How to Prescribe Food in a 15-Minute Visit with Dr. Laurie Marbas

[00:00:00]So, I want to get specific here. So, let's just say a provider has 15 minutes with a patient that has high cholesterol, hypertension, pre-diabetes, or metabolic risk. How do you begin the food as medicine conversation?

[00:00:16]>> Well, honestly, I know it's going to surprise you, but you don't start with food. And I think that >> Right.

[00:00:23]>> it didn't work before, so why should they listen now? So, basically what I do is I start with lab work, right? And I make this personal. Or maybe it's the vital signs. It's just really sitting right in front of you because this is the objective data.

[00:00:35]And then I say something like, "Hey, your fasting glucose is 118, which means your body is starting to lose the ability to clear sugar from the blood um efficiently." So, just say after that, you know, the good news is that it's one of the most reversible things I see. Um and that usually gets their attention because I've told them what's actually happening in their body, and that's really where you can see it change. And then I ask one question, really simple, "What does a normal dinner look like?" And I'm not saying breakfast or lunch, but actually dinner because dinner's where most of your calorie load lives for the majority of people, and that's really where the family dynamics show up. And then I just listen. Um I'm not trying to make a face or judgment. I'm not calculating anything.

[00:01:19]I'm just listening for like one detail that I can work with. And maybe so they say, you know, I like pasta. And I think, "Okay, great. I can work with pasta."

[00:01:28]>> [laughter] >> I think, "What if we kept the pasta but changed what goes on top of it, right?"

[00:01:32]So, maybe you bring in marinara and you load it with vegetables, or you add in lentils for protein. Um and you'd be shocked what your numbers could be in 90 days. And that's really the one thing I do, just make it one simple meal change, one That's it. Just one change. I'm not handing them a pamphlet with a huge pyramid or a list of things I want them to change overnight. I'm just kind of meeting them I think what's important is you're meeting them in their actual life. Because reality is 15 minutes is not enough time to overhaul someone's diet. I wish I had more time to do that.

[00:02:03]Typically, I have my own practice now. I can do what I want, but before I couldn't. And but that time that 15 minutes is absolutely enough time to make one specific actionable seed and make them believe that it's worth trying because it's very doable.

[00:02:18]>> Mhm. Mhm. So, you like kind of breaking it down into these small actionable habits.

[00:02:24]>> Right.

[00:02:25]>> Mhm. Mhm.

[00:02:27]What is one practical thing that a provider watching this could start doing tomorrow in their clinical practice?

[00:02:37]>> I think after what I just said would just be to write the food prescription.

[00:02:41]And I mean literally like take a prescription pad and write it down. Cuz I know it sounds odd and too simple, but there's really something that happens when you do this with them. So, the patient gets a piece of paper that says one eat one cup of beans or lentils for 90 days. And it's written in the same format as like their metformin or their statin or their high blood pressure medication. And something shifts in how they actually receive it.

[00:03:05]Um and it kind of signals that the doctor considers this real medicine, right?

[00:03:10]This is not a suggestion or some like little footnote on the real that the real after their appointment's over.

[00:03:15]This is just like, "Hey, this is a really important part of your treatment plan." And then I would say again, just focus on one food, not a huge change.

[00:03:24]But I typically go for beans because the evidence is so strong across the board for glycemic control, for cholesterol, for blood pressure. And you can point to actual data showing that a cup of legumes a day produces meaningful changes in your LDL and your A1C. And then compliance ends up being better um than I think most people expect because one beans are cheap. Uh they're familiar to most families and they can pretty much go into anything. So, and then it's really easy to follow up like, "Hey, how did the bean prescription go?"

[00:03:52]And that's That's really the main thing.