Prescription for food: What pharmacists should know about nutrition

All pharmacists know that for many conditions, medication isn’t enough. True management of chronic diseases takes a 360° approach that includes exercise, smoking cessation, and—unavoidably—nutrition. As trusted and accessible providers, pharmacists can help their patients make healthy food choices and changes. But how?

Kristi L. King, MPH, RDN, CNSC, LD, senior pediatric dietitian at Texas Children's Hospital in Houston and a clinical instructor at Baylor College of Medicine, said pharmacists shouldn’t be afraid to ask patients about their diet. “Ask if they eat breakfast, consume alcohol, consume dairy products, eat fruits and vegetables, or eat out frequently,” she said.

Education about nutrition can help patients reduce their reliance on medications and supplements and aid in deprescribing. King advises pharmacists to keep it simple.

Patients may be exposed to misinformation and bad advice. For example, despite what they see in magazines, online, or on social media, patients need to know that their bodies require all macronutrients to function properly. “That includes carbohydrates,” King said.

Hydration is a good place to start. “Patients should drink plenty of water—minimum 16 oz in the morning, 16 oz at lunch, 16 oz at dinner, and 16 oz before bed,” she said. “Many times, we may think we have a headache, but we’re actually dehydrated.” It’s okay to add fresh fruit to water to change its flavor, and carbonated water counts too, she added. Adequate hydration can improve mood and sleepiness—and help kick the caffeine habit. It can also help with weight loss and maintenance and curtail overeating.

Here’s another simple piece of advice: Fill half of your plate at lunch and dinner with fruits and vegetables. If patients aren’t already eating fruits and veggies, they can try adding one to breakfast, then one to breakfast and lunch, then one to dinner as well. That way they can work up to the “half the plate” goal.

“Fruits and vegetables provide more than just vitamins and minerals. There is a hypothesis—still awaiting peer review—that the biological availability of vitamins and minerals in food is superior to supplements,” King said. “They also provide fiber.” Fiber is one of the biggest deficiencies in our diets as Americans, she said, and fiber from the fruits and vegetables “will help to keep you full, lower your heart disease risk, as well as help keep the colon moving and healthy.”

Deficiencies in Vitamin D are also prevalent in the United States. “Consuming three servings per day of low-fat dairy or calcium and vitamin D–enriched foods will meet your requirements,” King said.

“Small steps equal big changes, so [dietitians] help patients identify one or two things that they feel like they can change but that will have a big impact,” said Kristen F. Gradney, MHA, RDN, LDN, senior director of health centers in schools at Our Lady of the Lake Children’s Hospital in Baton Rouge, LA. It’s best to let the patient drive those decisions, she said. “Ask patients what they eat and what they are interested in changing. Then offer resources and guides to help in those areas. Again, let the patient drive the decision making and goal setting.”

One manageable change is switching from regular soda to diet soda for a month, with the ultimate goal of switching entirely to water. “This would have a huge impact on diabetes without changing anything else. The patient will see improvements and be motivated to incorporate another strategy,” Gradney said.

Gradney also urges pharmacists to encourage the basics: increased intake of fruits, vegetables, whole grains, and water; and reduced intake of sugar, salt, and high-fat foods, e.g., anything fried. Highlight the foods that have the greatest impact on their disease state so that they know what affects their bodies. “Simple carbohydrates and sugar affect diabetes the most. Saturated fat and cholesterol will affect heart disease. Sodium and salt affect hypertension. Potassium, protein, phosphorus, and sodium affect chronic kidney disease patients.”

But consider that not everyone has the same access to nutritious food or the luxury to adhere closely to nutrition advice. “Some of your patients will live in food deserts, have little income and limited food choices, or may not be able to cook or obtain healthier foods,” Gradney said. She tells pharmacists to be aware of what resources—such as food banks, traveling farmers markets, and community feeding sites—are available in their area and to tell patients about them.

For the full article, please visit www.pharmacytoday.org for the February 2020 issue of Pharmacy Today.