Food is MORE than medicine

Funny how the news does not excite me too much: A hospital announces a new lineup of therapeutic diets that showcases meticulously assembled and scientifically proven nutrient dense recipes, I look at the menu: a breakfast of oats with chia seeds and farro, a lunch of Quinoa salad and a dinner of cheesy potatoes and turkey hams.

I have no doubt the meals are super nutritious and antioxidant-rich, but I wonder how “therapeutic” the meal will be for patients whose dietary regime never have foods cooked in such a manner? When a person is sick, they are usually less likely to be in a mood to try exotic food. We tend to crave comfort food when we are down and out, food we are familiar with, food that brings us happy memories. Such soul-soothing desire is strong and instinctive; It is itself very therapeutic. Sometimes it is all that matters in a person’s choice of food. When a food loses that side of appeal, I wonder how therapeutic it will be??

These experts are not wrong if they see food-is-medicine intervention as a set of vitamins, minerals, protein, bad versus good fat, simple versus complex carb, and how these bioactive chemicals stack up for and against biological health.

But food is more than medicine.

Food is culture. Food is tradition. Food connects us to our community, our way of life and our roots.

When we prescribe medicine, we factor in the effects of every bioactive ingredient against the patient’s risk profile. But when we prescribe food, we must weigh in not just the biochemical nutrients, but also the emotional, social, and cultural connection of the food to the individuals. The latter variables will influence the person’s food preferences, and whether they will consume the food again and again. The medicinal wonder of food will be best manifested not when the food is consumed once but eaten over a period of time to change health outcome.

Medicine and drugs do not need to taste good, look good or smell good to be consumed as prescribed. But food must embody all these feel-good factors, which are tied intricately to how one is fed at home and in their community. Food will lose its healing power, regardless of how nutritious it is when it is shunned by the person who needs it.

Compliance for medicine prescription is largely motivated by fear of the disease, but compliance for food prescription is complicated by the interconnectedness of cultures, ethnicity, country of origin, or religion. ?Simply put, if we want our patients to eat the healthy food we prescribe, we must make sure it is something already in their diet regimen so that the chances of them incorporating it into their lifestyle are high. For instance, it is probably not a good idea to insist on replacing white rice with brown rice in the design of medical-tailored-meals to patients who historically only eat white rice as their staple. You get my drift.

In my over 20 years of professional practice in the space of food-is-medicine, I have heard, and seen cultural blind spots such as this that could threaten the efficacy and success of Food-is-Medicine intervention, thereby hurting people who need it the most.

I often wonder how an individual will respond to care providers who try to tell them how and what to eat—a subject matter that is heavily marinated in culture but who are culturally tone deaf.

Cultural competency may not be the top job skill in professions such as IT or automobile, but in food and nutrition? It is!

Food-is-Medicine is about culinary skills as much as it is about disease prevention.? And since culinary is inseparable from cultures, customs, lineage, and religion and all those feel-good-factors, cultural competency or arrogance can make or break food-is-medicine practice.

Ultimate Goal of Food-is-Medicine.

The legion of fans for Food-is-Medicine has grown in recent years. Major health care and medical insurers are lining up behind the movement.? The number of medical-tailored-meal providers is growing. Glad to see philanthropic organizations, major health agencies and renown education institutions investing in training and establishing food-is-medicine standards: American Heart Association , The Rockefeller Foundation , Tufts University , you name it.

We truly live in an exciting time where we can potentially transform health care by making food prescription part of standard patient care! But do we yet have the blueprint for the success of the food-is-medicine business?

To do justice to the question, we must not lose sight of the ultimate goal of food-is-medicine, which is to close health disparity gap, and dismantle health inequities! ?People that stand to benefit the most from the integration of food in health care treatment plans are those living with diet-based diseases and/or those who cannot afford to eat healthy food----- Notably, a high percentage of them are from communities of colors and ethnic minorities whose food preferences or cuisines are not inspired the same way as the mainstream American diet, or prescribed by their providers. Minority populations who have long faced health disparities due to disproportionate high risk of chronic diseases need food-is-medicine intervention badly. ??The onus is on us who develop food-based solutions that will work for them.

