Ancient Views on Diet and Health

“Life is short, the Art long, opportunity fleeting, experiment treacherous, judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals” (Hippocrates: Jones:Loeb:Bk LV:p.99).

“Let food be thy medicine and medicine be thy food”
-Hippocrates

Hippocrates — The Father of Medicine on Diet and Health

It is generally believed that Hippocrates lived from c. 460-c. 377 B.C. and was born on the island of Cos in the Aegean Sea. His grandfather, Hippocrates, and father, Heraclides, were physicians and his mother was a midwife. After his parents died, he moved to Athens where he studied and taught medical students. He is said to have been a “wandering physician” travelling over Greece and Macedonia. Hippocrates was a member of the guild of physicians known as the Asclepiadae (Jones: Loeb:V1 :p.xliii).

Hippocrates is known to us primarily through authors who wrote about him some 200 years after his death. Although Plato, Aristotle, and Menon (a pupil of Aristotle), did mention him, his contemporaries had surprisingly little to say about him, despite his enormous influence and legacy. This has led scholars to believe that the “writings of Hippocrates” some seventy works, do not belong to one author but may indeed be attributed to many. The fact that there is no internal consistency to this collection of writings other than being written in the Ionic dialect, adds to the ambiguity and skepticism of authorship. The translator of the Loeb Classical series, W.H.S. Jones, ends his introduction with this statement: “In my work I have been constantly impressed, and depressed, by the truth of the proverb, “Translators are traitors.” (Jones: Loeb:p.11).” For the purpose of readability however, I will refer to Hippocrates in this paper as though a single author, mindful of the uncertainty.

The Role of the Physician

Many contemporary assumptions about the role of medicine and doctors were not standard in ancient times. Hippocrates statement that “The physician must aim at being useful or at least not harmful to the patient” (Hippocrates: Precope:1952:p.11) seems self-evident and simplistic. However, it was not uncommon in ancient times for physicians to give medications or recommendations that would either harm or kill the patient.

Hippocrates wrote extensively about medicine as a profession and what the role of the physician was. “In Medicine at all times the greatest consideration should be how to cure the disease.” (ibid:11). Hippocrates viewed medicine as an art and a science with a strong emphasis on ethics. “Essentially an experienced physician well versed in his art, he deals with it on pure scientific lines, focusing on each and every case all his attention and judgment” (ibid:13). In terms of medical ethics and physicians not being motivated by greed: “He studies not only the patient’s interests but the physician’s as well, who should remain free from blame for his own great advantage” (ibid:12).

Much has been learned about health and diet since Hippocrates’ time. However, it is quite remarkable how many beliefs and observations remain the same. Some of the ancient views that are inaccurate are interesting from a humorous, historical, point of view. One wonders how many of our current “scientific facts” will appear as ludicrous to future generations. I will highlight some of the Hippocratic views on diet and health and apply contemporary beliefs to them.

The Environment

Hippocrates wrote that physicians needed to be aware of many factors before treating an individual. He espoused a remarkably holistic approach, taking into consideration numerous variables and interactions before prescribing a treatment.

“In the human body there is perpetual exchange. Minute particles of everything that exists in nature are to be found in the tissues, heat and water continually interchange, some parts take up, others give up material and during this process energy is being expended. Homogeneous substances assimilate, heterogeneous substances reject each other. Man’s intellectual power is proportionate to his physical fitness. It cannot be developed in any other brain except that of man” (ibid:35).

Greek thinkers of the fifth and fourth centuries B.C. were part of an intellectual tradition stemming from pre-Socratic philosophers such as Empedocles (c.500-c.430 B.C.). Empedocles, a philosopher, and poet, believed that earth, air, fire, and water were the essential elements of all life. Each element possessed intrinsic qualities. Earth was dry; water, moist; fire, hot; and air, cold. Combinations of the qualities determined a person’s personality. So, if a person had heat and moisture as their dominating characteristics, they would be sanguine in temperament; cold and moist, phlegmatic; hot and dry, choleric; dry and cold, melancholic (Benham:1981 :76).

