Food is Not Medicine

rxI was at a party once and when a nice woman asked me what I did, I said I was a dietitian. She beamed and clasped her hands together and said, “Oh, that’s wonderful. Food is such medicine, isn’t it?”

I didn’t know how to respond at that moment. I was still recovering from years of restrictive eating, which had at one point taken the guise of “clean” eating, local eating, organic eating all for my “health” – when really I was just finding new ways to restrict for my weight. As I sautéed up a few stalks of chard in as little oil as possible, I would say things to myself like, “I’m gonna live forever!”

Obviously I cringe at that now. Why worry about living forever when the present is so miserable? That was my existence then – taking my medicine in the present in the hope of a longer future. I wasn’t happy then, so I was living as much in the future as possible.

But I couldn’t keep it up. Eating medicine is not as fun as eating food, and turning food into medicine is downright depressing. Food is food; it nourishes us, gives us energy, keeps us alive, and is necessary to our existence. Enjoyment of food is essential and here’s a great example of that: in a study from the 1970s, Thai and Swedish women were both given a traditional Thai meal1; the Thai women absorbed almost 50% more iron from the meal than the Swedish women, who were somewhat okay with the meal but felt it was too spicy. Then the traditional meals for both groups were pureed into mush and eaten. Guess what? Iron absorption for both groups decreased by 70% — even when eating their own traditional food. Why? Probably because for the most part, a pureed meal isn’t nearly as enjoyable as a non-pureed meal, especially if you’re not used to eating it that way. So, yes, enjoyment of your food is integral to good nutrition.

If you’re treating your food like medicine, holding your nose and shoving it in, or in a less extreme version, dutifully eating your “healthy” food but wishing you were having something else instead, you’re doing your body and your mind a disservice. The truth is, for most people, what you eat on a meal-by-meal basis is not as important as how you eat. Having a relaxed relationship to food, providing regular, reliable meals for yourself, allowing internal signals of hunger and fullness regulate your intake, and eating food you enjoy – otherwise known as eating competence  – actually helps you to be your healthiest self in respect to nutrition (I’ll explain more about eating competence in a future blog post). This is because people who approach eating this way tend to get the most variety in their diet, which ensures optimal nutrition.

Now, as a clinical dietitian, I do practice what is called medical nutrition therapy (MNT). There are certain disease conditions for which changing what you eat can help to manage that condition. But there is a big difference between disease management for people with disease vs. disease prevention for people with no disease. Eating low sodium your whole life will not necessarily stave off high blood pressure. Eating no carbs will not ensure you will never get diabetes. Many diseases have a genetic component, and eating a certain way does not guarantee that you will not get a disease. However, if someone is a competent eater, getting a variety of food reliably and enjoying their diet, this is the best disease prevention there is, since, as I linked to above, competent eaters have shown to be generally nutritionally (and socially and psychologically) healthier than non-competent eaters.

While diet can help manage conditions, it rarely cures them. Celiacs can strictly avoid gluten (which they must do) and live a very healthy life, but their condition is never cured by any particular food. People with hypertension can reduce dietary sodium to help manage their blood pressure, but there’s a whole host of other things they need to do too – exercise, manage stress, sometimes take actual medication. And you cannot cure cancer with food (I’m sorry, you just can’t). Food is important and will help keep someone with cancer alive because the body needs additional energy with a catabolic illness and while it receives actual medicine which really can cure. There is a reason we call this medical nutrition therapy and not medical nutrition medicine.

Unfortunately, I’ve seen food-as-medicine go wrong on too many occasions. One of my patients (a meat-eater) with MS was told by his doctor to go vegan to help manage his disease (for which there is some limited evidence). He did so, then gained 50 pounds and developed elevated off-the-charts triglycerides. He went back to his doctor who again said, “Go vegan!” to which he replied, “I already did!” After that, he switched to a different diet style he liked better that still managed to include lots of fresh vegetables, returned to his previous usual body weight, ended up with normalized lipids and generally felt pretty good. I’m not maligning vegan diets; it’s the diet-as-prescription mentality that can be the problem. A diet you don’t love is not good medicine. Too often, because of this food-prescription mentality, many of my patients think they can get good nutrition from a powdered supplement, and then develop all sorts of disordered eating habits to compensate for the actual food they are missing out on.

It’s true that many foods have medicinal properties. Cinnamon may help lower blood sugar in diabetics. Turmeric may have anti-inflammatory properties. Here’s the problem: will you start to sprinkle cinnamon on everything you eat even if it doesn’t taste good? I love turmeric – in a few dishes. A little goes a long way. But studies often show that in order to actually get enough of the medicinal properties of these foods, you usually have to have large quantities of it – more than you’d probably want to eat of anything in a day. Also, what we know about the synergistic properties of foods can so far fit in a thimble. Isolating compounds for their magic properties is reductive thinking at best. Food compounds interact with one another and we’re only just starting to understand this better now. Again, getting a varied diet will help you to get some of everything you need.

I know Hippocrates said, “Let food be thy medicine and medicine be thy food,” and back then that made sense when they didn’t have a lot of actual medicines. But now we’ve got another problem which is a world full of disordered eating, so maybe it’s time to back off this food-as-medicine idea for a while.

So food does not need to be medicine, especiallly in the absence of illness. Food just needs to be food – delicious, enjoyable, varied, reliable fuel for your body – because that’s how it serves us in the healthiest way possible.

1Hallberg L., Bjorn-Rasmussen E, Rossander L, Suwanik R. Iron absorption from Southest Asian diets. Am J Clin Nutr. 1977; 30:539-548.

 

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