Medical Food

(From my “A2W Aging to Wisdom” series, explorations of the joyful ways to go through life. This column was published Nov. 1, 2015 in Edge Magazine

Like many who eat to live rather than live to eat, I am joyful about toxic-free, rich-in-calcium-and-omega-3-fatty-acid marvels — and yes, lacinato kale counts, too. Naysayers are welcome to respectfully disagree with me, but I am convinced my pesticide-reduced nourishment choices, more than anything else I have done, helped me get through the worst and best of times, and to not look worse for the wear, except for those mornings when organic coffee is nowhere in sight.

A few months ago I saw an ad in a magazine featuring a board-certified neurologist. She prescribes medical food to her patients for various health issues. My curiosity was piqued, because I thought medical food referred to anything I usually bought from organic sections, the pomwonderous juices from refrigerated cases, or artisanal delicacies that have ingredients I recognize and can pronounce. This means they must contain no junk, as in “real junk.” Some items may come fresh or frozen, and may include marigold yolks of chickens that only eat medical foods, but all are certifiably sourced from organic, probiotic-friendly happy cows or even happier goats.

Medical food is actually none of those things on my grocery list. Instead, it is a category of products regulated by the Food and Drug Administration (FDA) that has a kind of six-degrees-of-separation-relationship to what we consider to be “real” food. The FDA website has helpful information — see the “Draft Guidance for Industry: Frequently Asked Questions About Medical Foods; Second Edition” revised August 2013 for this definition: “A medical food, as defined in section 5(b)(3) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3), is “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”

Even that doesn’t fully convey the seam-stretching use of the noun “food.” You’ll need to go a little deeper to learn: “…Medical foods are not those simply recommended by a physician as part of an overall diet to manage symptoms or reduce the risk of a disease or condition, and all foods fed to sick patients are not medical foods. Instead, medical foods are foods that are specially formulated and processed (as opposed to a naturally occuring foodstuff used in a natural state) for a patient who is seriously ill or who requires use of the product as a major component of a disease or condition’s specific dietary management.”

I tend to gloss over ads, but what caught my eye was the physician’s healthy, attractive photo and impressive credentials; she had done her residency at Albert Einstein School of Medicine. Among the services she offers is an FDA-approved medical food as part of the treatment for the dietary management of obesity. Also listed were FDA-approved medical supplements available for the treatment of insomnia, fibromyalgia, peripheral neuropathy, hypertension, joint pain and chronic pain. Who knew?

Not because I need to lose weight or have any of those medical conditions — but rather because I am like you in that we, you and I, know several people who really struggle with their health, are morbidly obese or are suffering with neuropathy or hypertension — I reached out to the physician via email. What I learned was that this progressive doctor discovered medical foods as a result of her frustration with the limitations of prescription medications, which are often associated with significant side effects, drug interactions and safety issues.

“I wanted to be able to offer my patients a more natural way to treat their medical conditions,” she wrote in response to my query. “Medical foods can be used alone or as adjunct therapy to traditional medications to treat a particular disease state. They often enable physicians to use less medication or lower doses of medication to manage their patients’ medical conditions. I have been prescribing medical foods to my patients for the past year.”

Since medical foods are not drugs, they are not regulated as such, and by law they are exempt from certain labeling requirements. Neither is there a requirement for a written or oral prescription by a physician, however, manufacturers may make them available by prescription only, to ensure patients achieve the best possible outcome while under medical supervision. Another stipulation: any facility that manufactures, processes, packs or holds medical foods for consumption must be registered.

This assures some valuable oversight but, arguably, a significant flaw is that the FDA premarket review and approval of medical foods is not needed.

The FDA-approved medical food for the dietary management of hypertension is called Hypertensa, which according to the neurologist “naturally increases neurotransmitters in the body that help relax constricted arteries in the presence of hypertension.” This is one reason why ongoing care with a physician’s guidance is needed with medical foods.

Hypertensa can be added to prescription antihypertensive medications, with the goal of eventually reducing the dose of medications and drug side effects.

Though medical foods are described as natural, the word natural has mutated. I think its usage can be toxic to clarity and even be misleading. Consumers may ascribe desirable qualities to some products that are marketed as natural that may actually be detrimental to one’s health or diet plan. If you spot the word natural anywhere on your food label, stop and dig deeper and think.

Think of arsenic.

It is a naturally occurring element, but that doesn’t mean we want it, for example, in the rice we eat. Consumer Reports, The Centers for Disease Control and Prevention, and the FDA helped bring attention to the particular concerns with inorganic arsenic. We’ve been advised by these guardians of our safety and health that sushi rice from the U.S. and white basmati rice from California, India and Pakistan on average have about half the amount of arsenic as most other types of rice. That is little comfort to me, and even buying organic rice may not reduce the contamination. Cooking your rice in drinking water, where arsenic compounds may also be found … well you get the picture. Natural. Arsenic. All of these things only compound the need to remain conscious about what we are choosing to take into our bodies, whether it’s natural, food for pleasure or a healing modality.

The neurologist helped clear up the natural point, explaining that medical foods are derived from nutrient-based compounds found in the normal food chain. They are considered safe for long-term use.

The neurologist also provides some patients with an appetite suppressant for the dietary management of obesity. The ones who qualify can try using AppTrim, in conjuction with a well-balanced diet and exercise. “I routinely refer my patients to a nutritionist in order to be placed on a Mediterranean, calorie-restriction diet. If a patient is reluctant to be evaluated by a nutritionist, they are strongly advised to join Weight Watchers. Having patients join a program that strongly encourages accountability significantly increases their overall success rate.”

Asking what qualifies as a medical food is an entree to a broad world of medical research and to the manufacturers who are providing physicians with more tools for the treatment of serious conditions from viral infections to cognitive disorders such as Alzheimer’s Disease, attention deficit hyperactivity disorder and early memory impairment. Though I am neither a scientist nor a physician, I can see there is considerable science behind such hopeful therapies and see the value in discussing all treatment options with your doctor to determine if medical foods may enhance your overall well-being.

If not, there’s always kale.

Giselle M. Massi copyright August 2015