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e-SPEN Journal 8 (2013) e260ee262

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Opinion paper

Let not thy food be confused with thy medicine: The Hippocraticmisquotation

Diana Cardenas a,b,*

aResearch Institute on Nutrition, Genetics and Metabolism, University El Bosque, Bogotá, Colombiab The Research Center for Meaning, Ethics and Society (CERSES), Paris Descartes University, 45 rue des Saint Pères, Paris, France

a r t i c l e i n f o

Article history:Received 12 July 2013Accepted 12 October 2013

Keywords:History of medicineEthicsNutritionDieteticsFood

* The Research Center for Meaning, Ethics and SociUniversity, 45 rue des Saint Pères, Paris, France. Tel.:

E-mail address: cardenasdiana@unbosque.edu.co.

2212-8263/$36.00 � 2013 European Society for Clinichttp://dx.doi.org/10.1016/j.clnme.2013.10.002

a b s t r a c t

Background and aim: The link between food and health has been documented since Antiquity. The aim ofthe article is to show that the alleged Hippocratic phrase “let food be thy medicine and medicine be thyfood” is a widespread misquotation, lying at the root of an entire misconception about the ancientconcepts of food and medicine.Methods: Examples of publications gathered from the MEDLINE� and Google Scholar databases whichcite the phrase verbatim and attribute it to Hippocrates were selected. Then, an extensive review of theworks 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 importanceof food to health and highlight new ethical challenges in medicine and dietetics. We showed that at leastone biomedical journal per year has cited the phrase.Conclusion: This literary creation has led to an essential misconception. For Hippocrates, even if food wasclosely linked to health and disease, the concept of food was not confused with that of medication.

� 2013 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rightsreserved.

1. Introduction

The importance of food in medicine was recognized in the 5thCentury BC by Hippocrates of Cos, who is considered the father ofWestern medicine. His work was compiled either directly or indi-rectly through his disciples, so that the existing knowledge onHippocrates’medicine consists of more than 60 texts known as TheHippocratic Corpus (Corpus Hippocraticum). This important text inthe history of medicine expounds on the theory of diet.1 However,the phrase “let food be thy medicine and medicine be thy food”, awidespread phrase quoted by today’s scientists, is nowhere to beseen. This literary creation is not only a misquotation but it alsoleads to an essential misconception: in the Hippocratic medicine,even if food was closely linked to health and disease, the concept offood was not confused with that of medicine.

2. Medicine and diet in the Hippocratic era

Hippocratic medicine was considered as an art and a sciencebased on two dietary imperatives. First, the necessity to adapt

ety (CERSES), Paris Descartesþ33 614751732.

al Nutrition and Metabolism. Publ

healthy people’s food to human nature: this implied cooking it,therefore differentiating it from animals’. The second imperativewas to modify and adapt the diet of sick patients according to theircondition, in order to avoid suffering and death. In the Classicaltheory of humoral pathology, based on the concepts of naturalphilosophy of that time, health and disease states were related tothe four bodily fluids or humors: blood, phlegm, yellow bile andblack bile. Health was related to the balance of the four humors interms of quantity and composition. Disease appeared in case ofhumor imbalance. Elements like food and seasons were thenidentified as possible causes. Up until Hippocrates, diseases hadbeen seen as a consequence of divine intervention. With him, theybecame seen as a state caused by natural causes, including diet.1

In order to fight diseases, Hippocratic doctors used two kinds ofinterventions. On the one hand, the previously existing therapeuticinterventions such as medicines, incisions, and cauterization andon the other hand the new regimen or dietetic interventions. In ahierarchical order, the most important intervention was diet. Sec-ondly, medicines seemed to be considered as means of evacuationor purgation of impure fluids from the various cavities of the body.Incisions with iron utensils to bleed the patient had the sameobjective 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

ished by Elsevier Ltd. All rights reserved.

Table 1Characteristics of samples of publications citing the phrase: “let food be thy medicine and medicine be thy food”.

Journal and year of publication Topic Type ofarticle

Use of the phrase

Journal of Functional Foods, 2012.4,a Functional foods,nutraceuticals

Review To explore the association between diet and healthTo 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 potentialas 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,aCardiovascular 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 nutritionBritish Medical Journal, 2004.11,b Nutraceuticals,

prevention ofchronic diseases

Editorial To emphasize the lack of knowledge in nutrition of doctors, and theirneglected attitude towards the alleged “Hippocratic philosophyof food as medicine”

Cancer Detection andPrevention, 2004.12,c

Cancer prevention Review To explore the role of herbal plants as medicines, and highlightthe relevance of prevention

