The purpose of this study was to find out how many of Maimonides’ 20 main food recommendations, written more than 800 years ago, are accepted today according to four modern major dietary guidelines. This study showed that only three of Maimonides’ recommendations should be fully rejected. The other 17 recommendations received either full or partial agreement.
The principles of health proposed by Maimonides present proper nutrition as essential for the health of both the body and the mind. In addition, he believed that physical activity was an important factor for maintaining health and emphasized that a person’s duty was to maintain one’s health before illness ever occurred (known in modern times as “preventive medicine”).
Among Maimonides’ medical recommendations were many commonly accepted today worldwide: development of healthy habits to maintain health; preventive medicine; holistic mental health medicine; the need for exercise; orderly and moderate eating; adequate sleep; and personal hygiene.
Rationale for Specific Food Recommendations by Maimonides
The fact that most of Maimonides’ nutritional recommendations are basically accepted by some of the major authorities worldwide is remarkable. Maimonides based his recommendations on astute observation of his patients throughout decades of medical practice. The only total disagreement between the modern recommendations and Maimonides relates to the consumption of fresh fruits, vegetables, and legumes. Hence it is important to understand his rationale for these recommendations.
When reading his recommendations in De’ot carefully, three particular themes recur throughout: the concern for proper digestion, healthy defecation, and urination. Hence, he suggested the eating of laxative fruits and vegetables first (grapes, figs, mulberries, pears, melons, and certain types of zucchini), while constipating fruits and vegetables were recommended for after the meal, and not in large amounts (e.g. pomegranates, quinces, apples, etc.).8(a) However, at the heart of everything he writes regarding diet is his concern for consistent, lifelong stool consistency that is loose and tends slightly towards diarrhea.
This is a cardinal principle in medicine: Whenever one suffers from constipation or has difficulty moving his bowels, serious diseases will beset him.8(b)
This begs the question, why? Magrill and Sekaran point out that his recommendations help to prevent hemorrhoids.33 Trowel discusses at length the importance of soft stool for health.34 It is well known today that constipation is often associated with stress, depression, and little physical activity or exercise.35 Maimonides makes reference to issues such as mood, exercise, and stress in connection with his dietary recommendations, and it is highly likely that he would have observed lose stool as a sign of healing. In addition, it must be remembered that diet was the only tool in a physician’s box for constipation during the time of Maimonides. Today, with the plethora of medications on the market, dietary considerations have become but one aspect of treating constipation and hemorrhoids. This, in addition to the fact that today there are no problems with food storage, could help explain why modern dietary recommendations for fruits and vegetables disagree with those of Maimonides.
Another possible reason why Maimonides had such a low view of fruits could be that Galen strongly opposed their use. Professor Gamliel suggests that it is possible that people did not wash fruits before eating, and they did not have the soaps and disinfectants used today. Hence, the fruits could have had a greater number of bacteria, microbes, parasites, etc., which led to a stronger intestinal reaction in Galen and his patients.36
With regard to legumes, Maimonides does not write specific reasons for referring to “horse-beans” (known today as fava beans), lentils, chickpeas, and other legumes as harmful and something to be avoided or eaten sparingly. However, today fava beans are recognized to be harmful and even life-threatening for certain people suffering from G6PD deficiency. This condition is transmitted genetically and is more likely to be found in people of Middle Eastern, Kurdish, or Sephardic Jewish descent.35
Other Health Recommendations of Maimonides
Maimonides also made additional health recommendations. Table 2
looks at some of those, which, in some way, are connected to eating habits in his writings. Here, the agreement between certain items is remarkable, albeit not in the dietary guidelines of most of the compared recommendations (i.e. exercise, amount of food consumed, food odor, and exercise after eating). Also noteworthy is the silence on many issues, i.e. seasonal eating, water intake at mealtime, stool quality, timing of eating, and sequence of foods eaten—all of which could well bear further investigation as they relate to healthy eating habits.
Agreement between Maimonides’ Recommended Eating Habits and Contemporary Recommendations.
The issue of clean air was included in this table since Maimonides was one of the first in his time to understand the implications of air quality on health. Noteworthy is that this issue has only become an important health concern in the last century.
Many of Maimonides’ recommendations were revolutionary in his time, although they are common knowledge today. For example, exercising, not consuming foods with a foul odor, and not eating too much in general fall into the realm of common knowledge. People involved in sports are well aware of the recommendation to avoid heavy exercise 1–2 hours after eating. However, this was new information for the patients who came to Maimonides, and testifies to his skilled observational and inductive abilities. Only a few of the items listed in Table 2 are included in present-day established dietary and health recommendations.