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Ghana is undergoing a rapid and dramatic food system transition, driven by urbanization and globalization. The ways that people eat are changing, and rates of new diseases – diet-related illnesses like diabetes, hypertension and heart disease – are becoming much more common. While these changes are worrisome from a public health standpoint, the ways in which they are popularly articulated are concerning in a different way. The models that are used to describe these transitions risk imposing a deterministic trajectory modeled on Western history and values, which can inhibit other ways of imaging food systems change. Case studies on local food knowledges and movements reveal other ways of imagining. The first case study considers a Ghanaian local food movement in Accra which challenges assumptions of linear progress by looking to local “traditional” foods to solve “modern” problems. The movement expands the definition of what qualifies as local in a way that makes space for Ghana’s hybrid postcolonial context. The second case explores how everyday people in the neighboring city of Tema account for the rise in new diseases. People draw a connection between the increased use of chemical fertilizer and new disease, which can be understood as a metaphor for broader concerns of modernization, highlighting how the often-violent historical process of modernization still causes harm.