News: Food as Medicine: Nutritional Prescriptions in the Emergency Room: Emergency Medicine News

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Lifestyle medicine, nutrition, diet

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Putting lifestyle medicine principles into a busy ED shift is daunting. I still find it difficult to decide when to bring it up and figure out who is interested in listening. I finally learned to use the same approach that I use with my substance abuse patients.

It is almost impossible to know when patients are ready to make a change, but if I don’t give them a chance today, it is extremely unlikely that they will change today. Invite everyone to change whether you think they are ready or not.

I was surprised at the patient’s response to this approach when otherwise we cannot find a clear etiology for their symptoms. This can be a simple tool to add to your conversations to calm them down and give them something tangible.

It can also be generalized to almost any lifestyle principle that needs to be addressed, but we’ll take a closer look at the dietary rules. Obviously the challenge is that we will not follow up on these patients, so stress that they should discuss these plans with their GPs.

Writing lifestyle recipes is a core competence of lifestyle medicine. (JAMA. 2010; 304[2]: 202; https://bit.ly/3dTqIqQ.) You should take a focused approach and be specific. Using the SMARTEST mnemonic is a good place to start. (Am J Lifestyle Med. 2020; 14[3]: 271; https://bit.ly/3wr5ozs.)

S: Specific

M: Measurable

A: Accessible

R: Realistic

T: Time-bound

E: Evidence-based

S: Strategically

T: Tailor-made

Rx-TAF

As an emergency doctor, however, I need a much shorter acronym. The American College of Lifestyle Medicine recommends that nutritional recipes (which are still being validated) take the form of TAF:

T: Type of food (the more specific, the better)

A: Amount of food

Q: frequency

Important concepts to consider and remember are:

  • Diet recommendations should focus on a predominantly wholesome, plant-based diet that promotes less meat and dairy products.
  • Positive recipes are better than negative ones. Patient compliance increases when you ask them to add something to their lifestyle instead of asking them to take something away.
  • Start slowly and remember that less is more. Prescribing too many items at once can be overwhelming for patients. Make sure you get a feel for what the patient can handle.
  • When writing nutritional recipes, consider medications that certain foods can affect, such as: (J Lifestyle Med. 2017; 7[1]:1; https://bit.ly/2SUNffA.)
  • Recommending increased consumption of high-volume, high-nutrient-dense but low-calorie foods can have a huge impact on weight, digestion, and overall health, especially with chronic illnesses. In other words, recommend vegetables that are as colorful as possible.
  • When prescribing antibiotics, in addition to prescribing probiotic pills and foods, such as: Probiotic foods are those that are fortified with live cultures, like most yogurts (including plant-based yogurt alternatives). However, tetracyclines and fluoroquinolones can bind to calcium in the gut, so ingesting them with foods high in calcium, such as dairy products, can reduce absorption. (J Lifestyle Med. 2017; 7[1]:1; https://bit.ly/2SUNffA.) Alternatively, you can eat a plant-based yogurt alternative a few hours after the antibiotic.
  • Americans are highly deficient in fiber and rarely meet current USDA recommendations. (Am J Lifestyle Med. 2016; 11[1]: 80; https://bit.ly/3yHb3D7.) Encourage your patients, especially diabetics, to increase this important macronutrient. Taking certain medications like digoxin with high fiber foods can decrease absorption. If you are unsure, recommend avoiding medication with high fiber foods.

Start the conversation

Nutritional recipes that can be used in ED include:

  • Add a serving of dark leafy vegetables (spinach or kale) to your diet every day for the next 30 days. Please speak to your GP about whether you think this has had an impact and discuss another plan. (Do not give this to patients taking warfarin.)
  • Add a serving of legumes (beans, lentils, chickpeas) to your diet every day for the next 30 days. They’re high in fiber and an easy way to increase your daily fiber intake. If you have diabetes, monitor your blood sugar closely as increasing the amount of fiber can lower your blood sugar, which may require adjusting your medication.
  • Add an apple to your diet every day for the next 30 days. They’re high in fiber and an easy way to increase your daily fiber intake. Please discuss this change in diet and how you felt with your family doctor. If you are diabetic, please monitor your sugar levels closely.

Starting nutrition discussions in the emergency room can seem unnatural, but hopefully these tools break down some of those barriers and begin the conversation. As emergency doctors, when we reassure patients, we hope that we have advised the patient of the correct next steps. We believe we understand our implications, but what we start in the emergency room goes well beyond the hospital walls. Let’s make diet a part of it! As Hippocrates said, “Let food be your medicine and medicine your food.”

Learn more about lifestyle medicine from the American College of Lifestyle Medicine below https://lifestylemedicine.org. For more information on diet prescribing and other practical tools for prescribing nutritional interventions, see the ACLM Food as Medicine course at https://bit.ly/3hsEiU8.

Dr. Harrisonis an Emergency Medicine and Lifestyle Medicine Specialist practicing Emergency Medicine at Bridgeport Hospital-Yale New Haven Health. Find out more about the interface between emergency medicine and lifestyle medicine on their website atwww.acute2root.com. For more information on the American College of Lifestyle Medicine, visithttps://www.lifestylemedicine.org. Follow her on Twitter@ acute2root.