The Intersection of Food and Medicine: An Interview with Dr. Lisa Haushofer

Interview by Kira Traylor

HHPR Editor Kira Traylor interviewed Lisa Haushofer, MD, Ph.D., Senior Research Associate, University of Zurich. Her research focuses on commercially-produced health foods and the unstable boundary between medicine and food in late nineteenth/early twentieth century Britain and the US. She earned a Ph.D. degree from Harvard University, MD degree from the University of Witten-Herdecke in Germany, and worked as a resident dermatologist at Helios Klinikum Wuppertal, Germany. She also holds an MA from the Wellcome Trust Center for the History of Medicine at University College London.

Kira Traylor (KT): Can you talk briefly about the research you are doing?

I'm trained as both a physician and a historian. In my research, I ask questions about change over time, how we’ve come to be in the situation that we’re in. And I'm particularly interested in the formation of our modern medical and scientific culture and our health practices. My current project looks at the intersections of the histories of science, medicine, food, and economic life. I’m interested in the role that food played in medicine over time. As a historian, I know that at some point diet played an important role in a physician’s diagnostic and therapeutic toolkit. As a physician, I learned that today nutrition in many countries plays a very small role in medical education and practice. I experienced how often patients ask about nutrition at a medical consultation even when the complaint at first glance seems totally unrelated to what they’re eating. From my research, I know that many patients will be taking dietary supplements, such as vitamin pills and omega 3 fatty acids, but not mention this to their physicians. So these products are understood by many patients to not belong in a conventional medical setting. The numbers of dietary supplement intake are astounding. In 2019 77% of US Americans took dietary supplements. So, one of the things I try to understand in my research is how nutrition came to be so marginalized in contemporary biomedicine and how instead it was absorbed increasingly by a nutritional consumer industry. So I'm investigating the commercialization of the intersection of food and medicine.

KT: Why do you think it is important that there is research done regarding the intersection of food and medicine? What are the real-world applications of the field?

I think it’s important partly because dietary supplements play such an important role in our nutritional culture and in people’s approaches to nutrition. The nutraceutical and health foods markets are among the fastest growing and most promising markets worldwide. Yet, we have so little evidence of the efficacy and even in some cases the safety of these products, and there have been efforts to make people aware of the lack of evidentiary standards with regards to such products. Many of us are to an extent aware of that I believe, yet we continue to take them. So, I think it’s important to understand why that is the case, what is the ongoing fascination with such products, why do we continue to place faith in them even in the face of evidence to the contrary, and why do they keep propping up? I also think it’s important to understand the current situation with regard to the role of nutrition and medicine as historically grown and therefore contingent which means that it doesn't have to be this way, there are alternatives. And, finally, studying the history of these products at the intersection between medicine allows us to understand our modern food system and nutritional culture more broadly because the forces that enabled the emergence of nutritional consumer products in the 19th century are the very forces that also shape our modern food system and our approaches to food and its relation to our bodies and the natural world. So, for example, the close collaboration between science and business, between nutrition scientists, entrepreneurs, economic thinkers, and agents of the state, or the role of empire, race, and class in shaping the approaches to natural resources, and to groups of eaters, and the emerging dominance of market logics and the rise of consumer culture and their impact on how we produce and consume foods. So, all of these forces converged in the creation of nutritional consumer products. And because of that the history of these products, at the intersection of medicine and food, can tell us a lot about why we eat what we eat, how we think about food, why we produce and distribute food in the way that we do.

KT: You recently published a paper in 2018 on artificial digestion, sickness, and Benger’s Food. What inspired you to write an article about this topic?

