Just when the connection between diet and health is getting the respect it deserves, there is a backlash surfacing about the food-as-medicine narrative, with some experts arguing there are downsides to seeing food as anything other than food. They're responding to the barrage of extreme "superfood" claims we find all around us, such as menus claiming lemon alkalizes the body or websites touting coconut oil as a treatment for osteoporosis. These outlandish statements make so much noise that they drown out the more nuanced messages about how diet truly affects well-being.
Hippocrates is reported to have said "Let food be thy medicine" more than 2,000 years ago, but for most of the past century, eating habits were given little more than a nod by the mainstream medical community. Dietary intervention in a doctor's office was mostly relegated to a sad handout listing foods to avoid tucked in with the drug prescriptions. From what I can tell, for much of the mid-to-late 20th century, eating with health in mind was generally considered a more fringe behavior, associated with hippies and the elderly, with little of the marketing allure it has today.
Now, the way we eat is widely recognized as critical to the prevention and management of many illnesses. The Center for Disease Control reports that up to 40 percent of deaths from chronic diseases such as heart disease and stroke, and some kinds of cancer, are preventable with lifestyle changes including diet. There is now a formally recognized, rapidly growing medical discipline called Lifestyle Medicine; a certification in culinary medicine available for clinicians through the Goldring Center at Tulane University; and programs such as the Fresh Food Farmacy at the Geisinger Shamokin Area Community Hospital in Pennsylvania, which focuses on food as a tool for managing diabetes. Eating for wellness has also moved beyond being merely socially acceptable to being outright hip and fashionable, with Beyoncé challenging her fans to go vegan and lines of millennials waiting to order salads and grain bowls at a fresh crop of healthy fast-casual restaurants.
"It's a movement whose time has come," says David Katz, past president of the American College of Lifestyle Medicine and author of "The Truth About Food." "If we think of medicine as something that can treat a serious condition then, yes, food is medicine." He listed several well-respected diet studies - the portfolio and DASH diets among them - that demonstrated that healthy food patterns can lower cholesterol, reduce blood pressure and decrease diabetes and heart disease as much, if not more effectively, as pharmaceuticals. "What we know about diet and health is so solid in the form of dietary patterns," said Katz. "But when we get to claims about individual foods, step away from your credit card and no one will get hurt."
That's where we hit the snag in the food-as-medicine concept. Overall dietary patterns are what matters for health, not any single ingredient or compound - but there is profit in misrepresenting that fact. "I see the push toward food as medicine as being a marketing push," says Marion Nestle, professor emerita of nutrition, food studies and public health at New York University and author, most recently, of "Unsavory Truth." "Marketers try to convince you that one food, one product, is going to make a difference, but that's not how it works."
Claims of the healing power of individual foods are rampant online, in the grocery store and beyond. I stepped into a smoothie shop recently that has a "Juice Farmacy" section on its menu board. It sells a drink called "Cough Syrup" that will set you back $7.45, and offers a selection of "Rx Shots" that run about $3 per ounce. Its signage asserts that specific ingredients in its smoothies have special healing characteristics, claiming, for example, that turmeric has "medicinal properties that help improve brain function," and that carrots provide "antibacterial properties that make for a powerful immune boost." Even if there is a seed of science behind these assertions, they run contrary to the medical movement to adopt a more holistic, long-view culinary approach to health. In fact, this type of marketing achieves the opposite, by bringing a reductionist, pill-popping, quick-fix mentality to food.
Approaching food as medicine in this way is not only probably a waste of money, it could be dangerous if people decide to consume turmeric tea or wheatgrass shots instead of their regular prescriptions. Robert Graham, an integrative medicine physician and chef in private practice in New York City sees this issue regularly. He recently had a patient who wanted to start drinking hibiscus tea instead of taking his prescribed blood pressure medication. Graham steered the patient away from the notion of a quick-fix tea cure to a gradual, integrated approach using the DASH diet and including hibiscus tea, with the goal of possibly reducing or eliminating the need for medication down the road.
Taking a pill-like view of eating also does a disservice to food as a whole. Beyond being a delivery system for nutrients, food is flavor, pleasure, connection and social interaction. Seeing, say, broccoli or ginger as purely medicinal detracts from the multifaceted delight these foods bring to the table. The taste of food is important to our well-being. It would be a loss to view food only as a "cure" you need a chaser to get down, like that "Rx Shot" at the smoothie shop.
While it is helpful and important to recognize the vital connection between food and health, the idea of food as medicine should be approached from a broad, longer-term perspective - it cannot be drilled down to any one particular ingredient or compound. Besides, food is so much more than medicine. As Nestle put it, "Food is one of life's greatest pleasures, and one you get to enjoy several times a day."
- - - Krieger is a registered dietitian, nutritionist and author who hosts public television's "Ellie's Real Good Food."
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