“Food is medicine” and other slogans that might cause you to blame yourself for being sick
Dr Hannah Ryan
Clinical Psychologist, Two Leaves Therapy
Making sense of sickness.
Arguably, one of the most important relationships we will have in our lives is the one we have with our own bodies. However, embodiment, the state of being in relation to a physical body, becomes infinitely more complex and painful for people with chronic illness and long-term disabilities.
According to the social model of disability, the experience of being disabled or chronically ill is not just made difficult because of the inherent suffering caused by the illness or disability itself. In fact, in some instances, it could be argued that there would be little or no suffering at all if society truly enveloped those with physical vulnerabilities in values of compassion, inclusivity, dignity and respect (rather than merely espousing those values tokenistically on their websites whilst coldly citing exclusionary policies behind closed doors).
None of us exists in a social vacuum. Those with chronic illness are incredibly vulnerable to micro-aggressions and daily acts of exclusion, invalidation and blame, which are not actually ‘micro’ at all but, in fact, profoundly wounding and harmful to their self-worth. They are also constantly imbibing the discourse on wellness that we are all immersed in, for better or worse, and filtering their perception of their bodies through the lens society is continuously constructing on their behalf. It turns out that our sense of self is not, in fact, ours alone but unavoidably refracted through the words of that podcast host, Instagram guru, wellness coach and doctor-whose-book-you-just-downloaded-on-audible.
What is wellness culture?
But what even is ‘wellness culture’, and can we actually define something as inchoate and socially constructed anyway? Writer Christy Harrison certainly attempted to do so in a somewhat tongue-in-cheek way in her book The Wellness Trap:
“…wellness is defined by the things you do, and doing those things typically requires a fair amount of economic privilege. As a 2021 New Yorker article humorously put it, “Wellness encompasses a broad range of activities including juice cleansing, transcendental meditation, snail serum application, buying a Peloton, napping, switching to oat milk, switching to charcoal water, Kegel exercises…micro-dosing LSD, mega-dosing CBD, intuitive fasting, avoiding blue light, seeking out red light…maintaining ketosis [et cetera]”.
Besides sounding exhausting and expensive, you might wonder what the problem is. After all, isn’t it both a pleasure and a privilege that we now have such an abundance of easily accessible, evidence-informed information about the impact of everything from food, alcohol, sleep and stress on our health so that we can live as well as possible? Yes, in principle, I do not contest this. Harrison also points out in her book that the health and wellness world can be fascinating, entertaining, fun, insightful, revelatory and undoubtedly helpful. My concern is that this information frequently comes wrapped in messaging that can be harmful and misleading. Moreover, I worry about the impact of this messaging on people with chronic illnesses who disproportionately turn towards this industry for information, solace, comfort and advice.
This is especially concerning people of all genders with invalidated illnesses such as chronic fatigue syndrome and Long Covid and other marginalised people who feel abandoned, neglected, abused or gaslit by the medical system and end up turning towards alternative wellness- not as a supplementary hobby or to build on a state of baseline health, but for vital medical support.
The wellness messages that can turn sour when you’re sick
My message is strongly influenced by two writers: Dr Joshua Woolrich, an NHS doctor and author of Food Isn’t Medicine and Christy Harrison, author of two books, The Wellness Trap and Anti-Diet. Here is my interpretation of some of the issues Woolrich and Harrison have identified with the messages that permeate this industry:
1. They are highly individualising. They tend to overestimate the extent to which an individual can control their health, promising (and usually monetising) magical cures and an illusion of control that is virtually impossible to achieve.
2. Linked to the above, they locate responsibility for health outcomes in the individual, which takes responsibility away from healthcare and corporations and detracts from the pressure which should be put on food companies and their marketing, as well as the government and their decisions regarding taxation, housing and the economy.
3. They minimise the impact of genetics and biology on health, selling an idea that an individual can eat, exercise and de-stress their way to a fantasised state of perfect well-being. While this is an enticing idea, it can encourage health perfectionism, “orthorexia”, self-blame and depletion of finances in an obsessive and elusive pursuit of wellness.
4. They idealise “natural” treatments and denigrate medical, “chemical” or pharmaceutical ones. This can lead to dangerous choices, such as people choosing to stop taking necessary, even lifesaving, treatments in favour of “natural” ones such as fasting, visualisation or plant-based diets.
5. They disguise the extent to which the disseminators of this information monetise and benefit from the messages and fantasies they sell.
6. They fail to take responsibility for the extent to which they promote restrictive eating, obsessive eating, and disordered relationships with one’s food and body image.