I came across by chance this collection of archival sources that had been curated by archivists in the Museum of Science and Industry in Manchester about a 19th century food product that had digestive enzymes added to it. And I just thought that was so strange because an enzyme enriched food would have been something that I expected to be produced now in the 21th century. So, when I looked more closely I discovered two thing: (1) that this enzyme enriched food, Benger’s Food, really was only one of many commercial food products that had been enriched with enzymes, and that enzyme enriched foods were not just a random, marginal curiosity, but there was a wide-reaching nutritional trend that evolved around enzymes and artificially digested foods. I became really intrigued by this phenomenon and wanted to learn what it was about. Second, I discovered that Benger’s Food and other enzyme enriched foods were exhibited at the International Health Exhibition in 1884 in London alongside many other foods that claimed to be more than food and possess superior nutritional effects, and they were placed explicitly in a special category at the exhibition. So, it occurred to me that nutritional consumer products that lay claim to a special place in between normal foods and pharmaceuticals have a much longer history than the recent history of our dietary supplements, and that to understand their emergence it was necessary to look at the historical context at that time in the 19th century. When I followed the historical context of these products, I quickly came across a fascinating web of political, social, and economic concerns at the center of which was food and its nutritional and commercial use. So, one of the reasons why enzyme enriched foods become such an important and wide reaching trend is also because of a turn towards digestion as an important plane of intervention in economic considerations of food supply. The desire to use food more efficiently settles on individuals' digestive systems and their capacity to take up food in an economic matter and not be wasteful. That’s why foods like Benger’s Food and other enzyme preparations were really concrete manifestations of this fascination with controlling and optimizing digestive systems, and that’s something that really piqued my interest.

KT: Your paper primarily focuses on the significance of Benger’s Food. Are there other food items that played a similar role in society?

Yes! Bengers food was only one example of a surprisingly large group of products that had a similar significance. Some of these products we still recognize today, but we don't necessarily relate them to enzymes. For example, Pepsi Cola was once advertised as being enriched with pepsin which is a digestive enzyme. Also, our breakfast cereals, such as granola and corn flakes, were inspired by this trend of enriching foods with enzymes because they were developed as enzyme-free artificially digested foods where the conversion of starch into sugar, which is normally done by a digestive enzyme, was replaced by the toasting process which supposedly had a similar transformative effect on starch. The earliest corn flakes and granolas were marketed as pre-digested or partially-digested foods. But, beyond enzyme enriched foods, there were so many products that were advertised as being food-medicine hybrids. More and more of these products emerged as this category became more fleshed out and as the regulation of food and pharmaceuticals became more stringent. Food-medicine hybrids could sort of slip in between, and my favorite example of this is Fleischmann's Yeast (nutritional yeast), which started out as a baking product in the 1860s. In the late 1910s, when homebaking declined, it was reinvented as a health food through the cooperation of nutrition scientists and physiologists who conducted research on the healthful properties of yeast and found that it contained vitamins. So, Fleischmann's Yeast had a sort of revival as a health food and was marketed to fairly affluent consumers on one hand and at the same time this association between yeast and nutritional content fueled some of the first attempts to combat malnutrition on a global scale, and food yeast was investigated and produced in parts of the British empire as a potential hyper-nourishing food supplement that could be an intervention into nutritional crises and global health. So, this is a product that really captures the divergent fates these early nutritional consumer products, which is why I think that it's important that we understand them as predecessors of both highly engineered nutritional supplements in rich and western industrialized nations, but also a particular approach to nutrition in global health that is still very much alive in nutritional projects and global development.

5) What do you hope are the impacts of your article?

I hope that the article will help readers understand our current fascination with nutritional consumer products a bit better, get an insight into the longer trajectory of the role of nutrition in medicine, understand how nutrition was somewhat marginalized in medicine, and become curious about these kinds of products and want to learn more. Also, this article is only one contribution in the first Special Issue on the topic, so I hope that more historians take up this topic and help us create a much more complex picture of how the relationship between food and medicine has changed over time and in different places.

KT: Can you tell me a bit about your upcoming work about "wonder foods?"”

I'm currently finishing a book manuscript titled “Wonder Foods: The Science and Commerce of Nutrition” in which I explore the history of commercial nutritional products more broadly in the 19th and 20th century. The book follows a series of products and charts the emergence of a nutritional consumer culture that has developed in close connection with food science, food entrepreneurship, the economy of food, and food consumer culture. The term “wonder foods” encapsulates my central argument. I use this term on the one hand to point to the miraculous qualities that are ascribed to these products, both scientifically and socially, they’re given this imaginative quality with regard to nutritional therapies and broader global health strategies. I also use the term wonder foods to build on scholarship from people like Katharine Park and Lorraine Daston on the history of wonders and wondering as historically distinct categories of knowledge production. I argue that wonder foods are foods to wonder with and tools to think with, material ways of engaging with big abstract questions about the nature of nourishment and digestion, about how to organize a national and global food supply, and who deserves to eat and why. And lastly, I draw on the scholarship on wonder drugs and magic bullets by people like Alan Brandt and others to argue that wonder foods often acted as magic bullets, that is they crystallized and refocused broader discussions about food and nutrition towards narrow solutions like commercial-scientific fixes, as was the case with enzyme enriched products and food scarcity.

