“Our medicines are no farther away than the shelves of the grocery and the sidewalks so that we can use for a brisk walk,” said U.S. Secretary of Health and Human Services Tommy Thompson, in a press release announcing the Dietary Guidelines for Americans 2005
Secretary Thompson’s pronouncement has odd echoes with the statement by Hippocrates, “let your food be your medicine,” which in turn has often been used as a justification for the importance and value of dietary supplements.
Indeed, Secretary Thompson sounded arguably holistic when he told reporters: “The choices we make every day of what to eat and how much to exercise will really determine how long we live, how much energy we have, and how healthy we really are.” Health is in our hands, after all, and our nutritional and dietary choices play a key factor. Taking this logic a step further, the “doctor knows best” ideology (characterized as hierarchical, white-coat, dominant-subordinate by Yale professor Jay Katz in his book, The Silent World of Doctor and Patient) that characterized medical parternalism in the 20th century is indeed, crumbling and yielding to the kind of patient-centered partnership with shared decision-making that the Institute of Medicine recommended in a recent report.
In the 2005 guidelines, the old Food Pyramid is crumbling too, yielding to a new and more generalized “guidance” system.
Secretary Thompson summarized the guidelines’ highlights as follows:
“Number one, Get the most nutrition out of your calories, based on the fact that there is a correct number of calories for you to eat each day. If you use up the entire amount on a few high-calorie items the chances are you will not be able to get the full range of nutrients that your body needs.
“Two, find your balance between food and physical activity. Regular physical activity, at least 30 minutes for adults, 60 minutes for children most days of the week, is important for your overall health. Physical activity also helps you control your weight.
“Make the smart choices from every food group. Eat a variety of the nutrient-packed foods to give your body the balanced nutrition that it needs. Just stay within your daily calorie needs, depending upon your body size and your daily physical activity. Mix up your food choices– variety is really the spice of life. Know what’s in your packaged food by reading the nutrition facts label.
“Play it safe with food by keeping hands and food contact surfaces clean and cooking meat, poultry and fish to the temperatures that will kill the germs.
“And if you choose to drink alcohol, do so in moderation. Some people or people in certain situations should not drink at all.”
Of course, supplements are powders, pills, liquids, and so on–not the same, many would argue as real foods. We are not yet living in the kind world Michael J. Fox inhabited in “Back to the Future” when his inflatable pill turned into a full-blown meal and he complemented his mother by saying, “Mom, you sure know how to hydrate a pizza!”
Still, there’s an increasing governmental emphasis on the notion of food as medicine, and an increasingly conceptual blurring between the three different regulatory categories of foods and drugs.
Use of the word “medicine,” as explored in Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives, is heavily regulated: one cannot practice “medicine” without a license, and courts have interpreted the notion of “medicine” sufficiently broadly to encompass a number of healing professionals within the legislative prohibition’s sweep. Similarly, in scope of practice cases involving non-physicians, some courts have interpreted the medical licensing laws’ prohibitions against “prescription” (or recommendations of “drugs”) sufficiently broadly to include recommendations of food supplements.
One can quibble with each of the recommendations announced by HHS and dispute their vaildity or suggest refinement. The larger point here, though, is the slight shift from a “food pyramid” to “food guidance,” and the broadening of regulatory definitions to include the notion that food is medicinal.
Ethically, if a new understanding is embedded in the health care regulatory system the our own lifestyle choices create health or disease, we may see greater emphasis on informed choice, realigning the balance between medical paternalism and patient autonomy in an improved balancing test to encourage a more thorough informed consent process (one that includes viable approaches whether labeled “conventional” or “CAM) and shared decision-making.
As Agriculture Secretary Ann M. Veneman put it in the same press conference: “…people are looking more and more at what it takes to live a healthy lifestyle. I think people have gotten the message that people need to take personal responsibility for what they do…what is needed for healthy living.”
The new federal emphasis on prevention, personal responsibility, and the importance of individual choice, could also be an arrow in the quiver of those seeking licensure for CAM professions such as naturopathic medicine. It could also furnish ground for those advocating the so-called “Minnesota model” of allowing certain unlicensed CAM providers (including lay homeopaths, lay naturopaths, energy healers, and those practicing at the borderland of medicine and religion) to practice within a simple registration system.
*** From the key recommendations ***
Key Recommendations for the General Population
ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS
Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
FOOD GROUPS TO ENCOURAGE
Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.
Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.