Marian is a bright young woman living in Toronto in the mid-late twentieth century, an employee at a small market research firm who spends her off-hours juggling an attractive but hard-to-please boyfriend, an irresponsible roommate, a tittering gaggle of officemates, and unenvied friends stuck in the baby-making grind. She is well-educated and able-bodied, and filled with all the hopes and dreams a woman could imagine for herself before the Feminist Revolution took hold: Marriage, she supposes, to a man, and kids, maybe, eventually? Friends to entertain, certainly, in a nice home, although come to think of it, Marian isn’t entirely sure what she wants. In fact, Margaret Atwood’s 1969 novel The Edible Woman (Atwood herself called it “protofeminist”) is primarily concerned with what Marian doesn’t want, and how her disinterest is culminating in physical symptoms. Marian, a product of—and an important cog in—consumer society, eventually finds herself unable to consume. “This is ridiculous,” she says to herself when she first encounters her problems with food.¹ What, our protagonist wonders frequently, could possibly be wrong with her?

Atwood is short on details of Marian’s life before her digestive issues arise, toppling with them her status as able-bodied: the book opens with the entirely forgettable sentence, “I know I was all right Friday when I got up.” The author is similarly stingy with elements of Marian’s person, as well as with precise descriptions of her emerging ailments. Still, there are plenty of words between the opening sentence and the appearance of Marian’s consumptive failures some 170 pages later, and many of them, upon close inspection, reveal themselves to be cleverly feminized alarm bells. As Marian grows increasingly concerned about her inability to eat, she becomes alienated from her own body—reflected in a shift from first- to third-person narration between the two halves of the book—and increasingly unable to articulate her concerns: she stops being “all right” sometime after Friday, but because Marian never verbalizes her concerns, the reader doesn’t have any clues when she gets sick or what form her illness really takes.

What we gather about Marian in the first half of The Edible Woman is that she is white, Canadian, upper-middle class, and professional—“normal,” we’re given to believe, if a bit reticent to contradict the insufferables she seems surrounded by. Her character is filled out in the negative: she is “not blonde,” she disapproves of her roommate’s drinking habits, she backs away from conversations about child-rearing. Marian desires not to bring offense, clearly, but Atwood designs her inoffensively: she is Everywoman, that literary device into which Atwood’s largely white feminine readership might slot themselves. In the common parlance, Marian is “relatable.”

Yet Marian’s apparent normality is a large part of the trouble, for there is no visible manifestation of her problem with food. She does not develop a tumor, for example, or appear alarmingly frail to any of the other characters in the book, nor does she gain weight. As the adage goes, seeing is believing; not seeing, therefore, leaves one at risk of not being believed, although Marian offers no explanation whatsoever for why she can’t eat, so is in no danger of being discredited. The reader only ever knows that, to Marian, the problem is quite real. Yet without any detail regarding symptoms, the reader also has no clue if the problem is biological or psychological.

A “refusal of her mouth to eat,” it’s called at one point; the blame for her disability placed on “whatever it was that had been making these decisions, not her mind certainly.” Her jaw fails to open, she cannot lift her fork, she is hungry but finds she cannot take a bite—Marian has been diagnosed by successive decades of readers as vegan, anorexic, nervous, allergic, hysterical, and a victim of our hyperconsumerist environment.

It might be more to the point to diagnose her, simply, as a proto-Everywoman—and Atwood a visionary. Recently, ailments remarkably similar to Marian’s have become quite common among relatively young North American women—including well-educated upper-middle class whites. A 2014 study² found around 11 percent of the population worldwide—three-quarters of them women, with twenty-five to forty-five million living in the US—diagnosed with irritable bowel syndrome (IBS), for example, a diagnosis often bestowed upon patients with symptoms and concerns as vague as Marian’s. Alongside dozens of other autoimmune diseases—many with food aversions of unknown biological or psychological provenance—IBS has, in the nearly fifty years since Atwood first envisioned something like it, become a modern epidemic.

