Let not thy food be confused with thy medicine: The Hippocratic misquotation

Abstract

Background and aim: The link between food and health has been documented since Antiquity. The aim of
the article is to show that the alleged Hippocratic phrase “let food be thy medicine and medicine be thy
food” is a widespread misquotation, lying at the root of an entire misconception about the ancient
concepts of food and medicine.
Methods: Examples of publications gathered from the MEDLINE� and Google Scholar databases which
cite the phrase verbatim and attribute it to Hippocrates were selected. Then, an extensive review of the
works related to food and diet in the Corpus Hippocraticum was made in order to search for the phrase.
Results: At least for the last 30 years this phrase has mistakenly helped scientists confirm the importance
of food to health and highlight new ethical challenges in medicine and dietetics. We showed that at least
one biomedical journal per year has cited the phrase.
Conclusion: This literary creation has led to an essential misconception. For Hippocrates, even if food was
closely linked to health and disease, the concept of food was not confused with that of medication.

Full text

Opinion paper
Let not thy food be confused with thy medicine: The Hippocratic
misquotation
Diana Cardenas
a
,
b
,
*
a
Research Institute on Nutrition, Genetics and Metabolism, University El Bosque, Bogotá, Colombia
b
The Research Center for Meaning, Ethics and Society (CERSES), Paris Descartes University, 45 rue des Saint Pères, Paris, France
article info
Article history:
Received 12 July 2013
Accepted 12 October 2013
Keywords:
History of medicine
Ethics
Nutrition
Dietetics
Food
abstract
Background and aim: The link between food and health has been documented since Antiquity. The aim of
the article is to show that the alleged Hippocratic phrase “let food be thy medicine and medicine be thy
food”is a widespread misquotation, lying at the root of an entire misconception about the ancient
concepts of food and medicine.
Methods: Examples of publications gathered from the MEDLINE
Ò
and Google Scholar databases which
cite the phrase verbatim and attribute it to Hippocrates were selected. Then, an extensive review of the
works related to food and diet in the Corpus Hippocraticum was made in order to search for the phrase.
Results: At least for the last 30 years this phrase has mistakenly helped scientists confirm the importance
of food to health and highlight new ethical challenges in medicine and dietetics. We showed that at least
one biomedical journal per year has cited the phrase.
Conclusion: This literary creation has led to an essential misconception. For Hippocrates, even if food was
closely linked to health and disease, the concept of food was not confused with that of medication.
Ó2013 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights
reserved.
1. Introduction
The importance of food in medicine was recognized in the 5th
Century BC by Hippocrates of Cos, who is considered the father of
Western medicine. His work was compiled either directly or indi-
rectly through his disciples, so that the existing knowledge on
Hippocrates’medicine consists of more than 60 texts known as The
Hippocratic Corpus (Corpus Hippocraticum). This important text in
the history of medicine expounds on the theory of diet.
1
However,
the phrase “let food be thy medicine and medicine be thy food”,a
widespread phrase quoted by today’s scientists, is nowhere to be
seen. This literary creation is not only a misquotation but it also
leads to an essential misconception: in the Hippocratic medicine,
even if food was closely linked to health and disease, the concept of
food was not confused with that of medicine.
2. Medicine and diet in the Hippocratic era
Hippocratic medicine was considered as an art and a science
based on two dietary imperatives. First, the necessity to adapt
healthy people’s food to human nature: this implied cooking it,
therefore differentiating it from animals’. The second imperative
was to modify and adapt the diet of sick patients according to their
condition, in order to avoid suffering and death. In the Classical
theory of humoral pathology, based on the concepts of natural
philosophy of that time, health and disease states were related to
the four bodily fluids or humors: blood, phlegm, yellow bile and
black bile. Health was related to the balance of the four humors in
terms of quantity and composition. Disease appeared in case of
humor imbalance. Elements like food and seasons were then
identified as possible causes. Up until Hippocrates, diseases had
been seen as a consequence of divine intervention. With him, they
became seen as a state caused by natural causes, including diet.
1
In order to fight diseases, Hippocratic doctors used two kinds of
interventions. On the one hand, the previously existing therapeutic
interventions such as medicines, incisions, and cauterization and
on the other hand the new regimen or dietetic interventions. In a
hierarchical order, the most important intervention was diet. Sec-
ondly, medicines seemed to be considered as means of evacuation
or purgation of impure fluids from the various cavities of the body.
Incisions with iron utensils to bleed the patient had the same
objective as medicines. If any of these last interventions failed,
burning cauterizations were the last option. The dietetic interven-
tion, which included a food regimen and exercises, was considered
*The Research Center for Meaning, Ethics and Society (CERSES), Paris Descartes
University, 45 rue des Saint Pères, Paris, France. Tel.: þ33 614751732.
E-mail address: cardenasdiana@unbosque.edu.co.
Contents lists available at ScienceDirect
e-SPEN Journal
journal homepage: http://www.elsevier.com/locate/clnu
2212-8263/$36.00 Ó2013 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.clnme.2013.10.002
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revolutionary at the time. The properties of foods were meticu-
lously analyzed in the treatise On Regimen. Physicians were then
able to prescribe a detailed food regimen to patients based on their
individual nature, activity, age, season, etc.
2
Thus it is considered
that medicine in the Hippocratic era was in fact mainly a dietetic
medicine, not a pharmacological or surgical medicine.
3. Food and medicine misconception
But Hippocratic doctors clearly saw a difference between food
and medicines. In fact, food was considered as a material that could
