Unpacking Food as Medicine
A brief overview considering the rise, risks, and opportunities.
In my Contemporary Issues in Food course, I had the opportunity to do a deep dive into the rise of Food as Medicine and consider potential areas for risk and opportunity. The following is adapted from my final paper for the course, and offers an overview of my thoughts on the complex factors that need to be considered as American society begins to more wholeheartedly embrace the idea of food as medicine.
We all have a comfort food we gravitate towards when we’re sick, whether it’s chicken soup for a cold or ginger tea for nausea. Using food to support our health and wellbeing has been practiced globally for thousands of years.1 These practices have come to be known as food as medicine, encompassing approaches sitting at the intersection of disease prevention, diet, food access, nutrition, and health.
As food as medicine has grown in popularity, it has exposed deep tensions in how we view what we eat as tradition, history, connection to our social groups, and medicine. Many are calling for greater recognition of food’s impact on our health and pushing for policies that support food access as a medical right. But connecting food to the idea of medicine also invites us to consider food as a product that may be rigorously tested, trialed, and prescribed in doses. Do we really want to hold food, with its deeply emotional ties and all the artistry its preparation entails, to the scrutiny of empirical science and medical rigor?
A (very) brief history
Food has been an integral component of healing and disease prevention in many cultures for generations.2 Practices such as Ayurveda and traditional Chinese medicine have perpetuated over thousands of years and have significantly contributed to our modern understanding of how food, herbs, and spices might impact health, longevity, and disease support.3
However, today the role of nutrition and food in contemporary medicine has been increasingly marginalized. Colonialism, patriarchy, and white supremacy has worked to erase the knowledge primarily held by women and people of color regarding traditional healing uses for medicinal food, herbs, and plants.4 Modernization of medicine and technology has also encouraged shifts away from more holistic healthcare towards allopathic approaches that emphasize the treatment of disease through drugs and surgery, rather than whole body health and nutrition.5
Today, diet-related disease places enormous financial strain on healthcare systems and ironically most heavily impacts individuals facing food insecurity.6 In response to these challenges, public health professionals have sought to develop approaches that support both individual and community health by investing in healthier diets, nutrition education, and access to fruits and vegetables.7
Growing interest in interventions such as medically tailored meals, produce prescription, and nutritional counseling has led to significant investments in food as medicine. In some states, Medicaid is used to cover access to these interventions for low-income patients.8 In 2022, the White House committed $8B to efforts addressing diet-related disease and food insecurity, including several food as medicine projects, and the Rockefeller Foundation has has committed $4.6M in grants explicitly advancing food is medicine.910 However, there are several areas in which the unintended consequences might outweigh potential benefits.
Misinformation
Misinformation about food is everywhere, from celebrities hawking cleanses to food influencers promoting so-called “clean” ways of eating, and combatting this misinformation requires building a body of evidence that can refute harmful claims. While many in food as medicine advocate for increased funding to build a body of research that can be shared widely with the general population, it is worth noting that not every form of information related to food as medicine is necessarily backed by empirical evidence.11
For example, practices like Ayurveda and TCM are centered in extensive bodies of anecdotal and historical evidence that have value but do not fit squarely into a modern and western approach to research.12 Furthermore, academically qualified health information in the United States has historically been filtered through a Eurocentric lens and targeted to white Americans, ignoring the ways in which other cultures may have different approaches to eating.13
We all want to be informed consumers when making choices about what to put into our bodies. But when food is claimed to be medicine in addition to a meal, it demands an added layer of quantification that we might not necessarily expect from our dinner plates each night.14 It benefits the field of food studies to build a body of solid evidence to support itself. But forcing our understanding through the lens of empirical data can also limit our knowledge of what medicine, and food, might be.
We should take care to better incorporate more traditional food as medicine practices into empirical study or accept that there might be a need to expand our acceptance of different forms of knowledge. We can recognize that data can come from a variety of different sources, and still demand that our information about the role of food in our health be grounded in evidence, be it historical, cultural, or medical.
Commodification
Access to culturally relevant and health supportive food is a human right, yet food is treated as a private good.15 A 2022 report from Deloitte emphasized how the food as medicine market is poised to grow exponentially, citing how rising inflation and concerns about health means consumers are seeking ways to spend their money on food that will support their wellbeing.16 However, if left unchecked this growing market for food-based medicines runs the risk of destroying public trust, appropriating cultural knowledge, and exploiting the practices, materials, and traditions of minority groups.