Marian’s troubles arise one night at dinner with her fiancé Peter when she can’t finish a steak. Her standard diet of TV dinners, packaged puddings, and boil-in-the-bag entrees often leaves her craving something freshly made, so she rarely leaves leftovers when she goes out. Yet she can neither clean her plate, nor offer any reasonable explanation to Peter for her sudden disinterest in the meal. Although she keeps up appearances in the coming days, her difficulties only worsen.

“The day after the filet, she had been unable to eat a pork chop,” Atwood writes. All meat is out. Soon Marian finds she can no longer stomach a growing list of foods: next is dairy, and shortly after that, vegetables. Her primary concerns are social, for she continues attending parties and dinners, but resorts to hiding food whenever she finds she cannot finish it. The third-person narrative voice further confounds readers seeking details of the protagonist’s digestive troubles, and it becomes difficult to trust Marian’s description of events as accurate.

The novel ends tidily, in a too-neat domestic scene in which Marian symbolically offers herself up for consumption but, rejected, ends up consuming herself. Deeply rooted social norms—like that convenience food is harmless, for example, or that single women crave marriage to eligible bachelors—now overcome like that, Marian is cured. She can eat again and, newly single, can offer her symbolic self up for other men to eat, too. Marian is back on the market, as it were: Atwood’s joke about Marian’s re-entry into consumer society.

It reads false and, as we will soon see, it is false, at least for the millions of women in North America who suffer ailments resembling Marian’s. Yet on all other fronts, the book is unusually prescient, even for an Atwood novel. For The Edible Woman is not only a story about consumerism, about the body’s need to eat as biological phenomenon and as cultural metaphor. It is a story about broken political economies and their impact on the physical self.

Take the difficulty in diagnosing Marian, for example, which comes from her seemingly normal existence. She works in advertising—ahem, “market research”—and intends to marry a good-looking young lawyer. Obviously she is surrounded by brands, and thinks about how they might fit into her life for a good part of every day. She considers ads, and whether she likes them, even outside of the office: she has internalized her role as a consumer so thoroughly that she is apt to have a product for dinner that she worked on during the week. Her friends are having children—both in and outside of wedlock (although those who start outside of it quickly want in). Her future, in other words, seems clearly planned.

Unfortunately Peter, her good-looking, young, lawyer-fiancé, has no positive interpersonal attributes. He is dismissive of Marian, and the sex they have is perfunctory and passionless. He enjoys hunting and then describing the animals he has killed over dinner. He is a bore, and a bit of a letch, but it is unclear how much of this Marian can perceive, because her behavior is either predictable for a character of that time period—she deflects to him more and more over the course of the book—or inconsistently written, which is unlikely, since Atwood tends to create characters with rich interior selves. The reader experiences the friction between the two potential explanations for Marian’s submissiveness through a simmering rage, an experience common to gender-minded readers of works written before the second wave of feminism. At the time, of course, marriage represented one of the only paths to financial security for women, aside from being born rich. (Women in the US couldn’t have credit cards in their own names until 1974, for example.) So readers won’t be surprised that Marian pursues marriage, even with a partner she acknowledges—although only occasionally, and via interior monologue—is imperfect. After all, financial security is necessary to lead the well-branded life she clearly desires. Marriage, therefore, is not something Marian finds negotiable.

Yet something is wrong. That Marian’s entire life trajectory is thrown into question when her consumptive issues arise is one clue that the book is about far more than mere consumption, but the New York Times missed it in its 1970 review:

As her wedding day approaches, Marian quite literally begins to lose her ability to consume things. First she rejects steak, finally she cannot even stomach salad. A case of bridal jitters, says a married friend. Or, as I think the author means us to half-seriously see it, a piece of truth-telling dementia that is a symbolic answer to lying sanity. Not to eat or be eaten up like a confection of calculated flavors might be her heroine’s unconscious aim and Miss Atwood’s symbolic sense.³

The thesis that “consumerism” is the entirety of the problem that Atwood means to point out likely held a certain logic—maybe even an unwashed allure—when the review was published. (A tried-and-true revolutionary of the 1960s recently told me that, by the 1970s, he had believed capitalism was over. It seemed clear to him and his colleagues, he said, that culture had reached peak consumerism. Then he laughed.) The onset of Marian’s ailment, however, isn’t a reaction to food itself, nor the infiltration of ads, brands, sales pitches, and jingles into her world. Her revulsion is triggered instead by an awareness of how it all works together, a glimpse at the man behind the curtain and what he’s preparing for her back there.

