Hippocrates conceived one of the most revolutionary health concepts, “Let food be thy medicine and medicine be thy food,” around 400 BC, yet modern society has yet to capitalize on this concept. The world’s pharmaceutical market, worth $934.8 billion in 2017, is projected to reach a staggering $1170 billion by 2021, while the average American lifespan has decreased over the past few years. This is due, in large part, to a dramatic increase in the early onset and acceleration of chronic diseases that are perpetuated by poor nutrition and lack of exercise, such as heart disease, cancer, Alzheimer’s and diabetes.
Nutrition businesses, under soft food regulations, are vested in exploiting our palates with high-carb, high-protein and cheap, unhealthy high-fat products. The consequent surge of chronic diseases has created an opportunity for the pharmaceutical industry and the “sick care” model of medicine to create a “multi-pill-a-day” standard of care that has prolonged the sick part of our lives rather than our healthspan, i.e. the healthy part of our lives.
The U.S. healthcare system is at risk of bankruptcy unless we invest in the economic potential of lifestyle improvements, with food as medicine as a top priority. Food is the only “product” we ingest every day, multiple times a day, so it has the potential to be the most powerful medicine or poison. A nutrition-tech company can use the same research and scientific standards when developing its nutrition programs and/or products that the biotech industry uses.
As a physician and the CEO of a leading nutrition-tech company developing products based on clinical research from the USC Longevity Institute, I believe evidence-based nutrition formulations have the potential to greatly increase our healthspan. Realizing the potential of this emerging industry will require several paradigm shifts for patients, healthcare providers, consumers, corporations, regulatory systems and payers’ policies. Here a few key considerations.
Food As Powerful Medicine
Recent scientific evidence shows that, at the cornerstone of all major chronic diseases, lie common metabolic factors driven by unhealthy lifestyle factors, specifically nutrition. It is along these lines that some are calling Alzheimer’s “Type 3 Diabetes.” One strategy for maintaining optimal health is to eat less, less frequently. Various recent clinical trials are showing how the stress induced to the body by fasting activates the body’s own defense mechanisms against multiple cancers, diabetes and autoimmune diseases.
According to the International Food Information Council Foundation’s annual survey, intermittent fasting (IF) was the U.S.’s most popular diet in 2018 and a close runner-up to “clean eating” in 2019. While intermittent fasting helps improve weight loss and certain metabolic markers, prolonged fasting for several consecutive days is showing additional rejuvenating effects by enhancing the body’s own protective capabilities. Intermittent fasting and diets that can mimic prolonged fasting are becoming new interventions – besides pharmaceuticals – for doctors and health practitioners to effectively recommend.
Health Care Before Sick Care
Another paradigm shift that supports the proliferation of nutrition-tech is a growing emphasis on true “health care” instead of “sick care.” Preventative medicine is cheaper and more effective, while empowering people to assume more responsibility for their own health outcomes. Insurance companies are increasingly incentivizing patient-driven preventative medicine efforts, offering gym membership reimbursement, for example. The U.S. health coach market, worth $6.14 billion in 2017, is projected to reach $7.85 billion by 2022, while a reported 60% of Americans say they want health coaching. A certified health coach could be the ‘“nurse” of the new healthcare model.
Similarly, the demand for increased nutrition education for medical practitioners reflects a growing consensus that health practitioners should prescribe food as medicine. Indeed, first line therapy for the reversal of prediabetes and early diabetes lies in better nutrition and lifestyle – drug therapy could be used thereafter. According to David Eisenberg, an adjunct associate professor of nutrition at Harvard T.H. Chan School of Public Health, most U.S. medical students currently receive fewer than 25 hours of nutrition education and less than 20% of American medical schools mandate a course in basic nutrition.
Today’s physicians have little faith in food as medicine, because the standard food industry has cut corners to sell diets based on taste and profits rather than health value and evidence-based protocols. However, the tide is turning with the burgeoning nutrition-tech industry.
Food Regulation And Payer Policy Reform
A large part of reshaping the way we think about food as medicine lies with the FDA. Currently, the FDA classifies “medical foods” as “intended for people who have a disease or condition that results in a distinctive nutritional need which cannot be met by a diet of regular food, but is met by the medical food.” Put simply, a medical food supplements a nutritional lack or deficiency, e.g. a potassium deficiency. The FDA has a great chance to expand this definition to include foods that impact the progression or the treatment of common diseases such as diabetes, cancer and Alzheimer’s.
However, there is currently no clear pathway for classification of foods to treat or better manage mainstream chronic diseases, such as cancer, Alzheimer’s and autoimmune diseases. The FDA could relax the interpretation of this definition to include foods that have strong scientific evidence and a degree of novelty with respect to alleviating or reversing mainstream chronic diseases.
Finally, insurance companies, driven by financial pressure, are slowly shifting to embrace reimbursement of certain nutrition plans. This year, Secretary of Health and Human Services, Alex Azar, announced that Medicare Advantage will begin reimbursing some social determinants for health, such as home-delivered meals – a milestone step in the right direction for increasing access to nutrition-tech products and creating a predictable, therefore investable, nutrition-tech market. Similar Medicaid policies could encourage the poor to use food stamps for nutritious or fasting-mimicking food products instead of cheap fast food. If this true healthcare model were realized, the benefits to individuals and society could be enormous.