be assimilated after digestion (e.g. the air was also food) and con-
verted into the substance of the body. For example, food was con-
verted into the different parts of the body such as muscles, nerves,
etc. By contrast, the concept of medicines at the time was a product
which was able to change the body’s own nature (in terms of humor
quality or quantity) but not be converted into the body’sown
substance. Thus a food wasn’t considered a medicine. A possible
root of the food-medicine confusion is the following cryptic phrase
found in the work On Aliment:“In food excellent medication, in
food bad medication, bad and good relatively”.
3
This text is nowa-
days attributed to the Hellenistic period, but was considered to be
Hippocratic in Antiquity by Galenus in particular.
1
Finally, the guidelines pertaining to the duty of physicians in
Antiquity were established in the Hippocratic Oath whose legacy
still persists. The imperative “Do no harm”is implicit in the
following statement concerning diet: “I will apply dietetic measures
for the benefit of the sick according to my ability and judgment; I will
keep them from harm and injustice”.
1
Thus diet became with Hip-
pocrates’endorsement a moral value and responsibility in the area
of medical practice.
4. The Hippocratic mythical quotation
There is no doubt about the relevance of food in The Hippocratic
Corpus and its role in health and disease states. In fact, in order to
confirm and emphasize the importance of food to health and to
highlight new challenges to medicine and dietetics, scientists have
been citing this phrase at least for the past 30 years.
4-18
Table 1
shows some examples of publications gathered from the
MEDLINE
Ò
and Google Scholar databases which cited the phrase
verbatim. All these publications dealt with nutrition and health
concerns, and were aimed at proving the role of nutrition in
different fields such as cancer, epigenetics, immunology, disease
prevention or chronic diseases. Some publications aimed to vali-
date and legitimate scientifically and ethically the current concepts
of nutraceuticals or functional foods from Antiquity.
4,11,16
However,
by attributing pharmacological properties to foods, authors are
confusing both food and medicine. In fact, none of the authors cited
the original text of this alleged Hippocratic phrase accurately. Two
of the examples referred to no primary sources.
References and quotation errors are relatively common in
biomedical journals and are not a new concern.
19,20
This problem is
found in all types of journals and the rate of errors is independent of
the journal’s impact factor, showing that journal quality does not
necessarily correlate with reference accuracy, as has been shown
previously for surgery journals.
21
The primary responsibility for
accuracy of reference and citation lies on the author. However, this
aspect is frequently neglected, all the more as the policy in most
journals is not to correct an error in reference. Several consequences
resulting from misquotation could be considered. First, the original
author may be displeased to see their original concepts or state-
ments misunderstood. Second, the reader may be misled; and last,
the most serious consequence of inaccuracy and misinterpretations
Table 1
Characteristics of samples of publications citing the phrase: “let food be thy medicine and medicine be thy food”.
Journal and year of publication Topic Type of
article
Use of the phrase
Journal of Functional Foods, 2012.
4,a
Functional foods,
nutraceuticals
Review To explore the association between diet and health
To legitimize the ancient origin of the idea
Free Radical Research, 2011.
5,a
Inflammation, cancer Review To attribute to naturally-occurring agents in the diet a potential
as anti-cancer drugs,
Biochemical Pharmacology, 2010.
6,a
Epigenetics,
chronic disorders
Review To “reinterpret”the phrase within a epigenetic medicine application
Clinics in Dermatology, 2010.
7,a
Dermatology Review To explain diet as a cause of acne.
Journal of Cardiovascular
Pharmacology, 2009.
8,a
Cardiovascular disease Review To explore the role of grapes, wines, and resveratrol in reducing the risk
of morbidity and mortality due to cardiovascular complications.
Medical Hypotheses, 2007.
9,a
Immunology Review To explore immunostimulatory potential of food proteins.
The Lancet, 2005. Ref.
10,a
Historical keyword Perspectives To highlight the importance of proper nutrition
British Medical Journal, 2004.
11,b
Nutraceuticals,
prevention of
chronic diseases
Editorial To emphasize the lack of knowledge in nutrition of doctors, and their
neglected attitude towards the alleged “Hippocratic philosophy
of food as medicine”
Cancer Detection and
Prevention, 2004.
12,c
Cancer prevention Review To explore the role of herbal plants as medicines, and highlight
the relevance of prevention
British Journal of Nutrition, 2002.
13,a
Cancer phytochemicals Review To highlight the medicinal properties of foods
The New England Journal
of Medicine, 2002.
14,a
Prevention and treatment
of diseases
Book
Review
To emphasize the skeptical attitude of doctors towards nutrition and
to say that hundreds of internet sites use the phrase for the marketing
of nutritional products
Journal of the American College
of Nutrition, 2001.
15,a
Chronic diseases Review To emphasize the skeptical attitude and the absence of nutrition
in medical therapies
Journal of Nutrition, 1999.
16,a
Functional foods Review To emphasize the antiquity of the “widely accepted for generations
philosophy of medicinal power of foods”
Nutricion Hospitalaria, 1990.
17,a
Clinical nutrition Review To highlight the lack of nutrition care in hospitals
Phi Delta Kappan, 1979.
18,a
Children’s diet Review To highlight the relationship between the food children consume
and academic achievement
a
The article presents the quotation without reference.
b
The article presents the quotation with an alleged source: Lucock M. Is folic acid the ultimate functional food component for disease prevention? BMJ. 2004; 328: 211e214.
c
The article present the quotation with an alleged source: Shultes RE. The kingdom of plants. In: Thomson WAR, editor. Medicines from the earth. New York, NY: McGraw-
Hill Book Co.; 1978. p. 208.
D. Cardenas / e-SPEN Journal xxx (2013) e1ee3e2
Please cite this article in press as: Cardenas D, Let not thy food be confused with thy medicine: The Hippocratic misquotation, e-SPEN Journal
(2013), http://dx.doi.org/10.1016/j.clnme.2013.10.002

