Food and drink as medicine

What is food and drink for? ‘Let food be your medicine’, said Hippocrates. As we all know, orthodox nutrition science is modelled on medicine, as is dietetics. Their unstated governing principle is that what matters about food and drink is its relationship with health, in the medical sense of physical disorders and diseases. The same goes for orthodox public health nutrition, except that it addresses diet and epidemic diseases. Food and drink that protects against obesity, heart disease and the jim-jams is good, as is that which prevents nutritional deficiencies and relevant infections. Food and drink that causes these and other disagreeable, disabling and deadly conditions is bad.

Obviously this take on food and drink is important and true; and checking out the evidence is valuable for those prepared to pay attention. But it is not the whole truth. And is it the main truth? Do you believe this is what matters most? Judging from the original papers contributed to nutrition journals, most researchers in the field seem to think or assume so. But is this really what you feel and – to be more pointed – how you eat? It is fairly well known that the percentage of conventionally qualified nutritionists and dietitians whose own habits comply with the full set of any international or national dietary guidelines is round about zero. Noel Solomons and co-workers find that Guatemalan peasant farmers get close⁽Reference Campos, Solomons, Vossenaar, Soto, Medina and Anderson¹⁾, but not as a result of reading and inwardly digesting expert reports. Some top profs responsible for dietary guidelines no doubt put their mouths where their recommendations are. My observation and educated guess is that most do not.

So what’s up? There are two explanations. One is that the vast majority of dietitians and nutritionists are cognitively dissonant. Two is that we all know, without saying so in our professional work, that there is very much more to food and drink than its effects on the risk of disease. This column ponders the second explanation.

Food and drink as delight

Pausing to reflect as I check the references below at the end of a sunny day on a visit to London, I enjoy a glass of chilled Vin de Pays d’Augues, a snip at £3·99 from the Nicolas chain of wine shops, and a couple of peppered oatcakes, whose savour also comes from a recipe including lots of fat and salt. Later as the shadows lengthen, for supper I relish some slivers of Serrano ham exported by Esteban Espuña of Girona in Catalonia and a massive tomato bought at Waitrose, with a fat slice of ‘pain de campagne’ freshly baked by Marks and Spencer, plus another glass of wine.

We eat and drink not just to prevent disease but also for sensual pleasure, and this is a form of nourishment. Back in Brazil my diet is simpler and more austere. London, by contrast, is fun city.

Food and drink as gift

If a friend, knowing you to be a non-smoker, asked you to import a slab of 200 cigarettes (or whatever the limit is these days), would you do so? My guess is that you would not, even if you evaded refusal and instead later resorted to evasion, such as an apology for ‘forgetting’ or a story of a tight connection. That is to say, I reckon that as a knowledgeable non-smoker, you do not think of cigarettes as a suitable gift.

But food and drink is different – at least, I think so. On recent trips to London, I have come with gifts for family, friends and colleagues. These have included coffee; bricks of guava jelly, jars of tropical fruit jams; and ‘cachaça’. None of these feature in the foundation layer of any food pyramid. They are right up in the ‘consume only occasionally’ top slice, along with hot dogs and French fries. Indeed, booze doesn’t even make it into some pyramids. (By the way, what mutt chose to position pathogenic foods and drinks on the apex of the pyramid? Everybody knows that it’s best to be on top.)

Why I bring these foods and drinks as gifts is because they are all typical of Minas Gerais, the Brazilian state where I live; plus my selections are all manufactured by small businesses or on family farms. Coffee was first grown in a big way in Minas; our condominium is built on the site of a coffee farm – a couple of bushes have survived in our garden. Locally produced and home-made jams and jellies are enjoyed as desserts in traditional comida mineira (cuisine from Minas), together with a slice of the local mozzarella-type semi-soft cheese. Cachaça, the national hootch, is distilled by hundreds of mineiro smallholders, with labels often of rustic design. These may suggest virility, adventure, maternal love or sensual allure, or else – taking a different tack – may depict topers with illuminated noses in incapacitated states. The better brands have distinct subtle different aromas and flavours.

