Gourmet - Q & A: Daphne Miller

As a doctor with a private family practice in San Francisco, Daphne Miller has seen her share of patients suffering from “Western diseases”: diabetes, depression, heart disease, and breast cancer. Rather than treating or preventing these ailments just with Western medicine, though, Miller—who completed a fellowship in integrative medicine at the University of Arizona after graduating from Harvard Medical School—also uses a nutrition-based approach, prescribing whole foods (local, seasonal, and organic if possible) and advising her patients to avoid most processed foods. Her new book, The Jungle Effect: A Doctor Discovers the Healthiest Diets from Around the World—Why They Work and How to Bring Them Home (HarperCollins), examines the traditional diets in places around the world where rates of Western diseases are minimal, offering a selection of recipes from each region. Gourmet Associate Web Editor Christy Harrison spoke to Miller about the problems with Americanized ethnic cuisine, the great thing about extra-hot Cheetos, and why al dente penne is less likely to give you diabetes than mushy spaghetti.

Christy Harrison: How did this book come about?

Daphne Miller: Originally it was supposed to be more of an encyclopedia of traditional foods from around the world. But as I started to travel and do my own research, and started to talk to patients about it, it became clear that it wasn’t just about documenting cultures. It was really about the whole experience of discovering these foods and how it affected me—and, by extension, my patients. So Okinawa, for example, has been written about almost ad nauseam at this point; but I chose it on purpose because all of these articles about it move away from the personal; you walk away and say, “Well, how does this affect me and my lifestyle here in Wichita?” And so I thought it was important to try and integrate it with stories from real people here.

CH: I was really struck by the parallels between your descriptions of your travel discoveries and the way that food magazines like ours cover travel—it’s about the search for the authentic, the search for relatively unknown regions that have sort of evaded the creep of modern industrialized foods. It makes you realize that the search for interesting, delicious food and the search for nutritious food have a lot in common.

DM: Absolutely, yes. And what’s becoming even clearer now, and I don’t think people have totally made the link yet, is that search for good food, nutritious food and saving the planet are also parallel. In most instances, these things all align.

We have no authentic collective food traditions in the United States, you know. Everybody has what their ancestors brought with them, which has basically been 100 percent erased at this point by the predominant food culture, which is big industrial food. Michael Pollan talks about this very eloquently; I can’t even begin to do as good a job as he does. But my book is kind of like part two—it’s, how can we start to take these key elements and begin to recreate an indigenous diet?

And I think step one really is going back to what’s already there, to understand these food combinations that have existed forever within the context of their culinary traditions. Step two, hopefully at some point, is that these morph into something that really makes sense within our current lives—but turns its back on Big Food. And I’m really optimistic about that these days. I think it’s going to start to happen. I mean, Northern California has always been a little bit on the vanguard in terms of food issues, and I do feel like there is a food tradition starting here. But still it needs to be in the context of your family to be something that really has deep meaning to you.

CH: That’s a good point, because people have such nostalgia and such memories of certain things that they ate growing up. In the book you talk about a patient, a woman who is really just staunchly against vegetables, and she says her family is a bunch of... I forget the word ...

DM: Dough dogs.

CH: Yes, dough dogs! Meaning that they ate lots of breads and meats without any vegetables. It was a strong identification for her.

DM: Yes, absolutely. And boy, was she relieved to hear that there are healthy people around the world that don’t sit there and eat big, leafy greens every day. That, for her, was revolutionary. And it gave her room to begin to explore foods that were more nutritious. Because she felt that she didn’t have to subscribe to this one-size-fits-all model of healthy eating, which is really what you get when you read these power-nutrition type books.

CH: Like, “here are the five vegetables that will change your life.”

DM: Exactly. And the story day in and day out for me in my practice is that I see people who are getting modern chronic diseases at a very young age. And in their minds, they’re not just pulling up to the 7-11 and the McDonald’s three times a day. They’re being good, they’re trying, they’re following the diet du jour, and their bodies and their lab tests are continually telling them that they’re screwing up. And that’s really what pushed me to want to spend a bunch of time on this project. Because it just felt like there had to be another way.

CH: Your chapter about diabetes was really interesting in that respect. Your patient had tried the low-carb regime without any success, and he decided that he’d be better off just eating what his Mexican grandmother ate, because she was healthy—so he starts eating these massive burritos every day, from a taqueria in San Francisco.

DM: Yes, for me probably one of the most profound moments was when I was in Copper Canyon, Mexico, and I bought burritos there and compared them to what we call a burrito in San Francisco. You can barely call it the same animal. But that happens everywhere. Look at Chinese food versus Chinese-American food. The first time I ate authentic Chinese food I just couldn’t even believe it, because Chinese-American food is this sickly sweet, white flour-y stuff with the occasional vegetable and chunks of deep fried meat—this is what we think of as Chinese food.

