Nutrition and Medicine: Are They Connected?

Lifestyle has many perspectives, . . ., but I submit that none is more fundamental to our lives than the food we eat.

If “medicine” means pharmaceuticals, lifestyle medicine is an oxymoron. Lifestyle medicine does not mean pharmaceuticals, of course, even if we have succumbed to thinking otherwise. As far back as Hippocrates over 2 millennia ago, he said “Let food be thy medicine and medicine be thy food.” Have we forgotten his advice?

Lifestyle has many perspectives, and all deserve our attention, but I submit that none is more fundamental to our lives than the food we eat. We eat often and regularly, and its effect can be surprisingly quick, within hours. Our choice of food affects our well-being, our behavior, our cultural practices, our financial well-being, our economic strength as a society, and most recently, our environment. However, to truly understand our choice of food, we need to understand nutrition, the biological means by which it works in our body. But regrettably, this is not understood, judging by the way food and health claims are made, and by the way public opinions arise, consciously and subconsciously.

When considered as a science, nutrition is not considered a serious medical discipline and it has been this way for more than 2 centuries. And worse, the professional communities of medical practitioners, related health caretakers and other professional biologists are untrained and uninformed, leaving the public to fend for themselves in a market maze. The public looks to these professionals for advice. I would have hoped that I could enthusiastically support my own professional community of nutrition researchers, counselors, and policy makers but I cannot. In these communities, I do not blame individuals, professional or lay, for this turmoil. In my experience from within the professional nutritional science research community for more than 6 decades, from the laboratory to lecture halls to food and health policy boardrooms, we have just as many thoughtful, responsible and caring individuals as any other sector of our society. But, woefully, like others, we fall short. Something more sinister—not easily discerned—is at play. We don’t know what we don’t know, however much some of us may be trained and however much we may think otherwise.

In the public arena, there is far too much confusion about food and nutrition. It is reckless and hurtful. I hear it in private conversations, sense it when reading food labels that are read with too much certainty, listen to health claims being stretched in the marketplace and wince when shills, falsely pretending to be responsible authorities, write books and make news. We, the public, aimlessly wander in a food and health turmoil without meaning.

A few disturbing statistics illustrate. From 1986 to 2016, fast-food consumption increased 226% in variety, portion size, and energy. ¹ According to the Centers for Disease Control and Prevention (CDC), 6 in 10 adults have 1 or more chronic diseases that mostly can be controlled by nutrition. ² But we rank number 1 in per capita use of pharmaceuticals, not knowing that these products are responsible for the fourth leading cause of death. ³ Without explanation or apology, the CDC does not include this inconvenient factoid in their list of the chief causes of death. Also, among economically similar countries, the United States ranks number 28 in life expectancy among 44 “sister” countries. ⁴ We also rank number 1 in the world in per capita meat consumption. We like meat and fast-food then depend on drugs to fix the resulting diseases that may occur. We, the taxpayers, subsidize the production of food that makes us ill then rely on drugs to treat those illnesses. Why? Do we not see a connection?

During my 6-plus decades in the nutritional science profession,* I submit that a big reason for this lifestyle problem is that nutrition is not respected as a legitimate science, especially within medical practice and health care communities. No wonder. It is not included in medical school curricula and is not considered a dedicated specialty among the 130 or so medical specialties, which is an important part of an accounting system used for estimating professional reimbursement for services.

Furthermore, among the 27 National Institutes of Health (NIH), a US government agency that is widely regarded as the lead health research agency in the world, not one institute is dedicated to nutrition. In clinical practice (doctors, nurses), there is no education, very little or no professional compensation, and very little or no funding for nutrition science research. I’ve been abundantly aware of this problem throughout my career. Since 1965, as a recipient of generous amounts of funding for my research program (mostly concerning the causes of cancer and mostly funded by the National Cancer Institute of NIH), as a member of expert committees (“study sections”) responsible for professional evaluation of applications for NIH funding and as an advocate for a new Institute for Nutrition at NIH, it has been my academic experience that there has been a proactive stance against accepting nutrition on par with other medical disciplines.

This dark side of public nutrition information may be illustrated by a website of the European Food and Information Council (EUFIC), ⁵ a nonprofit organization established in 1995 who “covers a wide range of topics on nutrition, lifestyle and health, food safety, food quality, legislation and food risk communication” and who “collaborate with a broad network of academics, national and international organizations, businesses and professionals in food and health.” (Yes, food and nutrition information outside the United States is much the same!) This council, aiming to be publicly responsible, is funded by individual food and drink companies, the European Commission, foundations, and other umbrella organizations. Although discussing “topics on nutrition,” they fail to list nutrition as a “biological determinant of food choice,” suggesting that when individuals select foods to eat, they need not be especially concerned with nutritional value. Or perhaps, this is evidence that consumers are not sufficiently informed on nutrition to make rational choices—that is, they don’t know what they don’t know.