Thus I bring ‘a taste of Minas’ in the form of gifts to London. I like to think of my daughter Lou slicing and savouring guava jelly, its taste evoking her time in Brazil with us in 2004. This also is a form of nourishment.

Food and drink as memory

The same applies the other way round. My wife Raquel asks me to bring slabs of Cadbury’s wholenut milk chocolate and Walker’s shortbread back home from my London trips. I know why, without asking her. The sensory experience of these mass-produced foods takes her back to her time when she lived and worked in London in the mid-1980s, and to an epic journey with some of her friends through Scotland. This too is a form of nourishment.

Evocation of memory by the senses of smell and taste is altogether more powerful than by the sense of sight. For humans the eyes, the organs of thought, are primary; but as we can guess from observation of animals, our experiences through our noses and mouths, two of our organs of feeling, are primal. Touch is a felt sense too, as cigarette manufacturers know. Smokes were once cleverly advertised by association with romance, a reason being that if a deep kiss is followed by lighting up, and a sharp deep inhalation preferably of a Gitane, Camel, Chesterfield, Player’s Navy Cut or some other full-strength brand, your whole sensibility takes a hit.

What is nourishment?

So what is nourishment? What is food and drink for? Nutrition professionals have some answers to such questions, but these are not the answers. There are others. Why do we take ‘nourishing’ only to refer to the food and drink that best protects us against disease? Why do we not consider the other dimensions of food and drink – and of nourishment? Is this simply because nourishment of the mind, heart and – wait for it – soul, can’t plausibly be measured?

It seems to me that conventional nutrition science has confined itself to a narrow box. Yes, evidence that the nature and quality of what we habitually eat and drink vitally affects our chances of avoiding most chronic diseases is important and often conclusive or impressive^(2,3). Yes, if we stay physically active and consume lots of fresh food, therefore become and remain relatively lean, and also avoid tobacco, we are a lot more likely to enjoy later life and even to die of old age in good health⁽Reference Cannon⁴⁾. Yes, the work of independent research scientists and public health nutritionists in assembling evidence on diet and physical health, making reliably based recommendations and putting the message across, should be better funded and better known. But, to repeat, food and drink is not just about the prevention of disease. There is much more to it than that.

Food and drink as style

These first thoughts about the full meaning of nourishment are a prelude to the following report on the products coming from ‘the center for responsible hydration’ which, it seems to me now, are the shape of ‘lifestyle’ drinks to come. Well, not to come, for they are in the shops now, and set to turn over a cool annual $US 700 million in 2007⁽⁵⁾.

Here is an extract from the product promotion, crafted for the UK: ‘ahhh home at last it’s late. you’ve looked and smelt better. it takes a full five minutes to find your house keys… and now you have bitten a chunk out of your flatmate’s block of cheese. we’ve all been there and it’s not pretty. actually it’s pretty ugly. but there is hope. here at the center for responsible hydration we’ve developed a revitalising livener of potassium and b vitamins to help you wake up feeling that last night never happened… unless you snogged your boss’.

This is some of the blurb on the label of Revive, evidently a ‘health’ drink positioned as a hangover cure, designed to appeal to the market segment of unattached office workers. Revive has the colour of methylated spirits (the stuff you use to clean paint off brushes) and retails at £2 ($US 4) per half litre. By volume this makes it four to six times the price of large bottles of water or of Coca-Cola, and roughly half the price of yoghurt and fruit ‘smoothies’ and of standard wines.

The label says in big uncapitalised letters that it is ‘still fruit punch flavour spring water drink with vitamins’ and in even bigger letters that it is ‘vitaminwater^® glacéau’. Rather more discreetly the label mentions the 23 grams – about 6 teaspoonfuls – of sugars which supply 95 of the 95 kcal in the bottle. The nutrition information gives the calorie content of the drink as 19 kcal per 100 millilitres, which for any customer who skims labels and who knocks back the contents of the whole bottle could be seen to be a tad misleading.

