registered dietitian.
A patient with diabetes might receive dishes fit for Goldilocks with just enough carbs, while one with cancer gets high-protein foods, and a patient with kidney problems gets meals low in potassium and salt.
A study last year found that patients who received such medically tailored meals experienced 50 percent fewer hospitalizations and 72 percent fewer admissions to skilled nursing facilities. Overall, the program was associated with a 16 percent reduction in health-care costs. Last year, Community Servings delivered more than a half-million meals to 2,300 patients, and the organization often solicits recipes from patients and families to ensure the food is to their liking.
“Putting the right meal together can be really complicated,” said Seth A. Berkowitz, the study’s lead author and an assistant professor at UNC School of Medicine. “If you have heart failure or kidney disease, if you’re living with a disability and it’s hard to go out and get food, these meals can help make sure you get the nutrition you need.”
Another program in Pennsylvania through which diabetic patients received fresh, nutritious food every week led to a reduction in hemoglobin A1c levels, a marker of diabetes severity, from 9.6 percent to 7.5 percent. (For comparison, diabetic patients often require several medications to achieve a reduction of 1 percent in hemoglobin A1c level.)
While these are just two initiatives in specific populations — it’s not clear the effects would be as large for healthier or more affluent patients — the results are both promising and provocative, and are catching the eye of lawmakers.
California, for example, recently launched a $6 million, three-year project to improve nutrition for the state’s Medicaid recipients. The program brings together six community organizations to provide three daily, medically tailored meals to 1,000 patients with heart failure.
In New York, where I practice, low-income patients with high blood pressure can now get a prescription for fruits and vegetables through the “Pharmacy to Farm” program. Patients who get their medications at select pharmacies are eligible for “Health Bucks,” which lets them buy produce at farmers markets across the city. Early evidence suggests that nearly 90 percent of Health Bucks are redeemed for fruits and vegetables.
But these local efforts come at a time the federal government is moving to substantially restrict eligibility for food stamps and other nutrition support programs, including reduced-price school lunches. While the new regulations are tied up in the courts, they could potentially worsen food security for millions of Americans if ultimately implemented.
It was more than 2,000 years ago that Hippocrates reportedly counseled patients to “let food be thy medicine.” Since then, we’ve made profound advances in diagnosis and treatment, but have too often overlooked this fundamental component of health. But increasingly, evidence supports the notion that food is indeed medicine — and it’s time we act like it.
Dhruv Khullar is a physician at NewYork-Presbyterian Hospital, an assistant professor of hospital medicine and health-care policy at Weill Cornell and director of policy dissemination at the Physicians Foundation Center for the Study of Physician Practice and Leadership.
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2020-02-16 15:00:00Z
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