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Most cultures recognize that food has the capability to both heal and harm. In the past, much of the medical research into nutrition has focused on the ways in which foods harm health and contribute to the risk of chronic disease.1 More recently, some of this research has begun to examine the potential for food to help those with chronic diseases, perhaps as a frontline treatment, and even improve outcomes.2,3
The idea behind a “food first” approach is that patients with chronic complaints who change their diet first, before trying pharmaceuticals, or perhaps even nutraceuticals, often see dramatic improvements in their health.4 For example, whole-food, plant-based diets have been associated with weight loss, a lower prevalence of hypertension and diabetes, and a reduced risk of heart disease.4 A recent meta-analysis found a significant protective effect of a vegan diet (where all animal products are excluded) in the incidence of total cancer.4,5 Moreover, studies suggest that a plant-based diet may be beneficial in the treatment of some chronic diseases, including rheumatoid arthritis.4,6
This approach does not suggest that food can help every patient, nor that dietary changes alone are all that is needed to bring patients to wellness. Instead, it encapsulates the idea that changing eating habits can be an effective first step for many patients—and the improvements that they experience can serve as empowering feedback, motivating them to make other needed lifestyle changes.
For example, a 2018 study in the journal Nutrition suggests that a wider implementation of plant-based eating (specifically, a Mediterranean-style diet and/or a diet with a daily portion of soy-containing foods) may lead to improved health outcomes.7 There are a variety of approaches for plant-based eating, from Mediterranean-type diets to vegetarian and vegan diets; these diets aim to maximize the consumption of nutrient-dense plant foods (vegetables, fruits, beans, peas, lentils, and nuts) and minimize processed foods, oils, and animal foods (including dairy and eggs).8
The research into the effectiveness of a food first approach includes many population and epidemiological studies, as IFM educator P. Michael Stone, MD, discusses in the following video.
While the types of personalized dietary interventions that may be most beneficial for patients do not lend themselves well to randomized controlled trials, broader evidence that dietary change is effective in combatting chronic diseases abounds, including in the mainstream media9—the DASH diet for hypertension,10 the Mediterranean diet for cardiovascular disease,11 healthy eating in midlife for dementia prevention,12 and others. In the last five years, clinical trials, case controls, cohorts, and cross-sectional studies have demonstrated that carbohydrate-moderated, low glycemic index, protein-moderated, monounsaturated and polyunsaturated fatty acid–rich, omega-3-rich, and low saturated fat diets reduce inflammatory biomarkers both in healthy individuals and in those with cardiovascular risk (although the second group seems to benefit more from changes in the dietary profile).13
While this research is proof-of-concept that dietary interventions can improve outcomes, the functional medicine approach to dietary change goes beyond recommending a specific plan as a broad treatment for everyone with a certain disease. Instead, functional medicine advocates examining each patient’s specific genetics, history, and lifestyle and tailoring a dietary treatment that fits that patient’s specific needs. Indeed, recent research suggests that precision nutrition, in which nutritional treatments are based on an individual’s unique genetic makeup, is an idea whose time has come.14
Certainly, other factors can influence a patient’s dietary patterns, including stress, exercise, and sleep habits. Fundamental functional medicine principles focus on strategies for addressing these factors with tips for keeping patients engaged and aligned with their prescribed food plan. Through small, achievable changes in their diet and beyond, patients should begin to see meaningful improvement in their health.
Several food plans are available as part of IFM’s Functional Medicine Toolkit. The toolkit contains a wide range of patient education materials and resources for clinical care. To gain access to these tools, clinicians can either become an IFM member or attend IFM’s foundational course, Applying Functional Medicine in Clinical Practice.
For further reading on the topic of nutrition and human wellness, please visit the following resources on the IFM web site:
- Blackburn GL. Treatment approaches: food first for weight management and health. Obes Res. 2001;9(Suppl 4):223S-227S. doi:1038/oby.2001.122
- Zhang H, Wang Y, Jiang ZM, et al. Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: a prospective cohort study with propensity score matching [published correction appears in Nutrition. 2017;42:121]. Nutrition. 2017;37:53-59. doi:1016/j.nut.2016.12.004
- Sandquist L. Food first: nutrition as the foundation for health. Creat Nurs. 2015;21(4):213-221. doi:1891/1078-45188.8.131.52
- Storz MA. Is there a lack of support for whole-food, plant-based diets in the medical community? Perm J. 2019;23:18-068. doi:7812/tpp/18-068
- Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2017;57(17):3640-3649. doi:1080/10408398.2016.1138447
- McDougall J, Bruce B, Spiller G, Westerdahl J, McDougall M. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med. 2002;8(1):71-75. doi:1089/107555302753507195
- Schepers J, Annemans L. The potential health and economic effects of plant-based food patterns in Belgium and the United Kingdom. Nutrition. 2018;48:24-32. doi:1016/j.nut.2017.11.028
- Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013;17(2):61-66. doi:7812/TPP/12-085
- Park A. Why food could be the best medicine of all. Published February 21, 2019. Accessed March 23, 2021. https://time.com/longform/food-best-medicine/
- Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3-10. doi:1056/NEJM200101043440101
- Kris-Etherton P, Eckel RH, Howard BV, et al. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association step I dietary pattern on cardiovascular disease. Circulation. 2001;103(13):1823-1825. doi:1161/01.cir.103.13.1823
- Sindi S, Kåreholt I, Eskelinen M, et al. Healthy dietary changes in midlife are associated with reduced dementia risk later in life. Nutrients. 2018;10(11):E1649. doi:3390/nu10111649
- Silveira BKS, Oliveira TMS, Andrade PA, Hermsdorff HHM, Rosa COB, Franceschini SDCC. Dietary pattern and macronutrients profile on the variation of inflammatory biomarkers: scientific update. Cardiol Res Pract. 2018;2018:4762575. doi:1155/2018/4762575
- Laddu D, Hauser M. Addressing the nutritional phenotype through personalized nutrition for chronic disease prevention and management. Prog Cardiovasc Dis. 2019;62(1):9-14. doi:1016/j.pcad.2018.12.004