Food is not medicine - It is so much more important
The more I’ve tried to understand why I developed heart disease despite following all the rules, the more convinced I’ve become that food is not medicine, it is much more important.
To unpack and make sense of this I’ve tried to understand three things, namely:
Medicine
Human food
Human health
Medicine
Let’s start by defining medicine. I’ve copied below the definition from Wikipedia (there are many others but they’re essentially versions of the same concept).
“Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.”
Medicine, therefore, is a recent invention designed to prevent or treat illness. The definition refers to patients and to preventing illness using pharmaceutical drugs, surgery, and other interventional practices.
Real food is much more important than medicine because it is part of our existential three-way evolutionary relationship with our human microbiota and body. I explain below.
Human food
I’ll differentiate between the following:
Real food we evolved to eat and process traditionally
Industrially processed products
“Real food…is a vital component in a three-way relationship with our microbiota and our body”
Real food we evolved to eat and process traditionally
We are well adapted for the consumption of high calorie, nutrient dense animal, and plant foods. They allow easy direct absorption of macro- and micro-nutrients in our small intestine and relatively easy production of nutritious metabolites by our microbiota concentrated in our large intestine [1].
Real food does two things. It can replenish (probiotic) and nourish our microbiota [2] and nourish our body. It provides the energy and building blocks (macronutrients) we need to survive and grow and thousands of components (micronutrients) we need for our metabolism to work.
Our microbiota use the thousands of nutritional components in real food to communicate with our body. James Kinross [3] describes the microbiome as an orchestra which never stops playing to itself and its host. The microbial players in the orchestra play according to the instructions they receive from our food. Those instructions result in an immeasurable number of “small molecular notes” called metabolites that communicate, in a two-way fashion, with their fellow microbes and with every cell in every organ in the human body. Real food, therefore, is a vital component in a three-way relationship with our microbiota and our body.
Before proceeding to discuss industrially processed products, it is important to differentiate between those and traditionally processed food [1]. Traditional processing uses non-mechanical technologies to essentially start a sort of outside-the-body digestion (e.g., cooking, soaking), improve bioavailability (e.g., cooking, mechanical processing), improve nutritional content (e.g., fermentation, germination), destroy mold (e.g., nixtamalization), and preserve (e.g., fermentation, drying) [1,4]. Traditional processes largely retain or improve the complex nutritional benefits of real food.
Industrially Processed Products
Industrial processing transforms real food from plants and animals into intermediate chemicals used to create artificial, consumable products. Most of us now eat industrially processed products and for many (most?) they are all that we consume. Such products include breakfast cereals, savoury snacks, reconstituted meats, pre-packaged frozen meals, fruit juices, [4 – p17], seed oils, and others from a long list of familiar consumer products.
Industrially processed products do provide several advantages. They contain high amounts of calories from macronutrients (especially carbohydrates). They are designed to be very tasty, and we enjoy eating them. They also contain a number of chemicals which act as preservatives and enable long international supply chains and shelf lives.
Their greatest disadvantages is the absence of micronutrients and complexity that we require to live and reproduce healthily over the long-term.
Human health
An unprecedented number of people today have enough food and live long lives. This is despite ongoing hunger, wars, childhood deaths, and infectious disease in the poorest parts of our world and a dramatic increase in so-called “chronic diseases” in the wealthiest. With this relatively positive perspective, is it possible to still to see instances in which changes in our food have influenced human health?
To answer that question, consider the following:
The switch from hunter-gatherer to farmer
The introduction of industrially processed food
Health Outcomes associated with changes in food consumption
The switch from hunter-gatherer to farmer
Humans were apex predators and ate mostly meat from large animals for about two million years. The extinction of larger animals led early humans starting about 85,000 years ago in Africa, and about 40,000 years ago in Europe and Asia, to gradually increase their consumption of plant foods [5]. This led to what we now consider a traditional hunter-gatherer lifestyle.
The hunter-gatherer lifestyle started to change approximately 12,000 to 10,000 years ago when the earth warmed and the large northern hemisphere ice-sheets receded [4,7]. This climate change created warmer and more stable weather that favored human population expansion. Rapid expansion can be seen starting approximately 10,000 years ago. An increase in population may have underpinned the need to develop a more agrarian lifestyle that was also, conveniently, made possible by the warmer and more stable weather. By 5,000 years ago, agriculture had spread around the world [4].
As more of our ancestors became farmers, they fed their burgeoning communities by rearing and cultivating fewer types of animals and plants than their predecessors had hunted and gathered.
“...life expectancy increased from the 1850s to around 1875 and adjusted for infant (less than 5 years) deaths, was as good as it is today. During the same period the incidence of so-called “chronic diseases” was 10% of what it is today.”
The introduction of industrially processed food
Victorian England provides a valuable example of population-level change before and after the introduction of industrially processed foods [6]. Research into the period from 1850 to 1880 has revealed that life expectancy increased from the 1850s to around 1875 and adjusted for infant (less than 5 years) deaths, was as good as it is today. During the same period the incidence of so-called “chronic diseases” was 10% of what it is today.
The increase in life expectancy is attributed to a combination of improved agricultural practices, physical labour, and consumption of a diverse range of real food. Focusing on diet, they consumed around 50% to 100% more calories than we typically do today but their diet was less calorie dense and more nutrient-dense than ours. They ate a range of seasonal real foods including grass-fed muscle meats, organ meats, seafood, vegetables, and fruits.
Starting around 1875 and especially after 1885, cheap imports of white flour, canned meat and fruits, sugar, and condensed milk became widely available in Victorian Britain [3,4].
