In a season where diets are often veiled under shield of the "wellness" pretense, the idea of food as medicine is also in the spotlight - although it's been around for quite some time.
"Let food be thy medicine." -Hippocrates
Let's start with this quote. First of all, Hippocrates was probably misquoted. And second, it's okay to let food just be food.
And a third side note - even if Hippocrates said this, he lived in a time where bleeding was still considered a legitimate medical treatment. I'd take food over bloodletting any day, too.
BEFORE WE GET STARTED
This post is about the use of food to "cure" things that are actually just human - like bloating and gas and aging. I am not referring to the medical necessity to eliminate certain foods or eat in a certain way. If that's you, please know that your body is still worthy of care and there is healing for you. Here's a fabulous post about that if you're looking.
As with any conversation, there is a TON of nuance here - because if you’re in the midst of recovering from restrictive eating, food is your medicine because likely a lot of your symptoms are related to inadequate energy. Nuance matters. Here, I’m speaking specifically to the use of food to “cure” certain medical conditions or elevating food on a pedestal.
FOOD IS NOT MEDICINE
Viewing food as medicine elevates it to an unattainable pedestal and creates an unhealthy halo around certain foods. Once we label food as medicine, the next question is "what foods", which then stands to follow - what foods are not medicine? And once those are identified, we demonize them because they are viewed as antihealth and to be avoided at all costs. This works against the outcomes of food habituation studies, which show that the more free access we grant ourselves to a food, the less energy we consume from it over time. When we give ourselves unconditional permission to eat all foods that are available to us, balance finds us.
There are some exceptions to this - for conditions like food allergies and Celiac disease, avoidance of allergens/gluten is medically necessary and the only real treatment. As my girl Lauren says, "It is a privilege to be able to eat all of the foods" and if you live with an allergy or intolerance, know that this space is for you, and intuitive eating is still for you.
We need to stop giving food so much power, and that goes along with not using it as medicine. Food can be a lot of things - enjoyable, comforting, nourishing, etc. It's part of family gatherings, traditions, holidays, and everyday life. So to treat food as medication is to completely disregard all of the ways in which food can support us outside of what's on the nutrition facts label. It also creates very black-and-white thinking around what we eat, and draws a much stronger connection between nutrition and disease than what's likely reasonable.
FOOD AS MEDICINE PERPETUATES PATIENT BLAME
Because we can mostly pick and choose what we eat, how much we eat, etc (although our bodies send us cues, cravings, hunger, and fullness and the best nutrition stems from acknowledging and working with those), conditions that have relationships with nutrition can be falsely seen as completely controllable or preventable through food. This dangerous conclusion means that those with chronic conditions like type 2 diabetes or heart disease are often blamed for their condition, along with their weight.
This is a problem for two reasons: while there is a correlation between certain diseases and a higher weight, there is no evidence of causation and there's multiple schools of thought that weight gain may be an early symptom of these conditions or that there's a mediating third factor, like inflammation, playing into both. Also, when blame is falsely placed on a patient for their weight or disease, the recommendation for weight loss overshadows and precedes all other interventions. This serves the patient in no way, because not only do we know that 97% of dieters will regain the weight (plus some) in about three years, but conditions affecting metabolism like PCOS and type 2 diabetes mean that even initial weight loss (pre-inevitable regain) is unlikely. And that's okay, because there's a lot of things we can help patients with to improve their health! But telling a patient to try harder is shaming, and shame is not a motivator. "Try harder" is not good medicine. Medicine is good medicine.
FOOD IS A TOOL
I realize that this entire post sounds like I'm undermining my chosen profession, so I want to dig into that and assure you that I am not. Nutrition principles and medical nutrition therapy are tools that can be used to support and guide everyday self care, as well as care plans for medical conditions. The interprofessional team's diversity parallels how body systems work together. So just like not one professional is responsible for the plan of care and all interventions, one aspect of health should not be considered responsible for the management of disease.
There are conditions that have a closer relationship to nutrition than others, because of the nature of what systems are impaired or affected by the disease process. I keep referring to type 2 diabetes because the stigma surrounding it is so loud, but this is true of so many other conditions, too. With type 2 diabetes, the metabolism of carbohydrates is affected and there are several ways to approach eating that we can guide balance and promote insulin sensitivity. But if we villainize carbohydrates, that becomes an unsustainable and restrictive diet that our bodies will rebel against in order to get adequate amounts of the macronutrient we need the relative most of, that provides the preferred fuel for our brain.
To treat food as medicine in this and many instances means that if patients find this restriction to be unsustainable (likely), not only do they get blamed for their condition, they get blamed for its progression and stigma is created around the use of pharmaceuticals that were invented specifically for the purpose of helping manage the condition.
It's okay to let food just be food. Try new stuff. Eat food you like. Let your nutrition be gentle.