Food is medicine, and better than medicine

Food is medicine, and better than medicine. Medicine may be a source of relief but is rarely or never a source of pleasure; food is a daily source of pleasure. Medicine is not something to share with family and friends — but food is. Medicine is not the centerpiece of our gatherings, holidays, and celebrations; food is. The medicine we take to treat a given symptom or disease rarely makes us well in other ways. The right food as medicine always goes far beyond a targeted risk factor, symptom, or condition — and contributes to health and vitality at its very foundations. We have randomized trials to show that high blood pressure, pre-diabetes, dyslipidemia, and coronary artery disease — just to name a few — can be treated with diet (and, at times, other lifestyle interventions) as effectively as with state-of-the-art pharmacotherapy. We have long known this, but there is reason to talk about it now.

For one thing, even as I write this we are wrapping the 29th Annual Art & Science of Health Promotion Conference I was privileged to chair this year. The conference has been a stunning assembly of great content, keen insights, inspired and inspiring people, and vital energy. In short, the gathering has been a memorable, indelible, illuminating success. And throughout, food as medicine has been among the salient themes. It figured in three plenary addresses ranging across the future of digital health, to epigenetics, to effective community interventions and culture change. For the one, and for the many, food is powerful medicine.

Just this week, a paper was published in The Lancet entitled: Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. As the title suggests, this was a massive, global research project involving many scientists. Impartial funding for this effort came from the Gates Foundation. Media coverage has been extensive, highlighting the diets cutting lives short around the world, and noting the need to attend to what we aren’t eating, as well as what we are.

The basic findings were, in the authors’ own words: Our findings show that suboptimal diet is responsible for more deaths than any other risks globally, including tobacco smoking, highlighting the urgent need for improving human diet across nations. Although sodium, sugar, and fat have been the main focus of diet policy debate in the past two decades, our assessment shows that the leading dietary risk factors for mortality are diets high in sodium, low in whole grains, low in fruit, low in nuts and seeds, low in vegetables, and low in omega-3 fatty acids; each accounting for more than 2 percent of global deaths.

This global study aligns with a great mass of prior evidence, including a quite similar look from altitude focused on only the U.S. It aligns with all we’ve learned from the world’s Blue Zones. And it corrects the distorted view offered by the large PURE study, which misguidedly focused on macronutrients rather than foods and dietary patterns.

The right food — whole, minimally processed, mostly plant-foods in any of many sensible assemblies — is the very best of medicine. The wrong food — is the leading cause of premature death in the modern world. That stark contrast reveals how many miles there are to go before we sleep; how much work remains if ever we are to get that best of medicine to go down. By virtue of the various roles I play, I am privileged to a rarefied view of evolving new means to those tantalizing ends from digital therapeutics, to meal delivery, to smart ovens, to a whole new way to assess and track diet quality.

Each of these innovations, and many others, are potential pearls on a common string. As we discover the ideal combinations, we may hope for a whole effect greater than the sum of contributing parts.

Food is medicine, and so much more than medicine. Ever more science, sense, and global consensus tell us clearly what food can do to add years to lives, add life to years, and help save the planet, too. And we know reliably what dietary patterns and foods are part of the relevant Rx. But to fulfill this promise, we need to scale our capacity to get this powerful medicine to go down. There are new and exciting ways to get that job done — so while the prescription is time honored, the opportunities before us are brand new. I find that… very appetizing.