Thursday, May 23, 2024

White Coat Debate: Is Food Medicine?

The food-as-medicine debate has been around for decades, but research on the power of food to treat or reverse disease is pushing food centre stage as a formal part of treatment, on par with medications and other therapies. Most people agree food plays an important role in overall health and well-being, but how big a role does it play in healthy aging? Is food medicine? 

Dylan MacKay, a nutritional biochemist and assistant professor in community health sciences at the University of Manitoba, and Emily Campbell, a registered dietician with Shoppers Drug Mart, discuss the semantics and science.

Dylan MacKay: The “food as medicine” messaging is not particularly effective, mostly because it’s been co-opted. It’s allegedly from a Hippocrates quote: “Let thy food be thy medicine, thy medicine be thy food.” There is some debate as to whether this was something he actually said or whether it was created afterward by a diet guru. I know that many registered dieticians, physicians and practitioners think it’s a very good way of inspiring people to think about their food, but with that comes guilt: “You are the cause of disease, because you haven’t been eating the right foods,” gets tied to food when it’s called medicine. It also promotes food as a fuel, stripping away some of the cultural and community-based attachments. We, as healthcare professionals or researchers, should avoid using that narrative.

Emily Campbell: You bring up some interesting points. I want to stress that registered dieticians are regulated health professionals. Like physicians, we are guided by a college, and our recommendations are evidence-based. When the “food as medicine” analogy is used, it’s more of a collaborative approach with the patient, not to place blame, but to optimize nutritional status and highlight the benefits and importance of nutrition in our lives. Food can be used as a lifestyle modifier to make changes for behavioural intervention. We know that there’s a place for nutrition, as food influences everything in our day-to-day lives. Following a healthy diet throughout the life cycle can possibly delay the need for medication. 

DM:  I don’t disagree: I might even say that food is more important because it’s part of our entire lifespan. But overall, I’m opposed to “food as medicine” because evidence suggests that food tends to have smaller-effect sizes and it’s over a long term. You don’t get quick fixes with food, except in very rare and specific cases, but calling it medicine raises expectations: “I’ll switch my diet and in a week, I will be feeling better.”   

EC: Nutrition definitely isn’t a quick fix. If you think of how much you eat in a day, it is going to take time, but small influences can have long-term health benefits. For example, research has shown that nutrition therapy can reduce A1C, your three-month average blood sugar reading, by 1 to 2 percent. We know that nutrition therapy can reduce the LDL, the “bad” cholesterol, by as much as 20 to 30 percent. There are many chronic diseases where nutrition can make a difference, especially for an aging population. There’s definitely a place for nutrition as a preventive and management approach. 

DM: Most of those chronic diseases increase with age, so if the Boomer generation is trying to avoid these, I agree it’s important they consider their diet. 

EC: You could say nutrition is preventive medicine. The Boomer population is very interested in nutrition education and their health in general. This is the first generation that actually has more income as they’re aging, so they’re actively seeking foods that nourish their minds and bodies.

DM: What they eat is very important to their health, and they’re living longer. But I still don’t like “food as medicine”: It may be semantics. Food doesn’t need to be lumped into medicine to be considered important. It actually does it a disservice. 

EC: I appreciate that viewpoint. Nutrition in general is a new science, and we’re using what we’re learning every day. For example, there is now a nutrigenomics perspective, looking at the link between genetics and nutrition, where there’s new research coming out. 

DM: I’ve done quite a bit of research, and it’s not at a point where I see it as clinically applicable, yet. It may be in the future, but there’s really no good randomized control data to show that it’s effective in improving people’s health. 

EC: Look at nutraceuticals, or functional foods, and how they can be beneficial to an aging population: antioxidants, additional fibre, omega-3 or probiotics. When we’re aging, our energy needs decrease, but needs for some vitamins and minerals increase. Functional foods—orange juice with vitamin C, omega-3 eggs or probiotic yogurt—provide health benefits beyond basic nutritional needs to possibly reduce the risk of chronic disease. It doesn’t mean that nutrition can mitigate a disease, but it can help address disease risk and compensate for age-related changes. Functional foods can make it easier to get extra vitamins and minerals.

DM:  The keys to healthy aging are pretty straightforward, but often unsexy. So, we use medicine as a way of spicing it up. There’s no evidence that you need functional foods or supplements, for the most part, if you’re eating a diverse diet. I’m a big proponent of registered dieticians, but dieticians have to call out things that don’t meet the evidence or standards. 

EC: Dieticians are trained to translate evidence and research for the public, and we know nutrition is critical to our health. Food can work similarly to medicine in a preventive capacity. 

DM: I don’t think it needs to be called “medicine.” It should sparkle on its own.

EC: Nutrition often doesn’t get the big sparkle that medication does, but it should.  Food influences every facet of your life. 

DM: Agreed.


Originally published in Issue 02 of YouAreUNLTD Magazine. PG. 52

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