Jim Grove loves blueberries — and that’s a good thing, considering that for the next year, he’s required to eat a cup of them every day.
“I’m up to 35 pounds now, I think, in blueberries. That’s what I’ve eaten since the start,” he said, before blending yet another smoothie in his home in Halifax.
Grove, 67, has just come from an appointment, during which he underwent a series of physical tests and answered numerous questions like whether he could do his own banking, count backwards in multiples of six and list as many animals as possible in one minute.
At the end of all that, a research co-ordinator handed Grove a large box of frozen Nova Scotia wild blueberries.
“Here are your blueberries for the next two weeks,” she said.
Grove is a participant in a new study by researchers in Dalhousie University’s faculty of medicine, looking at whether providing blueberries for people to eat every day, combined with 30 grams of protein powder and personalized exercise routines three times a week, will improve frailty and heart health in older people. If it does, researchers hope the results will bolster the argument for doctors to prescribe blueberries.
It’s part of a larger trend gaining traction in Canada: food prescribing. It’s exactly as it sounds. Doctors identify patients who are experiencing food insecurity and at risk of diet-related chronic diseases, and write them prescriptions for fresh food. This gives them access to subsidized or free healthy foods.
“When we think about prescribing, we usually think about someone being sick and needing a medication prescribed,” said Leah Cahill, a registered dietician and principal investigator on the study, which she’s dubbed STRONG.
“The idea of prescribing lifestyle as a way to prevent people even getting sick, that’s where our hearts are.”
Cahill and her team are still looking for more people to join their clinical trial, which will include 240 people in total, aged 65 and older. Out of them, 120 will be in the treatment group, eating antioxidant-rich blueberries every day, while the other 120 will be in the control group, following their usual diets. Everyone will undergo assessments every three months for a year, and then another assessment a year later.
The team received a $1-million grant from the Nova Scotia- based River Philip Foundation, as part of the philanthropic organization’s commitment to fund “transformative medical research” at universities and medical schools in Canada.
Cahill, who is also an associate professor of medicine at Dalhousie, says although most people know eating fruit and exercising is good for them, they don’t necessarily do it. She hopes providing the food and custom, monitored workouts will decrease the “mental load” of having to figure it out alone.
She says frailty and heart health are linked — cardiovascular disease is a significant source of death and disability in Canada and frailty makes people more at risk.
“We wanted to keep [people] stronger for longer.”
Food prescribing growing rapidly
As Canadians grapple with an affordability crisis, researchers say interest in food prescribing is growing rapidly.
A June 2024 commentary article in the peer-reviewed scientific journal Health Promotion and Chronic Disease Prevention in Canada looked to critically assess the “limitations and opportunities” of the practice.
It found that food prescribing improved fruit and vegetable intake, and “shows promise” in helping health-care providers simultaneously address food insecurity and chronic disease management.
But the article finds more research is required to evaluate the effectiveness and cost-efficiency relative to other health care, public health and social welfare programs.
Its lead author, Matthew Little, an associate professor at the University of Victoria, says food prescribing is often just a matter of connecting people with services that already exist in their communities, but that they may not be able — or choose — to access.
Prescriptions provide the added incentive of “doctor’s orders,” he said.
But he cautions it could be seen as paternalistic, and questions whether it would be more dignified to “prescribe cash.”
Additionally, he says more research is needed regarding whether there may be people in need who might miss out because they don’t have a family doctor.
“Would this actually exacerbate some of the health inequities that exist in the Canadian context?” he said, in an interview.
In Canada food prescribing is happening only in small pockets, usually on a local scale — largely in Alberta and Ontario. Little says most of the research in this area comes out of the United States, mainly because the 2018 Farm Bill established dedicated funding for produce prescription programs.
Guelph doctors already prescribing food like medication
Clinicians at the Community Health Centre in Guelph, Ont., are already prescribing fresh food just like medication, and have been on some level since 2019. People can redeem their prescriptions at the centre’s online grocery store.
Melissa Kwiatkowski, chief executive officer, says severe food insecurity has dropped by nearly half among the centre’s 260 clients. She says there have also been improvements in clinical markers tied to diabetes and heart disease.
But she says the program is funded mostly through grants, which is not sustainable. She’s submitted a pre-budget proposal asking the Ontario government to invest $14 million over three years to launch a provincial food prescription program.
“Eventually my hope is that fresh food prescribing is just part of primary care, part of standard practice,” she said.
She said if successful, “rigorous research” on the scaled up model would continue to be important.
Little agrees and says more studies, such as the one at Dalhousie, are “sorely needed” in Canada.
STRONG is a rolling study, meaning not all of the participants start at the same time. It will be complete once 240 participants have been in the program for a year each.
Grove, who lives with Type 2 diabetes and arthritis, acknowledges it was difficult to get used to a new regimen at first. But now, working out three times a week and eating blueberries every day is a pleasant routine.
He says his body started aching and “everything went downhill” when he turned 60, but three months into the program, he’s already noticing a change in himself.
“I just think if I improve, it’s only going to help me down the line when I get older, hopefully.”