Marian is not, in other words, symbolically over-satiated by the “confection of calculated flavors” on offer. Here, her body prepares to reject beef for the first time:

Watching [Peter] operating on the steak like that, carving a straight slice and then dividing it into neat cubes, made her think of the diagram of the planned cow at the front of one of her cookbooks: the cow with lines on it and labels to show you from which part of the cow all the different cuts were taken. What they were eating now was from some part of the back, she thought: cut on the dotted line. She could see rows of butchers somewhere in a large room, a butcher school, sitting at tables, clothed in spotless white, each with a pair of kindergarten scissors, cutting out steaks and ribs and roasts from the stacks of brown-paper cow-shapes before them. The cow in the book, she recalled, was drawn with eyes and horns, and an udder. It stood there quite naturally, not at all disturbed by the peculiar markings painted on its hide.

She cannot finish her steak, and it’s not because she’s already full, symbolically or otherwise. The “Planned Cow,” she later calls that steak, and soon adds the Planned Pig and Planned Sheep to her growing list of food restrictions. What rankles her is not solely that meat is flesh: it is that an entire system is devoted to keeping her from realizing that meat is flesh, a well-regimented design incorporating safety scissors, clean uniforms, and dotted lines, all in place to ease and conceal the elaborate machinery that turns living bodies into food. Consumption is not distressing her, nor the culture that facilitates it. Instead, she is repulsed by the economic and political system that create them—marked more by the factory, the uniforms, and the workers than the presentation of cows as meals.

Nonfiction food writer Michael Pollan describes a similar scene in The Omnivore’s Dilemma. At the meat counter in your local supermarket, he suggests, “you encounter a species only slightly harder to identify” than in the produce aisle, where foods tend to retain something of their original form. “[T]he creaturely character of the species on display does seem to be fading,” he notes, as more and more the animals on offer for consumption “come subdivided into boneless and bloodless geometrical cuts.”⁴

The Planned Cow. The Planned Pig. The Planned Sheep. Who is behind them? What Marian’s body begins to reject is the contraption that offers them up. The friendly face of industrialism hides not only the assembly line from the consumer (Marian), but also from the consumed (the cow, who seems perfectly content with its role in the proceedings, however short-lived it may be). Of course, these two roles are fungible: “Every time she walked into the supermarket and heard the lilting sounds coming from the concealed loudspeakers she remembered an article she had read about cows who gave more milk when sweet music was played to them,” Atwood writes. “But just because [Marian] knew what they were up to didn’t mean she was immune. These days, if she wasn’t careful, she found herself pushing the cart like a somnambulist, eyes fixed, swaying slightly, her hands twitching with the impulse to reach out and grab anything with a bright label.”

Therefore it’s not totally wrong when Marian’s married friend attributes her stomach troubles to wedding jitters—the “piece of truth-telling dementia” noted in the Times. For marriage is simply another stage of the assembly line’s conveyor belt to which Marian feels strapped. The Edible Woman also predicted correctly that feminist sci-fi of the era to come would liken hell to a reasonably happy marriage to a businessman or tenured professor, replete with kids and a dog. Joanna Russ’ The Female Man (1975) draws such a comparison; I, Vampire by Jody Scott (1984) contains a harrowing nightmare sequence in which a morally ambiguous character’s death results in an afterlife of baking, child-rearing, and hubby-coddling. (It is how we know the bloodthirsty lesbian has met her demise.) As she plans her wedded life, Marian may well be seeing the pathway open up on a dystopic Stepford Wife future. (Ira Levin’s The Stepford Wives was published only three years after The Edible Woman.)