Rising food trends that capitalize on our desire for wellness have already set precedents allowing for the exploitation of ingredients, herbs, and plants in the name of profit. For example, white sage, a sacred plant for several western indigenous groups in the U.S., has been dramatically overharvested due in large part to the rising desire for the herb for spiritual and herbal remedies made popular by white social media influencers.1718 Similarly, rapidly increasing demand for other trending spices like turmeric, moringa, holy basil, ginseng, and ashwagandha has led to an extractive system that perpetuates inequality, exploits lower wage workers, and degrades limited environmental resources.1920
Plant medicine, herbalism, and other food as medicine practices are highly specific to individual experiences, climates, traditions, histories.21 Viewing these ingredients only as a product to be sold demeans their significance and often creates barriers for the communities who are their caretakers to access them. It is our responsibility to ensure that food as medicine knowledge and sources are shared sustainably and with the input, permission, and guidance of the people to whom these remedies belong.
Medicalization
Public health research and advocacy focusing on the medical rights of individuals to healthy food has led to increased investment in access from private and public sources.22 The testing of interventions such as medically tailored meals and produce prescriptions allow us to clearly demonstrate the link between access to better food and improved health. This is critical information that supports advocacy and directs funding to historically marginalized communities.23
When these approaches are tested and demonstrated effective with health outcomes data, it makes a stronger case for investment. Many funders require demonstration of effective use of their dollars through the tracking of specific data points related to physical health. However, these structures may actually limit our collective thinking by centering and funding only those programs grounded in medicine. Requiring the involvement of the medical community, within which doctors are rarely trained in basic nutrition, might in fact limit our collective understanding of what can and should be supported as a food as medicine intervention with public dollars.24
These programs depend on funding to survive, and it makes sense that they would orient themselves towards medical approaches that allow them to request more resources. But as support for food as medicine grows, it is important to encourage advocacy for and investment in a wide range of programs and interventions. Otherwise, we might hamper our ability to see food as a right to which we all have access and risk devaluing its joy and social significance.
Final thoughts
Looking ahead, it may be the role of food studies to encourage an expanded understanding of food as medicine that supports a wide array of disciplines, knowledge, traditions, and data that we may not necessarily recognize in the western world. Work is already underway to decenter western ideals of what medicine and food can or should be. Creating more intentional space for BIPOC, indigenous, and traditional food as medicine practitioners can also work to create a centralized and expansive understanding of food as medicine that includes multiple traditions and ideas worth exploring.
As alternative medicines grow in popularity, aligning with voices that have historically been silenced may provide valuable information to the public, and help make the case for additional investment, protection, and equitable distribution of food as medicine intervention. Doing so will ensure that food as medicine is poised to be an exciting and justice-oriented new approach to ensuring all of us can access the food, nutrition, and health we deserve.
Platkin, C., Cather, A., Butz, L., Garcia, I., Gallanter, M., & Leung, M. (n.d.). Food As Medicine: Overview and Report: How Food and Diet Impact the Treatment of Disease and Disease Management. Hunter College NYC Food Policy Center. foodmedcenter.org
Chen, N. (2008). Food, Medicine, and the Quest for Good Health: Nutrition, Medicine, and Culture. Columbia University Press. http://ebookcentral.proquest.com/lib/nyulibrary-ebooks/detail.action?docID=908244
Chen, N. (2008). Food, Medicine, and the Quest for Good Health: Nutrition, Medicine, and Culture. Columbia University Press. http://ebookcentral.proquest.com/lib/nyulibrary-ebooks/detail.action?docID=908244
Minkowski, W. L. (1992). Women healers of the middle ages: Selected aspects of their history. American Journal of Public Health, 82(2), 288–295.
Alves, R. R. N., & Rosa, I. M. L. (2007). Biodiversity, traditional medicine and public health: Where do they meet? Journal of Ethnobiology and Ethnomedicine, 3, 14. https://doi.org/10.1186/1746-4269-3-14
Food is Medicine Massachusetts, H. C. for H. L. and P. I. (n.d.). Food is Medicine—Snapshot. Food Is Medicine Massachusetts. Retrieved November 20, 2022, from https://foodismedicinema.org/food-is-medicine-interventions
Why Good Nutrition is Important. (n.d.). Center for Science in the Public Interest. Retrieved November 18, 2022, from https://www.cspinet.org/eating-healthy/why-good-nutrition-important
The Medically Tailored Meal Intervention. (n.d.). Food Is Medicine Coalition. Retrieved November 19, 2022, from http://www.fimcoalition.org/our-model
White House Domestic Policy Council. (2022). Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health.
