A Prescription for Plants

A visit to the doctor typically involves checks for blood pressure, cholesterol and blood sugar levels, followed by some general advice about diet and exercise.

It is sound advice. We all have a general idea that we should eat better as a pathway to better health. But it can be challenging when neither provider nor patient has a good understanding of what might be missing or what might be in excess in their diet. Remembering to take medication is easy when the instructions are on the prescription label. It’s more difficult to know, “What changes to my diet will be enough to correct the problem.”

Cheri Granillo is the Translational Nutrition Program Manager and NC State Extension associate at NC State’s Plants for Human Health Institute (PHHI) in Kannapolis. Her goal is to help providers and patients understand the diet component of disease treatment and embrace diet as a means to improve general health.

She can authoritatively explain the benefits of a healthy diet. She holds a biology degree with a concentration in nutrition from NC State, and undergraduate and graduate degrees in nursing from Johns Hopkins University. Her knowledge base is enhanced by the research done by the scientists at PHHI. 

“The principal investigators at PHHI are researching phytochemicals — the naturally occurring compounds found in plants — what these chemicals do for the human body, and how they can improve health,” Granillo said. “We already know that fruits and vegetables are good for you. We are looking to the science to better inform us about how these compounds can treat and prevent disease.”

Granillo wants to use that knowledge to benefit North Carolinians through a pioneering program called PhytoRx. It is based on phytomedicine — the science of medicines from plants for preventive and therapeutic outcomes. 

“I’m taking the research and translating that into something medical practitioners can use to improve the health of their patients,” she said.

More than Vitamins

There’s a reason why parents repeat the mantra of “eat your fruits and veggies” to their children. We have a general understanding that food that naturally grows in the ground or on bushes and trees contains essential vitamins and minerals that are beneficial to our health. Less familiar are the many phytochemicals present in those fruits and veggies. 

Related: Learn more about NC State Extension’s efforts to promote health through fruits and vegetables.

The human body is an amazing machine. It takes the food we ingest, uses chemical reactions to process it as fuel, and converts it into energy. Essential vitamins and minerals help to form enzymes that carry out the biological reactions.

Phytochemicals go beyond sustaining life to actually promoting optimal health and can, in certain cases, even replace medicine. For example, to manage type-2 diabetes, medical providers often prescribe DPP-4 inhibitors, such as Januvia or Tradjenta, as a means to help the body release more insulin and decrease blood sugar. There are similar types of chemical reactions with plant compounds.

“What we’re finding is, anthocyanins like those found in blackberries and blueberries, work like a DPP-4 inhibitor,” Granillo said. “Could providers prescribe blackberries to a patient as part of type-2 diabetes treatment? I’d like to see it happening, but the first step is educating providers about these nutritional treatment options and giving them the tools to carry out a ‘PhytoRx’.”

Prescribing Improved Health

PhytoRx is an effort to literally prescribe anthocyanins and carotenoids, two phytochemicals with significant research identifying health-promoting bioactivity in the body, in conjunction with elements of the NC State Extension program Med Instead of Meds.

Phytochemicals found in fruits and vegetables promote optimal health and can, in certain cases, even replace medicine.

Anthocyanins are present in dark red, blue and purple fruits and vegetables, including blueberries, raspberries, strawberries, red cabbage, red and black grapes, beets and black beans. They have been found effective against diabetes.

Carotenoids are found in yellow and orange fruits and vegetables, including mangos, carrots, sweet potatoes, tomatoes, spinach, kale and bell peppers. They can help with  skin disease and eye disease, and also can decrease inflammation related to heart disease.

The Mediterranean eating style is the foundation of Med Instead of Meds, which demonstrates how shifts from a Western diet can improve health. These shifts include eating more vegetables and fruit, snacking on nuts and seeds, making your grains whole, changing your protein and swapping your fats.

The concept of PhytoRx is to take the pool of rich, evidence-based information and develop a useful tool to improve health outcomes. With the PhytoRx prescription pad, a medical provider can check off their patient’s diagnosis and form a plant-based treatment plan. It’s designed so the provider can customize the starting point in the Med Instead of Meds plan and choose the appropriate phytochemical (and corresponding foods) for the diagnosis. 

Granillo hopes to partner with Family and Consumer Sciences Extension agents throughout the state who teach Med Instead of Meds classes. These partnerships would be a valuable component of patient success by offering cooking demonstrations and tastings alongside a group of peers working toward the same goal. 

Medical providers can use the PhytoRx pad to prescribe fruits and vegetables to help with certain medical conditions.

The pilot program was just getting started when COVID-19 hit. HealthReach Community Clinic in Mooresville, where Granillo works one day a week as a nurse practitioner, received a grant from Blue Cross Blue Shield of North Carolina to fund PhytoRx for 30 patients. A provider would write the PhytoRx for patients and the prescriptions would be filled at Feed NC in Iredell County for three months. The patients agreed to pre- and post-treatment bloodwork, which would help measure the efficacy of the program.

The pandemic put the program on pause, in part because of the ensuing strain on the food bank. But with restrictions easing, Granillo is reviving PhytoRx.

She is continuing to work at the local level through the clinic in Mooresville and Iredell County FCS agent Andrea Sherrill, but Granillo has a bigger vision for the program that includes educating providers and involving Extension agents across the state. 

Learning Curve Ahead

Education is a key component of the PhytoRx program because the vast majority of medical providers don’t have nutrition knowledge. Granillo recalls a recent article where a doctor stated that she had 80,000 hours of training to be a cardiologist and zero hours of nutrition training. Further, the American Heart Association’s 120-page cholesterol recommendations include one paragraph on diet. 

“Nutrition education in medical schools, nursing schools, and pharmacy schools is extremely limited,” Granillo said. “The curriculum doesn’t reflect the wealth of nutrition information that can affect health. Providers have been through medical school or nursing school, where they’re taught that medicine X treats disease A, and here’s the chemical structure and how it works. There simply isn’t that kind of structure for nutrition. It’s just an overgeneralized, nebulous recommendation of ‘eat more fruits and vegetables.’”

The science-based research showing the effectiveness of anthocyanins as a food-based treatment for diabetes, for example, is an important part of PhytoRx becoming an accepted practice.

“That’s very relatable to a medical provider,” Granillo said. “I want to fill that role of educating providers on how to use phytochemicals in foods similarly to the way they use medications.” 

Granillo will launch an online course this fall to reach providers, sharing research on phytochemicals and disease treatment (as well as health support) and introducing the PhytoRx program. 

Putting the Puzzle Together

Extension’s existing local networks are a key part of patient success.

Related: NC State Extensions’ recipe library can help turn fruits and vegetables into delicious meals.

“Extension agents have such a wealth of knowledge to give to patients and providers,” Granillo said. “Agents can provide programming, but perhaps as important, they know the culture of their clients, what’s available in their county, and how to make meaningful connections between people, food and health. They could become champions for the program, as they are already champions for community health.”

Granillo would love to see PhytoRx become a statewide program. But while she is working to get medical providers on board, she hopes the concept of phytomedicine reaches far and wide.

“When people realize they can eat delicious, locally available foods to improve their health, perhaps they will be empowered to ask their provider for a PhytoRx at their next visit, so they can head to the farmers market rather than the pharmacy” she said.