in reference or quotation, is that mistaken information may become
“a truth”or an “accepted fact”. This is the case of the Hippocratic
misquoted phrase. Today’s scientists have accepted it improperly as
true that the concepts of food and medicine were confused in An-
tiquity by Hippocrates.
5. Conclusion
Misquotation can lead to persistent misconceptions. “Let food
be thy medicine”is a fabrication that was accepted worldwide
based on the iconizing of Hippocrates, who appears to give moral
and ethical sanction to the phrase. Yet, though food and medicine
have been highly related since Antiquity, for Hippocrates, they were
not conflated as scientists claim today. More research is warranted
to ascertain the precise origin of the Hippocratic misquotation.
Conflict of interest disclosure
The author has no conflicts of interest to declare.
Acknowledgments
The author thanks Professor Jaques Jouanna, Professor and
President of the French l’Académie des inscriptions et belles-lettres,
specialist in ancient Greece, for his expert opinion and the confir-
mation that this quotation is not found in the Corpus Hippocraticum.
The author wishes to thank Dr Carole Birkan-Berz of the Paris Des-
cartes Language Center who assisted in the editing of the manuscript.
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Please cite this article in press as: Cardenas D, Let not thy food be confused with thy medicine: The Hippocratic misquotation, e-SPEN Journal
(2013), http://dx.doi.org/10.1016/j.clnme.2013.10.002