Renaissance of "food as medicine" in modern clinical trials

By Vijay Kumar MalesuApr 17 2024Reviewed by Susha Cheriyedath, M.Sc.

In a recent news feature published in the journal Nature Medicine, the author Priya Venkatesan writes about how dietary interventions can effectively treat or delay some diseases.

In a world where chronic non-communicable diseases increasingly dominate public health concerns, the concept of "food as medicine" is undergoing a renaissance. Emerging scientific research now suggests that targeted dietary interventions not only offer potential therapeutic benefits but may also play a crucial role in disease prevention. This feature explores how contemporary clinical trials substantiate ancient wisdom about diet and health and considers the implications for future medical practices and public health policies.

Food is medicine: clinical trials show the health benefits of dietary interventions. Image Credit: Marilyn Barbone / Shutterstock

For centuries, the idea that dietary choices affect health has been both intuitively understood and observed anecdotally. However, this concept has only been rigorously tested in clinical settings in recent decades. Traditional diets, characterized by high consumption of fruits, vegetables, whole grains, and lean proteins, have long been associated with reduced risks of chronic diseases. Conversely, the modern dietary regime, which often includes high intakes of processed foods, sugars, and saturated fats, is known to significantly increase the risk of conditions such as obesity, coronary heart disease, type 2 diabetes, cancer, osteoporosis, and cognitive disorders.

The shift towards validating the medicinal properties of food has gained momentum through various significant studies. According to Jordi Salas-Salvadó, professor of nutrition and bromatology at the Rovira i Virgili University in Reus, Spain, one of the foundational pillars of managing chronic diseases effectively is ensuring equitable access to nutritious foods. He states, "Equitable access to healthy foods is one aspect of disease management that I believe is needed."

The PREDIMED trial, a pivotal study in the field, highlighted how a Mediterranean diet supplemented with extra-virgin olive oil or nuts substantially lowers the risk of major cardiovascular events. This trial not only confirmed the cardiovascular benefits of such diets but also suggested potential mechanisms, such as the reduction of inflammatory markers and improvement in lipid profiles.

In the realm of diabetes management, the DiRECT trial conducted in the United Kingdom (UK) provided compelling evidence that a low-calorie, total diet replacement can lead to significant remission in type 2 diabetes patients. This study challenged the traditional view that type 2 diabetes is an irreversible, lifelong condition, instead suggesting that substantial weight loss can lead to long-term remission. Naveed Sattar, a leading researcher in the trial, emphasized, "Type 2 diabetes has the most evidence for being modified by dietary interventions since weight loss can rapidly improve glucose levels."

These studies underscore a broader potential shift in healthcare practice- from a primarily pharmaceutical approach to one that also incorporates significant dietary intervention as a standard part of medical treatment. Dariush Mozaffarian, director of the Food is Medicine Institute at Tufts University, stresses the underutilization of diet in medical settings, "There are numerous diseases for which dietary changes should be prescribed as first-line treatment, according to broadly accepted clinical guidelines. However, meaningful dietary intervention very rarely happens in practice."

Despite the promising results, the integration of food-based interventions in medical practice faces numerous obstacles. Standardizing dietary interventions that can be tailored to individual needs while being broadly applicable across different populations remains a significant challenge. Additionally, there is a need for further research to establish stronger causal links between specific dietary patterns and their effects on various diseases.

The concept of "food as medicine" also raises important social and economic questions. Ensuring that all segments of the population have access to the necessary dietary options requires addressing systemic issues such as food security, economic inequality, and educational disparities. The cost-effectiveness of dietary interventions, compared to more expensive pharmaceutical treatments, suggests that there could be substantial public health benefits and reductions in healthcare costs if such strategies were implemented at scale.

As the body of evidence grows, so does the interest in integrating dietary strategies into standard medical practice and public health policies. Future directions will likely include more personalized dietary recommendations based on genetic profiles, lifestyle factors, and specific health conditions. Moreover, the increasing use of technology and data science offers new ways to track and optimize the impact of diet on health, potentially leading to more dynamic and responsive healthcare solutions.

Exploring food as medicine expands our understanding of how diet influences health and disease. With each clinical trial and new evidence, the medical community is moving closer to a paradigm where diet is not just a footnote in medical treatment but a central component of preventing and managing disease. As research continues to uncover new insights, it becomes increasingly clear that the path to a healthier future is inextricably linked to our foods.