by The notion of food as medicine is certainly nothing new. You’ve probably heard the saying “Take food as medicine.” This is usually credited to the ancient Greek writer and physician Hippocrates. Although this phrase does not actually appear in his written texts, he believed that food and nutrition play key roles in health and healing.
And now, 25 centuries later, the Food as Medicine movement is gaining steam as an organizing principle of medicine. While I think the movement is well-intentioned, I want to push back against the idea that food is medicine.
Pushing back on food as medicine
As I know you know, non-communicable diseases such as cancer, heart disease, Type 2 diabetes and obesity account for a huge share of our society’s medical burden. These diseases are often referred to as “lifestyle diseases,” a term I hate. As if suffering from these diseases is simply a failure to make better choices, or if a healthy lifestyle is equally available to all.
(Like anything else, I’ve noticed that most people who advocate “lifestyle medicine” lead very comfortable lifestyles, with a fridge full of healthy food, a kitchen to prepare it, time to shopping, cooking, meditating and going to the gym all guaranteed, but I digress.)
Correlation between diet quality and disease risk
It is true that poor diet and nutrition are correlated with an increased risk of many of our most common diseases. So the idea that a better diet could prevent or even treat these conditions is understandable.
But our current health care system is not focused on improving diet quality. And, for that reason, it’s not really aimed at preventing disease. Most insurers will pay for drugs and hospitalization but not for salad bars. Which certainly seems short-sighted. Imagine how cost-effective (not to mention, humane) it would be to underwrite the costs of a healthy diet rather than the costs of drugs, surgeries and medical devices!
But, for better or worse, we live here in the US a for-profit medical system. If we want to change the system, we will have to show the receipts. In theory, if we could demonstrate that prescribing products reduces the burden of disease, we could convince insurers to stop.
Unfortunately, pilot programs to produce prescriptions (say they are 3 times fast!) failed to bear fruit, as it were. Not that you would know if from the press releases.
The issue of producing prescription programs
In early 2023, a study to produce 9 recipe programs billed as “the largest evaluation of product prescription and health outcomes to date, increasing the statistical power to detect effects on dietary intake, health outcomes, and other clinically relevant endpoints.”
Unfortunately, the perceived effects were of questionable validity. For one thing, there was no control group, so it is impossible to attribute the improvements to the product recipes, as opposed to other factors. And the improvements observed were only significant in certain subgroups of the population that had the worst values at baseline.
Whenever you’re measuring things in a large population, outliers tend to move toward the mean over time. This effect is called “regression to the mean” and may fully account for the small improvements found in this analysis.
How do you clean your product? Bloggers recommend everything from bleach to baking soda. Food safety experts argue that tap water is all you need. What is the best way to kill germs on fresh produce? Monica shares her part in the following episode; listen below.
A “Gold Standard” randomized trial with amazing results
Just last month, a much better study was published. This was a randomized controlled trial (the “gold standard”). The IS study enrolled 500 patients suffering from Type 2 diabetes and were randomized into two groups. The control group was placed on a waiting list. Meanwhile, the intervention group was not only given written recipes for fruit and vegetables. Ten healthy meals per week were provided to participants – many for their entire family – for an entire year.
If any study should be able to document the impact of an improved diet on diabetes management, it should be this one. And people in the intervention group showed improved glycemic control at the end of the study. But the people in the control group did. Much to the researchers’ surprise, there was no statistical difference between the groups that did and did not receive the product prescriptions.
Food as medicine & policy change
That’s not to say that the people who got the healthy food didn’t benefit. Or that increasing access to (and demand for) healthy food is a bad idea. But if we are billing food as medicine, and expect to get insurers to pay for it, we need to be able to demonstrate medical benefits.
I have written before about our tendency to exaggerate the influence of diet and nutrition on health and disease. Smart diet and lifestyle choices can reduce our risk of disease. But not to zero. You can do everything “right” and still end up with Type 2 diabetes or cancer or heart disease. This is because there are so many other factors at play – including many that we really have no control over, such as our age, sex, environment, genetics, and the We just get lucky in the biological pull.
To me, it’s a gimmick to write prescriptions for products that confuse health care policy with food policy. In a nation as rich as ours, we should be fully pursuing food policies that make healthy food more accessible. However, simply watering the so-called food deserts with produce stands is not enough.
Education and dietary diversity
We also need to educate people about the benefits and pleasures (as well as the practicalities) of nutritious diets. And all this must be done in an atmosphere of respect and inclusion. The Mediterranean diet isn’t the only game in town. You can create a healthy diet just as easily with traditional foods from Africa, Asia, South America, Scandinavia, Eastern Europe or Indigenous cultures.
If we could increase access to and respect for healthy food choices – across all levels of society, it could reduce medical spending. But even if it wasn’t, I still think it was worth doing. Because food is not medicine. Food is food. And its purpose is not to reduce medical expenditure. Its purpose is to provide nourishment and enjoyment and to foster healthy bodies and communities.
Even if I could wave my magic wand and everyone magically ate 5 servings of vegetables every day, people would still be diagnosed with Type 2 diabetes and heart disease and cancer. People would still need medical care. And our ability to diagnose, treat and cure disease is truly a miracle.
Conclusion: Food is food, medicine is medicine
Let’s not diminish the need or power of actual healing by compromising it with food and nutrition. And let’s not judge food by its impact on disease risk alone.
Food is food. Medicine is medicine. We need both.
