In The Field

At 7:30 am on a chilly springtime Saturday, I head off to San Francisco’s Alemany Farmers’ Market, established in 1947 after a long fight with competition-wary retail grocers. It’s perfect territory to meet family practice physician Daphne Miller, author of The Jungle Effect, a different kind of diet book that chronicles Miller’s search for the world’s healthiest diets, with an eye to long, disease-free lives. Miller is also an associate professor of nutrition and integrative medicine at UCSF, but she still finds time to shop the market every Saturday morning.

Over the past three years, Miller’s traversed the globe to find “cold spots,” areas with low incidences of chronic diseases such as cancer, heart disease, and diabetes, while investigating traditional diets in those areas. Her book offers a fascinating travel journal combined with information about time-tested, indigenous diets, including recipes, from five regions across the world.

In Copper Canyon, nestled in the Mexican state of Chihuahua, Miller discovered that the native Tarahumara Indians ward off diabetes with nopales (prickly pear cactus pads) which help regulate blood sugar; in Okinawa, Japan, a cold spot for breast and prostate cancers, she learned that mushrooms contain cancer-fighting substances. On the Greek island of Crete, she found that freshly foraged wild greens, fish, yogurt, olive oil, and a little wine are high in antioxidants and essential fatty acids, and that their anti-inflammatory properties prevent heart disease. Certain combinations of foods—like olive oil, lemon, and greens—eaten together have synergistic effects that make nutrients more bioavailable. She also visited Iceland and Africa, cold spots for depression and colon cancer.

Miller says that traditional diets always begin with seasonal, unprocessed whole foods, organic by default.
“People fare better on anything that’s not a processed, Western diet,” she says as she makes a quick survey of the stalls at Alemany. “Indigenous diets are really recipes for eating that are grounded in tradition. Cooks over centuries have refined these recipes for generations, using ingredients that grew near each other and tasted good but also kept people healthy.”

Even at this early hour, the market is bustling with shoppers and vendors meeting at stalls filled to the brim
with fresh greens, herbs, spotted eggs, and the beginnings of the season’s sweet strawberries. Engaging and bubbly, Miller tells me she’ll be shopping for a dinner party she’s hosting that evening. The feast draws upon the different diets she discusses in the book. On the menu are slow-cooked pork with mole sauce, potatoes, handmade tortillas, green salad, and those beautiful strawberries with freshly whipped cream for dessert.

We wander slowly through the market, chit-chatting about her favorite vendors. Soon we find a stall featuring nopales; Miller speaks to the vendor in fluent Spanish asking for the smaller, more tender pads. “The interesting thing about nopales is that they have a substance that is really close to Metformin, a drug that doctors use to lower blood sugar in patients with diabetes,” she explains. “Nopales are great for patients who need to gain better control of their blood sugar.”

The vendor demonstrates how to use a cheese grater to cut off the sharp spines. “I usually don’t use a cheese grater,” Miller, says, shaking her head. “I use a knife. This is a great trick! I wish I’d known this for my book.”

As we meander on, I ask about using food as medicine. “I feel that food has become this other religion that
people get crazy about,” Miller says cautiously. “At the end of the day, food is food. There are lovely ways to put food together that are healing and delicious, but one of the big risks I run as a physician who does this work is causing confusion. People think I’m proposing something like ‘medical food,’ and I’m not doing that—food is foremost for pleasure, but it so happens that I use its added benefits for healing.”

Diet has always been a topic of confusion and contradiction. From fat-free foods to the promise of weight
loss with bacon, diet plans are as faddish as pet rocks. In Miller’s practice, she sees patients whose weights yo-yo up and down on the latest hot diets. When she began to recommend traditional diets based on indigenous foods, those patients found success keeping weight off—though that quest soon became an adjunct to feeling more vital all around.

The traditional diets Miller uncovered on her travels share key components: Foods are always seasonal, fresh, and local; preparation techniques have been honed and passed down for centuries; food is shared communally and eaten for satiety, with observation paid to fasts and rituals; sugars and salts come from natural, unprocessed sources such as honey or sea vegetables; meat is used in small quantities, with fats more likely to come from nuts, seeds, and minimally processed oils such as olive or coconut; fermented foods are used as condiments, and spices such as cinnamon and cumin are likely to have healing properties
of their own.