7. They promote healthy eating and being slim as a moral achievement and minimise the meaning that comes from experiencing pleasure from food, as well as the cultural symbolism of food that comes from childhood memories and shared traditions.
8. Last but definitely not least, until recently, they have grossly minimised the impact on health outcomes caused by socio-economic factors, constructing issues like “stress” and “healthy eating” as individual responsibilities resulting from willpower whilst paying little to no attention to poverty, racism and disadvantage which we know are significant causal factors of stress, trauma and disease. Additionally, they fail to acknowledge that healthy food is not equally accessible to everyone.
This last point is highlighted in an article also called “When Food Isn’t Medicine” by medical doctor Dr Sean Lucan. Dismayed by the simplistic messaging in the article title, Dr Lucan decided to go into a nearby neighbourhood supermarket and take a photograph, which he would later use to illustrate his point to his classmates who might be tempted to advise local patients to simply ‘lose weight’ and ‘eat better’:
“A photograph I snapped during one store visit—a sad wooden bin containing blemished potatoes and discoloured onions—is one I still use in presentations to this day: this is a produce aisle of a ‘supermarket,’ in an urban, low-income, minority neighbourhood. Other photos show shelf after shelf of candy, chips, cookies, cakes, rainbow-coloured cereals, and sugary drinks... The choices patients like T.C. can make are, of course, constrained by the choices they have… food cannot be medicine when it is not available to patients (or when available only in the form of unhealthful fare).”
The insidious power of implicit messaging
It may also be helpful to distinguish between explicit and implicit messages here. Deborah Tannen, a conversation analyst, writes in her books about how relational harm can be perpetuated in families when people refuse to take responsibility for the implicit messages in their words. Consider an exchange in which a mother says to her daughter: “You can’t go out in that skirt; it looks like a belt! Do you want to be attacked?” to which her daughter says, “You’re making me responsible for the actions of a potential perpetrator?” to which her mother retorts: “How dare you; I never said anything of the sort- you’re putting words in my mouth!” In an exchange like this, the mother does what Tannen beautifully calls ‘pleading literal meaning’. In this case, it would be obvious to any rational, fair outsider that the daughter’s interpretation is reasonable. However, the mother is shirking responsibility; she is pleading literality. By doing so, she avoids having to reflect or take accountability.
Something similar may happen with the discourses produced by the so-called wellness industry. Wellness gurus will never explicitly say: it’s your fault that you are chronically ill. You caused your own disease. You are the reason you are infertile. You haven’t been doing enough. You never finished my book. You didn’t eat enough turmeric. You haven’t been eating enough plant foods or exercising enough or exercising in the right way or breathing through your nose or breathing in a paced way or meditating or spending enough time in nature or taking cold showers or whatever else it is they feel is both magically and scientifically going to render us all invulnerable and immortal and perpetually happy (although the things they say are often astoundingly similar to this). They don’t have to say it because it is implied, with or without intent, and they don’t say this because if they did, they would have to take responsibility for their words.
Instead, obscured messaging renders their power more dangerous and insidious. Thus, when a person comes to therapy and says, “I feel like I am to blame for my recent flare up”, and a psychologist asks them “, Where do you think that thought comes from?” the majority of people will shrug and say, “I don’t know”.
Consider the following statements. These are slightly paraphrased twists on actual quotes I have been inspired by from wellness books, podcasts and Instagram pages (content warning: if you are a chronically ill person trying to avoid this messaging, feel free to skip this section):
“Getting up at 6 am and going to the gym every day is hard. Cutting out sugar is hard. Counting your macros is hard. But you know what’s harder? Waking up in ten years unhealthy, with chronic illness, overweight, and with a life full of regret.”
“When you experience the evolutionary magic of a carnivore diet, you will be amazed at the level of wellness your body can achieve. You will discover that most “diseases” you thought incurable – migraines, hormonal issues, autoimmune conditions, PCOS, infertility, diabetes- can be reversed in just a few months with the simple power of science.”
“Fasting is a magical way to tap into your body’s healing powers. It can reset your hormones, help you lose weight effortlessly, reverse chronic illnesses and prevent chronic diseases coming down the line. Once you start, you won’t want to stop either because you’ll be so goddamn excited about what fasting can do”.
“Most of my patients don’t realise that if they just went back to the basics like exercise and diet, most of their symptoms would vanish.”
“If you start eating a fat-based breakfast, you will have a fundamentally different experience of life".
“Just drinking apple cider vinegar and walking twice daily caused Terry to lose seven pounds in a week! She couldn’t believe it! ‘This isn’t even a diet!’, she told me. She was sleeping better, her skin improved, she had more energy and mental clarity, the brain fog was gone, her cravings were cured, she had no more headaches, her IBS was gone, and her fatigue had vanished. Best of all? She threw her anti-depressants in the bin”.