British Journal of Nutrition, 2002.13,a Cancer phytochemicals Review To highlight the medicinal properties of foodsThe New England Journal

of Medicine, 2002.14,aPrevention and treatmentof diseases

BookReview

To emphasize the skeptical attitude of doctors towards nutrition andto say that hundreds of internet sites use the phrase for the marketingof nutritional products

Journal of the American Collegeof Nutrition, 2001.15,a

Chronic diseases Review To emphasize the skeptical attitude and the absence of nutritionin medical therapies

Journal of Nutrition, 1999. 16, a Functional foods Review To emphasize the antiquity of the “widely accepted for generationsphilosophy of medicinal power of foods”

Nutricion Hospitalaria, 1990.17,a Clinical nutrition Review To highlight the lack of nutrition care in hospitalsPhi 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: LucockM. 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: ThomsonWAR, editor. Medicines from the earth. New York, NY: McGraw-

Hill Book Co.; 1978. p. 208.

D. Cardenas / e-SPEN Journal 8 (2013) e260ee262 e261

revolutionary at the time. The properties of foods were meticu-lously analyzed in the treatise On Regimen. Physicians were thenable to prescribe a detailed food regimen to patients based on theirindividual nature, activity, age, season, etc.2 Thus it is consideredthat medicine in the Hippocratic era was in fact mainly a dieteticmedicine, not a pharmacological or surgical medicine.

3. Food and medicine misconception

But Hippocratic doctors clearly saw a difference between foodand medicines. In fact, food was considered as a material that couldbe 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 productwhich was able to change the body’s own nature (in terms of humorquality or quantity) but not be converted into the body’s ownsubstance. Thus a food wasn’t considered a medicine. A possibleroot of the food-medicine confusion is the following cryptic phrasefound in the work On Aliment: “In food excellent medication, infood bad medication, bad and good relatively”.3 This text is nowa-days attributed to the Hellenistic period, but was considered to beHippocratic in Antiquity by Galenus in particular. 1

Finally, the guidelines pertaining to the duty of physicians inAntiquity were established in the Hippocratic Oath whose legacystill persists. The imperative “Do no harm” is implicit in thefollowing statement concerning diet: “I will apply dietetic measuresfor the benefit of the sick according to my ability and judgment; I willkeep them from harm and injustice”. 1 Thus diet became with Hip-pocrates’ endorsement a moral value and responsibility in the areaof medical practice.

4. The Hippocratic mythical quotation

There is no doubt about the relevance of food in The HippocraticCorpus and its role in health and disease states. In fact, in order toconfirm and emphasize the importance of food to health and tohighlight new challenges to medicine and dietetics, scientists havebeen citing this phrase at least for the past 30 years.4-18 Table 1shows some examples of publications gathered from theMEDLINE� and Google Scholar databases which cited the phraseverbatim. All these publications dealt with nutrition and healthconcerns, and were aimed at proving the role of nutrition indifferent fields such as cancer, epigenetics, immunology, diseaseprevention or chronic diseases. Some publications aimed to vali-date and legitimate scientifically and ethically the current conceptsof nutraceuticals or functional foods from Antiquity. 4,11,16 However,by attributing pharmacological properties to foods, authors areconfusing both food andmedicine. In fact, none of the authors citedthe original text of this alleged Hippocratic phrase accurately. Twoof the examples referred to no primary sources.

References and quotation errors are relatively common inbiomedical journals and are not a new concern.19,20 This problem isfound in all types of journals and the rate of errors is independent ofthe journal’s impact factor, showing that journal quality does notnecessarily correlate with reference accuracy, as has been shownpreviously for surgery journals.21 The primary responsibility foraccuracy of reference and citation lies on the author. However, thisaspect is frequently neglected, all the more as the policy in mostjournals is not to correct an error in reference. Several consequencesresulting from misquotation could be considered. First, the originalauthor 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 andmisinterpretations

D. Cardenas / e-SPEN Journal 8 (2013) e260ee262e262

in reference or quotation, is that mistaken informationmay become“a truth” or an “accepted fact”. This is the case of the Hippocraticmisquoted phrase. Today’s scientists have accepted it improperly astrue that the concepts of food and medicine were confused in An-tiquity by Hippocrates.

5. Conclusion

Misquotation can lead to persistent misconceptions. “Let foodbe thy medicine” is a fabrication that was accepted worldwidebased on the iconizing of Hippocrates, who appears to give moraland ethical sanction to the phrase. Yet, though food and medicinehave been highly related since Antiquity, for Hippocrates, theywerenot conflated as scientists claim today. More research is warrantedto 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 andPresident 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.

References

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5. Sung B, Prasad S, Yadav VR, Lavasanifar A, Aggarwal BB. Cancer and diet: howare they related? Free Radic Res 2011;45:864e79.

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