Tulsa Researcher Receives Federal Grant to Study Food as Medicine Intervention for People With HIV

In the healthcare profession, food is increasingly seen as medicine – a healthy diet can lessen the severity of disease and prevent additional chronic conditions from complicating a person’s health. A new federal grant awarded to the University of Oklahoma Health Sciences Center will be used to study how food can best be used to improve the health of Oklahomans living with HIV.

Studying the effects of healthy diets in people with HIV is important for many reasons, said Marianna Wetherill, Ph.D., who is leading the grant for the OU Health Sciences Center on its Tulsa campus. About 21% of people with HIV may have insulin resistance, which contributes to numerous chronic conditions, including diabetes, renal insufficiency and liver disease; the prevalence is even higher among those with limited financial resources. In addition, some of the antiretroviral medications taken by people with HIV are associated with insulin resistance, she said. Another factor is that anywhere from 24% to 50% of people with HIV are considered food insecure, meaning they don’t have reliable access to affordable, nutritious food. long before you see elevations in blood glucose. That’s why we’re focusing on insulin resistance for this study – so that we can identify food as medicine strategies for intervening sooner. But the intervention we ultimately develop will benefit people regardless of where they are on that spectrum, from showing initial signs of insulin resistance to having Type 2 diabetes or other related conditions.”

“There are many behavioral risk factors for insulin resistance, and we suspect that food insecurity will directly and indirectly influence these risk factors,” Wetherill said. “We’re taking the most holistic approach that we can, knowing that this is a food as medicine study, but if we need to provide wraparound services too, that will be part of our NOURISH-OK intervention.”

The study is being funded by a $2.4 million grant from the National Institutes of Health. The program created by the grant is called NOURISH-OK – Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in Oklahoma. It is an example of community-based participatory research, meaning it is heavily driven by a community partner, in this case Tulsa CARES. For 30 years, the agency has delivered social services to people affected by HIV/AIDS and created opportunities for healthy living. The comprehensive approach addresses unmet needs under one roof, including care coordination, housing, mental health and nutrition.

Licensed clinical social worker Casey Bakhsh, director of programs for Tulsa CARES, is leading the study for the agency, which has long-term relationships and strong rapport with its clients. Over the past three decades, medication has vastly improved for people living with HIV to the point that they can expect to live just as long as anyone without the condition, Bakhsh said. However, those advancements have come with a caveat, which the NOURISH-OK study is also addressing.

“When HIV was a major epidemic in the 1980s and 1990s, we were encouraging people to eat a high-calorie, high-fat diet because they were dying from HIV wasting,” Bakhsh said. “The message was, ‘You don’t need to lose weight and, ideally, we want you to be overweight so that if you get sicker, you’ll have some reserve.’ We addressed the issues we had at the time because we didn’t realize that people were going to age. So we unknowingly promoted an unhealthy diet that is leading to other chronic conditions, and that messaging has remained ingrained in the HIV community.”

The NOURISH-OK study will begin with data collection – surveying HIV-positive clients from Tulsa CARES and other agencies in northeastern Oklahoma. The information gathered will be robust: Participants will be interviewed about their food security status and their diet, as well as other factors that may affect insulin resistance, including adverse childhood experiences, tobacco use, stress and sleep quality. Other objective measures will include body composition to measure body fat, lean muscle mass and hydration, as well as blood work to measure chronic inflammation. A metric called the Dietary Inflammatory Index, which has been shown to predict insulin resistance, will be used to create a dietary score for each person. The study also will analyze samples from participants’ gut microbiome, where bacteria changes shed light on the connection between food and insulin resistance.

Rather than telling participants to follow an anti-inflammatory diet, the research team will use its findings to customize intervention foods with the specific goal of lowering (improving) the study population’s Dietary Inflammatory Index score. Then, boxes of food will be delivered to study participants, who will also learn skills about how to cook the foods in a way they enjoy and will be sustainable over time. Researchers will evaluate the effectiveness of the intervention by assessing participants to determine whether changes in food security and diet can be linked to shifts in microbiome, inflammatory markers and insulin resistance. Tulsa CARES will also play an important role in sustaining the food intervention through its in-house food pantry and farmer’s markets that serve hundreds of people each year.

“This is an innovative opportunity for us because we’ll not only be contributing to the data about food for people with HIV, but we’ll be able to stock those foods in our pantry after the study is over,” Bakhsh said. “Whether our clients come to us on a long-term basis or for emergency food assistance, we will have confidence that the food has health benefits.” Food as medicine is a growing part of the educational programs and health services at the OU-Tulsa campus. Wetherill, who is also a registered and licensed dietitian, co-leads the Culinary Medicine Program in which medical and physician assistant students learn the importance of good nutrition, both for themselves and the patients they will treat. Because of the interdisciplinary nature of her work, Wetherill holds faculty appointments in the OU-TU School of Community Medicine, the OU Hudson College of Public Health, the OU College of Allied Health, and the OU School of Social Work. Bakhsh, who earned her social work degree from OU, also serves as a field instructor for social work students.

“OU and Tulsa CARES already had a strong relationship, and we’re excited to work together on a project that will benefit the HIV community,” Wetherill said. “Because healthy food is often perceived as being more expensive than less-nutritious food, those who are marginalized in society are often excluded from the concept of food as medicine. This grant is about changing that.”