“When I first met Mary, she was severely overweight and suffering from diabetes and several other chronic health issues. When I put her on a radical plant-based diet, she couldn’t believe the results. It wasn’t easy, but the results were so astounding within a few months that her doctors were asking for my email address”.
Am I suggesting that these people are lying? No. Many of the evidence-based approaches, such as intermittent fasting, balancing blood sugars, cutting out ultra-processed foods and eating diverse plant foods, can have extraordinary, exciting, life-enhancing results. Nor do I intend to shame nutritionists, dieticians or doctors who promote nutritional science responsibly, ethically, and humbly. But a scary proportion of them take it too far; narcissism goes to their heads and they fancy themselves Godlike healers of diseases doctors and experts by experience know that people need medication for. I am not saying don’t eat the plants if that is the evidence-based advice. I am saying: don’t tell people to eat the plants and throw away their thyroid medication. Don’t imply that not eating enough plants was the cause of the thyroid disease in the first place.
Some of the purveyors of these messages have been ill themselves. Perhaps they once needed to cling to fantasies of immortality and existential control; perhaps they genuinely found something helpful and mean well. Others, however, are people who are privileged and powerful on multiple levels. An astonishing number of them appear to be male, able-bodied, healthy doctors who present as both arrogant and ignorant of the lived experiences of the chronically ill and who have a habit of over-attributing the reasons for their personal wellness to their own individual actions whilst minimising the impact of both luck and privilege. This, as the kids say, is problematic.
What is the psychological impact?
So what happens when these messages are internalised? What happens when a chronically ill person turns to the world of wellness for a sense of control during a time of great uncertainty and fear- when they feel their hopes rise at the promise of a dream that is sold to them in the form of a new supplement or, “diet that is not a diet” (but which is definitely still a diet), only to feel it all crashing down months later when they experience a flare up or when their results look nothing like the gushing testimonials?
Well, I’ll tell you what usually doesn’t happen: they don’t usually tend to blame the book they were reading called “How to Live Until 120, Reverse Ageing, Lose Weight Effortlessly, Feel Happy Every Day and Cure Chronic Disease in Ten Simple Steps”. Instead, they tend to blame themselves. Their thoughts – which are not neutral but always influenced by the social world- might sound a bit like this:
“I shouldn’t have had that bread yesterday; I was told that gluten could trigger my IBS. What was I thinking?”
“This was because of that coffee, wasn’t it. I know that caffeine is a trigger, so why am I so undisciplined?”
“My PCOS is all my fault. Why can’t I lose weight? I’m so lazy. I should be getting up earlier. Tomorrow, I’m going to set my alarm for 5am”
“It’s all my fault that my bloods are out of whack. I haven’t been managing my stress. I should have quit my toxic job ages ago and I haven’t used that meditation subscription either. I only have myself to blame”.
“It’s no surprise this round of IVF failed when I took on so much at work. I knew I should have tried acupuncture as well, why did I put it off? And now it’s thousands down the drain. I’m so angry with myself”
Does any of this sound familiar? If so, you’re definitely not alone and, I can’t stress this enough: it’s not your fault. It’s not your fault that you are ill, and it’s not your fault that you’re beating yourself up for it either. It’s also not your fault that you have reached out to the world of nutrition, health, wellness blogging and science. It makes complete sense that you would try to gain control over your body and help yourself move towards health, and it’s a sign of your resilience and determination that you do so. I am just sorry that when you reached out for solace and support, it came with a big, invisible and unsolicited dose of implicit blame.
What can the wellness industry do to be accountable?
This is the part where I am supposed to give you advice about what to do differently but, ultimately, it is the industry itself that needs to change, not you. (You are already probably doing way more than enough). As Dr Wollrich has said, “nuance and caveats cost nothing”, and it is the responsible, compassionate and ethical way to disseminate information. Adding a caveat also needs to go beyond tokenistic statements such as “always consult with your doctor”, especially when so many people are feeling abandoned by their healthcare providers. There is also no depth to blanket statements such as “there is no one size fits all” when this is immediately undermined by hundreds of minutes of messaging about the magical power of whatever the person is selling for literally everyone. Instead, responsible messaging might sound something like:
“Cancer is never your fault. There is currently no available evidence to suggest that stress causes cancer. Additionally, our society constructs stress as something within our individual control, whereas psychologists increasingly recognise that this is predominantly determined by luck and privilege; by the families we were born into and by our economic circumstances. Many people do find it helpful to have psychological therapy whilst they are undergoing cancer treatment; if you think you would, please reach out for support”
OR
“Studies have suggested that selenium rich foods can modestly support thyroid function in healthy people; however, thyroid disease is contributed to by a mixture of genetics, viruses, hormones and other factors outside your control and we know that medication is often vital for people with thyroid autoimmune conditions. It is never your fault if you have one of these conditions, and food is just a small part of the picture”.