The Rockefeller Foundation Invests $4.6 Million To Scale Food Is Medicine Initiatives in U.S. (n.d.). The Rockefeller Foundation. Retrieved November 30, 2022, from https://www.rockefellerfoundation.org/news/the-rockefeller-foundation-invests-4-6-million-to-scale-food-is-medicine-initiatives-in-u-s/
Downer, S., Berkowitz, S. A., Harlan, T. S., Olstad, D. L., & Mozaffarian, D. (2020). Food is medicine: Actions to integrate food and nutrition into healthcare. BMJ, 369, m2482. https://doi.org/10.1136/bmj.m2482
Downer, S., Berkowitz, S. A., Harlan, T. S., Olstad, D. L., & Mozaffarian, D. (2020). Food is medicine: Actions to integrate food and nutrition into healthcare. BMJ, 369, m2482. https://doi.org/10.1136/bmj.m2482
Nast, C. (2018, July 31). Our Idea of Healthy Eating Excludes Other Cultures, and That’s a Problem. SELF. https://www.self.com/story/our-idea-of-healthy-eating-excludes-other-cultures-and-thats-a-problem
Skerrett, P. (2017, August 7). Hey, Hippocrates: Food isn’t medicine. It’s just food. STAT. https://www.statnews.com/2017/08/07/food-medicine-hippocrates/
Culture, A. G. (2022, November 8). What would it take to decommodify food? [Substack newsletter]. Offshoot. https://agrowingculture.substack.com/p/what-would-it-take-to-decommodify?publication_id=627171&isFreemail=true
Fresh food as medicine. (n.d.). Deloitte Insights. Retrieved November 30, 2022, from https://www2.deloitte.com/us/en/insights/industry/retail-distribution/future-of-fresh-food-sales/fresh-food-as-medicine-for-the-heartburn-of-high-prices.html
A Note on White Sage Overharvesting and Cultural Appropriation. (2021, February 9). Chestnut School of Herbal Medicine. https://chestnutherbs.com/a-note-from-juliet/
Shaukat, A. (2021, February 14). Whitewashing White Sage: “WitchTok” and the Appropriation of Spirituality. The Bull & Bear. https://bullandbearmcgill.com/whitewashing-white-sage-witchtok-and-the-appropriation-of-spirituality/
Reclaiming African Herbalism as an Act of Resistance. (n.d.). YES! Magazine. Retrieved November 28, 2022, from https://www.yesmagazine.org/health-happiness/2018/02/15/reclaiming-african-herbalism-as-an-act-of-resistance
Sana Javeri Kadri of Diaspora Co on Why You Should Buy Better Turmeric | Bon Appétit. (n.d.). Retrieved December 15, 2022, from https://www.bonappetit.com/story/sana-javeri-kadri
Jordan, C. (n.d.). An ode to herbalism, seeking help outside of disparities – Athens Science Observer. Retrieved November 21, 2022, from https://athensscienceobserver.com/2022/03/22/an-ode-to-herbalism-seeking-help-outside-of-disparities/
The Gus Schumacher Nutrition Incentive Program—Produce Prescription Program. (n.d.). National Institute of Food and Agriculture. Retrieved November 20, 2022, from http://www.nifa.usda.gov/grants/funding-opportunities/gus-schumacher-nutrition-incentive-program-produce-prescription
Berkowitz, S. A., Delahanty, L. M., Terranova, J., Steiner, B., Ruazol, M. P., Singh, R., Shahid, N. N., & Wexler, D. J. (2019). Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: A Randomized Cross-over Trial. Journal of General Internal Medicine, 34(3), 396–404. https://doi.org/10.1007/s11606-018-4716-z
Tan, J., Atamanchuk, L., Rao, T., Sato, K., Crowley, J., & Ball, L. (2022). Exploring culinary medicine as a promising method of nutritional education in medical school: A scoping review. BMC Medical Education, 22(1), 441. https://doi.org/10.1186/s12909-022-03449-w