Health outcomes associated with change in food consumption
Three broad patterns emerge from studying changes in food consumption and human health.
• We shrank when we ate less diverse real food
• “Chronic diseases” appeared when we ate industrially processed products
• Good health can be restored when we stop eating industrially processed products
By approximately 5,000 years ago, early farmers are estimated to have been as much as 13cm shorter than the hunter-gatherers that preceded them [4]. In China and Japan as rice cultivation was adopted, the decline in stature was about 8cm. In the Americas it is estimated that the shrinkage was around 6cm and 8cm, for men and women, respectively [7]. These negative outcomes were likely caused by the reduced diversity of nutrition and weather-induced food shortages as our ancestors came to rely upon farmed food rather than hunting and gathering for survival [1].
When Victorians reduced the proportion of real food in their diet, they also shrank. In 1883, the British army had to reduce its minimum height for recruits by three inches, and again 18 years later by an additional three inches [6].
The introduction of industrially processed food by the Victorians had the additional effect of reducing their long-term health. By 1900, the increased incidence of tooth decay was so bad that many people were no longer able to chew some vegetables, fruits, and nuts [6]. We can also see the dramatic emergence of so-called “chronic diseases” that occurred (Figure 1) [6].
Infant/mother mortality, accidents at work and infections accounted for most deaths in Victorian times. Today those are greatly reduced and have been superseded by cancers and diseases of the circulatory system (e.g., heart disease and stroke) [6].
Figure 1 Causes of death in England and Wales. Reproduced from reference 6
Industrially processed products are associated with many forms of so-called “chronic disease” because they trigger oxidative stress, overwhelm our normal detox mechanisms, damage our microbiome and cause long-term, widespread inflammation throughout our bodies. Between the 1970s and the late 2000s, the rates of obesity and diabetes, for example, increased greatly. This coincided with a reduction in consumption of fats from 42% to 34% and a substantial increase in dietary carbs [8].
Fortunately, an English GP by the name of David Unwin has shown us that we can reverse the detrimental effects of industrially processed products. Dr. Unwin and his colleagues switched their type-2 diabetes patients onto a low carbohydrate diet. Within the first year of the study, they found that 77% of patients following a low carbohydrate diet were able to reverse their disease. By the end of the study, 51% of their patients had maintained reversal of type-2 diabetes. In January, 2023, Dr. Unwin and colleagues published the results of their work in the British Medical Journal Nutrition, Prevention & Health.
“...”food is medicine” isn’t supported by factual evidence but I fear it is catchy and easy to remember”
Summary
Real and traditionally processed food provides essential complexity and diversity of nutrition. It is part of a sophisticated and existential three-way cross-talk between real food, our human microbiota and our human body. This exquisite evolutionary adaptation underpins incredible resilience. We have been able to fuel ourselves, to thrive, reproduce, and populate our planet over millions of years, despite many large environmental disruptions. Unfortunately, there is now ample evidence that when we significantly deviate from the food we are adapted to eat, we create an evolutionary mismatch [7] and our health consequently suffers.
When we stop consuming a diverse supply of real food, our physical stature is diminished, we actually shrink…! Worse, when we replace real and traditionally processed food with industrially processed products we eliminate probiotics, and diversity and complexity of nutrition.
Industrially processed products tip us towards a state of chronic inflammation, the symptoms of which are popularly referred to as “chronic diseases”. Data from the Victorian era to present time provide very strong evidence that what we now describe as “chronic disease” may in fact be chronic malnutrition from a lack of real food and too many industrially processed products.
If this is true, we are making a big mistake in conflating real traditionally processed food and medicine. For me, “food is medicine” isn’t supported by factual evidence but I fear it is catchy and easy to remember. Fortunately, Dr. David Unwin has shown us that the negative health effects of industrially processed food can be reversed when we simply stop eating them.
It makes no sense to turn to medicine to fix something if it is caused by not eating properly. The best way to prevent and even reverse our current state of chronic ill health may simply be to eat better food. At least, that’s my approach. You can decide for yourself.
References
Crittenden AN, Schnorr SL. Current views on hunter-gatherer nutrition and the evolution of the human diet. Am J Phys Anthropol. 2017 Jan;162 Suppl 63:84-109. doi: 10.1002/ajpa.23148. PMID: 28105723
Healthy soils for healthy plants for healthy humans Heribert Hirt EMBO Reports (2020) 21: e51069https://doi.org/10.15252/embr.202051069
Kinross, J. (2023) Dark Matter: The New Science of the Microbiome. Penguin Random House, Dublin
T.D. Noakes et al (Eds.), Ketogenic: The science of therapeutic carbohydrate restriction in human health (1st ed, pp 3-700). Elsevier
Ben-Dor, M, Sirtoli, R, Barkai, R. The evolution of the human trophic level during the Pleistocene. Yearbook Phys Anthropol. 2021; 175(Suppl. 72): 27–56. https://doi.org/10.1002/ajpa.24247
Clayton P, Rowbotham J. How the mid-Victorians worked, ate and died. Int J Environ Res Public Health. 2009 Mar;6(3):1235-53. doi: 10.3390/ijerph6031235. Epub 2009 Mar 20. PMID: 19440443; PMCID: PMC2672390
Daniel Lieberman (2014) The Story of the Human Body. London, Penguin Books
David S. Ludwig et al., Dietary fat: From foe to friend? Science 362,764-770(2018). DOI:10.1126/science.aau2096