Yale Sustainable Food Project Podcast

Interview with Dr. Miller - Healthy food, healthy body

Daphne Miller, Family doctor, author, professor and some-time farm hand on the ways that sustainable farming can help us think about healing and staying healthy and about changing the way that doctors understand and treat illness.

KQED Forum with Michael Krasny

What Can Farming Teach Us About Living?

When physician Daphne Miller visited farms across the country, she wondered how she could relate farming to treating her patients. In her new book “Farmacology: What Innovative Family Farming Can Teach Us About Health and Healing,” Miller shares her experience at seven family farms and suggests that if people treated their bodies the way farmers treat soil, we would be a lot healthier and happier. She joins us to discuss ecological farm habits and its relation to healthy living.

Listen here

Berkeleyside Magazine

Farmacology: Farm-to-Body Lessons

By Sarah Henry

Dr. Daphne Miller is author of The Jungle Effect and the new Farmacology: What can innovative family  farming teach us about health and healing? She is an associate clinical professor of family medicine at the University of California, San Francisco, a practicing family physician, and a contributing writer for several magazines and newspapers. She writes about the connections between biomedicine, food, farming and the natural world. She lives and gardens in Berkeley. 

We caught up with her to chat about her new book.

What inspired you to write ‘Farmacology’?
I had been writing about food and nutrition for over a decade before it dawned on me that I needed to learn more about the places where our food is grown. Of course I’d advise my patients to look for labels like “organic,”  “pasture-raised” or “non GMO” as markers of healthy farms and food. But beyond the labeling, it was all pretty much a mystery.

So recently I began to take time away from my medical practice to visit sustainable farms and see what went on there. As I journeyed across the country, milking cows, gathering eggs, weeding, laying irrigation pipe and hawking produce at farmstands, I discovered that good medicine and good farming had much in common. In fact, I began to see family farmers as healers whose jobs were more complicated than mine, since they were responsible for the health of an entire ecosystem — soil, soil creatures, animals, plants, water, air, people — while I was expected to care for just one member of that ecosystem.

You say that ‘Farmacology’ offers farm-to-body lessons. What do you mean by this?
The more I learned about the science of farming, the more I recognized its connections to medicine. For example, did you know that our gut physiology actually mirrors what happens in the soil? The intricate nutrient exchange between soil, microbe and plant is like the dance that takes place in our intestine, involving the mucosal lining, resident microbes and food (plants and animals). The biochemical makeup of soil also roughly matches ours, with a similar nitrogen-to-carbon ratio and the same range for normal pH (6.0 to 7.5). In fact, the carbon, nitrogen and every other mineral and vitamin building block in our body is derived from soil (via our food). In other words, we are not simply nourished by the soil, we are of the soil!

So, starting from that premise, it stands to reason that we should care for our bodies in the same way that a mindful farmer cares for the soil. And, of course, we should treat our farms and soil as if they are an extension of our body…

One of the first lessons in your book is about the similarities of rejuvenating soil and bodies. Can you explain?
Yes I learned that a holistic, regenerative approach seems to work best for soil and for our own bodies.

This became clear to me while I was doing an internship with Erick Haakenson, a biodynamic vegetable farmer in Washington State. He told me that when he first tried to bring his depleted soil back to life he sent soil samples to a lab and replaced missing minerals according to the lab reports — this “test and replace” method is standard practice in agriculture. But after a couple of years, several tons of additives, and many thousands of dollars, he was still not satisfied with the health of his soil or the quality of his produce and he wondered if the soil additives were getting to the plant. He also began to consider the unintended consequences of spreading foreign additives: for example, were they “locking up” existing soil nutrients — ones that were essential for healthy plant growth. He decided to look for an alternative, holistic, and cheaper way to improve his soil and boost the health of his farm.

He read books written by the pioneers in the organic agriculture, people like Sir Albert Howard and F.H. King, and realized that to really nurture his farm, he needed to nourish the Farm’s vital force: the billions of soil organisms that lie just below the soil’s surface. These micro creatures, which farmers refer to as “unpaid workers”, amend and aerate the soil. They also harvest nutrients from the soil and pass them along in perfectly packaged doses to the plant roots.

To support these earth creatures, the farmer Erick stopped using farm additives and began to imitate nature’s full-cycle way of farming. This included recycling organic matter back into the soil, conserving water, rotating crops, growing cover crops and resting the soil, using local seeds, avoiding all pesticides and synthetic fertilizers and grazing animals on the land so that their manure would be the main fertilizer. Several seasons after changing his practices, the farm began to thrive and the soil test results were better than ever.

So how did this influence the way you work as a doctor?
Hearing Erick’s story, I realized that it is not uncommon for doctors, myself included, to use “test and replace” strategies to solve our patients’ health problems. When we feel something is off, we immediately order a lab and then prescribe vitamins, minerals, and medications to correct any number that lies outside the norm. Our tendency is to think of the human body as a test tube and add things into this complicated system with the belief that the pill or potion will find its proper home.

Of course, supplements and drugs sometimes have a role in making us healthier, but their overuse and misuse can create the same unintended reactions as additives in soil. (Excess calcium can “lock up” zinc and iron in humans and excess phosphorus does the same in soil.) Given our close connections to soil, I began to wonder: Could this ecological approach to rejuvenation offer me a new way to rejuvenate my patients?

And what did you discover happens to our health when we connect to healthy farms?
Eating from an eco farm and treating your body like an eco farm may help rejuvenate and rebalance in a way that testing and supplements cannot.

