Pharmaconutrition in Practice: How Pharmacists Can Lead the Way in Patient Nutrition and Wellness

At McKesson IdeaShare 2025, Lara Zakaria, PharmD, MS, CNS, CDN, IFMCP, delivered a compelling presentation calling for a reimagining of pharmacists’ role in patient nutrition. As the founder of Foodie Farmacist, LLC, and the creator of the concept of pharmaconutrition, Zakaria advocates for a future where pharmacists are recognized as trusted nutrition experts in their communities.¹

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“I want to make this a thing,” she said. “I want this to be the way that we are thought of in our communities, that we are that pharmacy team that makes sure we talk about nutrition at every opportunity that we can.”¹

Zakaria emphasized how food and nutrition have become moralized, affecting societal perceptions of body size and obesity. She pointed to the limitations of body mass index (BMI) as a health metric, noting it fails to reflect the quality of body composition.¹

“Under-nutrition is just as dangerous as over-nutrition, and that’s something we need to pay attention to,” she said, citing data showing mortality risks at both low and high BMI ranges.²

Rethinking Diet Quality and the Role of Ultra-Processed Foods

Ultra-processed foods (UPFs) were another focus of the presentation. Zakaria referenced a narrative review published in Nutrients that found no studies linking UPFs to health benefits but considerable evidence linking them to adverse outcomes such as obesity, cardiovascular disease, and cancer.³ With their heavily altered ingredients, UPFs complicate traditional calorie-based thinking.

“There’s a whole spectrum of connections between the increase of UPF in our diet and this increased risk, so we can no longer really afford to just look at this as a ‘calories in, calories out’ problem,” she explained. “We have to start thinking about this in a more nuanced way, and we have to start thinking about quality [of food] as well.”

Zakaria encouraged pharmacists to use patient interactions to “plant some seeds” about nutrition, tying advice to each patient’s broader health goals. For instance, the Mediterranean diet can reduce cardiovascular risk and improve metabolic and inflammatory markers. Drawing from the PREDIMED study, she cited a 30% risk reduction in cardiovascular disease⁴ and emphasized the role of phytonutrients, polyphenols, and the cultural aspects of food.

“There’s something to be said about how we eat and how it affects how we view our food, and it might be part of why the Mediterranean diet is so effective.”¹

Addressing Nutrient Depletion, Drug Interactions, and Gut Health

Zakaria highlighted the importance of macronutrients, micronutrients, and phytonutrients—natural compounds found in foods that influence microbiome function and gene expression. Most people, she noted, are deficient in several key minerals, especially potassium. She also added that there has been an overwhelming number of conflicting headlines about macronutrients, leaving patients confused about whether to consume carbohydrates and fats.¹

Biological and external factors also influence nutritional status. Chronic disease, strenuous physical activity, genetic variations, and environmental exposures all affect nutrient absorption and metabolism. Drug-induced nutrient depletions (DIND), however, are a key concern. Many medications can directly or indirectly impair how the body absorbs or utilizes nutrients. Patients often report symptoms to their physician and start a medication, which eventually leads to different symptoms as a result of depletion. Introducing DIND and nutrition earlier in that conversation can stop this cascade.¹

She also described the stages of nutritional deficiency, noting the importance of early detection before permanent damage occurs. Common drug culprits include proton pump inhibitors, statins, metformin, estrogens, angiotensin-converting enzyme inhibitors, and even caffeine and alcohol.¹

“What we want to do is try to catch those deficiencies as early as possible, before they get to the point where they impair metabolism or cause damage.”¹

Zakaria concluded with some simple food-as-medicine interventions that support gut health and immune function, noting that addressing nutritional issues does not have to be overwhelming for patients. Ingredients like ginger, fennel, turmeric, aloe vera, and epigallocatechin gallate (found in green tea) were highlighted for their anti-inflammatory and digestive benefits and can be easy to incorporate into patients’ diets.¹

With pharmaconutrition, Zakaria hopes to lead a movement that empowers pharmacists to guide patients toward better health, 1 conversation at a time.¹

Starting With the Foundations: Practical Steps for Patient Engagement

To put pharmaconutrition into practice, Zakaria advised pharmacists to start with foundational strategies. The Mediterranean diet can be an accessible and enjoyable starting point—it’s familiar to many patients, doesn’t require excessive counting or measuring, and is widely supported by evidence.¹

Simple lifestyle modifications can also go a long way. Zakaria recommended encouraging patients to take a 20-minute walk after dinner, incorporate movement throughout the day, and engage in basic exercise. Assessing sleep quality and ruling out sleep apnea is another key step in supporting overall health.¹

Finally, pharmacists should guide patients in reducing alcohol and caffeine consumption and support tobacco cessation. These basic yet powerful changes, she emphasized, can have significant ripple effects on patient outcomes and well-being.¹

REFERENCES

1. Zakaria L. The Nutrition Games: A Tribute to Nutrient and Medication Collaboration. Presented at: McKesson IdeaShare 2025. Nashville, TN; July 10, 2025.

2. Visaria A, Setoguchi S. Body mass index and all-cause mortality in a 21st century US population: a national health interview survey analysis. PLoS One. 2023;18(7):e0287218. doi:10.1371/journal.pone.0287218

3. Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. Ultra-processed foods and health outcomes: a narrative review. Nutrients. 2020;12(7):1955. doi:10.3390/nu12071955

4. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378:e34. doi:10.1056/NEJMoa1800389