Yet Marian isn’t balking exclusively at marriage itself, or even just marriage to charmless Peter. At one point following their engagement, she finds him acting inscrutably, and she imagines he must have purchased a marriage guidebook, to match the camera and legal manuals on his coffee table. “It would be according to his brand of logic to go out and buy a book on marriage, now that he was going to get married; one with easy-to-follow diagrams,” she thinks. She uses loving words, but soon her body is rejecting her placement on this assembly line, too.

What triggers Marian’s illness is her glimpse of the elaborate system she feeds into and from, a multi-use machine with a myriad of moving parts, all of which push different aspects of her life toward a single end-goal. Her every move, consumables inclusive, has been predetermined, and her clothing, relationships, and even reproductive goals (she is annoyed to discover) selected for her in advance. It makes Marian sick. Atwood doesn’t name the system her protagonist glimpses, but we now know it’s called capitalism.

Rachel is a mid-twenties pharmaceutical graduate student in Kansas with three dogs, three cats, and a fantastically attractive boyfriend named Alexey. Rachel is quite pretty herself, with long dark hair, clear skin, deep dark eyes, and a strong, sincere smile. Like Marian, Rachel’s planning to marry soon, but she’s been having some digestive issues, and managing them is taking up a lot of her time.

Luckily her boyfriend is patient and supportive, even when their dinners together make her outrageously ill. “Alexey and I have found some really good frozen pizzas,” Rachel writes in a 2009 post on her blog. “[W]e split a pizza one to two times a week and by split I mean he has two thirds of the pizza and I eat the rest. . . . In the past, I have gotten some heartburn from it and definitely a ton of gas build up, but it’s never made me sick. Last night was the first time it did.”⁵

Her story, instructive in its detail, continues. “Immediately after I finished the last piece,” Rachel writes:

my stomach felt extremely bloated. I had to stand up it hurt so bad. When I tried to sit down, I literally felt like my stomach was going to explode. . . . Then out of nowhere came the urgency, so I ran up to the bathroom. . . . The feeling of needing to get to a restroom with no time to spare is horrible, and experiencing it out of nowhere in a crowded place or somewhere you can’t leave quickly is terrifying.

Rachel goes into some detail regarding diarrhea and nausea—she’s got a fear of vomiting that makes the latter particularly unpleasant—and expresses gratitude that she was not only able to get through that pizza night without throwing up, “but also that I only had to take GasX.” Other brands whose products she cites would be immediately recognizable to her readers, many of whom suffer similar symptoms (“Pepto” and Immodium are her go-tos), as would the cycle of illness she describes:

I hate it so much when foods I’ve eaten for months with no problems suddenly cause me to have an episode. I had just said to my mom earlier that day that I thought I was finally regaining control of my life and not living it in fear of what food was going to hurt me and make me sick again. All I ate today was cereal because I didn’t want to get sick again. I am so sick of cereal. Just when I think I’m in the control, my body steps in to remind me how much of a joke that really is.

Rachel’s tale of pizza-related torment was published four decades after The Edible Woman was released. Although her story has much in common with Marian’s, the only thing she mentions reading on her blog is her own blog, which she uses to catalogue her IBS. It isn’t a platform for self-pity, however; her blog offers the public service of community building. Commenters regularly leave notes on this post, about pizza and IBS, as well as on her other posts, which may be about diet, drug regimen, the social anxiety of living with this particular disease, planning a wedding with a chronic illness, or plain old poop. Rachel’s been blogging approximately once a month for seven years, and her readers often leave notes to thank her for writing, or briefly describe their own similar stories. (“Reading your blog post, it honestly sounded as if I was reading one of my own journal entries,” one writes.) Commenters frequently note how desperately they have been searching for stories that reflect their own experiences. (One example: “My sister has been dealing with this for the past 2 years and people really have no idea just how much of an issue it really is. It totally changes your life!”)

