The cost of health care in the United States continues to rise, totaling over $3.8 trillion per year. Gastrointestinal diseases contribute significantly to health care costs and were recently estimated to be $135.9 billion annually. Innovation in gastroenterology has traditionally focused on expensive pharmaceuticals, devices, and new procedures. Many of the conditions and diseases treated by gastroenterologists, including colon cancer, inflammatory bowel disease, fatty liver disease, alcohol-related liver disease, irritable bowel syndrome, reflux, and more are influenced by nutrition and lifestyle. Practicing clinicians, however, have not received extensive training in these areas. As a result, most patients do not receive adequate guidance and support for making lifestyle changes.
Lifestyle medicine offers evidence-based lifestyle therapeutic interventions to prevent, treat, and often reverse chronic disease. Lifestyle medicine includes incorporating a whole food plant-based eating pattern, regular physical activity, sleep, stress management strategies, avoidance of risky substances, and positive social connection. In the field of gastroenterology, using a multidisciplinary lifestyle medicine approach can provide innovation and a framework for improved patient care in both urban and rural settings.
Recent research on the gut microbiome provides a scientific rationale for the pivotal role that lifestyle plays in chronic diseases, especially digestive diseases. The gut microbiota, the trillions of organisms that inhabit the gastrointestinal tract, particularly the colon, have a functional role in health and disease. Diet is a major player in shaping the gut microbiota. A diet rich in diverse plants and fiber is the basis for cultivating a healthy gut microbiome. Alterations in the gut microbiota may trigger metabolic and inflammatory diseases in and outside of the gut. Fiber is present in plant foods, is non-digestible by humans, and serves as food source to nourish microbes as a prebiotic.
While many tertiary medical centers are located in urban areas, rural health systems have the unique opportunity to collaborate with local agricultural partners. In many cases, these community organizations already provide advocacy, education, and address problems such as food insecurity for rural Americans. Agricultural organizations can further benefit patient care by improving whole food plant-based diet access.
Our gastroenterology practice has been collaborating with an on-site farm and provides a model for other rural communities. The organic farm, run by a partnership with the hospital and a local non-profit called the Allegheny Mountain Institute, provides a unique clinic-to-farm-to-table paradigm for clinical care. It provides insight into the interconnection between the soil and human microbiome that heavily influences nutrient density, food quality, and the integrity of the gut microbiota. The health of the farm heavily influences human health. The farm, located on the campus of our health system, utilizes sustainable practices to provide locally grown food to hospital patients and staff, provides nutrition education, runs a farmer’s market for the hospital, offers nutrient-dense foods to community members with chronic disease through a “food farmacy” program and delivers produce to area food banks. When a patient is identified with food insecurity in the clinic, they can access weekly home delivery of seasonal produce.
Collaboration with farmers on a medical campus provides an opportunity to build a holistic program extending beyond the sterile clinic room. Workshops can be conducted on the farm and in the kitchen alongside registered dietitian nutritionists, health coaches, and chefs. Plant-forward eating and Mediterranean anti-inflammatory cooking are emphasized in the patient care plan. Patients have the opportunity to learn about the importance of the microbiome, make fermented foods on the farm, and identify herbs and new plants that they may not be familiar with. It also helps educate patients on the pitfalls of modern agricultural practices and the importance of the regenerative farm movement. Improved soil health benefits both microbial diversity and human health while reducing impact on the environment and climate.
Gastroenterology clinics in rural areas have the unique opportunity to innovate the field by working with local community organizations and farms. Patients and physicians develop a deeper understanding of the root cause for chronic disease, particularly digestive diseases using a food as medicine approach. Cultivating gut microbes in the soil and gut can re-shape the management of chronic diseases rooted in inflammation and metabolic dysfunction. Rural gastroenterology clinics can be at the forefront of shaping the innovative clinic-to-farm-to-table paradigm in health care that can lead to cost savings and improved outcomes. This model ultimately can foster deeper connections between patients, physicians, communities, and nature as well as better health outcomes.
Savita Srivastava and Christina Tennyson are gastroenterologists.
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