“Let thy food be thy medicine,” the ancient Greek physician Hippocrates is believed to have said.
But that has not been the experience of Manitoba mother Katrina McAllister. McAllister’s two-year-old daughter has been in the hospital for six weeks and is approaching discharge.
One of the milestones she needs to meet to leave the hospital is eating solid food. With the hospital food that is brought to her daughter’s room, this is a difficult goal to meet, McAllister says.
It’s “tasteless, slimy, colourless,” she said.
“I’m struggling to get [my daughter] to eat this food,” McAllister said she told the doctors. “But I don’t live nearby, so it’s not simple for me to cook for her.”
Even though health specialists have long known that diet is essential to health, Canada’s health-care system does not prioritize diet in everything from hospital foods to the medical training it provides doctors.
“Nutrition is as vital as a prescription to someone’s health,” said Heather Keller, registered dietician and University of Waterloo professor. “The nutrients you consume on a daily basis impact how your body functions and… keep it functioning well.”
“And when it’s taxed with a disease state or with an infection, nutrition is vital to recovery.”
The health-care system needs to incorporate better nutrition training for doctors in order to prevent disease, said Keller, who is also a Schlegel research chair in nutrition and aging at UW and the Schlegel-UW Research Institute for Aging.
Nutrition is left up to patients
Keller has studied the direct effect diet has on preventing and combating sickness.
For example, her research has shown that seniors who lose their partners often stop cooking altogether and consume only ready-to-eat pantry meals. This poor diet then leads to muscle loss. “They get weaker, and they might fall and break a hip,” said Keller.
Diet is also important to helping sick patients heal. When someone catches a virus, such as COVID-19, the body becomes inflamed and fights the illness with protein. If the person’s diet does not include enough protein, the body will draw it from muscle tissue.
“You lose muscle, you lose function — and that’s all linked to nutrition,” said Keller. “You have to put the protein in the body to make the muscle.”
Yet, personal nutrition is left up to patients, except where a diet plan is directly involved in a patient’s diagnosis and prescription — such as needing an epipen for a food allergy or insulin for diabetes.
“Health care is not about wellness,” says Raisa Deber, professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Even though diet is as important to health as peoples’ environment or biology, it falls outside the scope of the health-care system.
In Deber’s view, overseeing healthy diets would lead to an unwieldy expansion of the health-care system’s responsibilities.
“I think it’s important to recognize there’s a difference between what you need to keep you healthy, and what’s part of healthcare,” said Deber.
But doctors still have a responsibility to make recommendations related to diet, says Dr. Jordan Heuser, a general surgeon in Ottawa, who specializes in abdominal surgery.
“In Canada, medications are not covered. If you’re going to recommend medications, and it costs [the patient] money, as a physician you still need to do that” even if the patient can’t afford the prescribed medication, says Heuser.
“Similarly, if a dietary change is necessary, and it’s going to be more expensive — increase fruits and vegetables, whatever it might be — it’s still definitely part of the discussion that has to happen and that… a physician [is] responsible to do.”
‘Just as bad as medication errors’
Canada’s public health care system funds both medications and food given to patients in hospitals.
But most hospitals are not provided with the budget required to provide high-quality food, says Keller. So a beige plastic tray carrying small bowls of mashed peas, watery Jell-O and flavourless steamed chicken becomes the typical meal.
“Food in hospitals is seen as more hospitality rather than as health care,” says Keller. “It’s just as bad as medication errors, quite frankly, in hospitals that we’re not providing high-quality food.”
Medical staff often fail to recognize when health issues are related to malnourishment, according to a 2015 report by the Canadian Malnutrition Task Force. The report found malnourishment led to longer stays for the majority of the 45 per cent of patients who were malnourished when admitted. These extended stays cost the health sector about $2 billion a year.
At least 25 hospitals across Canada are now prioritizing health in hospitals. Nourish Health, an initiative aimed at upgrading hospital food, has added salmon with fresh greens and Indigenous staples to the menu. Their tagline reads, Food is Our Medicine.
But these hospitals are the exception, not the norm. Part of the problem is that many hospitals don’t have dieticians on staff, says Keller. “Outside of [nutritionists and dieticians] there really isn’t anyone paying attention to nutrition as the focus in health care.”
Medical staff need to be better trained to make nutritional recommendations to cater to patients’ health needs, says Keller.
Limited diet education in medical schools
Canada may lag behind the United States in prioritizing diet in medical education. Last year, the U.S. House of Representatives passed a bipartisan resolution that calls for medical schools, residency and fellowship programs to provide nutrition education that teaches about the connection between diet and disease.
“We cannot continue to ignore the correlation between diet and health. It’s time to make sure our medical providers are equipped with the best knowledge and tools to help their patients,” said congressman Michael C. Burgess, M.D. (R-TX), who co-authored the bill.
In Canada, a 2010 study showed 87 per cent of medical students in nine Canadian universities said their programs should have more nutrition education.
Yet the Canadian government has not taken steps to address nutrition education in medical schools.
There is limited nutrition and diet education in medical school, said Heuser, who graduated from McGill University’s medicine program in 2013.
“I think (awareness of) the importance of diet… on a preventative level, with family physicians… is increasing, but I don’t think it’s where it needs to be yet,” said Heuser.
“We know a lot about medications and physiology and how those sorts of things work,” said Heuser. “Everybody eats, and we’re putting all sorts of things in our bodies every day, and we know a lot less about it.”Â
Editor’s note: This article has been updated to include the statements by Katrina McAllister.