However, irritable bowel syndrome is hardly rare. A relatively common diagnosis given folks that experience discomfort in the large intestine, including cramping, abdominal pain, bloating, gas, diarrhea, and constipation, it’s something of a catch-all diagnosis, bestowed upon sufferers with symptoms but no recognizable disease (although IBS does often evolve into something more clearly defined, like ulcerative colitis). You may not even know if your friends have it: as may be surmised, propriety keeps the diagnosis from coming up in most polite conversations. Internet discussions, therefore, which offer both a degree of anonymity to sufferers and, presumably, the comfort of writing from a controlled environment, do not infrequently result from Rachel’s posts, although her blog is not the only one to tackle IBS, nor the only one to do so from a personal narrative standpoint. Others offer insight into recipes, drug regimens, new treatment options, fitness routines, legal advice, or other aspects of living with IBS. (There is, for example, a YouTube channel devoted to toilet jokes from someone going by Positive vIBS.) There are, in fact, countless blogs by people who suffer a range of gastrointestinal disorders and autoimmune disease—Ali on the Run looks at marathon training with Crohn’s, for example, while ChronicBabe covers a wide range of chronic illnesses.

Reading such blogs offers a glimpse into the suffering of what the American Autoimmune Related Diseases Association (AARDA) estimates to be one in five Americans afflicted with autoimmune conditions. The primary struggle of the afflicted (like Marian’s) is to understand why their bodies have betrayed them, and to do so, input from other sufferers is required. Even the least talented writers have dedicated readers and commenters, so community seems to be forged not around talent, but out of sheer desperation. Most blogs are kept by women, who make up approximately 75 percent of the diagnoses of autoimmune disease worldwide. From a labor perspective, we should note that the keepers of such sites probably aren’t getting paid for blogging, or are at best offsetting site update fees (in the tens to low hundreds of dollars per year) with ads, so most of the work of blogging could be described as the unpaid emotional labor of creating resources for a community that cannot find sufficient help anywhere else. Whether or not bloggers have day jobs may also be relevant—it is notoriously difficult to have the most common autoimmune diseases officially recognized as disabilities and receive social service benefits, despite the inability of sufferers to consistently meet the demands of day jobs. Let’s situate this, too, in the context of a capitalist—as opposed to consumerist—society. The work Rachel and other health bloggers do fills a medical need for patient-focused lifestyle and wellness conversations currently untended to by privately funded, profit-driven healthcare systems, who consistently defund support groups, online chat spaces, and counseling services that could provide similar.

That symptoms just as mysterious as Marian’s would become quite common in the decades that followed The Edible Woman’s publication was certainly unforeseen. But because mysterious feminine digestive troubles and invisible ailments have started to gain medical recognition in recent years, they have lost some of their comedic bite. In fact, “half-serious,” “dementia,” and “lying,” are only a few of the pejorative descriptors the Times lends a scenario in which a woman simply can’t eat whatever is put in front of her. It is only through the steadfastness of Atwood’s pen, it seems, that we refrain from considering Marian a wholly unreliable narrator. “[P]eople suck, in general, when it comes to accepting and respecting IBS as a real issue,” Rachel writes in a blog post entitled “Wedding Series: In Laws.” I’m apt to let her speak for the millions of other sufferers of understudied diseases. Today, people with similar symptoms are often passed from doctor to doctor for several years—the average is seven—before receiving a diagnosis. Many have watched as their symptoms are written off as psychological—the medical-industrial complex version of the Times’ “lying.”

The problem, however, might not lie in millions of women’s heads. A 2001 study at the University of Maryland found that, although women in general have lower thresholds for pain than men, and tend to experience it for longer, their symptoms are often treated less aggressively.⁶ In emergency rooms, for example, women wait for pain medication an average of sixteen minutes longer than men, and are 13 to 25 percent less likely to receive an opioid medication. A separate study in the esteemed New England Journal of Medicine showed that, among cancer patients, women were significantly less likely than men to receive adequate treatment for their pain.

