Food as Medicine

How MANNA, a Philadelphia volunteer service, helps a Jefferson physician nourish her patients to achieve greater health.

I started doing food insecurity screenings when I began doing Medicare Annual Wellness exams. I probably do it more in that population because it’s a routine thing that I ask in the course of that visit.

When I first started at Jefferson in Philadelphia, I had some patients checking off on their questionnaires that they’ve had trouble getting food. They couldn’t go shopping for themselves, they didn’t have transportation to get to a grocery store or they had other issues. Proper nutrition is fundamental to an individual’s overall well-being and to the healing process. Some of my patients were not in a good place. That’s when I found MANNA.

Air, water, food, shelter. If you can’t get those, who cares if you can get your pills?

Since 1990, MANNA (Metropolitan Area Neighborhood Nutrition Alliance) has delivered over 14 million nutritious meals to more than 26,000 clients-neighbors who are fighting serious illnesses that affect their nutritional health and wellness. MANNA serves portions of nine counties across Pennsylvania and New Jersey: Philadelphia, Bucks, Chester, Montgomery, Delaware, Burlington, Camden, Gloucester and Salem.

Earlier in my career I was practicing in a more suburban location, and it actually really surprised me that food insecurity existed there as well. In more suburban locations, transportation can be a big issue. If you can’t or don’t drive, you are out of luck if there’s nowhere to walk to. This is especially true if you’re older and you don’t get around that well. I’m finding out that food insecurity is not just experienced by my older patients, but also among a lot of my younger patients with diabetes or COPD or other health issues that prevent them from really getting around that well.

People will not necessarily offer that, they will not bring that information up unless you ask them. Maybe if they’re diabetic I ask, “why was your sugar so great in the hospital but as soon as you went home it’s 200 points up?” They’re just eating what’s available.

If patients check that box, I ask: “Did you worry about where your next meal is coming from?” Or, “were there ever times that by the end of the month you weren’t sure if you’d be able to get groceries?”

infographic containing information about food insecurity

They’re usually very receptive to me saying, OK, I’m going to put in a referral for you and MANNA will contact you. I send MANNA the patient’s sugar and cholesterol info. There is a downloadable form that we fill out together and the patient signs to give permission to send their last test results over to MANNA. And then MANNA contacts them directly. They have a nutritionist who will do consults if we want, and then they arrange for the food service.

MANNA’s Nutrition and Client Services team includes five dietitians and one nutritionist who all educate and support patients with the development of individualized meal plans.

They deliver food to their clients’ homes and the nutritionist will do counseling for them on their disease state. Maybe they need to reduce sodium for a heart problem; maybe they need calorie control or carbohydrate education for diabetes, or maybe there’s a COPD patient or somebody who has trouble swallowing because of a stroke. MANNA has a fully certified nutritionist who does all those things, as well as meal planning.

Example of chicken dinner plated from MANNA

With MANNA, patients certainly have a lot more hope, which is really important. You forget how that fear of having enough food (and the right food) just hangs over someone like a cloud. They feel like they have to keep it a secret. I feel like this must be something they carry around inside of them and you can tell they have more hope. With MANNA, I can see that they are better able to keep to the nutritional instructions we give them so they can keep their sugar under control or to help them keep from filling up with fluids from the salt if they have heart failure.

And it frees them up to attend to themselves a little more when they’re not spending all their energy figuring out, “where’s my next meal coming from?”

MANNA’s model posits that food can be powerful medicine for people living with serious illnesses. If you don’t have quality food or you don’t have good food for your disease process, it undermines other things. The food that you eat, just like the exercise that you do, has as much of an effect on your A1C and your cholesterol panel as some of the medicines we use do. There are a lot of things that, at least if you get the underlying nutrition right, you can really help a person along medically, or at least you won’t make it worse by doing the wrong things with food.

Medical schools are starting to do a lot more nowadays to help students recognize the importance of proper nutrition inpatient care. And Jefferson is doing more and more online, and with local classes, for patients to address food insecurities and proper nutrition.

I know MANNA wants to expand and get information about their services out as well. It’s definitely a very valuable service and I’m just so grateful that it’s available in this area for patients.

Air, water, food, shelter. If you can’t get those, who cares if you can get your pills? Patients are not really worried about whether they’re meeting their sodium content and the carbohydrates goals or if this is going to make their cholesterol go up. It’s like: I have food today, I’m eating.

Dr. Marie Kairys is a family and community medicine physician at Thomas Jefferson University Hospital.

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