“Let food be thy medicine, and let medicine be thy food.”
The quote is often attributed to Hippocrates, but you won’t find the words anywhere in his writings. Nonetheless, there are good reasons to say it is the kind of thing he ‘might’ have thought. The Ancient Greek physician considered nutrition one of the main tools that a doctor can use. More than that, dietary measures play a lead part in the original oath of Hippocrates.
If, in modern renditions of the oath, the central importance of diet is hidden under vague terms like ‘treatment’, in the original Greek the sense is nearer to being something like: “I will apply diet, exercise and medicines to help the sick to my best ability and judgment”.
You see, all three aspects of health are contained in just one word in Greek, διαιτήμασί. And we can be sure that Hippocrates really did include food in his prescription. There’s another text attributed to Hippocrates, “De Alimento” (“On Food”), in which there’s a statement which runs: “In food excellent medicine can be found, in food bad medicine can be found; good and bad are relative.”
The idea of food as medicine was also passed on to the Romans as can be seen by the neat division of therapeutics into three branches in the preface to a first century text by Aulus Cornelius Celsus (a Roman encycolapedist) called ‘On Medicine’. He explains that for the Greeks:
“…the Art of Medicine was divided into three parts: one being that which cures through diet, another through medicaments, and the third by hand. The Greeks termed the first diaitētikē (dietetics), the second pharmakeutikē (pharmacology), the third cheirourgia (surgery).”
Today, though, diet has become the poor relation to pharma or surgery in health matters. One debate in particular, that over how to treat heart disease and high cholesterol, is emblematic of this shift in the perception of health.
Jane Brody, health correspondent of the New York Times, set out the zeitgeist in an opinion piece a year and half ago:
“Are you among the 73 million Americans with cholesterol levels that current guidelines suggest should be lowered by taking a statin for the sake of your cardiovascular well-being? Have you and your doctor discussed the pros and cons of statin therapy and whether it is appropriate for your circumstances? If not, now is the time to do so.”
Similar pieces appeared in mainstream news outlets around the same time all over Europe too, and doubtless for the same corporate reasons. Perhaps the most vehement call for ‘more statins’ came in the supposedly liberal Guardian newspaper in London, under the byline of its long-standing health editor, Sarah Boseley. Under the punning headline ‘Butter nonsense: the rise of the cholesterol deniers’ she took on those who were saying dreadful things like ‘butter is back’, ‘saturated fat is good for you’ and ‘cholesterol is not the cause of heart disease’. She warned of a conspiracy to put things like cheese, dairy and meat back on the menu.
Here, food is not a medicine, only a threat to health. Boseley even warns that, according to “leading scientists” (sigh) AND the medical authorities, fatty foods cost lives. “Encouraging people to eat more saturated fat is dangerous and irresponsible” obediently pronounced Professor Louis Levy, the head of nutrition science at Public Health England (PHE).
However, we’ve been here before. Public health bodies and activist academics have too often insisted there is a ‘consensus’ around actually rather debatable dietary policies which focus on traditional foods as a source of illness and also often later favour ‘new foods’ or even the mass-prescription of drugs. Such advice is anything but scientific. However, there are always plenty of people making money from saying that it is.
Above all, there is Big Pharma. The global statin market 2019–2023 is expected to expand to around $1,647 million in the next few years, according to the latest market research report by Technavio.
Statins are already the most commonly prescribed drug in the UK. It is believed that six million Britons today are taking these drugs, ones that indisputably many of them do not need and can cause serious side-effects. Over in the United States, a staggering 73 million Americans are considered by the medical industry to need to take the drug — for the rest of their natural lives. You could say they have become a sort of ‘food’ — but if so, they are a junk one.
If originally the drugs were proposed for people with a clear, and probably existing risk of heart disease, they soon become considered appropriate for healthy people too on the very unscientific principle that what is sauce for the goose is sauce for the gander too. Thus we have the ludicrous systems of ‘risk assessment’ that automatically mandate statin prescription for everyone over 75. People who are a particularly vulnerable market.
