Some Minnesota medical providers are writing new kinds of prescriptions for patients battling chronic health conditions such as heart disease and diabetes.

In an innovative twist, the state's largest food bank, Second Harvest Heartland, is filling them.

Medical staff at seven clinics are prescribing healthy food, and Second Harvest is handing needy patients boxes full of groceries and complimentary recipes at their clinic visits.

Second Harvest's FoodRx program, launched in 2016 in Minnesota, is helping low-income people heed the doctor's advice to eat healthy.

"It's unique and it makes complete sense," said Oren Avery, senior clinic manager at the University of Minnesota Physicians Broadway Family Medicine Clinic in north Minneapolis, which is part of FoodRx. "We as medical professionals are assisting patients with heart conditions, hypertension and diabetes. Of course their health is dictated by the food they eat."

The FoodRx program has provided 500,000 meals to 3,000 patients in the past year. Most are on Medicaid and all have a chronic condition that can be improved through a better diet. The nonprofit is partnering with five healthcare systems, including Park Nicollet, North Memorial and Mayo Clinic, and studying the results.

It's a back-to-basics approach to health.

"It's food as medicine," said Second Harvest Heartland CEO Rob Zeaske.

Leaders at Second Harvest — one of several food banks across the country now filling food "prescriptions" — say the program addresses the realities of hunger in America. Poor people who can't afford healthy food eat what they can afford: inexpensive and often unhealthy alternatives that damage their health.

The food connection

Food insecurity and health are intricately linked, according to Feeding America, a national network of 200 nonprofit food banks.

Poor diet can increase a person's risk for developing health problems, according to a host of studies. And managing a chronic disease such as diabetes or hypertension becomes more challenging for people who can't afford foods or prescription medications.

Feeding America surveyed 60,000 individuals seeking food-shelf assistance and found that 79 percent of households reported purchasing inexpensive, unhealthy foods to feed their families, and more than half said they crave more access to fresh fruits and vegetables. About two-thirds of those surveyed reported choosing between paying for food and medicine or medical care in the prior year.

Dr. Diana Cutts, a pediatrician from Hennepin Healthcare, part of the FoodRx program, said the dilemmas poor families face are real and wrenching. She recalls re­admitting to the hospital a 3-year-old boy suffering from asthma.

"He had only been discharged four days before for asthma. To see him come back in and be in distress and need to be in the hospital was really disheartening," Cutts recalled.

She sat down with the boy's grandmother, who said she simply could not afford groceries and co-pays for the boy's five medications.

Jason Reed, Second Harvest's director of strategy and new ventures, said FoodRx started "with a very simple premise: You can't be healthy if you are hungry."

Food insecurity is a risk factor for developing diabetes and other chronic conditions, according to several studies.

In addition, doctors say they realize health care extends beyond the exam room. In one survey of 1,000 primary care physicians, 85 percent said patients' social needs are as important to address as their medical conditions, yet most reported they did not feel confident in their ability to meet those nonclinical needs.

"All of that together is why we launched FoodRx," Reed said.

Second Harvest has completed a yearlong clinical trial monitoring patients with diabetes who have received the FoodRx boxes. The first important finding is the food is being eaten.

"We found more than two-thirds had consumed all the contents of the box every month," Reed said.

The nonprofit is waiting on the study's results to be published in an academic journal, but the results are promising.

"The study shows FoodRx produced significant improvements in their health outcomes," Reed said.

Healthful alternatives

Lisa Hiltner was prescribed a food box for a year.

"I am overweight and diabetic. Diet is definitely a struggle every day," said Hiltner, 43, of Waite Park.

Staff at her medical clinic brought the food boxes out to her car after doctor's appointments.

"There were only a couple items we didn't use," she said. "They gave us recipes with the box and the box had almost everything you needed to complete the recipes."

She said the healthy food helped her keep her blood sugar levels steadier. She said the variety each month also made eating healthy more fun.

"It gave me options. There was something different and it was a better food choice," Hiltner said.

She especially liked the fresh fruit and vegetable voucher that came with her box.

"It was awesome to go get a bag of apples," Hiltner said.

Her biggest complaint was that the trial program ended. She said she would definitely participate in FoodRx again.

Each FoodRx box weighs about 30 pounds and contains seven to 10 days' worth of shelf-stable food, including boxed and canned foods. That's so the food will not spoil during storage at the clinic or in the homes of clients who lack access to refrigeration. Some participating clinics have provided grocery-store gift cards to supplement the boxes and offered to deliver them if patients struggle to carry the boxes home.

Boxes vary to accommodate Somali and Hispanic cultural preferences. The recipes help patients take the products, such as cans of tuna fish and black beans, and turn them into filling meals, said Kristen Williamson, a Second Harvest registered dietitian.

"One of my favorites is the black bean burger recipe," Williamson said. "It's really simple and can be prepared in a variety of different ways."

Recipients of the boxes pick up more skills in the kitchen as they learn healthy culinary alternatives.

"They have started cooking and making some of those behavior changes. That is encouraging to us," Williamson said. "People are looking forward to the boxes. We have had a lot of requests for the recipes."

Avery said the biggest challenge has been finding space to store the food at the Broadway clinic. But he said the patients' gratitude and enthusiasm have been overwhelming.

"Now, we are a resource for food that is new and different," he said "The patient response has been so positive."