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Check these Lesser-known Boxes:

Food-is-Medicine must be done through the rigors of science. That’s a given. But the following boxes must be checked to ensure a lasting change in the health outcome of ethnic minorities.

?1.???? Culture and Traditions versus Science:

The question of whether certain food is part of the person’s traditional diet regimen must take precedence over the nutrient values of the food for any food-based intervention to work.

Ensure people who develop Food-is-Medicine are not only experts in nutritional science, but look like the people they serve, have the lived experience or understand the culture, tradition, heritage of the people they serve.

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2.???? Diet Diversity versus One-size-fits-all

There is no one best diet. There are many versions of “best”, for different people at different times.

In the Food-is-Medicine world, the Mediterranean diet has been quoted a lot. But the Mediterranean Diet is not the poster child for healthy eating for everyone on this planet earth. The Mediterranean diet as the name indicates is a dietary pattern characteristic of the people living in the Mediterranean regions such as Italy, Spain, Portugal, Greece. Is it healthy? Absolutely? Is it evidence-based? You bet. Is it a prescription for everyone? NO.?

Simple: A Mediterranean diet will not make sense to someone whose cuisine does not include olives, couscous, or yogurt. Diet prescription will not be very helpful in guiding someone to eat healthily if people cannot relate to it.

The truth is that there are many traditional diets that are just as health promoting and have raised generations of people around the world throughout the ages but are seldom or rarely in the spotlight. One of the reasons the Mediterranean diet enjoys Rock Star media attention is that most nutrition research and data has been Euro ethnic-centric. Time to abandon one-size-fits-all prescriptive mindset, embrace diet diversity in the practice of food-is-medicine.

3.???? Cultural Humility vs Supremacy:

In America, a dairy-focus diet has become the NorthStar for all federal funded and many private food programs including medical tailored meals, thanks, but no-thanks to the USDA Dietary Guidelines for Americans and its derivative Healthy Eating Index, both of which place over-rated values on cow’s milk in health and disease prevention. Such a gold standard has shaped Americans’ definition of high-quality healthy diet in the past 50 years, leaving individuals who are lactose intolerant or have different diet ideology the feeling that their dairy-free diet is never good enough, and/ or be pressured into consuming dairy.

Think about how a diet prescription of “3 servings of milk/day” would resonate with people whose dietary pattern historically has zero or minimal dairy and yet statistically are healthier by a lot of measures?

The idea that a traditional diet that has nourished generations of people for thousands of years is somehow not good enough and must be fixed is fundamentally wrong. A diet prescription that smirks with such an air of supremacy will not have much success in changing behavior and long-term adherence. ??

Side Bar: In case you are not aware, lactose intolerance is not a disease that needs to be cured. Insisting on lactose-free milk for people who historically do not consume milk or rely on dairy as their main source of calcium is suggesting to them their ancient-old dietary practice somehow is not good enough and must be modified. Instead of badgering them with all sorts of fanciful lactose-free milk, it would be best to remember people can live healthily on other calcium-rich foods and dairy-free dietary patterns.?

? Another Side Bar: Asians never eat white rice as a stand-alone item, like one would eat a donut or French Fries. White rice is consumed as part of plant-based dietary pattern, it has not been associated significantly or independently to risk of chronic diseases such as diabetes or obesity in this population.? To be told by someone who historically has never been part of the heritage that they have to forgo their staple food is offensive and only leads to erosion of faith in the system that is meant to help them.?

The best food-is-medicine intervention is not about fixing someone’s cultural eating pattern, it is about working with them and through them with the food they already treasure and love.

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Conclusion

We can close health disparities through food-based intervention. But we must rethink Food-is-Medicine, through cultural lens.? Redesign diet-based services through cultural humility. ?Respect diet diversity.

Implement Food-is-Medicine intervention not as medicine, because food is MORE than medicine.

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