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The Plate: Q&A, Food as Medicine


metabolism and nutrition

Welcome to The Plate, where food meets science at your table. 


In each episode, founder and CEO Sherry Zhang, Ph.D., asks subject experts questions in nutrition, biology, and health that are relevant to our approach to eating and living healthfully in our time. We visit complex topics such as how the science of metabolism influences our healthy body compositions, why it’s important to understand and practice personalized weight loss/gain, and how food affects us as individuals. 


We invite you on an intellectual tour of current scientific ways to envision and approach solutions to many of our questions and problems revolving around food in modern-day living. We may not know all the answers, but we will always be one more step closer to the truth by asking scientifically fueled questions. 


So, come join us! 


In this The Plate episode, Kristin Ricklefs-Johnson, Ph.D., M.S., R.D.N., and Kelly Van Gorden, M.S., R.D.N., C.D., join Sherry in a dynamic discussion on food as medicine.


Sherry:  “Food is Medicine” is a term which was originally coined approximately 2500 years ago by Hippocrates. It was his belief that eating wholesome food is the basis for good health. According to Ayurveda, a practice of medicine that originated centuries ago in India, food is medicine and medicine is food. Eating the appropriate foods in the correct quantities for your “type” is the most important aspect of Ayurvedic life-style in both the short term and the long term. 


Ancient Chinese medicine was also well known for utilizing food and nutrition into medicinal therapies aimed at maintaining health, preventing diseases, treating illnesses, and healthy aging. In fact, many of the nutritional practices that were founded in Chinese medicine are still commonly used today. 


Growing up in Tianjin, China, my childhood memories were filled with fascinating theories and practices of food is medicine, the essence of a long history of Chinese medicine. When I had acne and rashes or as Chinese called it “a heated body”, grandma would cook me bitter melon. I can never forget that unique blend of bitter taste in the vegetable with the sweetness of love and care from my grandmother. Years later, when I became a Ph.D. molecular biologist, I finally connected the dots. It was the anti-inflammatory effect of bitter melon that was taming down the inflamed body, probably triggering a cascade of gene expression reactions to reestablish the off-balanced state of cytokines and interleukins. 


While many of us agree that good nutrition and healthy food choices are the foundation for good health, the definition of healthy food choices can vary greatly from person to person. Since the late 1900s Americans have shifted towards a diet of processed or refined food that is high in fats and added sugars. The consequences of this standard American diet (SAD) are that rates of obesity and other malnutrition-caused metabolic diseases have increased significantly.


If food has the power to prevent much of the chronic illness we experience today then it makes sense to consider how we can alter our diets to use food to our own advantage. In this two-part series, we are going to explore the phrase “food is medicine”, what is the potential for food to be used in medicine, individual responses to food, and how we can start to customize or personalize our own diets in order to help us achieve optimal health and a long happy productive life free from chronic diseases. 


I am a firm believer that food is medicine and by achieving optimal nutrition we can largely improve our quality and quantity of life. Kelly, you have extensive experience working in the hospital setting as well as with clients 1-on-1, could you describe your perspective on the link between food and health? 



Kelly:Perhaps more than anything else in our lives, the food choices we make on a regular basis impact our risk of many chronic diseases and play a large role in how we age. In addition to the macronutrients (fat, protein, and carbohydrates) and micronutrients (vitamins and minerals), foods contain additional nutritional compounds that can impact our health including antioxidants, phytonutrients such as isoflavones, flavonoids, and polyphenols, and fiber.


Nutrient deficiencies and toxicity from a poor diet are linked to nearly all modern chronic health conditions. Many of us are aware that diseases such as diabetes or heart disease may be a reflection of a person’s diet and that food choices may play a role in your risk for certain cancers. However, many people outside of medicine realize that one of the most commonly undiagnosed conditions found in hospitals is malnutrition which can occur regardless of body weight or BMI. While someone may be consuming enough calories, they may not be consuming the right kinds of nutrient-dense foods. 


Malnutrition plays a huge role in diminishing the prognosis or recovery of a patient. Additionally, good nutrition and healthy food choices can benefit all of our biological systems from our skin to the immune system to the digestive tract. Having a body that is running efficiently and able to protect itself from microorganisms or the ability to repair and maintain tissues is an important foundational component of health.


Health practitioners are becoming increasingly focused on the connection between food, disease, and how we can use nutrition to modify our health outcomes. One of the advantages of this is that food is something we all consume and to a large degree have control over. Additionally, when we are talking about any type of preventative healthcare, the overall costs have shown to be significantly more cost-effective compared to reactive health care or health care for the treatment of disease.


Sherry Zhang:Today’s American healthcare is realistically “sickcare”. We get sick, then we go to the doctor and hope the doctor will fix our health problems. This is not the ideal state of an effective healthcare system. The best healthcare system should function equally competently as the patient’s prevention health partner. 


That is a really interesting point that you made, preventative medicine is cheaper than health care that happens in response to once we get sick. Kristin, you have included nutraceuticals and functional foods in multiple research projects in the past, how would you frame these nutrients under the framework of “food as medicine”? 