Chronic disease rates skyrocketed when people migrated from rural areas to cities and began eating modern-day processed foods that gradually edged out traditional diets. It made sense to Miller that combinations of indigenous and unadulterated foods have health-promoting properties lacking in today’s refined foods. Whole foods provide the nutrients that prevent disease and lessen the effects of chronic illness.

So what separates Miller’s book from a fad diet book? “These foods and recipes make sense to people on an intuitive level,” Miller says. “[Readers] can manipulate the recipes to work with their food preferences.” And, she adds, “Everyone has a story about a grandmother or great-grandmother who used to cook, and those traditional recipes are passed from generation to generation.” Some of that information has found its way into Miller’s book, and “when people read it, they resonate with that wisdom,” she says.

Miller dashes away to score a beautiful head of lettuce. “I always get so distracted by food,” she says, apologizing for disappearing mid-thought. “I’ll serve this with a citrus and avocado dressing. Sound good?”

We approach a stall brimming with red, purple, brown, and yellow-skinned potatoes. “You’re looking at a whole range of glycemic indecies here,” she says as she gestures toward the colorful array. The glycemic index refers to a food’s effect on blood sugar levels; eating low on the glycemic index can help prevent diabetes and weight gain. But while ingredients are the foundation, explains Miller, “Different ways of cooking foods can give you different benefits.” In this case, the brown russets are much more starchy and release more sugar, making them less desirable, and the reds and purples are more waxy, so they release sugars much more slowly. “If you cook them and cool them before eating, it lowers their glycemic index,” she says. Miller learned this in Iceland, where smaller, waxy spuds are traditionally used.

After Miller selects potatoes, I ask her if an indigenous diet means eating according to one’s ethnicity—if I’m Japanese, should I stick to seaweed-and-fish-based meals? “That’s really a bunch of BS when you look at genetics,” Miller replies. “You can optimize your health no matter who you are just by eating healthy foods. Statistically, what’s killing us is the bad food we eat, the exercise we don’t get—and stress. I recommend that people follow their taste buds. I think the diets in the book can work for all people.”

I ask about her staple recipes and favorite cookbooks. “Recipes are short little poems for me,” she replies. “I read them the way people read magazines. I’m Jewish, so I cook a lot from Claudia Rodin’s Jewish cookbook. She provides amazing traditional recipes. It’s a microcosm of global cooking.” She mentions Alice Waters’ work and San Francisco’s Zuni Café cookbook. “There are about ten to fourteen recipes I cook around, and I make a lot of slow-cooked recipes where I’ll put everything in a pot on a low simmer.”

After the market, we head over to La Palma, a mexicatessen in the Mission District, where Miller looks for finely ground masa to make handmade corn tortillas. She explains that traditional tortilla preparation calls for treating the corn with lime, which makes the tortillas more nutrient-rich, a tip she learned in Copper Canyon.

As we cruise the aisles, Miller points out the reddish-hued dried corn grain used to make pozole, a thick Mexican stew traditionally served for holiday feasts. She orders the masa flour along with a fresh, warm, corn tortilla for me to sample—a real treat. It far surpasses store-bought varieties that may contain hydrogenated fats or preservatives.

After La Palma, we wander down the street to Dynamo, a little independent coffee stand famous for its inventive donuts, such as candied orange blossom or Meyer lemon huckleberry. Miller orders a cappuccino along with a maple bacon donut, a treat before she heads off for her weekly dance class. “Everything in moderation,” she says. “Sweetness is one of the five tastes, and dessert is wonderful but should be just that—dessert—and not used as an energy snack.”

As we wait for her coffee, we discuss the connection between health and diet. “When you become a doctor and learn how to use fancy drugs, you start to realize that medicine has limitations, and it’s really like putting a Band-Aid on things,” she says. “The minute you want to work with what’s causing the illness, you have to look at what the person eats.” Miller explains how very natural it was to bring diet and food into her practice: “That’s the definition of integrative.”

Our urban foraging for Miller’s dinner party also epitomizes the ideas behind slow food: shopping locally, eating organic and seasonally, and cooking recipes steeped in tradition with friends and family. “Food is pleasure, and if people start to embrace that, they’ll start to eat better,” Miller says. “I was just in Europe eating the most amazing meals with friends last week, and I watched them eat. They don’t pig out, and we spent two hours at the dinner table. Eating mindfully is part of it.”

She takes a sip of cappuccino and a bite of donut and tells me, “As a culture we’ve taken food to extremes—we’re obsessed with it or completely disassociated with it. I think that’s really unhealthy.”

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