Researchers are just beginning to uncover all the amazing health connections between healthy bodies and healthy farms. For example, scientists in Washington State like John Reganold are now comparing plants grown using biodynamic farming techniques to plants grown in conventional or even certified “organic” soil. What they are finding is that fruits and veggies from the Biodynamic soil pack a bigger nutritional punch.  This is because the Biodynamic soil is more bioactive and biodiverse. It hosts all those “unpaid workers” who are able to harvest organic matter and pass it on to us!

But nutrients are not the only positive health link between our bodies and the farm. Microbiologists around the world are discovering that soil microbes (or DNA from microbes) are silently hitchhiking on our food and transferring health information to the resident microbes in our gut. If the soil is healthy then, in turn, this information can help build our immunity and support our metabolism. Of course, treating our bodies or the soil with lots of antibiotics or chemicals can have the opposite effect, promoting antibiotic resistance, inflammation, and even chronic disease.

Your book puts forth a convincing argument for why ecological farming is good for our health and why factory farming can be just as harmful as factory medicine. But don’t you feel that there is a role for technology and innovation in farming and medicine?

Actually I have found that biotechnology is not at all antithetical to taking an ecological approach. Scientific innovation can play an important role in both health and farming as long as it preserves and complements the natural system. I love Aldo Leopold’s quote: “if the biota, in the course of aeons, has built something we like but do not understand, then who but a fool would discard seemingly useless parts? To keep every cog and wheel is the first precaution of intelligent tinkering.”

In each story in Farmacology, the farmer is an “intelligent tinkerer.” Take Cody Holmes the rancher, for example. He has constructed a paddock system using the latest in fencing technology, but he did this in order to imitate nature’s grazing pattern. Along these same lines, the vintner at Scribe Winery judiciously uses pheromone traps and other inventions in order to maintain a balance between pests and beneficial insects in his vineyard. In almost every instance where these farmers rely on technology, it is not to disrupt nature’s design but rather to preserve or restore what nature has given them.

And now you are an “intelligent tinkerer”?
Yes, when it comes to our health, I have found that the best interventions are also those that support our body’s natural patterns. I give examples of this in every chapter of this book: an asthma and allergy researcher who is interested in innovative immunotherapies but only in so far as they support (and do not override) the immune systems of her young patients, a microbiologist and a cancer researcher who are working on therapies that maintain a healthy ecological balance, whether between microbe and gut or between tumor cells and surrounding tissue. I also talk about a famous stress expert who is interested in how to preserve a healthy stress response. To this end, he is open to using pharmaceuticals along with lifestyle changes and a supportive environment.

So it’s a revolutionary way of thinking about our health. What are some terms that you use to describe this new way of thinking?
Well, I would love your readers’ suggestions. I have referred to myself as a “medical ecologist” or and “eco-doc” or an “integrated patient manager”— this is borrowing from the farming term “integrated pest management.”  But perhaps I should call myself a “Farmacologist.” What do you think?

Prevention Magazine

Five Farm-to-Body Lessons

Wisdom from Dr. Daphne Miller’s new book, Farmacology

It sounds like the premise of a zany sitcom: A Berkeley-based doctor who admits she doesn’t know the difference between humus (the soil layer) and hummus (the pita topping) visits farms across the country and wackiness ensues! But there’s nothing simplistic or surfacey about Farmacology, the new book by Daphne Miller, MD, a professor of family medicine at University of California, San Francisco. Here, why drinking raw milk is a little like having unprotected sex, along with some other surprising lessons she learned along the way.

1. Chickens can teach us about good stress vs. bad stress
“We have this fantasy that pasture-raised hens are living in some kind of Club Med,” says Dr. Miller. “But they have their own kinds of stressors: They can get picked off by a hawk or a bobcat, or terrified by a thunderstorm.” Sometimes, those stressors kill (see hawk, above)—but most of the time, “it’s a healthy jolt to the system and then they go back to their healthy, playful lives.” Note to us all: Pasture-hen stress is the kind we should all be after. Factory-raised birds may never know the terror of going beak-to-fang with a bobcat—but the conditions of living in a crowded henhouse lead to chronic, low-grade stress. “That’s the kind most of us experience,” Dr. Miller says: “poor sleep and nutrition, bad relationships—being overcrowded on the subway.” It’s also the kind that most taxes our immune systems. (Calm your stressed self in a hurry with these 22 Ways To Chill Out.)

2. Drinking raw milk is a little like having unprotected sex
“I’d come to regard drinking unpasteurized dairy as tantamount to having unprotected sex; in both situations one should only consider doing it after a good deal of intimacy and trust have been established and preferably some testing has taken place,” writes Dr. Miller in a chapter devoted to visiting Rockin’ H cattle ranch in Missouri. Satisfied with the sustainable farm’s practices, she took a swig of unpasteurized milk and not only lived to tell but began delving into the controversial and intriguing world of raw dairy. Under the wrong conditions, raw milk can host potentially deadly pathogens, including salmonella and E. coli. But some studies, including one published in 2011 in the Journal of Clinical and Experimental Allergy, suggest that unprocessed farm-fresh cow’s milk may decrease the risk of developing asthma, hay fever, and other allergic responses, thanks to immune-system-buffering elements present in the milk. She’s not exactly ready to prescribe raw stuff, but Dr. Miller does suggest patients try non-homogenized milk, which may be less allergenic: Homogenization appears to bring allergy-causing proteins to the surface of the milk, where they’re more in contact with the gut, she says.