CH: You discuss this in regard to West African food, too—we always think of that cuisine as being deep-fried, with lots of fritters and that kind of thing. But as you say, it’s actually more of a special occasion thing. Nobody eats deep-fried stuff at every meal.

DM: Oh, absolutely. The oil is just too pricey, and it’s actually an issue of fuel, too. If you’re going to really traditional areas, if you want to deep-fry, go ahead and try and deep-fry over an open fire, I challenge you. It’s really hard. Things get burned on one side and uncooked on the other, mushy in the middle. Deep-frying is, by and large, a product of modern technology. Just the way that the oils that we deep-fry with are.

At a conference last week I was asked to help people determine what’s a healthy oil and what isn’t, because it’s so confusing. So I sat down and looked at traditional oils, which are oils that have been used for cooking for thousands of years, versus the oils that we’ve had since the Industrial Revolution (essentially for the past 100 years or so, or a little less). The way that you can make the distinction easily is to take a mortar and pestle and see if you can make that oil—if you even have a fighting chance of making that oil. Take a kernel of corn, for example, and stick it in your mortar and pestle and go at it. And you call me when you get that corn oil, okay? Versus take something like a palm fruit or an olive or a piece of coconut or something like that—you’re not going to make gallons of oil [when you grind it yourself], but you’re going to get something greasy. So I think that that is a really helpful distinction for people; [industrial oils] are produced using acetone and denaturing heat, not just by grinding.

CH: In a lot of the traditional diets you explore, one of the central protein sources is fish—but buying fish is so incredibly stressful these days, with all the considerations about overfishing and mercury.

DM: Fish is the one thing that I struggle with in this whole concept of healing yourself, healing the planet. I’m working with that one. Because traditionally, if we were anywhere near the ocean or a stream or a pond, we ate fish—it was a cheap, easy, delicious source of protein. And it’s really the first place where everybody is suffering as a result of global warming. You might still be able to afford your SUV and water your lawn and things like that, but you’re not getting fresh fish. Not only did we mess up with fishing in terms of mistreating our waterways, and trying to get too much bang for our buck by farm-fishing and fishing with nets rather than lines, but also we were eating too high on the food chain with fish for too long. So I’m really encouraging people to start going for those little tiny fish. You know, the ones that we used to feed just to other fish, or to our sheep or whatever.

When I was on Crete, all they were eating was the little fish. They’re easily line caught; they’re right offshore, so you don’t need a lot of gas to get yourself out to them; and they’re very rich, proportionately incredibly high in omega-3 fats. Two little helpings of sardines a week will give you your weekly dose. They have one problem, though: They taste like fish. And a lot of people want their fish to taste like Chicken McNuggets.

We need to do some work in general about accepting foods that taste authentically as they should taste. There’s been a lot of breeding of various strong-tasting vegetables—like Brussels sprouts, for example, which are very much bred to taste un-Brussels-sprout-y. I’ve actually been really intrigued by this playground-culture thing going on with the extra-hot Cheetos. My 13-year-old daughter has been buying them, and it’s become a cool thing for kids to have these contests eating these things. And I’m thinking, well, they have 40 ingredients, and every dye under the sun and every other additive, and they’re absolutely horrific for you. But how interesting that this [extreme spiciness] is something that they’re valuing. Can we harness this in some way? Why not a real fresh jalapeno full of vitamin C?

CH: Yes, the taste of hot is lost from a lot of people’s palates in the U.S., I think. Hot and sour and fermented are all sort of erased from the average American diet, so we basically just have sweet, salty, and fatty.

DM: Absolutely. There is hot, but it’s very combined with sweet. Hot is not actually an instinctual taste that we seek out, like sweet, salty, and fatty; hot is a learned healing taste. So [the food industry has] harnessed the idea that hot is somehow good, but matched it with loads of high fructose corn syrup so that it becomes palatable.

But fermented is probably one of the greatest losses, I’m figuring out. I swear, if we could get everybody in this country to eat one serving a day of a really good-quality yogurt that was relatively unsweetened, and truly made through a fermentation process, I think that in itself would be a major step forward in terms of public health. That, or some other fermented food. But most people have nothing that’s truly fermented in their diet. Even the pickles and sauerkraut and things that you can buy in some supermarkets across America aren’t made through a true fermentation process anymore. So they lack all the health benefits. But recently the medical literature has been showing that genetic information is actually put into our gut through eating fermented foods. It’s becoming really obvious that this plays a key role in everything from food allergies to possible cancer prevention.