KT: How has the relationship between food and medicine changed throughout history?

This is one of the things that we try to tackle with this special issue, and we came to the conclusion that a lot of historical research about the relationship between food and medicine still needs to be done and we still don't really have a good sense of exactly how this relationship changed and why. We do have glimpses of some particular professional, scientific, political, cultural constellations of these fields in particular times and places, but it doesn't yet amount to a full and satisfying historical narrative of change. One of the insights from the special issue was this relationship really is historically and locally specific, and needs to be studied with attention to historical context. At the same time, there are a few interesting trends to take note of. One is the gradual loss of a place of premise for food and nutrition in medical practice in western biomedicine. Not too long ago, food played an important role in medicine in many countries and was a central aspect of diagnostics and therapeutics. With the development of public health systems in the 18th and 19th centuries, food and nutrition at least for a brief time seemed to be promising areas of wide-reaching social change. Then, as public health measures in many places towards the end of the 19th century moved away from large-scale structural interventions and focused increasingly on individual behavior and consumption, nutrition too was rethought along these lines. On the one hand you get some legislation with regard to food adulteration but on the other hand this is when the incorporation between nutrition science and food businesses becomes increasingly formalized and when consumer nutritional products, because they resonate with this increasing focus on individual consumption and behavior, really take off. By rechanneling public health in this way, they take attention and resources away from other more structural solutions. Another profound change that we know of is that expertise over food increasingly required formalized training in science and medicine. Prior to the 18th century, the sensory properties of a food, such as taste, smell, or color, still played an important role in indicating the nutritiousness of a given food for a given individual eater, so the assessment of nutritional value of a food was much more accessible to ordinary people. So, when assessments of nutritiousness increasingly required chemical analyses of food, the nutritional value was no longer directly accessible to non-expert eaters. So, increasingly, mediation and translation of the meaning of food was required. As physicians relinquished their role in diet, that function was increasingly subsumed by nutritional entrepreneurs and producers of nutritional products in collaboration with physicians and nutrition scientists. This was when commercial products began to take hold of an emerging market and assumed a place in our nutritional culture.

KT: Do you have any predictions about what this relationship will look like in the future?

Historians are notoriously bad at making predictions but I think that this is a very exciting time for the relationship between food and medicine. I think that the importance of nutrition in matters of health is increasingly recognized in medical schools and there seems to be a growing awareness of the absence of nutrition from medical education. Fields such as medical humanities, social medicine, histories of medicine, and nutrition have played an important role in revealing the contingency of our current situation, and by examining how we got here, they suggested that we need not let it continue to be that way. There are new nutrition programs, new food studies programs, and even new fields such as culinary medicine, all of which contribute to our understanding of food and medicine. In global health, the central role of nutrition has increasingly been underscored, for example by the 2016 Declaration of the United Nations Decade of Action on nutrition and in 2 weeks the world food program will be awarded the Nobel Peace Prize. So a lot has happened. At the same time malnutrition continues to be the leading cause of death worldwide and our current pandemic will only exacerbate these existing inequalities, so a lot of work remains to be done.

KT: What is a research topic that you hope to eventually explore?

I'm currently very interested in the relationship between nutrition and global health and the multiplicity of competing approaches to nutrition in various sites of global health. So, I'm planning to explore that in a future research topic. I'm also really interested in the history of cortisol which plays a very important role in nutrition and is the basis of insulin focused diets, but it also has become in some ways the quintessential symptomatic therapy, for example, in dermatology, which is the field I did part of my training in. Cortisol has also become a biological marker in studies of trauma and inequality. So, I'm very interested in these various manifestations of this physiological substance.