Dr. Katz: The sense, and dollars, of food as medicine

Dr. David Katz

What would you call the following scenario: a nation of families spends a portion of their income on poor-quality food that routinely makes them sick and kills them prematurely. Employers, insurance companies and the government help most of them pay for the drugs and treatments necessary to treat the conditions caused in large measure by “bad” food. The costs of treatment for conditions hardly anyone needed to get in the first place routinely exceed the costs of the food largely responsible for engendering those conditions. Perhaps “crazy” comes to mind?

I would call it: just another day in America.

Bad outcomes of eating per routine in America prevail. And thus, bad food prevails. Food is not supposed to ravage organ systems, propagate degeneration of body parts or accelerate our surrender to senescence. We will eventually succumb to these forces no matter how well we eat and live, but the Blue Zones show us how vibrantly and how long a well-nourished, well-tended body is apt to defend itself. There is nothing genetically special about Blue Zone populations; the “blessings” they enjoy — a greater bounty of years in life, a far greater bounty of life in years, unencumbered by the chronic diseases they routinely avoid — are courtesy of lifestyle. In principle, a salutary diet and lifestyle is an option for all.

In practice, however, that is not the case. The choices people make — whatever our level of personal responsibility and self-discipline — are subordinate to the choices people have. Aggressively peddle willfully addictive junk food, and normalize the notion that chronic disease is a societal rite of passage, polypharmacy an inevitable consequence of reaching mid-life, and the good choices people otherwise might make reside on the far side of a bridge too far.

I fully support the SNAP program, directed at helping nearly one in seven American families struggling to put adequate food on the table. But a dispassionate appraisal shows how deranged this status quo is. We, the American taxpayers, spend tens of billions of dollars to subsidize SNAP, and thereby help relatively poor people secure access to horribly poor food, and thus achieve dreadfully poor health. We then spend many more tens and hundreds of billions of dollars through Medicaid to treat that poor health, and all too often, do it poorly.

If you can spot the winner in this scenario, the golden jellybeans are all yours.

We might, instead, provide easy-to-understand guidance to better quality foods, financial incentives to choose it, and nip this whole noxious bloom in the bud.

A drumbeat has long been reverberating to tell us of the profound dysfunctions of eating in America. We have cause to hope the agents of a recent crescendo may overcome our complacency. We have cause to hope the entanglements of our fate with that of the planet may do the same.

We have cause to hope, as well, that there may indeed be a silver lining when the dark clouds of the COVID pandemic finally part: a bright light shining on the acute liabilities of chronic cardiometabolic ill health. Among the pandemic’s lessons is this: there is an acute case for chronic vitality. Those opposed to delayed gratification, take note, and take heart. The benefits of food as medicine — rather than as preamble to the need for medications — confer gratification right away, before turning into the gift that keeps on giving.

The costs of food to nurture rather than degrade health are limited to the cost difference between “bad” and “good” food. The incremental cost, already apt to be vastly less than the costs of ill-health as usual, would decline further with time as our food supply shifted its emphasis to the production of good.

We could transition from the dual costs of medication to fix only partly all the parts of us food keeps breaking. Food as the medicine long ago invoked by Hippocrates could save lives, vitality, biodiversity — and a vast fortune into the bargain. The drumbeat tolls of necessity in the guise of diabetes, heart disease, obesity, cancer, dementia, climate change — and the acutely calamitous toll of COVID, as well. We may, whenever so inclined, invoke the will to invent the better way.

Connecticut Media Group