Supporters of the drugs like to point out that they are ‘out of patent’ and create a picture of them being distributed almost ‘pro bono’ by the do-gooding pharmaceutical companies, yet generic or not, statins are still an incredibly profitable industry with an estimated value worldwide of $20 billion a year. In the US, a mind-boggling 100 million prescriptions of aborvastatin have been made while, in the UK, prescriptions of the same drug cost the NHS around £60 million a year — despite being generic.
So there is certainly a financial incentive to push mass prescription of the drugs, and that has led to doctors not presenting the ‘pros and cons’ of the treatment to each patient and creating the conditions for ‘informed consent’. In the case of the prescription of statins, too many doctors uncritically accept industry assessments of the drugs’ usefulness and see their role as reassuring patients that they are safe.
And the food and lifestyle leg of Hippocrates’ health tripod receives barely a mention.
Even though it is uncontroversial that a direct and effective way to improve heart health is through lifestyle changes, such as exercise and eating a well-balanced diet, patients and doctors alike share a deeply ingrained prejudice that favors pills and potions over mundane, everyday things like, well, taking a walk and eating your greens.
Patients will not be offered straightforward and practical dietary advice. For example, that:
- Garlic has acquired the status of ‘traditional’ remedy for hypertension and high cholesterol, after research in the mid-20th century found that it lowered ‘bad cholesterol’, as well as having rather wonderful antibacterial, antiviral and antifungal properties.
• Legumes like beans, peas and lentils can help lower cholesterol. A review of 26 randomized controlled studies found that eating a 1/2 cup (100 grams) of legumes per day lowered “bad” cholesterol by an average of 6.6 mg/dl,
* Eating a daily avocado is thought to provide monounsaturated fatty acids and fiber, two heart-healthy and cholesterol-lowering nutrients.
And then there’s nuts. Many nuts are high in monounsaturated fats and phytosterols. — plant compounds which are structurally similar to cholesterol and help lower cholesterol by blocking its absorption in your intestine. Walnuts, in particular, are also rich in the plant variety of omega-3 fatty acids, a type of polyunsaturated fat (“unsaturated” refers to the fact that the molecules contain less than their maximum amount of hydrogen) associated with heart health, while almonds are rich in L-arginine, an amino acid that helps your body make nitric oxide which, in turn, helps regulate blood pressure. What’s more, nuts provide calcium, magnesium and potassium, which it is thought help to reduce blood pressure and lower your risk of heart disease. One study found that a daily serving of nuts led to a 28% lower risk of both fatal and nonfatal heart disease .
Unfortunately neither doctors nor patients want to talk about nuts. Such health advice is seen as mere household ‘diet tips’ and inferior to the rather more scholarly and sophisticated stuff of pharmaceuticals, At the same time, the raft of problems with drugs is skipped over because neither doctors nor patients like talking about the nasty side effects of treatments. And no wonder! Statins on their own, for instance, run through
· sore throat
· a runny or blocked nose (non-allergic rhinitis)
· feeling sick
· problems with the digestive system, such as constipation, diarrhoea, indigestion or flatulence
· muscle and joint pain
· increased blood sugar level (hyperglycaemia)
· an increased risk of diabetes
That’s the official UK National Health Service list. However, there’s many more that could be added. How statins can cause memory loss for example. This is because drugs that lower blood levels of cholesterol may well impair memory and other mental processes by depleting brain levels of cholesterol at the same time. In the brain, these lipids are vital to the formation of connections between nerve cells — the links underlying memory and learning. When patients are encouraged to lower their cholesterol levels, they are not told that the brain, in fact, contains a quarter of the body’s cholesterol.
A study published in the journal Pharmacotherapy in 2009 found that three out of four people using cholesterol-lowing drugs experienced adverse cognitive effects “probably or definitely related to” the drug. The researchers also found that 90 percent of the patients who stopped statin therapy reported improvements in cognition, sometimes within days. (In February 2012, the Food and Drug Administration ordered drug companies to add a new warning label about possible memory problems to the prescribing information for statins.)
The fact is, neither patients nor doctors have a good handle on the risks drugs may involve. On the other hand, foods for heart health are not exactly complicated or obscure. Alas, both patients and doctors are co-conspirators in a deeply-embedded tradition of preferring pills to such practical remedies. The trouble with that is, as the case of statins well illustrates, there may be a very high price being paid in terms of public health.