The dark side of the food as medicine movement

Who gets to eat their way to health?

On lonely runs in summer 2020, I laced up my Asics, pounded my feet against the Bay Area pavement, and bopped along to health podcasts – mindbodygreen, Rich Roll, the usuals. Nodding along in agreement, I figured if the messaging was about the power of food to prevent and treat diseases, what was there to contest? Mainstream works like The Omnivore’s Dilemma and What The Health had earned spots in my personal belief system, in which I accepted “food as medicine” at face value. 

Food is a lot of things. Food is love, food is culture, food is memories. Food is identity, food is comfort, food is nourishment. And food is medicine…sometimes. Ever since my initial indoctrination, I’ve engaged with alternate perspectives on health and how we frame it. When I scroll through podcast titles and articles about eating to age backwards and timing your meals to optimize metabolism, I can’t help but feel a little annoyed. They say food is medicine, but for who? They say “eat this to live longer,” but who has access to the care and food they need to live longer? 

The title of this essay may imply that I’m about to ruthlessly go off with my limited credentials, but that’s not my intention. We’re spicy but civilized in this club. It’s no secret that food is integral to health and even if there are problems with the food as medicine movement, it has pushed forward some noteworthy developments, like medically tailored meals, produce prescriptions, and health insurance coverage to include these initiatives. This essay may be critical of some aspects of the movement, but not of the fact that food can and should be part of healthcare. 

What is the food as medicine movement?

“Let food be thy medicine and medicine be thy food.” - Hippocrates 

Although we have no evidence that Hippocrates made this statement, his so-called quote became a cornerstone of the food as medicine movement. What we do know is that Hippocrates and other ancient scholars considered dietetics in their medical practices a whole lot more than the modern American healthcare system, in which future physicians are not adequately trained in nutrition even though food is one of the top influences on human health. Instead, the healthcare system marginalized nutrition and allowed the consumer goods industry to take over in some respects; marketing not only makes consumers pay more attention to nutrition, but also to products that make miraculous promises. It seems like some functional medicine approaches to nutrition market themselves in a similar way, but we’ll get to that later. 

The NYC Food Policy Center’s guide summarizes how cultures from China, India, Latin America, the Mediterranean, and more have embedded food in their medical approaches as early as 300 BCE. For ancient cultures, relying on food as treatment was necessary, as they didn’t have the technologies we have today. Modern medicine is catching up and building on our ancestors’ practices – sometimes in honorable ways, sometimes in questionable ways. 

On MedicalNewsToday, “food as medicine” is described:

There is no single definition of the “food as medicine” concept, but it generally refers to prioritizing food and diet in an individual’s health plan, with the goal of either preventing, reducing symptoms of, or reversing a disease state…Foods that proponents claim have medicinal properties — sometimes referred to as functional foods — are of particular interest by people who consider food as medicine.

The problems with food as medicine

Is food only medicine for some people?

One of the appeals of the food as medicine movement is its potential to reduce healthcare costs and health disparities. Diet-related diseases occupy a significant proportion of annual medical costs, with daunting numbers catapulting to billions per year. People from low-income backgrounds tend to experience higher rates of diet-related disease, which is why addressing their needs with something as basic as food may be more accessible and healthier in the long-term. However, even health professionals who acknowledge the system’s role in perpetuating diet-related health conditions may proceed to teach people to choose “better” foods and exercise more. Time and time again, community health research in low-income communities has shown that people know that already. There are barriers to nutritious food besides education and individual choices. 

Say a food insecure individual is encouraged to eat more fresh produce and home-cooked meals, despite struggling to afford food and find time to cook in the first place. Perhaps the Mediterranean Diet is sprinkled somewhere in the doctor’s recommendations, because we know how some health professionals loooove to continue drawing attention to a diet backed by a huge body of research, thereby neglecting other ways of eating that patients may more closely identify with. The inaccessibility of some food as medicine approaches draws attention to the need to bridge health equity and food justice. Knowledge of nutrition at a biological level is not enough – providers need to be just as well-versed on the ecology and politics of food, or at the very least, the resources available to the populations they serve. 

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When food meets functional medicine 

Los Angeles has no shortage of functional medicine practitioners and NextHealths, led by perfect people trying to help you be perfect too! How kind! In these circles, food is not medicine as much as it is exclusivity disguised as accessible wellness. 

This is the point that initially inspired this essay, as I engaged with some forms of media that seemed harmless at first glance, yet proved to be complicated upon further consideration. There is nothing wrong with learning more about foods that support brain health or foods associated with longevity. It’s not inherently a bad thing that this information is available to whoever wants it, but it is problematic when the media or health professionals promote a particular lifestyle without similarly advocating for systemic changes to make that lifestyle attainable. 

Functional medicine proponents spew out information that can be difficult to grasp, requires time and energy to implement, and doesn’t exactly fly with balling on a budget. I’ve listened to quite a few of these podcasts because I’m genuinely fascinated by some aspects of functional medicine, but recently, I’ve been exhausted from seeing the same titles over and over again, claiming to be presenting cutting-edge ideas. Cut to an ad about some superfood mix to add to a morning smoothie and it makes me wonder if functional medicine is primarily medicine for the elite, helping the rich live longer. The Institute of Functional Medicine recognizes that its patients and clinicians are not diverse, but does not provide a promising plan to increase access.

While functional medicine approaches may benefit patients with a variety of health conditions, there are issues with how it is portrayed in the media and wellness industry, both of which are guilty of perpetuating misinformation. The documentary What the Health made sweeping statements that turned out to be supported by cherry-picked studies backing the filmmakers’ views. Brands like Goop exploit traditional alternative medicine systems and promise wellness miracles, assuming you can pay for them. The rise of functional nutrition coincides with the rise of interest in supplements, nutrient timing, and other factors that you can optimize for the individual. This further invokes the individual responsibility narrative without drawing a similar degree of attention to systemic change in the food system. 

