Nutrition and Chronic Diseases – Clinical Advisor
More than half of adults in the United States have a chronic disease. Diet is the largest modifiable factor that patients can adjust to mitigate their risk of developing or exacerbating a chronic illness. However, not every clinician incorporates lifestyle medicine into their practice, leading to gaps in patients’ knowledge of food as medicine.
In an interview with The Clinical Advisor, Alicia Craig-Rodriguez, DNP, MBA, APRN, FNPBC, DipACLM, FACLM, said that lifestyle medicine is “the future of health care.” Dr Craig-Rodriguez is a clinical professor at Florida State University College of Nursing, as well as a nationally certified family nurse practitioner (NP) and lifestyle medicine professional.
Alongside Melissa Bernstein, PhD, RDN, LD, FAND, DipACLM, FACLM, FNAP, associate professor and chair of the nutrition department at Rosalind Franklin University of Medicine and Science, Dr Craig-Rodriguez shared how clinicians can use food as medicine to improve health, in a presentation at the American Association of Nurse Practitioners (AANP) annual meeting, held from June 17 to 22, 2025, in San Diego, California.1
“Too often, our current medical model simply isn’t working. We are spending $4.9 trillion a year on health care, yet we’re not getting any healthier,” Dr Craig-Rodriguez said. She believes the solution lies in harnessing the power of lifestyle behaviors and food as medicine. “We look at the entire system, the whole body, to identify the root causes of illness rather than treating symptoms in isolation.”
How Poor Diet Harms Health
Out of a highest possible score of 100, Americans aged 19 to 59 years have a Healthy Eating Index score of 58. Americans aged 60 years and over scored a 61 on the same scale.2 These scores are driven by the average American’s relatively low intake of fruits, vegetables, and whole grains, which leads to low intake of fiber, antioxidants, and phytochemicals, and relatively high intake of ultra-processed foods, which contributes to high intake of sugar, sodium, saturated fat, and calories.
Table. Western Diet Versus Healthy Promoting Eating Pattern
| Typical Western Diet | Healthy Promoting Eating Pattern | |
| High consumption | – Ultraprocessed foods – Sodium – Sugar – Refined grains – Processed oils – Saturated fat – Animal products including red and processed meats |
– Fruits – Vegetables – Beans – Nuts – Whole grains – Seeds – Legumes – Water – Fiber – Antioxidants and phytonutrients |
| Low consumption | – Fruits – Vegetables – Beans – Nuts – Whole grains – Seeds – Legumes – Water – Fiber – Antioxidants and phytonutrients |
– Ultraprocessed foods – Sodium – Sugar – Refined grains – Processed oils – Saturated fat – Animal products including red and processed meats |
Drs Craig-Rodriguez and Bernstein indicated that an estimated 75% to 90% of chronic disease has been shown to be preventable by addressing factors like physical inactivity, alcohol or tobacco use, and poor diet. When diet is a contributing factor toward a patient’s chronic disease development, they propose that diet modification must be part of the solution.
When comparing the healthy recommended diet with the Standard American diet, they are almost exact opposites. “The goal is to add healthy, minimally processed plant foods, such as vegetables, fruits, and whole grains—those foods that most Americans are not eating enough of—and try to crowd out the ultraprocessed and unhealthy foods.” Dr Bernstein said.
The Food as Medicine Framework
The Food as Medicine framework considers food and nutrition as tools to prevent, manage, treat, and even reverse nutrition-related diseases such as cardiovascular disease, diabetes, and obesity, while also supporting overall health and wellness.
This framework aims to reduce disease burden through food-based interventions integrated into patient care and to facilitate a deeper understanding of the link between nutrition and health. The philosophy emphasizes the strategic use of nutritious food to promote health.
“Through lifestyle medicine, we begin by looking at the whole person,” Dr Craig-Rodriguez explained. “Instead of treating symptoms in isolation, we examine the entire system, the interconnected physiology, and work to identify the root cause of illness. Our goal isn’t to chase symptoms, but to understand why they are occurring in the first place.”
Dr Bernstein agreed. “Lifestyle medicine is an exceptional model for interprofessional care. Beyond the nurse practitioner and dietitian, it brings together the full health care team: the primary care provider, the physical therapist, the social worker, and the health coach, all working in concert,” she said. “It is the ideal framework for leveraging the strengths of each discipline while engaging patients as active, empowered participants in their own care.”
Lifestyle Medicine: The First Line of Defense
The American College of Lifestyle Medicine (ACLM) states: “For the treatment, reversal, and prevention of lifestyle-related chronic disease, the ACLM recommends an eating plan based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds.”
