When "Food As Medicine" Isn't Always Helpful

I recently listened to a podcast (I'll share the link below) that really inspired me to write my own post on the topic. Throughout my dietetics career, I myself have spouted the term "Food is your medicine" to clients in a number of different settings.  Let's be honest - it's simple, catchy, almost tongue in cheek; hence why it's used in sooooo many taglines by professionals giving nutrition education.  I think most people who use it aren't intending harm, but rather trying to meet clients or audiences where they are at.  In our dietetics curriculum, we are taught that there are many health benefits to consuming a variety of nutrients, so at the surface level, treating what you eat as "medicine" might feel useful at first.

So where could this otherwise harmless statement actually become harmful?  In my experience working with disordered eating patients, "Food as medicine" can become a way for the ED to twist and factualize the client's judgements about certain foods.  For example: my strategy during a session may be to challenge their mindset on a fear food (very common challenge items include desserts, carbohydrates, and/or fat sources).  When I attempt to educate why a healthy relationship with food is more important than the "healthfulness" of any one food source, ED clients might interpret my words as "Health doesn't matter." If I try to process more or re-frame that health is more nuanced, clients often try to utilize the statement "If food is my medicine, then I SHOULDN'T be filling it with junk!"  As you can see here with very rigid clients,  this belief of equating food with medicine becomes synonymous with "If food isn't healthy, I shouldn't even waste my time consuming it."  But we as dietitians know that "health" is much more nuanced than solely just the food we choose to nourish our bodies with.

There is actually a relatively new term used to describe this obsession with health.  Orthorexia, while not a formal eating disorder diagnosis, is still common in many dieters and ED clients alike.  Orthorexia is used to describe people who have an unhealthy obsession with consuming only "healthy" or "perfect" foods, whatever that means to them.  Like I stated above, people who have been a part of yo-yo dieting have probably experienced some form of orthorexia at periods of time in their life. Fixating on calories, specific macro- or micro-nutrients, fear/guilt/shame when eating a "bad" food...the list could go on and on with what "rules" they might judge their eating patterns (and possibly, self-worth) on.  But the fact of the matter is: food is more than just energy for our bodies to run on.   Food is supposed to be enjoyable, sensory, social, and cultural; it may even bring back positive memories for us.  Overall, human bodies are complex, and we are not just machines whom solely use food as fuel. 

Let's bring it back to the podcast and some useful nuggets I heard when listening.   On the What the Hell Do I Eat podcast, there is an episode titled "Is Food Medicine?" interviewing a UK medical provider, Dr. Josh Wolrich, as well as a nutrition researcher Alan Flanagan.  They unanimously agree that food isn't medicine, and go through a few examples why this is the case.  The first quote which stuck out to me is "The absence of a drug is not the cause of disease."  To be honest, it took me a while (really re-listening and re-reading this statement multiple times) to actually wrap my head around it.  But once it clicked, it sunk it.  

Allow me to break it down here: let's take for example a very common medication family that is successful at lowering cholesterol levels in humans (Statins).  If someone goes to their doctor and their LDL cholesterol is higher than the normal range, dependent on a number of factors they may be prescribed Simvastatin as an intervention.  They take this drug for a period of time, and as a result of a number of internal chemical and physiological factors, blood cholesterol levels can lower, in turn improving health outcomes long-term. But here's where it get's tricky:  While the medication can enhance this hypothetical person's health, this does not mean his or her lack of Simvasatin is the cause of his/her high cholesterol.  So when people try and state "Food is medicine," they are insinuating one of two things:

1. Health outcomes are always poor in the absence of a nutrient

or

2. Health outcomes are always positive, in direct correlation with intake of said nutrient. 

...but neither of those are always truth. 

I personally know many people who do not eat a balanced diet, and are in otherwise okay health. I also know others who try and follow strict dietary patterns in hopes to delay the onset of a genetic illness....and yet they might still be diagnosed with hypertension, diabetes or another condition regardless of their intake!  The belief that someone consuming an appropriate amount of nutrients should always be in perfect health their entire lifespan completely minimizes and underestimates the importance of other factors to our health (age, genetics, immune function, socioeconomic factors, socialization, mental health, stress, etc).  It also forces us to believe that we are 100% in control of our health outcomes, which many research studies have shown is not the case.

 Sure, consuming a variety of nutrients is a general recommendation for all populations, but there's no instant reward exceeding the daily recommendations of any vitamin, mineral, or macronutrient (and in fact, some vitamins/minerals can be harmful in excess). If one thing is guaranteed in this life, it's actually that none of us leave this earth without periods of being unhealthy!  (Seasonal flu, colds, broken bones, diagnosed diseases, etc). So if perfect health is what you are striving for, it's safe to say that this is overarchingly unachievable for most people.

As a dietitian, I'm well aware that food is important for a well-balanced life.  But the other key takeaway from the podcast that really resonated with me was this general idea:  "If you're going to use the rhetoric 'Food is Medicine,' FINE.  But in the same breath, you should also say 'Sleep is Medicine;' or 'Mental Health Awareness is Medicine;' 'Stress Management is Medicine;' or really 'Anything that benefits your health is medicine.'  But people don't say that, because it isn't 'sexy' and isn't something they can sell."  Food and dietary patterns have become a way for celebrities or media influencers to capitalize on our world's obsession with health and prevention.  Of course if someone tells you if you eat X because  it will cure whatever ailment you suffer from, the basic human instinct is to do just that for survival.  But we also know that shaming and blaming people for their diagnoses is actually not health promoting either! Even if someone did engage in behaviors that impacted their prognosis (say, long-term tobacco use resulting in lung cancer), this person still deserves respectful and unbiased healthcare. People have autonomy over their bodies and choices, and what is important to one person might be less valuable to another.  And that, my friends, is OKAY.

If you want to know more (really, to hear what inspired me to write this blog post), please listen to the podcast episode "Is Food Medicine?" on the What the Hell Do I Eat Podcast.  And at the end of the day I'll leave you with this: Remember that ANYTHING can be used as a tool or weapon in ED recovery.  If using the mantra "Food is my medicine right now" is helpful in healing your (or your client's) relationship with food, then use it!  But if you notice this mantra is causing more harm than good, it might be worth re-evaluating this messaging in your life or practice.