Kristin:  In the past two decades we have witnessed an upsurge in the use of nutraceuticals, in interventions and treatment plans. Nutraceuticals are non-specific biological therapies including botanicals, vitamins, antioxidants, minerals, amino acids, and fatty acids, which are reported to have a therapeutic effect. 


From a research perspective, we know that nutrient deficiencies play a large role in increased risk for certain health conditions. We also have a large body of evidence that “over-nutrition” with certain foods, especially those high in saturated fats, sodium, and added sugars contribute to chronic conditions such as CVD or diabetes. However, there is a pretty robust body of science that has linked many nutrients, food compounds, and medically-tailored nutrition that often rely on nutraceuticals to improve health outcomes.


In clinical trials flavonoids, which are the compounds that give fruits and vegetables their colors, have been linked to significantly improved high-density lipoprotein (HDL) cholesterol, the “good cholesterol”, decreased low-density lipoprotein (LDL) cholesterol, the “bad cholesterol”, decreased total cholesterol, and reduced oxidized-LDL cholesterol levels. Resveratrol, a polyphenol, acts as an antioxidant in the body and has also been associated with decreased risk of cardiovascular disease as well as risk of certain cancers. 


Several nutraceuticals used in clinical practice have been shown to target the pathogenesis of diabetes mellitus, metabolic syndrome, and their complications and to favorably modulate a number of biochemical and clinical endpoints. These include protein, vitamin C, vitamin E, vitamin D, calcium, fiber, omega-3 fatty acids, magnesium, chromium, as well as coenzyme 10, and L-carnitine. The effects that have been attributed to these different nutrients range from improved insulin sensitivity and increased insulin secretion to blunted glycemic response following meals. 


Research has shown that sulforaphane, a compound found in broccoli and other cruciferous vegetables, inhibits DNA methylation and controls certain processes in cell cycle progression that would otherwise contribute to the development of cancer. Unfortunately, we do not have time to really dive into all the amazing research that has been conducted on the impact of food compounds on chronic disease or disease recovery. What it does highlight is that what we eat has a profound effect on overall health.


Research shows that dietary habits influence disease risk. While certain foods may trigger chronic health conditions, others offer strong medicinal and protective qualities. Thus, many people argue that food is medicine. Others would argue that the phrase “food is medicine” is misleading since diet alone cannot and should not replace medicine in all circumstances. Although many illnesses can be prevented, treated, or even aid in recovery by dietary and lifestyle changes, many others cannot. 


 

Sherry Zhang:I agree. Everyone should take advantage of the many great advancements in medicine. Just like everything, food has limitations when it comes to treating illness. We could talk about this subject and the research that has been done for days! Fascinating. Kelly, what do you think when you hear the phrase “food as medicine”?

 

Kelly Van Gorden:When I hear the phrase “Food as Medicine,” I have this image in my head of a health care provider writing a prescription for a healthy diet full of whole foods, just as your grandmother gave you bitter melon. If only it was that easy to take one magical pill prescribed from our doctor for our optimal nutritional health. But an easy way to start would be incorporating more whole foods into our diet while reducing processed foods. 


We know that in reality, there are many factors and barriers when it comes to adopting a healthy diet. Nutrition and dietary behaviors are deeply rooted in our upbring, our social lives, and our culture. It may not be possible to change your social circle or your access to food. Psychological or emotional attachments to food may make it difficult to change your eating habits as well. There can also be a learning curve when it comes to healthy eating. You may be suddenly asking yourself where to find new ingredients, what portion size you should eat, and when to find time to cook meals at home. 


Though there are barriers, we know that it is worth the effort in the end. Research supports healthy diets when it comes to preventing or managing chronic diseases. While there is no magical superfood, small changes day by day can make a big difference.

 

Sherry Zhang:We have this deeply biological bond formed from millions of years of natural evolution between us and our food. We should always find a way to nurture that bond. Kristin, same question to you, what comes to your mind when you hear the phrase “food as medicine”?

 

Kristin Ricklefs-Johnson:If we look at the definition of medicine which is described as “the science or practice of the diagnosis, treatment, and prevention of disease” or “a compound used for the treatment or prevention of disease”, food would absolutely fit within these descriptions. I believe one reason we may have trouble fully embracing this concept is the fact that we are often focused on looking at medicine in terms of curing a disease or managing symptoms rather than prevention. 


Additionally, food does not act exactly like pharmaceutical drugs and results usually do not happen overnight. Food is also much more than medicine, it is tied in to many different areas of our life, both physically and emotionally, it is not just fuel and nutrients and we don’t consume it just to reduce our disease risk. Lastly, I want to point out that our response to food is not universal. Some people can eat bread or pasta and have a very low glycemic response while another person may have a significant increase in blood glucose. 


Similarly, the amount of improvement a person may have in something like cholesterol in response to a nutraceutical can also vary. That is why understanding how each of us utilizes nutrients and other food compounds and tailoring our diets accordingly is a really important concept. 



Sherry Zhang:Well said. Food is fuel to life. Food is joy to body and soul. Everything that we eat, matters. Food is deeply in our culture and civilization. Food is personal too. When it is tied with our health, we need to care about how it is personalized to our needs and happiness. Because THAT, is the essence of Food As Medicine. 


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