3. Farm-fresh food is good for our gut
A 2010 study by Italian researchers found that children living in a subsistence-farming community in Boulpon, Burkina Faso had a distinctively healthier set of gut bacteria than children living in Florence, Italy. Researchers suspect this was a result of the Burkanibé children’s diet (locally farmed, minimally processed vegetables, beans, and grains) versus the Italians (heavy on meat and refined carbs—not unlike the standard American diet). “Eating from a healthy farm, and eating healthy foods” can promote healthy gut flora, Dr. Miller says. “But eating food that’s been raised with lots of chemicals and antibiotics and pesticides will promote a less-healthy profile. There is a constant exchange going on with our environment.”  (Need proof? See the latest crazy research on how the weed killer Roundup affects your gut health.)

4. Urban gardens yield more than just tomatoes
When she visited a series of community gardens in the Bronx, Dr. Miller had some assumptions: “I thought what I was going to learn is that they’re producing these vegetables the community has access to, and that’s why it’s healthy,” she says. “The truth is, that’s only a tiny piece of it. What the research shows is that community gardening not only increases vegetable intake, it has surprising side effects like decreasing alcoholism and crime rates. It creates that community connection that has all of these trickle-down benefits. Social scientists call it collective efficacy.” Also: “Just trying to put supermarkets in these food deserts doesn’t necessarily increase vegetable uptake or improve health. Community gardens may be able to do what supermarkets can’t.”

5. We forget the true meaning of holistic
“Holistic—we misuse that word in our culture to mean whatever you think is natural; the real meaning is something that’s whole,” Dr. Miller says. “I asked a [holistic] cattle rancher: ‘Why so few calf deaths on your farm?’ And he said, ‘I can’t teach you one thing. It’s the whole picture—it’s the whole way my farm is run, from the microbes in the soil, to the fact that I don’t force-wean [the calves], to the fact that the grass gets time to rejuvenate.’ Truly maintaining our health in a holistic way isn’t just following some diet guru’s laws or buying supplements. It’s thinking of all of the pieces: our relationships, our diet, the kinds of work we do, the environment we live in, the air we breathe. And that’s a much more complicated endeavor but that really is the key to health—finding a balance in all of those things.”

Culinate.com

by Kim Carlson

Patients in her San Francisco family practice call her Dr. Daphne. It’s a fitting moniker for an upbeat M.D. — a picture of health herself — known to prescribe soup recipes for cold-symptom relief.

Daphne Miller was educated at Harvard Medical School and teaches medicine at the University of California, but her views of health break through convention. Raised by Peace Corps volunteers and back-to-the-landers, this dedicated gardener and friend of Michael Pollan firmly believes that food is potent medicine.

In her first book, The Jungle Effect, Miller ventured to regions of the world where the modern pandemics of heart disease, diabetes, and cancer are rare. Her travelogue illuminates the nutritional wisdom of indigenous cultures, distilled with modern-day research, to detail diets for wellness.

Intrigued by the relationship between agriculture and health, she then arranged seven farmstays around the country. Her newest book, Farmacology: What Innovative Family Farming Can Teach Us About Health and Healing, interprets the lessons she learned from sustainable agriculture and applies them to holistic medicine. Each chapter extracts insights on treating cancer, stress, aging, and other ailments within an enlightening framework she calls the “farm-to-body connection.”

In your book, you describe some surprising parallels between soil ecology and the human body.
As a doctor, I wanted to practice in a more ecological way, to think of my patients and my patients’ environment more as a complex organism and less as a series of specific diagnoses. That was one of the first things that attracted me to farmers: their ecological mindset.

Then I realized it wasn’t just that they thought like doctors; they had very similar patients. A cross-section of soil looks surprisingly like a cross-section of our skin, or a cross-section of our intestines, or of our lung tissue. It has the same kind of layers; it has these microorganisms that are harvesting nutrients and passing them on to plants, just as microbiota on our skin or in our intestine pass on nutrients to us.

It has similar pH to our bodies, a similar carbon-to-nitrogen ratio. This makes sense, because all of the carbohydrates, fats, and proteins in our body actually come from soil. In fact, we are soil.

In Farmacology, your prescription is for medical practitioners to become medical ecologists. What do you mean by this?
I propose that we stop thinking so much in a reductionist way and think more about how all the parts of our body relate to each other, all our organs and organ systems. Also, to think about how we as individuals relate to our larger environment.

What is the “farm-to-body connection”?
A great example of this is a chapter in Farmacology that takes place on an egg farm in Arkansas. On this farm there are two different farming systems. There is one that is more of an intensive, high-density laying system, and then there is a pastured egg system. As I spend time there comparing these two ways of producing eggs, I begin to learn interesting differences between good stress and bad.

The hens on the pastured system are experiencing stress — they are experiencing thunderstorms and hawks and so on — but it’s a very different kind of stress than the hens who are shoved 15,000 to an indoor house and have no room to move around and no access to pasture.

These lessons are ones I can apply to my patients in helping them create a lifestyle which is not stress-free, but has a beneficial type of stress rather than a detrimental type of stress.

On another level, I learned that the eggs produced in the pastured environment have greater value than the eggs produced in the high-density environment. In fact, there are nutrients in those pastured eggs, such as vitamin D and vitamin A and omega-3 fats, that might specifically help protect us from illnesses related to stress.

So, the bottom line is that food produced in these healthier models is also healthier for us. What is good for the farm is good for us.