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Stigmatization of disease and medications  

There are dangers in convincing people that they can heal anything with food, as medicine and technology have advanced to the extent they have for a reason! Food can be medicine without replacing medicine, but some of the phrasing in the food as medicine movement stigmatizes diseases and the use of medications to treat diseases. 

For example, one guide to functional medicine by a very popular doctor states, “Sadly, many of us are toxic waste dumps.” The guide continues to talk about “wrong food” vs. “right food.” It equates the “right food” to magic: autoimmune diseases “disappear” and depression “vanishes.” Like yes, I agree that food can be magical, but not like that! Messaging like this may make people feel like they aren’t working hard enough if a food as medicine approach isn’t working out for them or if they have to continue taking medications.  

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The gap between food as medicine and food production 

The food as medicine movement seems to emphasize the nutrients provided by food, but there is a gap between this calculative approach to eating and food production. Daphne Miller, M.D. is a physician venturing beyond the concept of “food as medicine” by studying how farming impacts our health. In her book Farmacology, as described in The Guardian:

Miller shares lessons learned from inspiring farmers and biomedical researchers and artfully weaves their insights and discoveries, along with stories from her patients, into the narrative. The result is a compelling new vision for sustainable healing and a treasure trove of farm-to-body lessons that have immense value in our daily lives.

Bridging the divide between agriculture and medicine may be beneficial for the food as medicine movement, which tends to quantify nutrients without fostering connections with the natural systems responsible for these nutrients. If the food as medicine movement did a better job of acknowledging the importance of planetary health, it could help develop initiatives that increase access to produce. However, to be effective, these efforts must confront the historical exclusivity of farm-to-table ideals. 

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Implementation 

In a podcast episode by yet another renowned functional medicine doctor, the doctor excitedly recounted how “300 African Americans showed up to drink kale smoothies” at his class in Ohio. Let’s just say there are better ways to phrase that. This example illustrates the cultural barriers that come up when implementing food as medicine approaches. In Daphne Miller’s article for the Washington Post, there is a section highlighting the importance of taste:

“Health-care providers also face a challenge of identifying which vendors offer food that appeals to the taste buds — and the soul. ‘None of these food interventions work if the people don’t want to eat the food,’ said Seth Berkowitz, a researcher who led some food is medicine pilot studies…He described food as offering gastronomic pleasure, cultural connection and family memories.”

Food is culture and comfort and so many other things, which is important to remember before we shout “food is medicine” from the mountaintops. Our foodways are layered and complex, so food will never be as simple as prescribing a pill.

What’s next 

This is a topic I’m continuing to explore and learn about, so writing this felt like a big brain dump. I hope it was somewhat coherent! Here are a few sources that talk a bit about where we’re headed. 

In “A Food is Medicine approach to achieve nutrition security and improve health,” the authors present a food as medicine pyramid, with the top of the pyramid including intensive nutrition-based treatments for complex illnesses and the bottom of the pyramid focusing on population-wide nutrition policies and programs. As for how to make food as medicine efforts affordable:

“...governments and private healthcare systems need to assess and understand the landscape of actors in this space; develop and apply screening and tracking tools to assess food and nutrition security and success of interventions; and employ, evaluate and scale improvements across each level of the Food is Medicine pyramid. It is time for these innovations to be adapted and extended to multiple diverse populations to increase access to nourishing foods across the lifespan and support nutrition security, health equity and wellness.”

In

Alicia Kennedy

's piece On ‘Good’ Food about the moralization of consumption, she brings up questions that I think are relevant here as well: 

“Can we talk about food justice without incorporating diet culture tropes? Can we talk about industrial agriculture practices in a way that prioritizes planet and worker without suggesting anyone is “bad” for how they eat? It’s a consistent refrain that local food is inaccessible—ok, now what? How do we make it so farmers and communities are connected? Who’s getting in the way of those connections?”

In

Laura Thomas

' third installment of her ultra-processed food series (highly recommend the whole series btw), she questions who gets to reimagine the food system. She contests the way elites in food may demonize ultra-processed foods: 

“When our communities and communal ways of caring for one another - through distributing the labour of growing, preparing, and cooking food - have been decimated, what choice do we have but to turn to ultra-processed foods as a means of survival?”

I also answered some questions for her essay, specifically about reforming the system without villifying foods that people depend on! 

“I think recognising the problems with the individual responsibility narrative is a great place to start. People working on food system reform must recognise that so much energy and resources are devoted to changing the individual and moralising individual actions, but it’s the system that is in shambles and needs attention.”

mini spice rack 

writing 

As I mentioned above, I answered some questions for Laura’s ultra-processed foods series! The piece is linked here. 

eating

The best thing I did this week was take an uncooked roti from one of those Indian grocery store packs, stuff it with spices and leftover dry flaxseed chutney, and fold it up like a lachha paratha. Flaky paratha in minutes! No kneading required!

Also pani puri (best evening snack), mushroom fried rice, and this thayir sadam – it’s curd rice flavored with a quick tadka of mustard seeds, chana dal, toor dal, chilis, and curry leaves. I used cashew yogurt, cabbage, cucumber, carrots, cashews, and raisins. 

reading/listening 

Enjoying Slow Days, Fast Company by Eve Babitz. And I have nine Lana albums to catch up on for all those years I spent ignoring her music. This reading/listening combination makes me feel very immersed in LA, which is great because I only have a couple months left to explore this sprawling city!