In the UK there are so far six vitaminwater^® glacéau products, advertised with a beautiful 16-page concertina point-of-sale leaflet which must have cost a truckload of moolah to originate, whose copy and photographs project each item. ‘Multi-V lemonade’ plus zinc, which says it is ‘great for giving you superhero-like powers’, has a picture of a bloke in what looks like an office dressed as Superman, arms folded, looking out of the window. ‘Defence Raspberry-apple’ plus vitamin C and zinc, has a photograph of another man in a full suit of armour flexing a bicep, and is ‘to help you spend less time reading old magazines in the doctor’s waiting room’. ‘Power C Dragonfruit’ with vitamin C and B vitamins will ‘ignite your inner beast’. ‘Essential’ with vitamin C and calcium ‘will give you a little more bounce to get your day started right’. ‘Spark Tropical Citrus’ with B vitamins and guaraná (the Amazon’s alternative to coffee) is ‘hydration with a kick and a jump discovered – but minus the pop, fizz, and burp’.

This copy is very clever ‘lifestyle’ magazine stuff. Its jokey riffs protect the manufacturer against strait-laced accusations of false descriptions and misleading claims, for nobody will really believe that ‘multi-v’ will transform its drinker into a super-hero. But it’s a nice idea. Even alienated junior staff can dream.

More evidence that the products are positioned for young single office workers is on the cover of the leaflet, whose headline is ‘Take me home, you’ve pulled’. (For staid readers, ‘pulling’ means scoring a casual date – and ‘snogging’ may involve tongues thrust down throats.) Inside, the headline is ‘Hydration that works every time’, followed by ‘with grab and go ease, each one of our 6 give-health-a-big-kiss varieties offers a unique blend to help you feel slightly more normal on those oh-so-boring-hide-under-the-duvet days, brain melting team bonding meetings, back-popping workouts and first-one-to-go-home-is-a-wuss nights out’. In the USA the complete range of thirteen vitaminwater^® products are positioned more emphatically, with one drink projected to customers who want to feel like a dancer, another for those who want to imagine they are – or can become – athletic, and so on.

Stepping back a bit, this marketing masterpiece is an advertisement for water, plus synthetic vitamins and minerals, plus various additives such as ‘glycerol esters of wood rosins’ (also known as ‘beverage-grade ester gum’ or E445), and of course dollops of sugar. The casual purchaser might get the impression that the products contain ingredients derived from fruits, but they do not. Well, two of the six list vegetable or fruit extracts, but otherwise the colours and flavours are artificial.

The leaflet features three ticked boxes. ‘great taste… your tongue’s worth it’. Tick. ‘low calorie… cos spare tyres are for cars’. Tick. ‘packed with goodies… 24/7 vitamin loveliness’. Tick. Low calorie? Well, the products do contain somewhat less sugar than cola drinks.

Food and drink as business

In the interests of investigative public health nutrition I purchased a bottle of Revive and had a swig. It has a very long ‘finish’ – half an hour later I could still taste a vaguely metallic flavour. The manager of Nani’s, my local sandwich bar in London, said that the products were selling fast. She thought they were made by some new British company named ‘Energy Brands’, as indicated on the leaflet. But I knew better, as may you, and I pointed her to the product label. Glacéau products are already very big business. The label explains. ‘Made for the center for responsible hydration (aka glacéau). bottled in the EU for Coca-Cola Enterprises Ltd’.

The manager asked me what I thought. At first I didn’t know what to say. Sure, you and I know how to be rude about the transnational food and drink industry in general and Coca-Cola™ in particular. Are sugared drinks good for your physical health? No, they are not⁽²⁾. Consumed habitually, do they make you fat and derange your metabolism? Yes, they do. Are the products made by gigantic food and drink manufacturers displacing those made by small firms, and wrecking traditional food systems? Yes, they are. Is Coca-Cola (the firm, not just that drink) turning over as much money or more than most of the smaller African countries? Yes, it is.