How are the strategies for integrated pest management (IPM) you learned about from a winemaker in Sonoma applicable to cancer treatment today?
In IPM, an invasive pest is controlled not through eradication but by gentle manipulation of the environment. This includes intercropping with plants that attract beneficials — bugs that are natural predators for that pest. It also includes managing water levels, dust levels, and so on, so that these are not optimal conditions for the pest.

This model can be readily applied to management of invasive cancers. In the past half-century, oncologists have done surprisingly little to bend the curve on cancer mortality rates. In Farmacology, I write about a handful of researchers who are changing the paradigm for cancer and focusing less on eradication and more on ecological containment of the disease, just like farmers do with pests. These oncologists are using IPM as their model.

You visit an urban garden in the Bronx. Can you talk about the benefits of gardening from the perspective of integrative medicine?
What I discovered is that urban farming has all kinds of health benefits beyond simply producing healthy vegetables. When you get a community working together to grow vegetables and create these centralized garden plots, you start to build a sense of efficacy, a sense that they can really do a lot of other things together.

What the research has shown is that this kind of behavior has surprising trickle-down effects: decreasing crime rates in that community, decreasing alcoholism rates, improving fitness for seniors, improving school performance for kids. It’s a great public-health intervention.

From a physician’s perspective, how do you see your role in all of this?
I like to think what I am doing is practicing real family medicine. It’s not that I have taken on another role as an agronomist, or an ecologist or a sociologist. Indeed, what I am advocating for is a true community-based health practice.

I don’t just rely on the limited tools of antibiotics and surgeries and whatever I was given in medical school. I try to have an eco-mind and a community mind and look at what patients truly need, not just what I have to offer.

What has been the reaction from your medical colleagues?
What a lot of people say is, “Sure, that’s fine. But we have a medical shortage, we need more doctors.” I think what they don’t understand is that if we can support people’s health, then we‘ll need fewer doctors.

Because these problems of not having access to fresh vegetables and communities we can exercise in and not having places where we can connect with other people are much further upstream from diabetes and heart disease or depression and stress. If we can start to work on those, we won’t have to sit in our clinics and deal with these pandemics of modern disease.

In Farmacology, you compare drinking raw milk to having unprotected sex. What is your perspective on raw milk and how do you advise your patients?
There are clearly some health benefits to drinking raw milk. The question is whether the benefits outweigh the risks. The milk is going to be much safer if you are getting it from a farmer who is taking really good care of his cows, keeping them on pasture, milking them in a very mindful way, and keeping their immune systems healthy. And when the milk is drunk very quickly by the consumer, there is less opportunity for unwanted bugs to grow.

But buying raw milk off the supermarket shelf, not knowing how long it’s been there and not knowing the particulars of the farm, is more concerning, and I certainly don’t advocate it for my patients. It’s exactly like unprotected sex. You really need to know who you’re doing it with and check them out very thoroughly.

On one of the farms you visited, you were served a big steak. In your view, what’s the appropriate place of milk, cheese, and pastured meats in a holistic diet?
That really depends on the individual, where they live on the planet, what their resources are, and what their health issues are. It’s hard to come up with a hard-and-fast rule for the perfect diet.

When I asked Cody Holmes, who is a rancher in Missouri, “How can you ethically be raising beef when you could use that same acreage to raise something lower on the food chain, like vegetables?” he laughed and said, “Have you checked out our soil here? I do a great job with cattle, but my carrots are stunted.”

He has this very shallow soil that’s really good for rotating cattle through his paddocks. He felt that his land was good for animals and wouldn’t have done so well for vegetables. That was an interesting concept for me.

I tend to recommend that animal products be eaten with a lot of vegetables and legumes and grains — a little bit more as a spice, not so much as a big slab in the middle of the plate.

Many people, including Dr. Oz, have wondered whether buying organics is worth it. You have a detailed section in your book defining organics. What’s your reply to the question “Why organics?”
“Organics” is the best label that we have for finding healthier food at the store. But it’s a really imperfect label. You can grow food organically, but not take care of the soil at all. You can dump a lot of fertilizer and nutrients and even organic pesticides into that soil, and kind of keep it going on life support.

On the other side, you have lots of farmers who farm in an incredibly sustainable way, who keep very healthy soils and vegetables, but who are not certified organic. A., because they can’t afford the certification or the paperwork associated with the paperwork, because it’s loads of paperwork, or B., because the label organic does not represent all they put into their farm and is therefore not worth doing. We need something better.

Personally, the way I find food that is the most delicious and nutritious is I get to know the farmers or at least the story of the farm. I always like to know that the farmer lives on that farm. The other way is that I look at the fruits and vegetables. We all intuitively know when these are coming from healthy soils. They don’t look like they are on steroids or just had plastic surgery to make them look all exactly the same.

Fermented foods are big right now. What are the benefits from eating fermented foods?
Fermentation is just controlled rotting. If you think about it, we’ve eaten fermented foods for thousands and thousands of years. Our intestinal systems and all our body systems have co-evolved with this rotten food and figured out a way to survive and even thrive on them.

Before refrigeration, we were interacting with a lot more microbes than we are now. The microbes in fermentation originally come from the soil, and there is a lot of data to suggest that they are augmenting and supporting our internal biota.

I learned about combining beans with rice from Frances Moore Lappé. I’ve also read about other combinations, such as lemon juice on greens, that offer more nutritional benefit from what you’re already eating. Do you have any other magical food combinations to share?
Another great example is traditional Mexican cooking, where you have your beans, your corn tortillas, and your squash. It’s interesting because corn tortillas have a fairly high glycemic index, meaning that they put a lot of sugar all at once into our bloodstream. But when you eat them with beans, it actually lowers the glycemic index, so the sugar isn’t absorbed so fast. If you look at traditional recipes from around the world, so many of them already have prescriptions for these healing food combinations. They are perfect prescriptions.

