Nutrition is foundational to health, but healthy eating does not look the same for everyone.
In Pharmacy Times’ second interview with Samantha Citro Alexander, the co-founder and CEO of bitewell, a novel food pharmacy (farmacy) that dispenses food-as-medicine and healthy-eating services, we learn why there is a need for services that bridge that gap between the provider’s recommendation and healthy food, why 10 minutes at the physician’s office is certainly not enough to figure out how to manage a condition or modify lifestyle, and the importance of patient care that encourages treatment with healthy food plus lifesaving pharmaceuticals.
PT Staff: So can you speak a little bit on the idea of personalizing food as medicine with physicians and pharmacists— this idea of personalization? Why is this so important?
Samantha Citro Alexander: Nutrition is the bedrock of our health, right? What we eat is one of the only things that we do for our health multiple times a day actively. We know that the food that you put into your body makes up a majority of your overall health, even more than physical fitness and even more in many cases than stress. It's the food that you're putting into your body, right. And everyone's body is different. And everyone's body needs different things.
When we come from (especially millennial Gen X generation) that grew up on the food pyramid) a world where we thought that the food pyramid was the right nutritional breakdown for every single one of us, when we come from that world, helping people to understand personalized nutrition becomes even more critical because we're coming from a baseline of incorrect and inaccurate understanding.
When we think about the food as medicine landscape more broadly, there are a lot of companies that are doing really interesting things in this space. Most of those companies tend to be focused in 1 of 2 areas.
There is a suite of companies that are focused on provider access. So if you've been diagnosed with a diet related condition, “How do I get you to a dietician or nutritionist or health coach who can help you through?”
There's another set of companies that are focused on the creation, or manufacturing, of food that is appropriate for different conditions—medically-tailored meal companies, for example, and even large food manufacturers who are making cereal specifically for diabetic patients or whatever they might be. That's wonderful that those 2 worlds exist but they're not useful for the patient unless there's someone in the middle to bridge the gap between a provider's recommendation provider saying to you “eat 5 servings of vegetables a day,” (or however many) and the medically tailored meal provider who is creating the food.
How do you bridge that gap and how do you translate the provider’s recommendation into action without something like a farmacy that sits in the middle? So that is why we exist in the way that we do.
PT Staff: I would think that, with you being the middle person, it was also a lot of learning on your part, learning about both sides and figuring out where the disconnect was. In your opinion, how do you feel like this is bridging that gap?
Samantha Citro Alexander: It was definitely a lot of learning. I was in the beauty industry for 10 years before doing this, andI have felt the pain on the patient side. I know what happens when you get diagnosed with a diet-related condition and then need to figure out what the world to do, but I'm not a health care expert. My co-founder, Chris, is a food industry expert and he deeply understood what was happening on the food manufacturing side of the house. Our job was to learn about what was happening on the provider side of the house so that we can figure out how to bridge that gap.
I think one of the easiest ways to describe what happens is [with this example]. Let’s say that you get diagnosed with a diet-related condition and your diagnosis usually goes something like this:
You get a phone call from your doctor, or you're in your doctor's office for 10 minutes, and they say, “Hey, your labs came back, and it looks like your cholesterol is riding high. So I'm going to give you a prescription. And I'm going to give you a pamphlet on some lifestyle changes you can make, and I'll see you in a year. And we'll check back again in a year.”
A year?!
You've got 10 minutes of information and a year, so what do you do? You go to Dr. Google, and you say, “Okay, Dr. Google, what am I meant to do?”
Some portion of those people will go see a dietitian and start working through this issue through food, but most people won't. And both of those people need help. So if it's just you and Dr. Google trying to figure out what to do, you enter the farmacy and tell the farmacy about your condition that you're trying to manage. “I'm trying to lower my cholesterol.” We help you figure out of all of the possible food options that are living over here that might address that issue. Which ones are right for you.
If you're coming through a provider through a dietician, who has said “All right, we are going to help you lower your cholesterol. I want you to start adding more fiber to your diet,” you still have to go to the grocery store and figure out what normal has fiber. “What should I buy of these 600 different protein bars I'm looking at in front of me? How do I know which one has the right fiber ratio for me.” That is an undertaking and so we do that work for you. Your goal is to lower your cholesterol [and] what you've been told to do is increase the amount of fiber intake; we can help you find foods that do that.
PT Staff: That's pretty fabulous. That's… it's fantastic. So I would like to address a (what is sometimes considered to be the) elephant in the room, which is that people think healthy food/good quality food is too expensive. “I can't afford it.” Now, in your experience, why does this idea continue to persist the landscape? And why does our current food system make it seem like that is what it is?
Samantha Citro Alexander: In some ways that's true and in some ways, it's not. Which makes it a really complicated question to answer. When you think about grocery store shopping (I'm just going to use this as an example because I think it's something that most people do often and have heard before), people talk about “perimeter shopping” as your healthiest option. If you perimeter shop (meaning to shop around the perimeters of the store, where its mostly produce, dairy, and meat) your cart is likely to be more expensive than someone who shops on the inside aisles.
Good quality produce is expensive. Dairy and eggs are expensive. Feat and fish are expensive. But what isn't discussed is that even if you need to do some more of your shopping in those inner aisles, there are better tradeoffs to be made. So if you look at a box of Lucky Charms versus a tin of oatmeal—[which contains] a ton of oats that you can make into oatmeal per serving— that tin of oats is going to be much less expensive than the box of Lucky Charms, even though the box of Lucky Charms is being advertised to you as 25 cents off. But doing that serving-by-serving comparison of everything that you buy is time consuming, and time is also money right?
When you're when you are operating on a budget, time is 1 of the most precious things you have, as well as if you're working multiple jobs, so you don't have time to do that. And so we've created this system that is really broken and complicated for people and doesn't support healthful food purchasing in a way that is sustainable. And so when we thought about building the farmacy, our goal with the farmacy (our product vision) is to make food as medicine both actionable (and we've talked a lot about that on this call) and affordable.
When we negotiate with our vendors— because we work with lots of different grocery vendors and lots of different prepared meal vendors— [and] the way that we set up our partnerships with them [makes it so that the] food that you buy inside the farmacy is anywhere from 5% to 35% less expensive than you would find it out in the world. And that's on purpose. We want to make sure that access to healthy food is not unachievable and affordable.
PT Staff: I think I want to close now. What I want to ask you is, if you could share some of your wisdom to pharmacists and providers prescribing lifesaving medications, what would you tell them about the role of diet and nutrition and accessibility for patients? How do they connect?
Samantha Citro Alexander: It’s food plus pharmacy. Many people are on life-saving medications, life affirming medications they need. But we do know through many, many, many clinical studies that medication alone is very rarely the answer. And my knowledge would be that, when you're chatting with a patient about taking a new medication or how their body is reacting to a medication, think about a lifestyle solution too. We have a food pharmacy lifestyle solution that helps people to access healthy food nutrition. That's one great way to talk about lifestyle medicine with your patients. But there are many, many others. And so my ask, I suppose if I'm allowed to have one at the end of this call, is that anyone who's listening really thinks about spending 2 minutes on a lifestyle component in addition to a medication component when chatting with a patient.
