Food Is Medicine. So Why Isn't BC's Health System Prescribing It?

Written by Clare Koning RN, PhD | April 2026

The evidence has arrived at a place many clinicians once considered implausible: type 2 diabetes can, in a meaningful proportion of patients, be reversed through diet.

Not managed. Not slowed. Reversed, with patients discontinuing medications, normalizing blood glucose, and sustaining those outcomes over time. This is now not a fringe claim. It is the position of Diabetes Canada's clinical guidelines, the American Diabetes Association, and a growing body of high-quality randomized controlled trial evidence.

Medical nutrition therapy has a key role in T2D management, with dietary strategies now shown to exert direct metabolic benefits independent of weight reduction. The Mediterranean diet consistently demonstrates metabolic and cardiovascular benefits along with improved glycemic control. Low-energy and ketogenic diets have shown benefits on glycemic control, insulin sensitivity, and other metabolic outcomes, often preceding substantial weight loss. Nature

Low-carbohydrate energy-restricted approaches have led to 35.7% of participants discontinuing all glucose-lowering medications at 12 weeks, a pharmacological impact achieved through food rather than drugs, with direct implications for medication costs, patient burden, and system spending. Springer

And yet, in most primary care settings in British Columbia, a person with a new T2D diagnosis is likely to receive a brief conversation about diet, a referral they may or may not be able to access, and a prescription.

The Gap Between Evidence and Practice Is a System Design Problem

This is not a story about uninformed clinicians. Most family physicians in BC understand that nutrition matters for metabolic health. The gap is structural: dietitians are under-prescribed and underfunded within primary care teams, sustained nutritional counselling is not a routine funded service, and the clinical infrastructure to deliver remission-oriented care at population scale simply does not exist in most of the province.

International treatment guidelines now support diabetes remission as a treatment option, with Diabetes Canada recommending a very-low-calorie diet of approximately 800–850 kcal per day using meal replacements for 3–5 months as a path to remission for selected patients with recent diagnosis and overweight or obesity, followed by structured food reintroduction and increased physical activity support. Diabetes Journals

The NHS in England has operationalized exactly this through its Type 2 Diabetes Path to Remission Program. BC has the clinical evidence, the community infrastructure, and the primary care investment to do the same. What it lacks is the system decision to treat therapeutic nutrition as a first-line clinical intervention rather than a lifestyle suggestion.

Cultural Responsiveness Is Not a Nice-To-Have

Any serious attempt to address T2D through dietary intervention in BC must grapple with the reality that standard dietary advice, designed for a generic Canadian population, fails many of the communities where diabetes burden is highest.

South Asian populations face substantially elevated T2D risk shaped by genetic factors, dietary patterns, and cultural contexts. Standard nutritional advice that does not integrate traditional South Asian foods, household cooking practices, or culturally meaningful frameworks for health does not simply underperform. It communicates, implicitly, that the health system was not designed with these communities in mind.

Community engagement work in BC has produced actionable insights for tailoring diabetes care strategies to South Asian communities, insights that could inform the design of culturally grounded nutritional interventions across the province. The opportunity is to embed those insights into how dietary counselling is designed and delivered, not to translate a generic brochure into Punjabi.

A Concrete Policy Window

BC's 2025–26 primary care investment exceeds $672 million, building on the $579 million committed in 2024–25, with an explicit focus on Primary Care Networks and community health center models that can integrate allied health services into team-based care. Government of British Columbia

This investment creates the infrastructure within which therapeutic nutrition could be formally positioned as a funded, structured component of T2D management, not a referral afterthought for those lucky enough to access a dietitian, but a standardized clinical pathway available to every British Columbian with a new or recent T2D diagnosis.

The return on that investment, in reduced medication costs, reduced complication rates, and fewer hospitalizations, would be measurable within five years. The evidence base to support the decision is already there. The question for health system leaders is whether the political and organizational will to act on it is, too.

IHSTS, through its strategic alliance with the Institute for Personalized Therapeutic Nutrition, is working to translate therapeutic nutrition evidence into clinical training and care model development across BC. Learn more at www.ihsts.ca.