CH: And I remember a couple of years ago a study showed that there was a difference between the gut bacteria of obese people and non-obese people. Although of course it’s impossible to attribute obesity to any one factor.

DM: Yes, absolutely. I sat on a panel last week with someone who’s made a big splash in the Times with a book about obesity, where he’s connected it specifically to one thing. And that just makes me giggle, as someone who’s out there in clinical practice, that we would ever be able to find Occam’s razor for obesity. It’s just so multi-factorial at this point. It’s not the hypothalamus. It’s not the insulin receptor. It’s not the fact that your mother didn’t give you enough food when you were young. It’s not the thyroid. It’s all of it. Obesity is a symptom of a really messed-up relationship that our entire culture has with food.

CH: And so it’s really telling to look at cultures where Western diseases just don’t exist.

DM: Right. And the proof positive is that we’re exporting this disease now. So effectively. Okinawa was just amazing: You have this culture that is so remarkable for longevity and low rates of cancer, and within one generation, our food corporations have achieved near-magical results in terms of transforming Okinawans into a group of obese diabetics with metabolic syndrome. You have these grandmothers who are 100 watching their great-grandchildren waddle around and suffer from obesity.

CH: On the subject of diabetes, in the section about blood sugar you say that food doesn’t actually have a fixed glycemic index—the way it’s cooked can make a difference. I had never heard that before, but it’s fascinating to think that al dente pasta is better for your blood sugar levels than overcooked, mushy pasta.

DM: Oh, dramatically so. And it’s that way with any kind of mushy grains, because of the way the sugars break down during cooking; [grains] get mushy if you just kind of set the pot on the stove and walk away, rather than thinking through carefully how you’re going to prepare them. (This rule does not necessarily hold true for nonstarchy carbs like veggies—a slow-cooked bean and veggie stew is not higher glycemic.) And then there’s also the way in which foods are combined. The classic example that I give is that corn tortillas have a relatively high glycemic index, but if you eat them with beans, all of a sudden the glycemic index of the tortillas comes down to match that of the beans. Because our stomach is not like some little sorting factory; things actually get processed together.

CH: Following these food traditions and combinations seems like it’s much easier to do at home than when you’re eating out. Because as you say, even if you go to an “authentic” taqueria, you don’t know what kind of processed, modern oils they’re using, and there are probably way more calories in their dishes than in the traditional versions from the home country.

DM: In one of the first chapters, I talk about a Thai restaurant that I love. I was waiting for the bathroom and I look over and I literally see these crates and crates of Skippy peanut butter. My heart just sank at that moment. So people have been asking me, are you anti-restaurant? Is the restaurant industry going to come after you for this book? And I started thinking of the role that restaurants play in these cultures that I visited. It’s not like people on Crete or in Okinawa don’t go out to eat. But the difference is that it’s a treat. It’s really like one of the feasting days, going out to a restaurant. Because the idea is that you’re getting something that’s just richer and more prepared than something you’re going to get at home. And so the family dresses up, you go out all together, and it’s a big deal, a special night.

CH: I was going to ask you about the convenience factor.

DM: I don’t mean to sound self-righteous about this, but I don’t have hired help. I’m a doctor, I have two kids, I teach, I manage to exercise most days, and I still manage to cook. It’s just a matter of priorities. It’s a matter of deciding that this is the way you’re going to spend family time and relaxation time—not in front of the TV, not driving somewhere in your car, but actually just in the kitchen for a half hour or 40 minutes, making a meal.

CH: And it doesn’t have to take longer than that.

DM: No, it doesn’t. I do believe in modern conveniences like rice cookers and slow cookers and things like that. I have to say I use them a lot, and I give riffs on a lot of the recipes using them. Actually pretty much all of the recipes you can throw in a slow cooker. But when people give me that as the ground rule—“well, you know, I just don’t have time to cook, so you’re going to have to find a solution for me that doesn’t involve cooking”—the answer is: Sorry.

When people really get sick, they have all the time in the world. All of a sudden they go to all these doctor’s appointments and they have to stand in line at a pharmacy to buy their medications. And they have to go for testing and they have to go for follow-up, and they have to spend all the hours being anxious about their disease, losing productive time doing that. And it’s like, just invest a little bit ahead of time. But I know that’s not the politically correct answer.

I mean, people are cooking, but it’s just not part of the popular culture to be proud of yourself as a home cook. I think it’s considered anti-feminist, because the idea is that women are the ones that ultimately are going to be trapped in the kitchen. I have quite a few friends that really feel that for them it’s been a strong political statement to not cook. But I think the onus is on the family, whatever your family structure is. Whoever lives under your roof, you all cook together.