Researchers remain baffled by these findings, although Hoffman and Taznian told lifestyle news outlet Mother Nature Network in 2015 that they’d come across a handful of recurrent explanations in interviews with medical staff. These include presumptions about men being able to manage pain better, and not complaining about it until it was “real;” some women’s ability to birth children, which is thought to imply an ability to manage any amount of pain; and women’s presumptive tendency to exaggerate and complain instead of describe sensation accurately.⁷

The world of medicine, in other words, tends not to believe women when they say they are in pain, which in the realm of invisible illnesses like Marian’s, is often the only symptom on offer. Fold in a host of known food-related disorders—anorexia, bulimia, etc.—and we can detect a general cultural tendency to label women’s problems with food as little more than psychosomatic, mere psychological issues undeserving of deeper study, never thought to be exacerbated by external or environmental forces, or indeed to be outwardly provable in any way.

Marian never describes the full range of her bodily failures, either to another character or to her audience. It’s a trick of Atwood’s, to force the reader to believe a female character’s version of events in order to follow a storyline. It also saves the character from the embarrassment that millions of other women have experienced, of being told—by acquaintances, loved ones, and doctors—that their illnesses are all in their heads.

You’ve heard of celiac disease, a diagnosis given to two to three times as many women as men, in which the body’s immune system attacks itself when triggered by the ingestion of gluten. Perhaps you’ve even reposted one of many articles claiming to debunk the wheat protein’s link to physical discomfort on social media, a sharable, friendly way to discredit women’s pain. (I know I have.)

However much the precise mechanics of the relationship between certain foods and autoimmune disease may not be understood, foodstuffs beyond gluten have been linked to certain autoimmune responses. Usually, autoimmunity is considered a medical mystery: for unknown reasons, doctors say, the body’s immune system turns on itself in the same way it would attack a parasite, virus, or other foreign invader. The resulting inflammation causes pain as well as physical impairment. Yet some health practitioners—naturopaths, in particular—root autoimmune disease in food sensitivities.

There are several food-elimination protocols suggested for the autoimmune, therefore: some name-brand, like the Paleo Diet, and others more tailored to individual responses, like the low FODMAP diet (to cut down on short-chain carbohydrates), elimination programs (to identify problem foods), low histamine diets (to quell allergic responses), and rotation diets (for those who can’t identify any specific food relationship to symptoms beyond ingestion). Such diets, however crazy they may sound to those who have not tried them, do tend to work for a large number of people.

Despite extensive anecdotal evidence, however, scientists have been slow to look into a relationship between consumption and autoimmunity. The reasons for this are likely myriad. While many in the post-Sanders campaign era would tend to blame Big Pharma’s exclusive focus on profits for the holdup, it may equally be due to the gender of the majority of sufferers. Although medicating illness is profitable, there are surely enormous profits to be made in staving off illness, if the price point for continued health is set high enough. It seems more likely that the tendency of the sciences to overlook autoimmunity is rooted in the low numbers of women in STEM (Sciences, Technology, Engineering, and Medicine). Women chemists, for example, make up only 35.2 percent of the field, and women chemical engineers only 22.7, according to analysis by the National Girls Collaborative Project. Nor are there enough women funders to ensure such studies take place: only 4.6 percent of the 2016 Fortune 500 CEOs are women, according to Catalyst, an organization that tracks women in business leadership. Women, earning on average 77 percent of what male counterparts do in the same jobs (specifically making $15,900 per year less than men in STEM jobs, according to a 2013 report by the US Census Bureau) do not currently have the economic clout as a class to fund or demand such studies. Anyway, those who perceive a clear need may be too ill to mount a campaign, or already wrapped up in the sustaining care work of blogging.⁸

Only recently, therefore, has a connection been proven between food and these poorly studied ailments. A June 2015 report in the peer-reviewed journal Autoimmunity Reviews found that common food additives contribute to intestinal leakage, which creates the conditions for autoimmunity. These additives are named in the report: “Glucose, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles are extensively and increasingly used by the food industry, claim the manufacturers, to improve the qualities of food,” note authors Aaron Lerner, a professor at Technion Israeli Institute of Technology, and Torsten Matthias, of the Aesku-Kipp Institute in Germany. They also:

increase intestinal permeability by breaching the integrity of tight junction paracellular transfer. . . . It is hypothesized that commonly used industrial food additives abrogate human epithelial barrier function, thus increasing intestinal permeability through the opened tight junction, resulting in entry of foreign immunogenic antigens and activation of the autoimmune cascade.⁹

In plain English, consuming these additives leads to intestinal breakdown—commonly called “leaky gut syndrome”—which allows for the autoimmune response to occur.

