With a new year comes the influx of pressure once again to lose weight, change routines, and shrink into unrealistic expectations. And while I’ve been pleased to see many more writers actively resisting diet culture these days, I’m less enthusiastic about how diet-coded language has wormed its way into how we talk about food as medicine. In particular, the Mediterranean diet has started to dovetail with food as medicine in ways that ignore critical elements of what this approach to health can and should be.
Diet culture is incredibly pervasive and has become much harder to spot. Health influencers, lifestyle blogs, Instagram, and TikTok continue to push approaches to eating that are either unsustainable or just plain dangerous but are still couched in health promoting language. While some professionals out there (like the fabulous Abbey Sharp) try to combat misleading claims and attempts to repackage dieting online, it’s a constant slog to sift through all the information. And food as medicine is falling victim to the overload.
Diet culture pushes us to conflate dieting, eating, and lifestyle, leading to two disturbing trends. First, we continue to believe that if we search hard enough or have enough will power, it’s possible to find a gold standard to dieting that can make a difference in our health. And second, we uphold diet patterns made popular by those with the loudest voices and the most financial backing. In particular, I’ve noticed this with the Mediterranean diet and how it’s quickly becoming incorporated into many food as medicine approaches.
A year ago, Anjali Prasertong of
wrote an incredible piece about the Mediterranean diet that’s continued to echo in my head. Her thoughtful and nuanced take shook my understanding of what I had, to that point, considered to be a pretty standardized assumption of what healthy eating looked like.Everywhere I turned — in my studies, in my research for this blog, in my personal work as a food therapist — I was told that the Mediterranean diet is one of the best and healthiest ways we can eat. Recently, the New York Times even published a Mediterranean Diet Week as a kickoff to 2024. It feels like everyone is claiming the Mediterranean diet can solve everything from obesity and nutritious food access to achieving global sustainable development goals related to climate change. But of course it’s not that simple.
Prasertong references Kate Gardner Burt's 2021 paper in the Journal of Critical Dietetics: “The whiteness of the Mediterranean Diet: A historical, sociopolitical, and dietary analysis using Critical Race Theory.” The paper asserts that the Mediterranean diet is ultimately a diet grounded in whiteness, and that it ignores and marginalizes the food traditions of multiple non-white cultures while maintaining white euro-centric culture as normative. Gardener Burt has expanded on this work, further highlighting the need for diverse voices and approaches to nutrition, grounded in the understanding that a one-size fits all solution isn’t effective, fair, or realistic.
Sources that I and others in the food space are encouraged to look to for factual nutrition information — The Harvard Nutrition Source, American Heart Association, and Nutrition.gov — continue to uphold the Mediterranean diet as a gold standard. And when we give the Mediterranean diet this pedestal, it begins to take over our collective understanding of what is healthy, what is considered food, and how it interacts with our health.
An example of this appeared a few months ago, when I saw piece appear in my LinkedIn feed about the connection between diet and PTSD. As a former psychology researcher who specialized in trauma, I was excited to learn about this connection and curious what the findings were. But as I dug deeper into their methodology and considered the ways in which their research was shared, I was disturbed to see how easy it is to get carried away by the story we’ve been telling ourselves about the links between the Mediterranean diet and health.
The Harvard School of Public Health first highlighted the study, claiming “Researchers discover associations among PTSD, diet, and the gut microbiome.” But the actual study in question from which this claim is drawn does not hold water with such a sweeping statement. By their own admission, the researchers acknowledge several limitations including “We found no significant association between PTSD symptoms and the overall structure of microbiome.”A small sample size and a very loose interpretation of the Mediterranean diet conflating it with one that has a high intake of plant-based foods further underscores these oversights.
Plant-based diets are followed by multiple cultures around the world, and our gut microbiomes are unique across individuals, people, cultures, and countries depending on a range of factors beyond what we eat. Claiming that one type of diet has the potential to impact mental health through this pathway is not only limited in its scientific grounding, but increases the likelihood that dietary approaches from other cultures might be pushed to the wayside for their perceived lack of similar benefits.
I worry too that as the Mediterranean diet gains more support, it will start to creep into our food as medicine interventions without proper evaluation. I can easily see how hospitals or healthcare centers wanting to use medically tailored meals may automatically turn toward the Mediterranean diet approach without considering other culturally significant foods that can be utilized. And while I believe in and recognize the power of these interventions, I will continue to ask whether it’s good for us to so closely intertwine food, a critical component of culture and emotion, and science. Similarly, I’m still working through my own hesitation in relying on academic and empirical evidence to “prove” whether a certain food is good for us.
As I’ve seen more funds, institutes, and programs for food as medicine emerge, I also wonder who’s deciding what is healthy and what isn’t. What are the techniques being taught in culinary medicine classes, and what are the diet plans being developed by hospitals or nonprofits as part of their medically tailored meal programs? What is getting funding because it has already been tested and is well resourced? What gets left behind instead?
I don’t want to bash the good intentions of these programs. I believe they’re doing good work and providing much-needed nutritious food access in a system that often makes it difficult to do so. What’s clear is that there’s a deep tension in food as medicine between individual, highly-tailored care and expansive, community-based support. It makes sense that we’d want an easy solution like the Mediterranean diet, because coming up with solutions to these complex problems is really hard. But I want to push us, as
did in her recent post on food as medicine to wonder “why we were not instead putting money toward initiatives that we already know work to improve nutrition outcomes, but that have not yet been fully funded and implemented in the US, such as universal free school meals, or reformulating foods to be lower in sugar and salt. “A big part of dieting is the absence of choice - restriction and a prescriptive way of eating. This restriction, it’s been shown, is a big part of why diets don’t work. When we similarly constrict food as medicine to 1) only apply to what we eat and 2) limit the idea of a healthy diet to one approach to eating, we do a disservice to ourselves and the communities with whom we want to support change. What we really need is to build a more compassionate approach to food that provides choice and dignity, rather than telling people what or how they should eat.
I didn’t make any diet-related resolutions this year. I didn’t make any actually, except for one: to say yes to more things that bring me joy, be it building community with my chosen family or, yes, eating ice cream at the end of a long day and not feeling bad about it. I’m taking an expansive approach to understanding what’s good for me and what I need. I’m hopeful that in 2024, food as medicine will do the same.
Announcement!
I’m thrilled to announce that I’ll be co-instructing a Climate Philanthropy Messaging Class with my mentor and friend Eva Goulbourne. This 6-week class is for anyone working in food, nutrition, and/or public health who’s curious about how to both attract and unlock climate dollars to maximize and continue your impact. Click the link below to learn more!
Reading
School starts up again soon, and I’m absorbing as much as I can in preparation for my capstone project, which will focus on (surprise surprise) food as medicine! I was gifted Why Snap Works by Christopher John Bosso and Mark Kurlansky’s latest, The Core of an Onion over the holidays and I can’t wait to dive into both.
Cooking
Lots of brown foods, lit by warm lamps. Despite the darkness that makes it hard to get “the shot,” these meals brought me a lot of joy and comfort during the holidays and the cold of the last few weeks. Clockwise from left corner: liege waffles, cassoulet, potato gratin, black forest cake.
Insightful post Nora - “compassionate approach to food that provides choice and dignity, rather than telling people what or how they should eat.” That part!
Yes to all of this, Nora -- great post!