<p>Indigenous and traditional knowledge and practices have been acknowledged as offering potential solutions to the triple crises of climate change, biodiversity loss and poor health and nutrition. Yet, top-down, medicalized approaches dominate health and nutrition education and practice. On the basis of 39 peer-reviewed studies, this systematic review explores why this is the case and how it might be changed by strengthening food systems literacy—the knowledge, skills and communicative practices through which people engage with food systems. It also examines the roles of different worldviews and forms of knowledge production to highlight the challenges and good practices embedded in selected interventions with Indigenous communities. The studies included here encompass various communicative and learning practices, institutions and interventions around health and nutrition with Indigenous communities across regions. They offer insights into how culturally grounded, participatory approaches can advance food systems literacy and support pathways towards more sustainable, resilient, equitable and healthy food systems.</p>