What learning, from your any of your farmstays, most challenged your own ideas about maintaining good health?
On a personal level, I would say that my discoveries about sustainable beauty and graceful aging were profound. I had never contemplated how many messages we exchange with plants and what an important role they could play in changing our outlook on ourselves and on each other.

I had always thought of botanicals as simply being natural drugs, but now I look at them as having a much broader and more amazing function. They affect the way we perceive ourselves and, in many ways, they are the glue that binds us to each other and to our natural world.

Lynne Curry is a writer based in Joseph, Oregon. She is the author of Pure Beef: An Essential Guide to Artisan Meat with Recipes for Every Cut, and she blogs at Rural Eating.

The Daily Beast

Big Idea: Farming Treats Cancer?

What is your big idea?

We are more connected to the farm than we think.

Recently I began to take time away from my medical practice to visit sustainable farms and see what went on there. As I journeyed across the country, milking cows, gathering eggs, weeding brassicas, laying irrigation pipe and hawking produce at farm stands, I discovered that good medicine and good farming had much in common. In fact, I began to see family farmers as healers whose jobs were more complicated than mine, since they were responsible for the health of an entire eco-system (soil, soil creatures, animals, plants, water, air, people, and so on) while I was expected to care for just one member of that eco-system (people).

The more I learned about the science of farming, the more I recognized its connections to medicine. For example, did you know that our gut physiology actually mirrors what happens in the soil? The intricate nutrient exchange between soil, microbe and plant is like the dance that takes place in our intestine, involving the mucosal lining, resident microbes and food (plants and animals). The biochemical makeup of soil also roughly matches ours, with a similar nitrogen-to-carbon ratio and the same range for normal pH (6.0 to 7.5). Finally I realized that carbon, nitrogen and every other mineral and vitamin building block in our body is derived from soil (via our food). In other words, we are not simply nourished by the soil, we are of the soil!

In the introduction to Farmacology, you mention that it offers “farm to body” lessons. What do you mean by this?

Each chapter in Farmacology takes place on a different kind of farm in a different part of the country and offers new lessons on health and healing. A vegetable farmer teaches me about the links between rejuvenating depleted soil and rejuvenating ourselves; a cow/calf farmer shows me how his grazing methods can be applied to raising resilient kids; a laying hen farmer gives me insight into stress management; a vineyard’s pest management strategy offers a new take on cancer care; an urban farm in the Bronx lays out a novel approach to boosting community health, and an aromatic herb farmer helps unlock the secret to sustainable beauty. Throughout I seek out the perspective of noted scientists and weave their insights into the story. The result is a whole new approach to health and healing combined with practical advice for how to treat disease and maintain wellness.

Can you share one of these farm-to-body lessons with us?

In 1989, Erick Haakenson, owner/farmer of Jubilee Farms, bought 12 over-farmed, depleted acres in Washington State in order to start growing vegetables. Erick intended to produce food with (in his words) “nutritional punch,” so he started sending soil samples to a lab and replacing missing minerals according to the lab reports. This is standard practice in agriculture.

But after a couple of years, several tons of additives, and many thousands of dollars, Erick was still not satisfied with the health of his soil or the quality of his produce. Plus the test-and-replace method was giving him some serious misgivings. He wondered whether the minerals were taken from developing countries where they needed these minerals more than he did. He also questioned the safety of his approach, given that the manufacturer recommended that he wear a mask when spreading his additives. Finally he was not sure if the applications were even getting to the plant and he began to consider the unintended consequences of spreading foreign additives: for example, were they “locking up” existing soil nutrients—ones that were essential for healthy plant growth. He decided to look for an alternative, holistic, and cheaper way to improve his soil and boost the health of his farm.

Hearing Erick’s experience, I realized is that it is not uncommon for us to use these same “test and replace” strategies to solve our health problems. When we feel something is off, the first thing we do is order a lab. And when a result comes back outside the norm, we reflexively dump in vitamins, minerals, and medications in an attempt to rebalance. We tend to think of ourselves as test tubes, adding things into our complicated systems with the belief that the pill or potion will find its proper home. But the truth is, like Erick’s soil, we too have the potential to “lock up” something or create unintended reactions with this reductionist approach. (Excess calcium causing zinc and iron deficiency offers just one simple illustration of this kind of interaction.)

SF Magazine

Why You Should Raise Your Kids Like Cattle and Other Lessons from FarmacologyIn her new book, Farmacology, Dr. Daphne Miller set out to learn about human health by studying cutting-edge farming practices. A Berkeley-based family physician, Miller visited poultry farms, cattle ranches, urban gardens and more to answer the question: How can our food systems make us healthier? She spoke to San Francisco about what we all have in common with stressed out chickens. 

SFMAG: Your book opens with a visit to the farm of the agricultural philosopher Wendell Berry. What does he have to teach us?
DM: Wendell Berry is a wonderful philosopher, but not just about food. He came to the same conclusion in his pastures that I had in my clinic—we need to treat our land with the same respect that we treat our bodies, and to treat our bodies the way a farmer would treat the land. Once I started to actually meet these farmers, I was like, Holy cow! They’re doctors! 

SFMAG: It turns out you can learn a lot about being a parent from how to raise cattle, right?
DM: Most farmers lose a significant percentage of calves in the pre-weaning and weaning periods. But Cody Holmes, a rancher in Norwood, Missouri, a tiny town in the Ozarks, has an amazingly low mortality rate with his mob herding system. Bison style, you know, like Gangam Style. He had virtually no calf deaths.

