The concept of using food as medicine is certainly nothing new. You’ve probably heard the saying, “Let food be your medicine.” This is often attributed to the ancient Greek writer and physician Hippocrates. Although this statement did not actually appear in his written texts, he believed that food and nutrition played key roles in health and medicine.
And now, 25 centuries later, the Food as Medicine movement is gaining strength as the organizing principle of medicine. While I think the movement is well-intentioned, I want to abandon the idea that food is medicine.
Pushing food back as medicine
As I’m sure you know, noncommunicable diseases such as cancer, heart disease, Type 2 diabetes and obesity account for a large portion of the medical burden on our society. These diseases are often called “lifestyle diseases” and it is a term I hate. It’s as if suffering from these diseases is simply a result of not being able to make better choices, or as if a healthy lifestyle is equally available to everyone.
(By the way, I’ve noticed that most proponents of “lifestyle medicine” tend to lead a very relaxed lifestyle, with a refrigerator full of healthy foods, a kitchen to prepare them, time to shop, cook, meditate, and time to go out and go to the gym There is a warranty, but I digress.)
Relationship between diet quality and disease risk
It is true that poor diet and nutrition are associated with an increased risk of many of our most common diseases. So it’s understandable that a better diet could prevent and even treat these conditions.
However, our current healthcare system is not geared towards improving nutritional quality. There is also not much focus on disease prevention. Most insurance companies will pay for medications and hospitalizations, but not salad bars. This seems decidedly short-sighted. Think of how cost-effective (not to mention, humane) it would be to cover the cost of a healthy diet instead of the cost of medications, surgeries, and medical devices!
But for better or worse, we in the United States endure a for-profit medical system. If we want to change the system we will have to show receipts. Theoretically, if we could show that prescribing reduces the burden of disease, we could persuade insurers to pay upfront.
Unfortunately, pilot production recipe programs (let’s say 3x faster!) have sort of failed to bear fruit. Not that you would know from press releases.
Problem of producing recipe programs
One in early 2023 Review of 9 BOM programs It was billed as the “largest evaluation of product prescriptions and health outcomes to date, increasing statistical power to detect effects on dietary intake, health outcomes, and other clinically relevant endpoints.”
Unfortunately, the validity of the detected effects is questionable. First, there was no control group, so it is impossible to attribute the improvements to the product prescriptions as opposed to other factors. And the observed improvements were only significant in certain subgroups of the population that had the worst scores to begin with.
When you measure things in a large population, outliers will always tend to move towards the mean over time. This effect is known as “regression to the mean” and may fully explain the modest improvements detected in this analysis.
How do you clean your products? Bloggers recommend everything from bleach to baking soda. Food safety experts insist that all you need is tap water. What’s the best way to kill germs in fresh produce? Monica shares her opinion in the next episode; Listen below.
A “Gold Standard” randomized trial and its surprising results
A much better study was published just last month. This was a randomized controlled trial (“gold standard”). 500 patients were included in the study They had type 2 diabetes and randomly divided them into two groups. The control group was placed on the waiting list. Meanwhile, the intervention group was not only given written prescriptions for fruits and vegetables. Participants were provided with ten healthy meals per week (enough for the entire family) for one year.
If any study was to document the impact of improved nutrition on diabetes management, this should be it. And people in the intervention group showed improved glycemic control at the end of the study. But so did people in the control group. Much to the researchers’ surprise, there was no statistical difference between the prescription and non-prescription groups.
Food as medicine and policy change
This doesn’t mean that people who eat healthy food don’t benefit. Or that increasing access to (and demand for) healthy food is a bad idea. But if we’re billing food as medicine and hoping insurers will pay for it, we need to be able to demonstrate its medical benefits.
I’ve written before about our tendency to overestimate the impact of diet and nutrition on health and disease. Prudent nutrition and lifestyle choices can reduce our risk of disease. But not to zero. Even if you do everything “right,” you may end up with Type 2 diabetes, cancer, or heart disease. This is because there are so many other factors at play; including several factors over which we really have no control, such as our age, gender, environment, genetics, and the simple luck of biological attractiveness.
In my opinion, prescribing products is a ruse that confuses health policy with food policy. In a wealthy country like ours, we must follow food policies that will bring healthy food to wider masses. However, irrigating areas called food deserts with produce stalls is not enough.
Education and nutritional diversity
We also need to educate people about both the benefits and pleasures (as well as practicalities) of nutritious diets. And all this needs to be done in an atmosphere of respect and participation. The Mediterranean diet isn’t the only game in town. You can also easily create a healthy diet with traditional foods from Africa, Asia, South America, Scandinavia, Eastern Europe or Indigenous cultures.
If we can increase access to and appreciation of healthy food options across all segments of society, medical expenses may well decrease as well. But even if it wasn’t, I still think it would be worth doing. Because food is not medicine. Food is food. And its purpose is not to reduce medical expenses. Its purpose is to provide nourishment, enjoyment, and promote 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, heart disease, and cancer. People will still need medical care. And our ability to diagnose, treat and cure disease is truly miraculous.
Conclusion: Food is food, medicine is medicine
Let us not diminish the need or power of real medicine by combining food and nutrition. And let’s not judge foods solely by their impact on disease risk.
Food is food. Medicine is medicine. We need both.