In the spotlight

Food as medicine

A healthy diet and lifestyle as medicine for chronic illnesses: this is a very real solution, according to experts at Wageningen University & Research and other universities, as well as the Netherlands' National Institute for Public Health and the Environment (RIVM). Permanent diet and lifestyle changes can have extremely positive effects on the treatment of cardiovascular disease, diabetes, kidney disease and various bowel disorders.


Lifestyle changes can sometimes make medication unnecessary. Take type 2 diabetes, for example, which is also known as age-related diabetes. Several studies by institutes such as Wageningen University & Research (WUR) have found that many prediabetic patients can discontinue their medication entirely if they start eating a healthier diet and exercising more frequently. Even patients who have been using insulin for years can stop their injections after just a few months of support and supervision. One such successful programme is 'Turn the tide on type 2 diabetes' (In Dutch: 'Keer diabetes type 2 om').

Another programme, 'Nutrition Alliance' (In Dutch: 'Alliantie Voeding in de Zorg'), applies the 'food and exercise as medicine principle' in practice. The alliance is a joint initiative of Gelderse Vallei Hospital in Ede and Wageningen University & Research. Patients are given the tools to improve their lifestyle based on scientific insights. This includes heart attack and COPD patients, as well as patients preparing for surgery. For several years now, hospital patients have been able to order their favourite foods when they want them. This meal service, which consists of an excellent menu, improves patients' eating habits and contributes to their recovery.


The team of experts spent the past few months reviewing the literature and consulting other experts on nutrition measures that could help to alleviate the burden of chronic illnesses. They discussed the issue with nutritionists, doctors, dieticians, and representatives from patient associations and health insurers. The researchers compiled their findings in a report that was presented on 16 June during an Arts en Voeding conference for doctors interested in learning more about the latest scientific insights on nutrition and lifestyle. The report was commissioned by ZonMW, an organisation that promotes health research and health innovation.

Renger Witkamp
Diet and lifestyle advice deserves a prominent place in the treatment of chronic illnesses.
Renger Witkamp, professor of Nutrition and Pharmacology at Wageningen University & Research

Good Nutrition Guidelines

The study focused on type 2 diabetes, cardiovascular disease, kidney disease, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), breast cancer, colon cancer, lung cancer and COPD. The Good Nutrition Guidelines drafted by the Health Council of the Netherlands are used to prescribe a healthy diet that helps to combat and prevent chronic illnesses. The content is then tailored to the illness being treated. Specific diets have been developed for a number of illnesses, which have proven to have positive health effects. Other important issues include sufficient exercise, relaxation, sleep and smoking cessation.


The researchers also have good news for patients who suffer from multiple chronic illnesses, such as heart disease and diabetes. A healthier diet often has a positive effect on overall health and can reduce the severity of comorbidity. 'This is all the more reason to incorporate nutrition and lifestyle advice into the treatment plan as soon as possible,' says Renger Witkamp, professor of Nutrition and Pharmacology at Wageningen University & Research. In short: less medication, more prevention, lower health care costs and better quality of life.

How to achieve this

How do we incorporate nutrition and lifestyle advice into the treatment of chronically ill patients? The first step is to change the way health care is financed, according to Witkamp. 'Health insurers primarily reimburse medications, which offer patients relief in the short term. The effects of lifestyle changes, on the other hand, are only seen in the long term. However, these changes do make lasting improvements to a person's health, even after the treatment has ended. This, of course, is assuming that patients maintain their healthy lifestyle. The health care financing system was designed to achieve short-term effects, not long-term effects like these.'

A second point involves the training of health care professionals, such as doctors, nurses and primary care assistants. 'They need to gain a better understanding of the effects of nutrition, lifestyle and the work of dieticians and lifestyle coaches,' says Witkamp. It is also important to effectively utilise the practical knowledge gained by health care providers and patients.