SFMAG: Why do we think we know better how to raise calves than the calves’ mothers do?
DM: The truth is that what Cody does completely shows how wrong we are. There’s so many systems in industrial agriculture in which we use efficiency models that benefit the guy in the suit, rather than what truly works in a natural system. We’ve done the same thing in medicine.

SFMAG: What's an example of that?
DM: A perfect example is birth. Women give birth in the most bizarrely unnatural way now. Blue sterile sheet covering them, in a position from which they can’t get enough pressure to push the baby out. They’re slathered in antiseptic, with electrodes and IVs tying them to a bed. That’s exactly what we’ve done to farming. In an efficiency model, it works. In a health model, in a taste model, in a sustainability model, in a soil preservation model, a farm preservation model, a farm worker preservation model, it doesn’t work at all.

SFMAG: What about raw milk? Another writer we recently interviewed, Nathanael Johnson, sees the risks, but is favorable on the stuff. How does it fit into the models you write about?
DM: I see its upsides. The problem is that as a physician practicing the precautionary principle I can’t wholeheartedly be a proponent. The way that a lot of people get raw milk is not from a fresh, clean farm directly from the cattle, it’s something they are getting from the supermarket shelf that’s days old. But there’s definitely healing properties.

SFMAG: Maybe my favorite exploration in the book is about chickens and stress. It’s actually a pretty ingenious experiment that you stumbled across.
DM: The chapter is really about good and bad stress. I found a farm that raised the same chickens in two different ways. One operation was free range organic, which means that they have 15,000 hens to a henhouse who were allowed to move around and had a tiny scrap of paved outdoor space. That’s more or less what we voted for on the California ballot [in 2008]. Across the street, these same farmers had the hens pastured; 5,000 hens to a house with a quarter acre of land attached to it. They are getting a lot of their nourishment from scratching up worms. They have a big, wide door that gives them access to this beautiful green pasture. Those hens are at a spa.

SFMAG: So that second group of hens live stress free lives, don’t they?
DM: That’s what I first thought. But the farmer said, what do you mean? There’s bobcats, hawks, and thunderstorms. They have plenty of stress! So, later, I talked to Bruce McEwen. He’s the stress guru, who taught me the subtleties. What the outdoor chickens were facing are what he calls allostatic challenges. Getting their fight or flight turned on occasionally. These instincts are big and scary, but they’re sudden and within the natural repertoire of chickens. Versus these modern stresses of being in the 15,000-bird house, where the stress is never turned off. That’s the kind that kills you. The slow grind of sitting in a windowless office with a computer screen.

SFMAG: So how do we avoid the killer stress?
DM: One of the most important things is self-determination. For chickens it’s pecking in the soil, dust bathing, and chasing each other. For one of my patients it was to take control of his schedule to make more time for himself and his family. To be able to exercise during the workday and bring his lunch to work.

SFMAG: Last week at Stanford, there was a presentation of a computerized device that could grow a tomato plant with no human interaction. It’s like a little plastic cartridge with all the soil and seeds. You just watch for the warning lights. Does this strike you as a good or evil innovation?
DM: How fitting that you saw that at Stanford, the place that produced the "debunking organic" study. What you have there is a bunch of researchers who knew very little about agriculture who tried to compare growing systems based on a handful of antioxidants and a couple of specific pesticide residues. It’s the same as this little plant in an incubator. My guess is if you measured the plant for beta-carotene or something, it would do just fine and look like any other plant. But that’s not what our food is. It isn’t just seed grown in a test tube. The terroir of the surrounding environment makes a huge contribution to our health: the rain, the sun, the microbes in the soil, the surrounding plants, the way the soil was treated, and so on. There’s also that unmeasurable energy that we get from our food when a farmer or a community puts its best efforts into growing it.

Harvard Medicine Magazine

Medical Toque: When White Coats Do Double Duty, Prescriptions Can Be Tasty

Michelle Hauser

Mise en place: Resident physician, Cambridge Health Alliance; Chef, Le Cordon Bleu Diplome; 2009–10 Zuckerman Fellow in public policy, Harvard Kennedy School; achefinmedschool.blogspot.com

Preparation: When financial and family circumstances threatened her dream of a career in medicine, Michelle Hauser '11 pursued her second love: cooking. Armed with a degree from Le Cordon Bleu culinary arts program at Minnesota-based Brown College—and an internship at the California foodie mecca Chez Panisse—Hauser taught cooking classes to help pay the bills and, eventually, her tuition for medical school. Despite these dual careers, connecting food and health wasn't automatic for this physician-chef. "I knew that the majority of our disease burden can be prevented by factors like diet," she admits. "But I had always been warned not to teach 'healthy' cooking classes because no one would take them."

Plating: That changed when Hauser's students discovered that she was a vegetarian and challenged her to offer a course in cooking tasty, healthy fare. To her surprise, it was a hit. "The truth is, people are excited about healthy food," she says. "But they won't sacrifice taste." These days, Hauser combines her culinary knowledge with her medical training through workshops that educate patients with chronic conditions like hypertension or diabetes about healthy food choices. She's also interested in increasing community outreach and helping develop public policy approaches promoting better nutrition. Her biggest success, however, may be as a role model: Even as a busy resident, Hauser manages to eat a diet that's rich in vegetables, fruit, and whole grains. "If I can do it, anyone can," she says. "You just need to figure out what works best for you."

