Cod and ‘Immune Broth’: California Tests Food as Medicine

SEBASTOPOL, Calif. — On a foggy afternoon, Diana Van Ry, a retired judicial assistant, dropped by the boisterous kitchens of the nonprofit group where she volunteers to pick up rock cod, cauliflower couscous and an “immune broth” enriched with vegetables and seaweed. She planned to deliver the meals to Brandi Dornan, 46, who is recuperating from breast cancer.

“It’s food I wouldn’t have thought to make myself,” said Dornan, who started getting the meals during radiation therapy and is grateful for it. “Wow, bless their hearts.”

The Ceres Community Project — its meals prepared for cancer patients by teenage sous-chefs — is at the forefront of the “food as medicine” approach increasingly embraced by physicians, health insurers, researchers and public health officials.

The group is participating in an ambitious, state-funded study to test whether providing daily nutritious meals to chronically ill, low-income people on Medi-Cal — California’s version of the Medicaid program — will affect their prognosis and treatment, or the cost of their medical care.

Over the next three years, researchers from the University of California, San Francisco, and Stanford University will assess whether providing 1,000 patients who have congestive heart failure or Type 2 diabetes with a healthier diet and nutrition education affects hospital readmissions and referrals to long-term care, compared with 4,000 similar Medi-Cal patients who do not get the food.

The interest in food as medicine is largely an outgrowth of the nutritional know-how acquired during the AIDS epidemic of the 1980s. Organizations like Project Open Hand in San Francisco and God’s Love We Deliver in New York City sprang up to bolster the health of people whose lives were being decimated, often by the weight loss called wasting syndrome.

As the disease became treatable with antiretroviral medicines, many groups expanded their missions to help people with chronic conditions like heart disease and diabetes. “When you feel terrible, managing your diet falls to the bottom of your list,” said Karen Pearl, president and chief executive of God’s Love We Deliver.

The California study will build on more modest and less rigorous earlier research. A study in Philadelphia by the Metropolitan Area Neighborhood Nutrition Alliance retroactively compared health insurance claims for 65 chronically ill Medicaid patients who received six months’ of medically tailored meals with a control group. The patients who got the food had about $12,000 less a month in medical expenses.

Another small study by researchers at UCSF tracked patients with HIV and Type 2 diabetes who got special meals for six months to see if it would positively affect their health. The researchers found they were less depressed, less likely to make trade-offs between food and health care, and more likely to stick with medications.

Their care also cost less: the price of feeding each participant for six months was $1,184 per person, less than half the $2,774 cost per day at a California hospital, according to the study. “It lightens the load mentally,” said Conrad Anthony Nesossis, 69, a Mississippi native with diabetes who received hot meals delivered to his doorstep as part of the study. He still uses the seasoning mix of garlic, onion and chili powder he learned then. “I’m not a fancy cook, but it opened my eyes and my taste buds.”

Poor people can have an especially hard time controlling chronic diseases; they often eat cheap foods laden with sugar and salt, avoiding costly fruits and vegetables. “Sometimes there is a short-term sacrificing of food to pay the rent, or they go without medications because they can’t afford the copay,” said Dr. Sanjay Basu, an assistant professor of medicine at Stanford who will work on the new study. “That’s when they unintentionally end up in the ER.”

For cancer patients, a loss of appetite from treatment side effects can lead to malnutrition, which lessens the body’s ability to fight disease. Dr. Fasih Hameed, an associate medical director at the Petaluma Health Center, prescribes meals from Ceres to cancer patients and those with hepatitis C. “It’s a way of holistically rebooting,” he said.

The study here in California, which will include patients in Los Angeles, San Diego, Oakland and San Francisco, dovetails with efforts like the preventive food pantry at the Boston Medical Center and medical school culinary programs like one at the Goldring Center for Culinary Medicine at Tulane University, which has a teaching kitchen and medical student chefs leading community cooking classes. The House of Representatives’ Hunger Caucus recently launched the Food Is Medicine Working Group to look at how research into medically tailored meals might inform national policy, said Rep. Jim McGovern, D-Mass. and co-chairman of the caucus.

Although medically tailored meals delivered daily are more expensive than a visit to a food pantry, “it has the advantage of matching what we think people need to what they are actually getting,” said Dr. Seth Berkowitz, an assistant professor of medicine at the University of North Carolina School of Medicine, who is working on several studies with Community Servings, a nonprofit nutrition program in Boston.

Daniel N. Mendelson, chief executive of Avalere Health, a Washington research and consulting company, said that to qualify for coverage under Medi-Cal and Medicaid, the tailored meals need to be medically necessary. “If California’s large-scale demonstration with Medi-Cal populations reduces costs and provides proof of positive outcomes, every state will want to do the same thing,” he said.

Dr. Hilary K. Seligman, an associate professor of medicine at UCSF who will participate in the new California study, noted that “the critical epidemics of our day — obesity and diabetes — are diet related.” The medical profession, she said, “accepts the most expensive procedures and medications without batting an eyelash. But with food, we have to prove it’s inexpensive to be accepted.”