On Nutrition

The notion of food as medicine is a popular one, but while nutritious food does have a positive effect on health, a “healthy” diet is not the cure for everything that ails us. Numerous other factors influence health, including genetics (our genes) and epigenetics (how those genes are programmed), as well as social and environmental factors such as stress, racism, climate change and wildfires.

One way these factors affect health is by contributing to chronic inflammation, which in turn contributes to heart disease, diabetes, cancer and other chronic illnesses. Although anti-inflammatory diets are popular — indeed, I’ve written about them more than once — when we treat inflammation as an individual problem with an individual solution, are we ignoring its true root causes? In their new book, “Inflamed: Deep Medicine and the Anatomy of Injustice,” Dr. Rupa Marya and Raj Patel say we are doing exactly that — and that the consequences of that narrow view are serious.

In this engaging, deeply researched book, Marya and Patel explore what inflammation is, how it affects our bodies and our health, and what’s really stoking its flames. They make the compelling case that while individuals can suffer from chronic inflammation, our individual bodies are part of an inflamed society (due to systemic racism and global capitalism) and an inflamed planet (due to climate change) — and that we can’t separate one from the others.

“What we’re looking at in this book is transforming our understanding of what health is and moving the pursuit of health away from the individualist model to what we are calling deep medicine, which situates medicine and health as a practice of community engagement and [social and environmental] care and repair,” said Marya, associate professor of medicine and hospital medicine doctor at the University of California, San Francisco. She said if medicine keeps focusing on the individual, we’ll never understand why rates of diabetes, nonalcoholic fatty liver disease and inflammatory diseases are rising.

Each chapter explores the effects of inflammation on one body system — starting with the immune system and ending with the nervous system — and links them to causes rooted in our social, political and environmental systems. These include trauma, pollution, industrial agriculture, reliance on fossil fuels, debt, income disparity, dwindling biodiversity, climate change, gender violence, racism, social isolation and stress. And the interface between our bodies and the world around us? Our gut microbiota, the health and diversity of which is closely tied to the health of our immune systems and our levels of inflammation.

“All of this is registered in our gut,” Marya said. “Our mental health, our immunity, our ability to stay well is dependent on these ecologies inside of us. And it’s not about taking more pills, it’s about stopping the stress that’s denuding our microbiota.”

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The book’s approach is a far cry from those espousing that if you follow the “right” diet and exercise plan, you will enjoy perfect health. Rather, it blows up the myths that good health is equally accessible to all, and that poor health is a mark of personal failure or weakness. Marya and Patel say the increase in inflammatory diseases is the body’s natural response to a pathological world, and the underlying problems can’t be solved by shopping for organic food, downloading meditation apps — or loading up on probiotics.

In fact, Patel, research professor of public affairs and professor of nutrition at the University of Texas, said viewing health as a personal responsibility is effectively blaming the victim. “You’re trying to address the extinction of the world around us by taking a probiotic or two and that’s not how you stop extinction. There’s no pill for that,” he said. “If we are serious about living with rich, anti-inflammatory microbiomes, then we can’t supplement our way out of a social problem. If the problem is systemic, the solution has to be systemic as well, and that’s what deep medicine offers.”

Patel said when someone treats health as an individual pursuit, they’re seceding from the rest of the planet, in a sense. “By following an individualist pathway and trying to escape from the sort of the extinction that we find ourselves in the middle of, you’re actually postponing the proper kinds of solutions,” he said.

To trace the path of our collective inflammation, Marya and Patel reach back 600 years to the beginnings of European colonization — including the destruction of Indigenous communities — and explore the all-too-real modern manifestations, including civil unrest, the wildfires ravaging the western U.S., and COVID-19. It’s no coincidence that the presence of chronic inflammation is what can turn a mild course of COVID-19 into a fatal one. So, does nutrition matter at all when it comes to quelling inflammation and protecting health? Yes, but it’s not that simple.

“As a physician, I always counsel my patients as individuals to follow a nutritious diet and try to educate them about the benefits of eating organic and to avoid dietary chemicals that are so pervasive in our food system, but many people can’t afford to do that,” Marya said. “Part of the joy of deep medicine is starting to grow our connections to communities who are fighting for the right to be healthy, and a huge part of that is fighting for the right to a healthy food system.”

She said we can’t be healthy if others are suffering, and the delta variant of the coronavirus is demonstrating that — we can’t vaccinate our way out of the pandemic when the vaccine isn’t available all over the world, because new variants will just continue to emerge. “We’ve got to rise up and realize that no one is healthy until everyone is healthy,” she said. “That is truly part of what I would call the manifesto of our book — reconceptualizing health as a species and also as an entity on this planet.”