Change was brought about in the rather inert elements through two forces that were at constant war with each other, love, and strife. Strife was responsible for creating havoc in the world, natural disasters, and monsters. “Many creatures with faces fore and aft, and breasts both ways; oxen with human brows and conversely men with bovine heads and creatures mixed male and female, with deep-seated sexual organs” (Lambridis:1976:49). Love was a force that tried to unite and bring peace and harmony to the world.

Empedocles, a vegetarian, viewed plants in much the same way we regard humans; as beings with feelings, desires, and knowledge (Dombrowski: 1984:53). This view had its basis in the Pythagorean conception of transmigration of the soul that I will discuss further in the section on Pythagoras. Empedocles was said to have been a bush, bird, fish, and woman in previous lives (ibid:53). Because of his past lives and abhorrence to killing animals for food, to kill an animal for food or sacrifice is the greatest abomination among men,” (ibid: 21) Empedocles espoused a vegetarian diet.

Hippocrates placed his theories on diet and health within the framework that Empedocles used to describe the world. Foods, also believed to be made of the four elements, could affect temperament. A person who needed to become more sanguine could eat more hot and moist foods for example. In this way food nourished and molded the mind as well as the body. We have long been interested in the food/mood question and it is interesting to note ancient theories on this topic.

The relationship food played in growth was recognized:

“Without food there can be no growth. It is essential therefore that food which will serve as the diet of man should possess all the characteristics of the human tissues, otherwise, however plentiful, it will not serve its purpose of nutrition and will be rejected” (Hippocrates: Precope:35).

Seasonal Variations in Diet

One important consideration in Hippocrates regimen for health was the season of the year. Different seasons indicated different dietary practices. Optimal health necessitated changing dietary requirements based primarily upon what foods were locally available at the time and beliefs about food, energy, and heat. This practice is conceptually related to the macrobiotic diet in that it utilizes seasonally available food items, is thought to be unhealthy to eat foods out of season, and foods are believed to have characteristics (yin, yang) that interact within the body and affect the mind. The word macrobiosis means longevity and comes from the Greek makrobiosis: macro & biosis. In Hippocrates day as in much of the developing world today, eating seasonal, locally produced foodstuffs is the only option available to most of the population other than the rich who can afford to buy imported items. Hippocrates seasonal recommendations are as follows:

Winter

“In winter eat as much as possible and drink as little as possible; drink should be wine as undiluted as possible, and food should be bread, with all meats roasted; during this season take as few vegetables as possible, for so will the body be most dry and hot” (Hippocrates: Jones: IV:p,4S).

It is generally agreed that when the weather becomes colder, a little extra padding (fat) will serve as insulation against the elements. Therefore, eating more food, drinking undiluted wine (for the warming sensation– even though we now know this is a fallacy), eating roasted meat and bread, will all serve to give the body a feeling of satiety. Although eating a variety of fruits and vegetables would make nutritional sense, these items were simply not easily available in ancient winters. So, from a practical point of view, this advice is rational.

Spring

“When spring comes, increase drink and make it very diluted, taking a little at a time; use softer foods and less in quantity; substitute for bread barley-cake; on the same principle diminish meats, taking them all boiled instead of roasted, and eating when spring comes a few vegetables, in order that a man may be prepared for summer by taking all foods soft, meats boiled, and vegetables raw or boiled. Drinks should be as diluted and as copious as possible, the change to be slight, gradual, and not sudden” (ibid).

In the spring we generally expend more energy, planting gardens and engaged in increased physical work. This means we sweat more so our need for liquids increases. Hippocrates advocated a lighter diet with increased carbohydrates, well designed for increased physical work. Spring is a time when vegetables (wild and cultivated) become available again after the long winter and should be incorporated into the diet.

Summer

“In summer the barley-cake to be soft, the drink diluted and copious, and the meats in all cases boiled. For one must use these, when it is summer, that the body may become cold and soft. For the season is hot and dry and makes bodies burning and parched. Accordingly, these conditions must be counteracted by way of living. On the same principle, the change from spring to summer will be prepared for in the manner to that from winter to spring, by lessening food and increasing drink. Similarly, by opposing opposites prepare for the change from summer to winter” (ibid: 45-46).