OR
“Keto was helpful for me, but keto is not helpful for everyone and can even be harmful for some. Keto can also contribute to restrictive eating for many as it involves cutting out food groups and ignoring hunger cues. Ultimately, I feel it is not my place to advise anyone on how they should eat, so for that reason, I don’t feel it is responsible to talk in detail about it; instead, we are going to talk today about intuitive eating and weight stigma.”
OR
“We know that fruit and vegetable consumption can improve our gut microbiome, but we also know that access to fruit and vegetables is heavily affected by social and economic factors. As individuals in a cost-of-living crisis, we are not wholly responsible for our health choices and this is something we are going to discuss on the podcast today.”
OR
“Plants are incredibly good for you, but very few diets can completely cure illness. Food is helpful but food is not the same as medicine”
Oh, what a world it would be if this were the norm rather than the exception.
What can you do to protect yourself?
Becoming aware of the impact of this messaging is already a powerful first step. It can also be hard to disentangle yourself if nutrition and health science is an interest or passion for you, and this might bring up complex feelings or confusion about how to proceed. To ironically borrow from the language of the wellness industry, you could try taking a “detox” or “cleanse” (otherwise known as a good old-fashioned “break”) from health-related information for a while to give yourself some space.
You could also try deliberately exposing yourself to material that can act as an ‘antidote’ to the more harmful, salesy, individualising messaging that’s out there. Thankfully, there is an emerging genre of books and blogs which can increase your critical thinking and self-compassion and help you realise that it’s really not your fault, and it’s not all within your control either (an idea which might be hard to let go of by the way, but which should ultimately be freeing).
I highly recommend the two books mentioned above: Food Isn’t Medicine and The Wellness Trap. My only teeny critique of these two excellent books is that in parts I feel they tend to slightly throw the ‘baby out with the bathwater’ and I don’t think this is necessary. We can still have a passion for eating well and learning about health whilst expressing concern about the messaging this information is often packaged in. A third book I am delighted to recommend if you are interested in food science is Ultra Processed People by Chris van Tulleken. This is an excellent book that educates on nutritional research without making wild claims or blaming implications.
Consider trying to find a community of others who “get it”, perhaps because they share a lived experience of illness. This might mean joining a private Facebook group for people with long Covid or signing up for an in-person support group for people with sight loss. You don’t have to stay if the culture doesn’t feel right; but these are the people who are often in the best position to give you the empathy, validation and support you deserve.
Try, if you can, to occasionally validate yourself. This might involve saying something like, “anyone in my brain and body would find this hard”, “it’s never my fault that I’ve had a flare up” or “it makes sense that I feel angry after reading that”. You shouldn’t have to validate yourself whilst existing in a chronically invalidating environment, but gently challenging our own thoughts a small portion of the time can have a modest yet notable impact.
If you have access to a therapist, and I appreciate that not everyone has, consider exploring this in therapy or with a safe and supportive other. You deserve to have someone who will kindly reframe your thinking when you blame yourself or say, “and this is just a small thing, but…”. As a dear friend often reminds me, “the small things are the big things”. And remember, it is the wellness culture and its toxic messaging that is to blame, not you.
References and Sources
Harrison, C. (2023). The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being. Yellow Kite/Little Brown Spark.
Harrison, C. (2019). Anti-diet: Reclaim your time, money, well-being, and happiness through intuitive eating. Hachette UK.
Harrison, C. A., & Taren, D. (2018). How poverty affects diet to shape the microbiota and chronic disease. Nature Reviews Immunology, 18(4), 279-287.
Lucan, S. C. (2018). When food isn't medicine-A challenge for physicians and health systems. Preventive medicine reports, 10, 62-65.
Patel, B. (2023). Food Is Medicine Until It Isn’t–Part I.
Tannen, D. (2006). You're wearing that?: Understanding mothers and daughters in conversation. Ballantine Books.
van Tulleken, C. (2023). Ultra-Processed People: The Science Behind Food That Isn't Food. WW Norton & Company.
van Zweden, S. (2022). Heat and hope and attention: Body control in a time of chaos. Griffith REVIEW, (78), 188-195.
Wolrich, J. (2021). Food Isn’t Medicine. Random House.