Drs Craig-Rodriguez and Bernstein emphasized that, before turning to medication, dietary and lifestyle modifications should be offered to patients as the first line of defense against chronic conditions such as obesity, dementia, and cardiometabolic diseases, including heart disease, hypertension, and diabetes. They also underscored the importance of adopting a truly healthful, predominantly plant-based diet; one that focuses on whole foods, rather than simply reducing animal products while continuing to consume foods that contain added sugar, sodium, fat, and refined grains.
Table. Healthy Versus Unhealthy Vegetarian Diet
| Healthy Vegetarian Diet | Unhealthy Vegetarian Diet | |
| High consumption | – Complex fiber-rich carbohydrates – Antioxidants and phytochemicals – Monounsaturated fatty acids and polyunsaturated fatty acids – Vitamins and minerals |
– Refined carbohydrates – Added sugar, including high-fructose corn syrup – Saturated and trans fats – Salt and artificial sweeteners |
| Related outcomes | – Increased glucose tolerance – Lower insulin resistance – Lower low-density lipoprotein cholesterol – Lower blood pressure – Lower oxidative stress – Improved immune function |
– Increased hyperglycemia – Increased hyperinsulinemia – Increased dyslipidemia – Increased inflammation – Increased hypertension – Increased gut dysbiosis |
Prescribing Lifestyle Medicine
Drs Craig-Rodriguez and Bernstein emphasized that dose matters when prescribing lifestyle interventions. To meaningfully improve a patient’s health, the intensity of lifestyle medicine must match the severity of their condition. Individuals without active disease may do well with low-intensity changes, whereas those with advanced illness or high risk of morbidity or mortality require a much more intensive therapeutic dose of lifestyle modification.
Rather than taking a symptom approach, we look at the system, we look at the entire body, and we really try to aim for looking at the root cause of illness.
They illustrated this principle through the case of a man living with multiple chronic conditions. At age 67, the patient weighed 275 pounds and was taking the strongest rheumatoid arthritis (RA) medications available to him, along with treatments for hypertension, prediabetes, and high cholesterol. His RA caused significant hand stiffness and fatigue, forcing him to nap throughout the day and preventing him from enjoying hobbies such as fishing, woodworking, and glassmaking.
At age 68, the patient and his wife began meeting with Dr Bernstein, a registered dietitian nutritionist (RDN) who recommended transitioning to a whole-food, plant-based diet and incorporating regular physical activity. He also established care with a new cardiologist because he hoped to eventually reduce or discontinue several medications related to his RA and cardiovascular disease.
By age 72, the patient had lost more than 100 pounds and maintained the weight loss. He no longer required RA medications; his blood pressure and cholesterol stabilized within normal ranges. His wife also experienced weight loss. Now more active than he had been in his 60s, the patient returned to fishing and golfing, as well as resumed woodworking, building furniture for friends and family with renewed vitality.
Dr Craig-Rodriguez then shared a personal story that underscored the power of lifestyle medicine. In February 2025, she unexpectedly found herself in the emergency department (ED) after suffering a stroke and spent 4 days in the intensive care unit (ICU). “How could this happen?” she wondered. Extensive testing revealed no traditional risk factors; her coronary calcium score was zero, she had no plaque buildup, no high cholesterol, and all routine markers were normal.
More specialized testing eventually uncovered the cause: a congenital heart defect she had unknowingly lived with her entire life. Her cardiac and neurology teams explained that, given this condition, she should statistically have experienced a stroke in her 40s.
But because of her healthy lifestyle, she remained symptom-free 26 years before anything showed up,” she noted.
How the Health Care Team Can Partner with Registered Dietitians
“Working with an interprofessional team optimizes outcomes for both patients and providers”, Drs Craig-Rodriguez and Bernstein said. Partnering with RDNs, who have the knowledge and skills needed to help patients make dietary changes that will affect their health, is an important strategy for clinicians who practice lifestyle medicine.
Advanced practice providers (APPs) should consult an RDN when a patient’s medical condition requires a specialized food or diet plan and when:
- a patient has a new diagnosis, or a chronic disease is present;
- a patient is unable to prepare meals or desires assistance with meal planning;
- a patient has food or nutrition insecurity; or
- a patient requires medically tailored meals or groceries.
Drs Craig-Rodriguez and Bernstein are confident that lifestyle medicine will become even more mainstream as clinicians continue to work together to reduce chronic disease burden through dietary interventions.
“The momentum is strong, and we’re looking forward to helping our patients and our clients thrive with vitality,” she said.
Disclosure: Dr Bernstein collects royalties as an author of numerous textbooks on nutrition.
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