Among the more popular mantras that pervaded the local food co-op movement during the mid-1970s, none was quite as instructive as a quote often (mistakenly) attributed to the American dietitian Adelle Davis: “You are what you eat.”
Davis, the author of the 1965 bestseller Let’s Get Well and three other books promoting the transformational effects of a healthy diet, was something of a cult hero among those of us who believed the standard American diet was not just killing us but also despoiling the environment while rewarding a rapacious food industry that cared not a whit for anything beyond its quarterly profits.
So, my comrades and I gamely eschewed animal flesh (and shunned carnivores), avoided processed fare, and cultivated a surprisingly (for me, at least) ascetic devotion to whole foods. I recall surviving the winter of 1979 largely on alfalfa sprouts, sunflower seeds, homemade yogurt, squash, apples, and the carrots that my housemate occasionally chipped out of the frozen soil in our backyard garden and ran through his juicer. There was also cheese. Probably bread.
Unlike many of our countercultural pursuits of that era, the push to promote the health benefits of whole foods and create a market for sustainable agriculture has not been completely fruitless. The organic foods certification program created in 2002 has offered mainstream credibility to a style of farming that postwar America had relegated to the dustbin of history. Sales of organic foods, as a result, have grown from $1 billion in 1990 to $52 billion in 2021. And I suspect the late Ms. Davis would be heartened to see the federal government beginning to acknowledge, ever so cautiously, that food may be medicinal.
As Nicholas Florko reports in STAT News, the Biden Administration pitched the concept during a September 2022 nutrition conference where officials released a national strategy designed to improve access to healthy meals for people suffering from certain chronic illnesses. These programs typically include three types of services: dietitian-designed, “medically tailored meals” delivered to patients diagnosed with specific conditions; “medically tailored groceries,” or meal boxes, delivered to patients; and vouchers, also known as “produce prescriptions,” to cover the cost of fruits and vegetables.
The summit also produced a $250 million pledge from various organizations, including the Rockefeller Foundation, to fund a Food Is Medicine Research Initiative. The primary goal, explains Devon Klatell, Rockefeller’s vice president of food initiatives, is to create a “research infrastructure that can generate definitive evidence about which food-is-medicine programs are most effective, what is optimal program design, and for which patients.”
Meanwhile, the National Institutes of Health last month approved a plan to deliver $170 million in research grants to help designated institutions develop diet-intervention programs at a citywide level. And private Medicare Advantage providers are striking up partnerships with grocery chains such as Kroger to offer stipends their members can use to buy healthy food.
“We are at the inflection point,” says Dariush Mozaffarian, MD, MPH, DrPh, policy dean at the Tufts Friedman School of Nutrition Science and Policy. “Five or six years ago, I would go to major healthcare organizations and talk about food [is] medicine and I’d get blank stares, crickets, and polite emails.”
That’s not to say your doctor will be sending you to the farmers’ market this summer with a prescription for blueberries and broccoli. Formidable obstacles — institutional, political, and personal — loom on the horizon. Research on the health benefits of medicinal-food services is scant, regulatory restrictions hamper insurance coverage (basic Medicare is expressly prohibited from paying for any food services), physicians are generally ignorant about nutrition, and Congressional Republicans are about as likely to expand federal nutrition programs as they are to ignore Hunter Biden’s laptop.
More research is forthcoming, though. Kaiser Permanente and Tufts School of Nutrition Science and Policy will soon release the results of a clinical trial involving 450 Medicaid patients who were prescribed produce to treat their type 2 diabetes, Florko reports. And results of another recent randomized study of 1,400 children are expected to show the impact of produce prescriptions on their food security and BMI. Still, there’s a long way to go before physicians — not to mention insurance companies — will be forced by the data to admit that diet is something worth considering when treating chronic disease.
“There isn’t the robust evidence base that we see in other parts of healthcare,” argues Matt Eyles, president and CEO of the trade group American Health Insurance Plans. “If you compare just the volume of evidence that is available around food and nutrition, compared to prescription drugs, vaccines, devices . . . where you have a randomized controlled trial — we don’t have that breadth out there.”
There’s a reason for that, of course: There’s nothing to patent, nothing to sell, nothing to bump up a corporation’s return on investment. And if this sudden interest in the medicinal properties of food somehow convinces physicians and their patients that pharmaceutical solutions are less necessary than they’ve been taught, who stands to lose? Big Pharma will not go away quietly.
We should also remember that, no matter what the research eventually reveals, dietary purism offers no guarantees. I always thought it sadly ironic that Adelle Davis succumbed to cancer at the age of 70. She went to her grave blaming the junk food she ate as a college student, while dismissing the fact that life is capricious. Nothing we do will protect us from the inevitable.
At one point during the latter years of my ascetic food phase, I found myself pedaling past the golden arches and realized — really without giving it much thought at all — that a Quarter Pounder with cheese was absolutely necessary to my well-being at that moment. I pulled in, confident that none of my comrades would witness my blasphemy, and I chowed down.
I’ve loosened my culinary reins considerably in the years since in ways that would surely confound Ms. Davis, but I’ve also come to realize that food is not inherently good or evil. It’s the intention with which you choose it. There are times, in other words, when even a blasphemous burger may be just what the doctor ordered.
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