The report cites the rise in autoimmune disorders—many diseases have three times the diagnoses that they did three decades ago—that are primarily occurring in nations with high rates of processed food consumption. Also noted are the specific disease categories with rapidly rising numbers of diagnoses (neurological, gastrointestinal, endocrine, and rheumatic), as well as the geolocations of the diagnosed, which seem to indicate that environmental, and not genetic, factors are the primary reason for the uptick in these ailments. The report describes a corollary rise in the use of food additives, intended to increase “the world’s capacity to provide food through increased productivity and diversity, decreased seasonal dependency and seasonal prices.” (In Brazil, for example, the years 1987 to 2003 saw a 46 percent increase in the intake of processed food in the average household. Virtually unheard of three decades ago, today Brazilian rates of rheumatoid arthritis stand at around 1 percent of the population and incidents of psoriasis at 2.5 percent. Far more worrying is the Zika outbreak in the country, a virus that grew twentyfold between 2014 and 2015, and is linked to Guillain–Barré syndrome, an autoimmune disease that causes paralysis.)

To recap, the seven additives listed above are now being found in more foods. Those foods are eaten in more households around the world. And bodies in those households with previously healthy immune systems are becoming dysfunctional. Causality, the authors warn, “has not been proven”—the report only proves that these particular food additives contribute to leaky gut syndrome, from which the autoimmune response follows. “Precise mechanisms responsible for the development of nutrient-induced autoimmune disorders are unknown,” the authors contend.

Still, recommendations based on these findings are in order. “[I]ndividuals with non-modifiable risk factors (i.e. familial autoimmunity or carrying shared autoimmune genes) should consider decreased exposure to some food additives in order to avoid increasing their risk,” the report states. Additionally, strengthening FDA nutritional labeling standards—policies that have been designated “barriers to trade” by lobbyists and are being modified or dropped entirely¹⁰—and further studying the impact of food additives on immune systems are strongly recommended by the authors.

What this means is that individuals may be “going autoimmune” due to personal consumption habits. Yet autoimmune diseases in general—their worldwide spread, their increasing diagnoses, and their worsening symptoms—are likely triggered, at least in part, by the far-reaching machinery of globalized food production.

A food industry reliant on additives to ease its own spread throughout the globe has become central to a socioeconomic system based on private ownership of the means of production. McDonald’s stands as a shining example. In the decades since The Edible Woman first appeared, the chain has been documented using food preparation techniques from farm to table that are questionable at best and extremely dangerous at worst; exists now in outposts formerly hostile to Western presence; and—Marx would be impressed by the company’s allegiance to his definition of capitalism—exploits the workforce to such a degree that the fight to raise the minimum wage to $15 per hour is commonly sited at the burger chain. (The company had just opened it’s one thousandth restaurant and expanded to all fifty states when The Edible Woman came out; today there are over 36,000 restaurants in 119 countries around the world, according to the company’s own website.)

Michael Pollan describes a visit to McDonald’s in The Omnivore’s Dilemma, where he muses on the poultry-like meal his son orders. “[T]he most alarming ingredient in a Chicken McNugget,” he explains:

is tertiary butylhydroquinone, or TBHQ, an antioxidant derived from petroleum that is either sprayed directly on the nugget or the inside of the box it comes in to “help preserve freshness.” According to A Consumer’s Dictionary of Food Additives, TBHQ is a form of butane (i.e. lighter fluid) the FDA allows processors to use sparingly in our food: It can comprise no more than 0.02 percent of the oil in a nugget. Which is probably just as well, considering that ingesting a single gram of TBHQ can cause “nausea, vomiting, ringing in the ears, delirium, a sense of suffocation, and collapse.” Ingesting five grams of TBHQ can kill.¹¹

The mainstream food movement in which Pollan plays a significant role has given us a contemporary understanding that the standard consumption habits of the Western world can be quite damaging to consumer health.