According to this organization, determinants of food choice include hunger and satiety, palatability, sensory aspects, cost and accessibility, education and knowledge, influence of social class, cultural influences, social context, social setting, stress, mood, eating disorders, consumer attitudes and beliefs, optimistic bias, and time constraints. They cite nutrition counseling as an important component of promoting behavior change, but they are somewhat dismissive of this need because “cost implications of training primary care professionals in behavior and nutrition counselling are unclear.” Why the excuses?

From my point of view, a major reason for not understanding nutrition may be seen by comparing the opposing concepts of “wholism” versus reductionism. Traditional research during the past century, and more, has attempted to understand the chemical and physiological properties of nutrition on a nutrient-by-nutrient basis instead of a whole food comprehensive nutritional property. Experimental research efforts on isolated nutrients, isolated mechanisms of action and isolated health events are useful for expanding nutrition knowledge, but this information should then be used to describe the “wholeness” of nutrition, as in whole foods, not as nutrient “parts.” Isolated nutrients, when consumed as supplements for example, often do not have the same functions as they do when present in whole food, thus being a serious source of confusion. ⁶

I submit that the message for the consumer is simple. Consume plant-based foods in their whole food form. ^† A wide variety of these foods within different ethnic cuisines may be used in this simple diet. The health effects essentially will be the same, regardless of ethnic preference. Except for those who wish to study fundamental details, we all can set aside concerns about the infinitely complex mechanisms by which they work in the body, because this is within the realm of Nature to manage. Focusing on individual nutrients and their mechanisms of action often mislead. If a very simple message, which emphasizes plant origin and whole food form, were to be the only public message provided to consumers, I am confident that most of optimum health to be theoretically achieved can be achieved. Further, this would be a worldwide lifestyle message. The health benefits—all the way from humans and other sentient beings to the planet itself—would be incalculable.

A unique feature of this message is its demonstration of several profound principles of nutrition. ⁶ First, chronic degenerative diseases are simultaneously prevented and, in many cases, reversed (treated). Second, relative to pharmacological treatments that often become ineffective (drug resistance) and encumbered with unanticipated side effects, this nutritional protocol retains effectiveness without side effects. Third, a simple distinguishing effect exists between animal- and plant-based foods. Fourth, on dietary intervention, meaningful change occurs within 1 to 3 days. And fifth, the nutritional effect is consistent for a broad array of health and disease conditions. In short, it is reasonable to say that this nutritional effect does more to create and maintain human health than all the contemporaneous pills and procedures combined.

On this last principle, this breadth of effect now can be extended to the present-day coronavirus pandemic. My own research group, collaborating with principal colleagues in China, Taiwan, and England, among many colleagues elsewhere in the world, obtained evidence on a viral disease in a survey of diet, lifestyle, and disease mortality 25 to 40 years ago of more than 8000 adults in rural China ⁷ and Taiwan. ⁸ In addition to a multitude of other findings, ⁹ I also came to learn that this same diet is able to control viral diseases as well. Specifically, I speak of the most serious virus known, hepatitis B, which kills more than 700 000 persons per year, principally by primary liver cancer. ¹⁰

In this study, consumption of more plants, as whole food (“vegetables”), is statistically and significantly associated with a higher prevalence of viral immunity (antibodies) but not with its main symptom, primary liver cancer mortality. In contrast, consumption of an increasing but still very small amount of animal-based foods (only about 10% of Western customs) was associated with less prevalence of viral antibodies but more prevalence of active virus (antigen) and liver cancer mortality (P < .001). These results were especially impressive because relative antigen and antibody prevalence was correlated with several animal and plant food factors, all being statistically significant. ¹¹

These findings were still more convincing when compared with experimental results in our laboratory. In hepatitis B virus–infected (transgenic) mice, development of liver cancer was markedly increased by dietary animal-based protein, ¹² a response that also could be turned on and off by increasing and decreasing, respectively, dietary animal protein. ¹³ This effect of plant-based nutrition undoubtedly involves the immune system, not only by its enhancement of antibody formation and its repression of viral symptoms in the human survey but also by its production of so-called natural killer cells (an immune system activity) observed when animals were fed more animal protein. ¹⁴

In short, nutrition provided by whole plants is broad, profound, and relatively rapid in its effects. It is quite clear that this type of lifestyle, “wholistic” nutrition ⁶ could go a long way to help resolve an impressive array of interconnected socioeconomic problems in the world. In brief, nutrition is medicine, as told 2 millennia ago. Is it not time that this be recognized? A more complete presentation of these views may also be found in a recently published book. ¹⁵