Andrew Weil ’68. A firm believer that food is often the best medicine, Weil recommends following an anti-inflammatory diet that’s high in fruits, vegetables, whole grains, and fish, and low in processed foods.

Andrew Weil

Mise en place: Founder and program director, Arizona Center for Integrative Medicine; Cofounder, True Food Kitchen www.truefoodkitchen.com; Bestselling author of ten books, including Eating Well for Optimum Health and The Healthy Kitchen

Preparation: He's no stranger to soy milk. He was eating black cod with miso long before hot eateries like New York City's Nobu made it cool. He grows his own kale; organic, should you wonder. Yet Andrew Weil '68 wasn't always so selective about the food that sustains him. Banned from the kitchen as a child, he had little culinary experience until a world-spanning trip at age 17 opened his eyes to ethnic cuisines. Later, during his medical residency, Weil began cooking for himself as a way to temper the long hours spent on the wards. "Hospital food was dreadful," he says. "I found that envisioning a meal that would give me pleasure and satisfaction, then creating it, kept me healthy, physically and psychically."

Plating: Weil has long shared his passion for nutrition with both patients and the general public. A firm believer that food is often the best medicine, he recommends following an anti-inflammatory diet that's high in fruits, vegetables, whole grains, and fish, and low in processed foods. Although smart food choices can be easy at home, Weil admits such choices can be slim when dining out. But Weil aims to change that through a collaboration with restaurateur Sam Fox. In 2007, when the two met, "Sam thought healthy food meant tofu and sprouts," Weil laughs. "I set out to prove him wrong." It wasn't easy: Even after cooking dinner for Fox and his wife, it took a meeting with chef Michael Stebner to prove that fresh, local food could also be delicious. Today, Weil and Fox head a national chain of True Food Kitchen restaurants, where Stebner's menu offerings include grilled salmon, spaghetti squash casserole, and orange–olivello sorbet. And Weil is discovering that the way to the public's heart may, indeed, be through its stomach. "Showing people that healthy food can be delicious," he says, "may be more powerful than any amount of writing I could do on the subject."

Daphne Miller

Mise en place: Integrative family medicine physician, San Francisco; Author, The Jungle Effect: A Doctor Discovers the Healthiest Diets from Around the World—Why They Work and How to Bring Them Home; Associate clinical professor, Department of Family and Community Medicine, University of California, San Francisco

Preparation: For Daphne Miller '93, the seeds for eating well were planted early: With both parents in the Peace Corps, she grew up in areas where people valued food as much for its cultural and medicinal powers as for its gastronomic aspects. This point was underscored when she began a residency at San Francisco General Hospital, working with a low-income, multicultural population. "Patients would ask me questions like, 'Why did my Mexican grandmother live to age 95, but I'm sick with diabetes?'" she says. "Chances are the grandmother ate a diet that was completely different from that of the grandchild. And she probably connected to food in a whole different way, too."

Plating: That realization soon set Miller on a path to discover as much as she could about traditional diets and culinary customs. She spent three years visiting areas where the local populations have low chronic disease rates—Cameroon; Copper Canyon, Mexico; and Iceland—and learning their dietary customs and recipes. Her investigation grew into her 2008 book, The Jungle Effect: A Doctor Discovers the Healthiest Diets from Around the World—Why They Work and How to Bring Them Home (Harper Collins). A second book, on the link between farming practices and health, is in the works. Meanwhile, Miller's applying the nutritional lessons learned from other cultures to her patients in San Francisco. "Traditional diets have survived for so long because they taste delicious and keep people healthy," she says. "It's amazing how much I use this information even during routine primary care encounters."

Jessica Cerretani is a Boston-based health and medical writer.

Fitness Magazine

The World's Healthiest Diets

Week One: France

As a college student living in the international dorm, I should have been studying my Parisian roomie's eating habits instead of just coveting her style. In nations with low obesity rates, women know how to eat right and enjoy every bite. "The diets they follow often place an emphasis on whole grains and legumes and use meat sparingly," says Daphne Miller, MD, the author of The Jungle Effect: The Healthiest Diets from Around the World. They're a far cry from the typical U.S. diet, a processed, produce-deficient carb-fest. Although I can no longer use the excuse that I'm a broke college student, I still live on lattes, burgers, and apple cobbler. So I embarked on a 30-day culinary experiment, borrowing secrets from some of the world's healthiest places to slim my 170-pound frame.

Read more

Voice of America

US Doctor Prescribes Food

When patients go to see Dr. Daphne Miller, they are more likely to leave with a recipe for a wholesome meal than a drug prescription.

In 2000, Ronnie Sampson, 52, was diagnosed with neurosarcoidosis, a disease that tricks the immune system into attacking certain parts of the body.

Sampson’s doctor put him on prednisone, a corticosteroid that helps to suppress the immune system.

But while the drug helped eliminate symptoms of his disease, the self-employed graphic artist started having headaches, gained weight, developed insomnia and even became diabetic.

“The regular physician wasn’t really spending much time with me, so I wanted to get away from my regular physician and find somebody who was more attuned to a combination of western medicine and alternative medicine," Sampson says, "and my acupuncturist recommended Dr. Miller.”

Family physician Daphne Miller believes food - along with exercise and giving up tobacco - should be the first line of defense against modern chronic diseases.

Combination healing approach

Sampson started seeing Miller in late 2001. The family physician combines conventional and alternative healing approaches in her San Francisco medical practice. 

After taking an in-depth look at Sampson’s medical history and lifestyle, Miller designed a customized regimen of nutrition and exercise she believed would improve his health and make him less dependent on medication. 