Of course, there is also a disease called consumption that in the nineteenth century killed as many as one in four Brits. Susan Sontag traced its earliest usage to 1398 in Illness as Metaphor. “Whan the bode is made thynne,” writes John of Trevisa, “so folowyth consumpcyon and wasting.”¹²

“Consumpcyon” was the common name given to tuberculosis, a disease that at one point was as mysterious and misunderstood as autoimmune diseases are today. Mysterious, but ever-present: the ill were described as langorous, hollow-chested, romantic, and pale. They appeared to be in the process of being consumed.

It’s a markedly different metaphor than can be applied to the autoimmune, who have less a disease in the traditional sense than a dysfunction. However much autoimmunity may be triggered by food consumption—and despite the fact that many can control the negative effects of these disorders to at least some degree by restrictive diets—the autoimmune are not being devoured by any malevolent, outside force. The bodies of the autoimmune attack themselves. In some cases, yes, eating away at it, over time—but the immediate symptoms of inflammation occur at the site of self-generated attack. In fact, what is markedly different about autoimmune disorders as opposed to any other public health crisis in history is that the whole language of “fighting” disease does not apply: the body must instead be soothed into remission, must learn to lay down its weapons entirely.

This is the logic behind restrictive diets, that certain foods trigger attack more than others. This isn’t an explanation that makes much sense to medical professionals, however. Doctors who don’t outright laugh when asked about connections between autoimmunity and food are few; others are more tolerant, although one often gets the sense that one is being humored. (“There are people who feel better when they don’t eat certain things,” is a common medical response, if an unhelpful one). There are only a handful of doctors in the US, however, who believe food to be a primary trigger in autoimmune disorders that aren’t situated in the intestines, like rheumatoid arthritis, lupus, and psoriasis. Even Lerner and Matthias’ groundbreaking studies on leaky gut syndrome have been slow to filter through the medical world.

In some ways, the reluctance of the medical profession to acknowledge that disorders suffered by one fifth of the US population are partially triggered by modern food production is understandable. Recent changes to the global supply and processing chain were made, as Lerner and Matthias acknowledge, to increase nutritional access and limit hunger. Admirable goals, to be sure, and certainly one could argue that slight suffering among the few is a reasonable price to pay in pursuit of increased health for the many. Yet such a justification can only hold for so long before changes become necessary to restore public health. Incidents of type 1 diabetes rose 23 percent between 2001 and 2009, according to the American Diabetes Association, and to significant effect: autoimmune diseases as a class are thought to shorten a patient’s lifespan by eight years.

Some have also found symptoms worsening and triggers increasing in number. Celiacs who have trouble managing their symptoms, for example, are now urged to avoid dairy as well as gluten, which some suggest is an indication that dairy proteins have begun to mimic the wheat protein. Others, already diagnosed, are simply accruing more diseases at a seemingly unstoppable clip, regardless of how well their original symptoms have been controlled through standard food restriction protocols, a possible indication that more foods trigger the autoimmune response than is currently suspected. On several concurrent fronts, the negative effects of globalized food production seem to be quickening at an alarming rate.

Marian solves her problem with a symbolic gesture: a small cake replica of herself that is offered for Peter’s consumption. He doesn’t want it, so she eats some—a miracle!—then offers the rest to another man. It’s a joke about consumption. Who has the right, and obligation, to consume? The joke is on Marian, for she must be consumed, however symbolically. The unremitting inevitability of consumption is, of course, capitalism. Yet the joke is also on women like her, real-life women like Rachel. For Marian’s symptoms went away following no medical intervention. Perhaps it was all in her head after all? The reader is left to wonder.

Not all readers, of course: millions of women around the world know that their bodies are failing not through any mental or emotional flaw, but because the system under which they live is causing damage. They feel it as clearly as Marian did. Today, bodies regularly grow intolerant of production lines, global distribution, and decisions made with only profits in mind. Like Marian, women throughout the industrialized world are no longer capable of consuming what is on offer. Their bodies, too, are rejecting capitalism.

An excerpt from this essay was published as “The Planned Cow” in Women’s Review of Books.