Our diet can make us healthy, but can it actually replace medication?

"Food is Medicine" is a simple but highly debated phrase. Let's dig into the nuance.

Interning in 2009 (and eventually working) at an integrative medicine clinic in an academic medical center where doctors and dietitians emphasized nutrition, I remember 1) being surprised that doctors talked about nutrition with their patients and 2) thinking this is why I wanted to study nutrition.

Maybe because you’re reading a newsletter about nutrition, you’d be surprised at my surprise hearing doctors say that nutrition actually matters, or maybe you’re nodding along with me thinking: I’d like a doctor like that!

For better or worse, dietetic training is structured like medical training: Memorize organs and systems, pathophysiology, and medical treatment. Each organ is an island—separate from the rest of the body. We learned to restrict fluid intake in patients with heart failure, minimize sodium and potassium in patients with end-stage kidney disease, count carbs with diabetes. It was about symptom management for end-stage disease, it wasn’t about nourishing patients to health.

After a few weeks of shadowing, I thought this approach needed to be more widely known. I collaborated with a few medical and physical therapy students to start a group on campus. As we formed, we decided we couldn’t call ourselves the “Nutrition Club” because people might assume were only for nutrition students. So, after some discussion we decided to on:

Food is Medicine

I’m amazed that 15 years later Food is Medicine is still running on campus, and that in early 2024 the Biden administration declared “Food is Medicine” a key healthcare initiative. What I didn’t expect is that the phrase “food is medicine” would become controversial.

I noticed the debate on social media when some healthcare and even nutrition professionals expressed concern that dietary changes would be confused with medicine. They were concerned that people with serious health conditions might stop taking their medication and instead only focus on their diet. They thought someone might delay seeking healthcare and assume they could fix their health problems by just eating healthier.

While I trust that most people know the difference between food and medication (am I being too snarky?), I know some feel strongly that changing their diet will significantly impact their health (lower blood pressure, cholesterol, inflammation, or increase energy). They’re motivated by the idea that they could discontinue or even avoid medication if they change their diet. I mean, it’s not uncommon for clients to reduce or discontinue medications with the support and collaboration with their doctor.

I don’t want to downplay that lifestyle interventions can lead to medication adjustment, but I also want to clarify that some people’s health conditions require medication. Taking a drug that targets a certain biochemical mechanism is different than exercising or eating a salad.

But, I still can’t believe that nutrition professionals could disagree about the idea that food is therapeutic. I mean if we didn’t believe that, why would we make nutrition our profession? I wondered if some critics might never have seen someone’s health improve after changing their diet. That’s one reason I continue to practice nutrition after so many years: I’ve never stopped enjoying seeing people’s health improve through nutrition.

“Food is Medicine” Nuance

• Overall: Following a whole food-based diet with the goal to prevent or prolong disease onset will likely be more beneficial than risky to a person’s health.

• Medical diagnosis & treatment: It’s important to convey to anyone considering and using food therapeutically or “like medicine” should also know they need to regularly follow up with their healthcare provider to monitor overall biomarkers of health (e.g. blood testing, blood pressure, cholesterol, etc.).

• Economics & Accessibility: While in the U.S. whole foods are more expensive than many processed foods, it’s important to make whole foods more affordable so all people can access foods that are well-known to prevent chronic diseases. Ultimately, providing foods that support health will decrease healthcare costs, as fewer people might need to use the healthcare system as often. Making this happen will involve a combination of policy makers, community organizations, philanthropists, public health professionals, healthcare workers, and others.

• Evidence:

  • It’s unlikely that nutrition evidence will adequately satisfy anyone expecting double-blind, placebo-controlled trial-level research. It’s often impossible to carry out double-blind trials using food. Nutrition research must be designed and interpreted within the context of each nutrition question and study. Quality of evidence in nutrition research is different than quality of evidence in pharmaceutical research. We can’t compare apples to oranges.

  • Resist the urge to focus on any single study to justify a certain dietary approach or food for a condition or disease. It’s important to consider the landscape of all research on a certain diet or condition.

• Working with Nutrition Professionals: With seemingly endless confusion about nutrition, working with a professional who considers an individual’s biochemical individuality, their health history, medical diagnoses, risk factors, lifestyle, health goals, family history, cooking skill, and other factors that impact their interest and ability to make dietary changes.

• Medication vs. Food: While broccoli isn’t a blood pressure medicine, it’s still ok to approach our diet as part of an overall holistic approach to health. Working with a healthcare professional to monitor progress and adjust medications as changes are made is key for staying safe and healthy.

As a dietitian, of course I love the idea that people want to prioritize their lifestyle as seriously as they prioritize taking daily medications. It is just as important because we know from research that being consistent with lifestyle approaches to health are the key to making them “work” in any meaningful way for people. So, no food isn’t medication, but it is a valid therapy for health.

What do you think?