Why Coca-Cola? Googling industry trade journal coverage gives some answers. Vitaminwater^® was not Coca-Cola’s idea. It was invented by J. Darius Bikoff of New York who, observing that he kept himself fit and healthy by working out, and also by drinking water and consuming vitamin and mineral pills, had an epiphany. His Big Idea was in effect to dissolve the pills in water, add sugar plus a spectrum of colours and flavours and E445 and suchlike, and thus create a range of products. He also legally protected the words vitaminwater^®, smartwater^® and fruitwater^®, which was extremely – well, smart.

His original idea to use only distilled water, and the first bottles designed by Philippe Starck, were later sensibly modified. In the USA, by 2006 the whole ‘enhanced water’ market was growing at a rate of over 30 % a year. Between 2005 and 2006 Glacéau’s turnover doubled, from $US 175 to $US 355 million^{(5, 6)}. In August 2006 the Indian conglomerate Tata bought a 30 % share of the action for $US 677 million⁽⁶⁾. In May 2007 the firm was taken over 100 % by Coca-Cola for $US 4·1 billion cash⁽⁷⁾, so Tata trousered a bonus of around $US 350 million^{(5, 6)}. J. Darius was in London in late spring this year for the British launch.

Some industry commentators thought that the price Coca-Cola paid was high. Others pointed out that PepsiCo has taken a big lead in the production and marketing of still drinks and – with its purchase of Quaker, including Tropicana and Gatorade – ‘health’ and ‘fitness’ drinks. You also have to consider the strategic planning of Coca-Cola and PepsiCo. Both firms know that, long-term, sales of their original brands of cola drinks will dwindle. Both are seeking a greater product range. Both want to market products with a health image. And yes, senior executives of both companies want more of their products to be nourishing. The question is, though, what does this mean?

Coke™, which is water plus sugar plus various herbs and bits and bobs plus caffeine-type substances, is not about to be repositioned as a health product or a functional drink. But in the 2000s Coca-Cola can roll out water and sugar plus various synthetic vitamins and minerals, artificial colours and flavours and bits and bobs (including for one product guaraná, whose active ingredient is practically identical to caffeine), customise the range as sex aids, hangover treatments, suppliers of vim and vigour and positive health, and always weavers of dreams, and sell it for five times the price of what used to be known as ‘the real thing’.

Coca-Cola simply had to have Glacéau, the centre for responsible hydration, and vitaminwater^®, as part of its portfolio. Are Glacéau products misleading? In my opinion, on the whole, no. They are, after all, called vitaminwater^®; and that, plus sugar, E455 and all that jazz, is what they are.

Food and drink as dream

Vitaminwater^® in itself won’t do you any good in the sense of making you more physically healthy. It’s less a drink and more a style accessory, like wrap-round shades or a pop song. It’s part of a modern world in which the writer of the lead story at the end of June in The Sunday Times Style magazine ‘hangs out with the hedonistic queen of the youth scene’, and other stories feature plastic surgery that creates ‘designer vaginas’ and ‘the cult cobblers causing heel mania’⁽Reference Hattersley⁸⁾. Decadent? Of course. What about the price? Single office workers in London can easily afford to pay £2 a day or £10 a week for anything they fancy.

My guess is that vitaminwater^® is set to be a world brand, not so much like Coke™ as Power Rangers or Sex and the City, and that the Coca-Cola company won’t rest until every day there is a vitaminwater, smartwater or fruitwater ®®® bottle on the desks of one in ten younger office workers in the USA, the UK, and cities in India, China and everywhere else in the world. There is after all also the choice of justwater from the cooler.

So what does ‘nourishment’ really mean? When we experience a movie or a song we are nourished in a real sense, and we know they are unreal. Whether we want to live in a fantasy world is another matter. Besides, young single office workers eventually get married, and then they shop for food and drink at discount stores, and that’s another story. Meanwhile they are in the hedonistic market segment. If vitaminwater^® nudges them towards a lifestyle that includes working out at health centres and walking to work, it will indirectly do them some good.

The task of finding out which foods and drinks protect against chronic diseases, and which are a cause of disease, is honourable, but it seems to me that if we attend only to this aspect of nutrition we will be ineffective. There is more to movies than documentaries, and more to music than folk songs.