In hot climates a primary dietary need for people engaged in any sort of physical labor is for increased liquids. Most people find heavy meals difficult to digest and unappealing if the weather is hot. Heat decreases appetite and often makes one lethargic, so their caloric requirement decreases as well. Boiling meat makes it less fatty and easier to digest. Summer is also a prime time to be concerned about food poisoning so a reduction in the amount of animal protein would be sensible from a safety point of view.

Fall

“In autumn make food more abundant and drier, and meats too similar, while drinks should be smaller and less diluted, so that the winter may be healthy, and a man may take his drink neat and scanty and his food as abundant and as dry as possible. For in this way he will be most healthy and least chilly, as the season is cold and wet” (ibid:47).

Fall is the harvest season when the food supply is more abundant, and people are engaged in the physical work of harvesting. The increase in physical activity brings with it an increase in caloric requirements to provide energy. Since winter is a time of spending more time indoors and increasing the risk of infectious disease by breathing the same air, it is good to be in optimal health in preparation, so the body will be able to fight off infections.

Climate

“Great is the influence of climate on health and disease. The nature of the country, if mountainous or plain, sheltered from the north or from the south, near or far from the equator, produces its characteristic climate, dry or wet, warm, or cold, and affects vegetation and the human body accordingly” (Precope:55).

Wetness and Dryness
Hippocrates devoted a lot of attention to “wetness and dryness.” The nature of one’s physique further determined the dietary regimen an individual should follow. People with wet or moist physiques (fleshy, soft and red), should adopt a dry regimen for most of the year. Constitutionally dry bodies (lean, sinewy), conversely needed a moist regimen. Children did better with a moist regimen, “for this age is dry, and young bodies are firm, while older people needed a drier diet most of the time” (Hippocrates: Jones: 47).

Baths & Exercise

Baths were believed to be beneficial if taken under the right conditions. Baths were needed more in the summer than in the winter. This is sensible if one is engaged in hard physical labor as is often the case in the summer. However, “hard, thin people should bathe rather more than the obese” (Hippocrates: Precope:186). This does not make sense because one would assume that the obese would sweat more so therefore would have a greater need to bathe. The obese were advised to walk rapidly, and the thin slowly.

As far as dieting was concerned:

“Obese people and those desiring to lose weight should perform hard work before food. Meals should be taken after exertion and while still panting from fatigue and with no other refreshment before meal except only wine, diluted and slightly cold. Their meals should be prepared with sesame or seasoning and other similar substances and be of a fatty nature as people get thus satiated with little food. They should, moreover, eat only once a day and take no baths and sleep on a hard bed and walk naked as long as possible. Thin people wishing to grow fatter should do the opposite of what I have just said and before food should not perform any hard work whatsoever” (ibid:185-6).

Exercise is an excellent means of weight control and usually obese people do not get nearly enough exercise. However, drinking only diluted wine before “hard work” may not be enough to sustain a person to do the work. Obese people should steer clear of “foods of a fatty nature” which are high in calories. It is unlikely that small amounts of fatty foods would quickly lead to a sense of salty in the obese. Current nutritional research indicates that a low-fat diet causes people to lose weight much more easily than a low-calorie diet. The fat content of the food is the critical element.

As far as the advice for the obese about “take no baths, and sleep on a hard bed and walk naked as long as possible,” one can only wonder what this was based upon. Perhaps walking naked as long as possible serves as a form of humiliation for an obese person because they, and others presumably, are confronted with a critical look of the body shape.

“A porous body, one that perspires easily, is healthy. A dense body, one that perspires with great difficulty, is unhealthy. Those who perspire freely are weaker but are healthier and recover from illness easily. Those who hardly perspire are stronger but on falling ill they make a difficult recovery” (ibid :175).

Saunas have been used to purify the body by sweating out toxins. Aerobic exercise that works up a sweat also gives the heart a workout and strengthens it. Exercise and sweating are usually companions and both are done to promote health.

