Food as Medicine, or, What to Do When There’s No Treatment

Listening to my early research interviews can be fun. It can also be embarrassing. Knowing what I know now, some of the questions I asked seem extremely silly.

For example, one question I asked in early interviews was: “What’s the treatment for food allergies?”

I quickly learned that this was the wrong question – and I suspect it might have even felt like a trick question to the people I was speaking to.

Now, I know that I should have asked, what medications do you use to manage food allergies? That’s what I was interested in: learning about what pills, injections, and other medical products people use to maintain their health while living with food allergies.

Asking about treatments, though, may have seemed like a cruel joke. Right now, there are no FDA-approved, commercially available products that can “treat” food allergies, no products that can be taken either regularly or episodically to prevent the serious, systemic, and unpredictable allergic reactions, called anaphylaxis, that people with food allergies can experience when they eat their allergens. In general, food allergies must be managed, dealt with, endured. (This may be about to change, but it remains the reality for most people with food allergies today.)

Anthropologist Joseph Dumit coined the term “drugs for life” to describe medications that people must take consistently for the rest of their lives in order to sustain life. In his book he discusses risk-lowering interventions, such as blood pressure medications used to reduce the risk of heart disease, as paradigmatic of this shift. These medications must be taken every day in order to reduce the chances of future serious ill health. Unlike the “miracle drugs” of our parents or grandparents, like antibiotics, drugs for life don’t make us feel better in the moment. They may even make us feel worse and require the consumption of additional drugs to reduce their side effects. But in the long term, it is believed by many, they make us healthier overall as a population and extend both individual and average life spans.

In light of my research on food allergies, I’ve been toying with a term that is a play on Dumit’s concept: “eating for life“. In the absence of widely available, disease modifying treatments, the main food allergy management strategy is careful monitoring of the diet to avoid allergens. The front lines of monitoring for allergens is reading food labels to screen out foods that contain a person’s allergens. While there is some specialized knowledge that it can be important to master – technical names of milk- or egg-derived ingredients, for example – it is a doable task. Done consistently, it can lower the risk of having a reaction. With vigilance, people with food allergies may go months or years without a reaction, functionally “healthy” even though they have been diagnosed with a “disease”. Preventing serious allergic reactions can even mean preventing death, thereby extending life.

The kind of “eating for life” that people with food allergies must do is different from dietary fads promising big muscles, happy guts, clear skin, and even energy levels (I’m looking at you, paelo diet). The mainstream foodie preoccupation with the (potentially dubious) “naturalness” or “healthfulness” of outer edge and select center aisle foods is mostly beside the point for eating safely with food allergies. What matters for eating with food allergies is the purity of a food itself – its freedom from contamination of other, allergenic foods. This requires a totally different approach to investigating and interpreting the ingredients in foods than do other dietary regimes.

This is a highly individualized issue, too, since there is no “typical” allergic person. There are 8 foods that account for 90% of food allergies in the United States. However, an individual may have any combination of food allergies; their individual list may or may not include top 8 foods, may include any number of top 8 foods, and may include top 8 as well as non-top 8 foods. One individual’s ingredient detective work may not work for most, or any, other people with food allergies. In order to reduce the risk of illness and death from allergic reactions within the entire population of people with food allergies in the US, each person must be individually educated on how to reduce their own risk and must remain constantly vigilant about which foods are safe for them.

For people living with food allergies, then, food is the best medicine. Not just any food, of course: only carefully screened and investigated foods that do not contain an individual’s allergens. But the food allergy community is far from the only one where this is the case. Eating for life is similarly important in cancer, autism, and celiac communities. And this is far from the first time in history when diet has been linked to the promise of better health and more life. From university extension programs that trained housewives in food preparation during World War I, to 20th century dietary recommendations informed by ethnic discrimination, to low-fat fad diets in the 1990s intended to improve cardiovascular health, the United States has a long obsession with using food as medicine.

Yet even though eating for life is nothing new, food allergy is a singular and interesting case study. The unique needs of people with this diagnosis, including the essentially infinite combinations of allergens that a single person can react to, modifies our accustomed categories of food “safety” and “healthfulness” in unexpected ways.

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