In a recent article, cardiologist John Mandrola essentially states that food is not medicine and that disease prevention is not much better than treatment. The title of his article with Medscape was Food As Medicine: A Great Idea That Didn’t Work. You may be thinking this is a strange stance on diet. I agree with you!
Dr. Mandrola commented on a recent study published in JAMA Internal Medicine titled Effect of an intensive food-as-medicine program on Health and Health Care Use. This study sought to test whether people with Type 2 diabetes who were considered food insecure (limited availability of nutritionally adequate foods) were given ten meals per week, dietitian consultations, nurse evaluations, health coaching, and diabetes education that were compared to a control group. Researchers found that providing the food did not improve hemoglobin A1C levels over a year.
Mandrola commented that based on this study, lifestyle changes ( diet changes) are not helpful for conditions like Type 2 diabetes. His conclusion contradicts an earlier statement in his article where he notes that “everyone agrees that diet, exercise, sleep, etc. play central roles in diseases such as diabetes, hypertension, and obesity...”
It is always essential to take some time and look “under the hood,” so to speak, in terms of studies. It is well known that medical publications allow titles of articles to embellish what the results really are in order to gain more attention or click-bait in modern vocabulary. The study Mandrola is referring to does not give details on what the meal planning entailed. We do not know what “healthy food” includes. Moreover, there is no way to know if the participants ate additional food, including unhealthy food, during the day.
Anyone who has studied medical statistics knows that there are many ways that studies can be flawed. There is no such thing as a perfect study, and one should conduct a review of many high-quality studies (systematic review) before coming to a conclusion. Putting all your focus on one study is a poor way to make clinical recommendations. In a related study, researchers found that the majority of healthcare professionals had “widespread confusion” about the basic concepts of evidence-based practice.
Mandrola should have taken the time to research the effect of diet on type 2 diabetes treatment and prevention. For example, an earlier study published in the journal Nutrients reviewed 99 articles on the subject and found that low-calorie diets and carbohydrate restriction could have a reversing effect on Type 2 diabetes. A different review of studies demonstrated that Mediterranean and vegan diets also lower glucose levels for people with Type 2 diabetes. Why do I suspect that when a negative study on statin use for cardiovascular disease is published (and they have), doctors like Mandrola would take the stance that it “is only one study” and the positive studies should not be ignored?
There is always a place for improving diet to prevent and treat disease. This is especially true for Type 2 diabetes. Mandrola thinks that Americans cannot be motivated to make good enough diet changes to reverse Type 2 diabetes. Perhaps part of the problem is the medical establishment's attitude of underestimating the power of a healthy diet and attempting to fix everything with pharmaceuticals. I will encourage people with Type 2 diabetes to improve their diet and lifestyle and see what improvements occur. More often than not, people are very pleased with the results.
Doyle, J., Alsan, M., Skelley, N., Lu, Y., & Cawley, J. (2024). Effect of an intensive food-as-medicine program on Health and Health Care Use. JAMA Internal Medicine, 184(2), 154. https://doi.org/10.1001/jamainternmed.2023.6670
Hallberg, S. J., Gershuni, V. M., Hazbun, T. L., & Athinarayanan, S. J. (2019). Reversing type 2 diabetes: A narrative review of the evidence. Nutrients, 11(4), 766. https://doi.org/10.3390/nu11040766
Madrola, J. M. (2024, February 22). Food as medicine: A great idea that didn’t work. Medscape. https://www.medscape.com/viewarticle/1000187?ecd=wnl_infocu1_broad_broad_persoexpansion-both_20240302_etid6347803&uac=130325DZ&impID=6347803#vp_1
Martín-Peláez, S., Fito, M., & Castaner, O. (2020). Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. A Review. Nutrients, 12(8), 2236. https://doi.org/10.3390/nu12082236
Saunders, H., Gallagher‐Ford, L., Kvist, T., & Vehviläinen‐Julkunen, K. (2019). Practicing healthcare professionals’ evidence‐based practice competencies: An overview of systematic reviews. Worldviews on Evidence-Based Nursing, 16(3), 176–185. https://doi.org/10.1111/wvn.12363
