Eating for individual, public and planetary health

Mike Dixon, Chair, College of Medicine

Published in JHH16.3 – The Real Food Issue

Food is the most important factor in preventing disease. The right diet can also enable and speed recovery when we are ill. Yet diet seems to come bottom of the list when it comes to medical education or providing medical advice in the consultation. Our patients meanwhile – whether at home or in hospital – continue to eat relatively unhealthy diets and are spending a lower proportion of their income on food than ever.

Part of the reason for this may be because we medics don’t seem to agree on what is a healthy diet. There are some generally agreed truths such as eat more fruit and vegetables, eat less fatty meat; and the protective effects of a Mediterranean or anti-inflammatory diet are well proven. Some diets have shown to be particularly helpful in areas such as heart disease and prostate cancer. Nevertheless, ‘experts’ and the media continue to confuse the general public with foods that are claimed to be superfoods one day and demons the next. One minute we need to eat less fat, the next it is less sugar. No wonder then if doctors are almost as confused as their patients about what we should be eating.

Meat is a case in point. There is little doubt that fatty processed meat is bad for you. Yet we know that a pasturefed Angus steak is much healthier (eg higher omega 3 content) than the cheaper and more widely available meat from cattle grain-fed in barns. What we don’t know is the possible health-positive effects of meat from sheep or cattle grazed in natural pasture, perhaps containing plentiful herbs such as wild thyme and St John’s wort which might make such meat healthier still. Then there are wider issues such as how, without animal manure (and without importing chemicals from abroad), we would fertilise our fields. And when it comes to carbon footprint, let’s not ignore the ability of the pasture plants themselves to sequester carbon; an effect that is reversed by bare ploughed fields.

A further element of complexity comes from the discovery of the importance of the trillion bugs that make up our intestinal biome. We know that they matter and that their effects range from bowel problems to obesity and disorders of mood and emotion. We also know that this inner world of gut bacteria prefers a wide range of diet, and that some probiotics and even faecal transplants can restore a healthy microbiome. And though it is still as yet a far from an exact science, it is becoming clearer that the individuality of our biomes and genotypes mean there can be no precise one-size-fits-all ‘good diet’.

We are currently faced with an institutional and political unwillingness to reverse all the factors that stop us using the evidence available to help us lead more nutritional healthy lives. Healthy foods are, on the whole, more expensive than unhealthy foods. Supermarkets blame their offering unhealthy foods on the customers, who want to buy them. Farmers are encouraged to provide cheap food by the least friendly farming methods and, having bought all this cheap food, we throw away 40% of it. If politicians, food outlets, food producers, farmers and food academics could group together, surely there must be some means of reversing a system that currently ensures that those most in need of a healthy diet are least likely to be able to afford it or be sufficiently motivated to do so.

These are some of the issues that will be part of this year’s College of Medicine conference Food on Prescription at the Royal Society of Medicine on 24 October. With social prescription now national policy surely it is time to make access to healthy food part of governmental policy, and a programme to make genuine change instead of just tinkering around the edges.

The solution will have to deal with the current silo-thinking and political apathy. We are saddled with a system that competes to make ‘cheap’ food available, and
consequently favours commercial interests that encourage farmers and food processors to produce less healthy food. It will also involve a united front among the medical profession – some of whom have too often put their egos and pockets before the common good. The College of Medicine established a Food Forum of all interested parties after our last conference Food: The Future Medicine. This did not succeed in its aims because of those conflicting interests and because it will take more than a few motivated people to unsettle the system: it will require a social movement. The College of Medicine is working with the BHMA to create a movement that will connect farming, food and health and arouse the energy of change required so that we all can live more fulfilled and healthy lives in a system that nourishes us and sustains the health of our planet.