When I worked as a retail pharmacist, I saw patients that struggled to pay for their medications on a daily basis. In some cases, patients had to pick and choose which medications they could afford that particular month. Some would start taking medications every other day instead of daily in order to save on the cost. The irony of the situation is that even if my patients were taking their medications as prescribed, they weren't getting any better. At best, their diabetes was being "managed," with no hopes of being reversed.
Sadly, situations like this are becoming more frequent as the cost of medications have skyrocketed. Recently, I read an article in the Washington Post that documented the rise in cost of insulin - "According to IBM Watson Health data, Sanofi’s popular insulin brand Lantus was $35 a vial when it was introduced in 2001; it’s now $270. Novo Nordisk’s Novolog was priced at $40 in 2001, and as of July 2018, it’s $289."
They opened the article with a heartbreaking story of Alec Raeshawn Smith, who was no longer eligible to be covered under his mother's insurance after turning 26. Moreover, he made slightly too much money to be considered for Medicaid. Alec was shocked to find out that his insulin would cost him over $1000 per month out of pocket. Unable to afford his medication, he started skipping doses. Sadly, Raeshawn Smith's girlfriend found him dead in his apartment just one month after he was terminated from his mother's insurance plan. He died from ketoacidosis, a potentially fatal consequence of unmanaged type 1 diabetes.
Though this heartbreaking story was an extreme case of a patient with type 1 diabetes, I have personally seen many patients with type 2 diabetes suffer a similar dilemma from trying to ration medications to try to save on costs.
What if there were a better way?
What if we could make dietary choices that would not only reverse our type 2 diabetes, but also optimize our health, maximize our energy, and allow us to live with vitality and vigor? What if we could restore health and live a medication free life? What if, instead of getting a prescription for medication, we received a prescription for food?
Consider the fact that spending on drugs for treatment of diabetes exceeded $50 billion dollars in 2017, doubling the cost from just 4 years earlier! Shockingly,100 million Americans have diabetes or prediabetes, so clearly something needs to change.
Luckily, the Geisinger Health System in Shamokin, Pennsylvania is acting as that force of change in their innovative approach to treating diabetic patients. In their Fresh Food Farmacy program, doctors write prescriptions for food instead of for drugs. As a part of the program, patients receive 15 hours of education about diabetes and healthy habits in addition to 10 free, nutritious meals a week for the patients and their families.
Is the program working?
The website offers heartwarming patient success stories.
The best part -- these stories are not abnormal! Hemoglobin A1C, a diagnostic marker that indicates the average sugar level in the bloodstream over the previous 90 days, dropped from 9.6 to 7.5 over the course of the program! For reference, Diabetes is diagnosed with an A1C if 6.5% or higher. A normal A1C is considered to be less than 5.7%. That represents an average drop of 2 points across 150 patients! Compare that to the best, most expensive drugs we have available on the market which, on average, only drop A1C between 0.5 and 1.2 points.
We also know that risk of death and serious complications from diabetes decreases by 21% for each percentage point drop in the A1C. Since the study participants dropped their A1C by more than 2 points on average, collectively, they will enjoy a more than 40% reduction in risk from sudden death and diabetic complications. Sudden death can occur from cardiovascular events such as heart attacks or strokes and diabetic complications include a range of issues such as blindness, hearing impairment, kidney damage, skin conditions, nerve damage, etc.
***The above results were published in NEJM Catalyst in an article called "Prescribing Food as a Speciality Drug."
Show Me the Money!
Perhaps most surprising is the amount of money saved from this program. The cost of the program is $2400 per patient per year. Contrast this with the average out of pocket medical expenditures for people with diabetes of nearly $14,000 per year, according to the CDC.
Moreover, because some of the 150 participants in the program are insured by the hospital's health plan, the study investigators were able to collect data regarding participants' health expenditures over the course of the program. Shockingly, "costs for patients in Geisinger Health Plan dropped by 80 percent: from an average of $240,000 per member per year, to $48,000 per member per year." Though this is small sample set, the results are promising nonetheless.
In addition to 17.8% average drop in A1C levels, patients also decreased blood sugar levels by 26.9%, cholesterol levels by 9.8%, LDL by 12.2%, and Triglycerides by 16.4%, all of which indicate that these patients are metabolically healthier and have significantly reduced their risk of heart disease and associated complications!
So the question remains, can diabetes be reversed with food? Absolutely! Though the Fresh Food Farmacy program was limited in size, it nonetheless points to the potential of switching from a standard American diet, riddled with processed food-like substances, to a real food diet, filled with nutrient dense meals that nourish and heal us.
To conclude, I will borrow a quote from Dr. Mark Hyman:
"I believe food is medicine – and that what you eat is the single most important thing you do every day to affect the health of your body and mind. Food is the road to your fully expressed life. You vote three times a day with your fork. What you choose to eat has profound implications for your own health and the health of our society, environment and economy. We have more power than we think to change our health and the world and it all starts with food."
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