The Brain & Mental Illness

“Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pains griefs and tears. Through it we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant, in some cases using custom as a test. in others perceiving them from their utility. It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absent-mindedness, and acts that are contrary to habit. These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry, or suffers any other unnatural affection to which it was not accustomed. Madness comes from its moistness. When the brain is abnormally moist, of necessity it moves, and when it moves neither sight nor hearing are still, but we see or hear now one thing and now another, and the tongue speaks in accordance with the things seen and heard on any occasion. But all the time the brain is still a man is intelligent” (Jones 11 :1923:175).

“So, the cause of madness is a moist brain! Hippocrates goes on to state how phlegm in the brain makes for quiet, controllable madness. Bile, on the other hand, produces a madness that is “noisy, evil-doers and restless, always doing something inopportune” (ibid: 177). In Hippocrates view, the brain is the most powerful organ on the body. He accurately asserts that the brain is the “interpreter of consciousness”(ibid: 179). “Air is said to give the brain intelligence, reaching the brain first, and then traveling through the rest of the body” (ibid: 179).

Nourishment

“Now bodies, of men and of animals generally, are nourished by three kinds of nourishment, and the names thereof are solid food, drink, and wind” (Jones 11 :229).

Wind

Wind within the body is called breath, and outside the body, air. Wind is “invisible to sight, though visible to reason.” Wind is said to be omnipresent and omnipotent, part of, and a cause of everything, including the heavens, seasons, and life. While humans can live for some time without food or drink, they will die quickly without air. Hippocrates goes on to discuss in detail the relationship between air and disease. While I am not going to discuss that here, in summary he concludes:

“I promised to declare the cause of diseases, and I have set forth how wind is lord,
not only in things as wholes, but also in the bodies of animals. I have led my discourse on to familiar maladies in which the hypothesis has shown itself correct” (Jones 11 :253).

Solid Food and Drink

“Every food and beverage differ in value and action. It is not possible to classify them in general terms and ascribe the same properties to all sweet, all fat, or all salty foods. Some of these are astringent or relaxing, others of the same denomination may have the opposite effect. It is better, therefore, to treat them each separately” (Precope: 56).

This observation was quite remarkable since it was made centuries before protein, vitamins, and minerals were discovered. The ancients apparently paid much more attention to individual food items and the effect they had upon the body and mind. For example, Hippocrates gives specific recommendations about different foods and their positive and negative traits. I will quote directly from a translation of Hippocrates’ text. This description of foods and their properties gives us a clear idea of what foods were commonly available to the ancient Greeks.

“Of meat, beef is strengthening but difficult to digest and constipating (animals with rich blood produce rich milk and their meat is accordingly heavy). Goat’s meat is lighter and does not produce stasis. Pork is stronger than either and evacuant because it contains less blood. For the same reason lamb is lighter than mutton and kid’s meat lighter than goat’s meat. The same relation exists between veal and beef. Assess meat is evacuant. Horse’s meat lighter than asses. Dog’s meat is heating, astringent and strengthening. Boar’s meat is evacuant. Deer’s meat diuretic. Hare’s, hog’s, fox’s and birds have a slight diuretic action.

Generally speaking, the meat of birds is drier than the meat of quadrupeds and the birds that live on seeds much more so than those that live in water.

Of fish, the traveling sort is heavier than the non-traveling but less than the dweller in marshy water, which may even prove harmful. River fish is heavier still. Shellfish, such as oysters, etc., is dry, but shellfish extract has a peristaltic action on the bowel. Crabs have also a diuretic action.

Of domestic animals, those that live free in woods and fields are drier than those under cover, the savage more than the domesticated, the eaters of raw food, the dwellers in woods, the scantily fed more than those that feed excessively, those that live on hay than those on green pastures, those that eat fruit than those that do not, those that drink little than those that drink much, those that have much blood than those that have not, the middle-aged than the very aged or the very young, the males than the females, the testiculated than the non-testiculated, the fair than the dark, the hairy than the non-hairy. Strongest is the meat which belonged to that part of the animal, which was worked most during lifetime, had the most blood and upon which it used to lie most, and of the non-sanguine parts the brain and the marrow. The head, the genital parts and the feet are the lightest. In fish the head part is the driest, the centre part the lightest. The head is the most watery because of the fat and brain.

