An apple a day keeps the doctor away

The first wide-ranging study to look at whether healthy food prescriptions lead to better diets and healthier patients suggests there could be some truth to the saying ‘an apple a day keeps the doctor away.’

Researchers from The George Institute for Global Health and the Friedman School of Nutrition Science & Policy at Tufts University reviewed 13 healthy food prescription programs that either subsidised, or directly provided healthy foods like fruit and vegetables as a form of medical treatment. They found people not only ate more of these foods, but also saw improvements in weight and blood glucose.

Dr Jason Wu, Program Head of Nutrition Science at The George Institute, said that healthy food prescriptions could be beneficial, especially for people with limited access to such foods and those with certain medical conditions.

“Collectively, we saw a positive impact on the health of patients in these programs, even though there were quite different ways in which they provided the healthier foods and measured the outcomes,” he said.

“We found the effect of healthy food prescriptions on blood glucose was comparable to what you would expect to see from some commonly prescribed glucose-lowering medications – this adds weight to the growing evidence that food can also be medicine.”

Poor diet is a leading risk factor for chronic diseases and is thought to be responsible for one of every five premature deaths across the globe. Diet-related diseases including obesity, diabetes, and cardiovascular disease are on the rise and represent a growing burden on healthcare services.

Dr Saiuj Bhat, a clinician researcher involved in the review said that food insecurity – defined as lack of access to nutritionally adequate food – leads to poor diet and a higher risk of cardiometabolic diseases.

“People experiencing food insecurity are less able to manage chronic diseases owing to mental and financial strains, such as high costs of medications and other out-of-pocket health-related expenses,” he said.

About half the people recruited into the programs analysed in the review were experiencing food insecurity, and three quarters had specific existing medical conditions including overweight or obesity, high blood pressure, or type 2 diabetes.

“Boosting the intakes of healthier foods like fruit and vegetables has even greater potential to improve the health of more vulnerable people,” Dr Bhat added.

The focus of most healthy food prescriptions so far has been on fruit and vegetables. Other foods, including nuts, beans, whole grains, and fish are also important for heart health, but the impact of prescribing these foods hasn’t been studied yet.

While overall these findings provide encouraging evidence that healthy food prescription programs may lead to improvements in diet quality and measures of health, more research is needed to see if they should be more widely used.

“Our review strongly supports the need for more better designed and properly controlled clinical trials to test the real impact of food prescription programs on health” said Dr Wu.

This has now led to the development of a first-of-its kind ‘Food Farmacy’ pilot study involving 50 food insecure patients with poorly-controlled type 2 diabetes at Royal Prince Alfred Hospital in Sydney who have been prescribed boxes of healthy foods such as fruits, vegetables, nuts, dairy foods, and whole grains weekly over three months, courtesy of Harris Farm, a local family owned business specialising in quality produce.

“Through this pilot study, we will establish the logistics and feasibility of setting up a healthy food prescription program for vulnerable patients in Australia and assess its impact on the participants’ overall diet. Its early days for our study, but initial reactions seem very positive from both doctors and patients,” said Dr Wu.