Eggs possess a fortifying and nutritious element but produce flatulence. They are fortifying because they have a generating value; they are nutritious because they are, so to say, the milk of the hatching bird, they produce flatulence because though small in bulk they diffuse considerably.

Cheese is strengthening, heating, nutritious, but constipating. It is strengthening because so nearly related to generation, nutritious because it is the solid part of the milk, heating because it is fatty, constipating because it is a coagulating substance.

Barley is naturally a dry and constipating substance, yet a decoction prepared from barley husks has relaxing properties. Pounded barley is refreshing and astringent. Grilled barley loses in the process the superficial layer which contains the relaxing element. Barley cake should be used for astringent and cooling purposes.

Cinnus (a potion made of barley, grated milk and either water, wine or milk) prepared with water only is refreshing and nourishing, if with wine it is constipating, with honey it has an action on the bowels, with milk it is nourishing. Goat’s milk relaxes the bowel more than cow’s milk, horse’s and assess milk are still more relaxing.

Wheat is more strengthening and nutritious than barley, but it has a lesser evacuating effect on the bowel. Brown bread attracts water and moves the bowel, but white bread is more nourishing. Leavened bread is lighter and more digestible.

Of beverages, water is cooling and wine heating. Some wines are astringent, others produce flatulence or diuresis.

Honey is heating when taken pure, with water it relieves dryness; it acts as an evacuant to the constitutionally bilious but has the opposite effect on the phlegmatic. It needs, however, the admixture of a sweet wine for its evacuant effect.

Of vegetables, garlic is a purgative and diuretic and causes flatulence, onion is heating, leeks are less heating but more laxative, radish is an expectorant and produces eructation. Mustard leaves may cause dysuria. Cardamine (cress) acts in a similar way. Coriander has a soporific value. Lettuce has no strengthening power. Anise (anethum) is constipating, the smell of it stops sneezing. Celery is more diuretic than laxative. Basil (ocimum) has heating and constipating properties. Rue is used as an antidote to poisons. Asparagus is constipating. Sage is dry and astringent. Nightshade prevents wet dreams. Purslane is refreshing if not cooked. Nettle is a purgative. Catmint has the same effect. Mint is an anaphrodisiac if taken in large quantities. Sorrel acts as an aperient. Orach is heating. Blite is an evacuant. Cabbage is a cholagogue. Beetroot has a slight evacuant effect. Marrow has a purgative but no diuretic power. Turnips are heating and non-diuretic. Pennyroyal is an evacuant. Marjoram is a cholagogue and so is savory. Thyme is diuretic and expectorant. Hyssop has similar properties.

Fruits. Ripe fruits are purgative: fresh fruits more so than dry. Ripe pears are evacuant, unripe constipating. Apples when sweet are not so easily digestible as when they are acid. Apple juice is anti-emetic and diuretic. Pomegranate juice is evacuant. Cucumber is difficult to digest. Melon is diuretic and evacuant but produces flatulence. Grapes are heating and evacuant, especially the white. Figs are purgative. Almonds and nuts are heating but nourishing. Peeled chestnuts are evacuant, not peeled constipating.

Once we know that all animal and vegetable food contain heat and moisture, the amount of each of these can be augmented or diminished in our food according to our body needs.” (ibid.:56-64).

Careful observation taught Hippocrates about how foods interacted within the body. He was also able to observe the tenacity of the human body in fighting disease. Hippocrates observed the concept of homeostasis at work in humans:

His observation was that even with a very considerable “abnormality” of environmental stress the organism, in the majority of cases, manages eventually by its own inherent powers to adjust itself to the new conditions. “Merely give Nature a chance,” said the father of medicine in effect, “and most diseases will cure themselves” (Galen: Loeb:xi).

Given this approach to food and health that developed in ancient Greece, some of the philosophical beliefs of the early vegetarians are put in context and we should trust our bodies to heal themselves.

 

“All disease begins in the gut.”

“Just as food causes chronic disease, it can be the most powerful cure.”

      – Hippocrates

Bibliography