Sampson says it's done both. “My regular doctor had been focusing on making sure that I take my medication, and I think that Dr. Miller’s approach of combining medicine and lifestyle is really what turned things around for me.”

Miller originally pursued traditional medical training. She studied at the prestigious Harvard Medical School and did a two-year research fellowship, funded by the National Institutes of Health, at the University of California, San Francisco.

Filling the gaps

But after she finally opened her own practice in 2000, she recognized significant gaps in her training.

“I got into my private practice and suddenly realized that I really did not have the proper training to take care of the most salient issues that I was seeing every day," Miller says, "which were issues related to heart disease and diabetes and cancer, all of which in some way could be traced back to nutrition and lifestyle issues.”

Dr. Miller sampled ndole - a stew made of dried bitterleaf, shrimp, peanuts and spices like ginger and garlic - in Cameroon, which has little incidence of colon cancer.

Motivated by a desire to offer her patients more holistic medical treatment, Miller set out on a three-year journey around the globe to study the traditional diets of her patients’ ancestors - time-tested food combinations which, in many cases, had demonstrable health benefits.

“I really was surprised to see how different different cultures were in their approach to food," she says. "From Iceland, which really had a fairly high animal product-based diet, to a place like Okinawa in Japan, where it really was a lot of vegetables, to a place like Copper Canyon in Mexico where it was a lot of whole-grain carbohydrates.” 

For example, Miller found that Icelanders use their traditional fish diet, rich in omega-3 oils, to fight depression. Impressed by this kind of indigenous medical knowledge, she decided to organize it and use it in her practice. She started modifying traditional recipes with easy-to-find local ingredients to help her patients eat more nutritiously.

The Jungle Effect

She also chronicled her journey in a book called "The Jungle Effect," which serves as both a nutrition cookbook and a personal travelogue.

Daphne Miller's book, "The Jungle Effect," chronicles her visits to areas around the world which are still relatively free of modern chronic diseases.

But while Miller uses food for the prevention and treatment of modern illnesses, she believes that drugs can still play an important role in her patients’ lives. 

“In some instances, I feel that diet can absolutely replace medication, and then there are other times where medication is necessary and diet is there to enhance or augment it. And that is the art of medicine.”

According to Miller, many medical studies have shown the important role nutrition plays in overall well-being.

“So, for example, there are studies showing that nutrition, in particular within Japan, has a lot to do with the lower rates of breast cancer amongst the elderly female population, and that nutrition, in particular in western South Africa, has a lot to do with the low rates of colon cancer amongst the rural, traditional African populations.”

Food as medicine

A growing number of physicians agrees with Miller’s approach, including Dr. Dariush Mozaffarian, a cardiologist and associate professor at Brigham Women’s Hospital at Harvard Medical School.

Scientists are discovering that a diet rich in omega-3 fats is linked to less depression and other psychiatric problems, including bipolar disease, schizophrenia and aggressive or anti-social behaviors.

“There’s lots of research which has come together to tell us that our focus should be on healthy foods, and those overall healthy, food-based dietary patterns should really be the focus of our priorities in the U.S. and globally,” says Mozaffarian. 


Ronnie Sampson would certainly agree. After a short time on his personalized nutrition and exercise program, the San Francisco native started feeling better. And although his neurosarcoidosis is not cured, Sampson has been able to reduce his reliance on prednisone by half, and has essentially reversed his diabetes. 

“I feel better than I’ve felt in many, many years," he says. "At 52, I feel healthier than I did at 40.”

Sampson continues to see Miller about twice a year for checkups. He believes everyone could benefit from her holistic, integrated approach, in which food is often the best medicine.

O, The Oprah Magazine

They Might Be Weeds, But Wild Greens Pack a Nutritious Punch

By Anne Underwood

Wild greens are so nutritious, they can make spinach look like iceberg lettuce. Of course, you might know them by a more common name: weeds.

Daphne Miller, a physician who works in San Francisco, first laid eyes on wild chicory during a visit to the island of Crete. Miller assumed the unruly vegetation piled on her friend's kitchen counter was destined for the garbage. To her surprise, it turned out to be dinner—and a delicious one, sautéed with olive oil and garlic and finished with a twist of lemon. "Children in other parts of the world eat wild greens the way kids here eat fries," says Miller, author ofThe Jungle Effect: The Healthiest Diets from Around the World. "They're an essential part of the Mediterranean diet."

For many Americans, though, there's a stumbling block: our bias against plants we've been taught to regard as invasive weeds. Gardeners spend entire summers trying to eradicate dandelions, not sautéing them. But to James Duke, PhD, author ofThe Green Pharmacy,a perfectly manicured lawn is a wasted dining opportunity. "These are plants that our ancestors ate—that humans evolved to eat," he says.

Wild greens also rank among the world's most nutritionally potent superfoods. Of the leafy vegetables, purslane is the richest known source of omega-3 fatty acids. Dandelion greens are full of vitamin E and iron. And Miller postulates that the folate, antioxidants, and fiber in African wild greens may contribute to the low rates of colorectal cancer among West Africans, who develop the disease less than one-tenth as often as Americans. It scarcely matters which of the edible weeds you choose. "I call it the Lake Wobegon effect," says Duke. As Garrison Keillor says of his fictionalized town's inhabitants, "They're all above average."

Where to Get Them

If you think, "Why would I buy weeds when I can find them in the backyard?," a new book by John Kallas, PhD, Edible Wild Plants, is an excellent guide to identifying and cooking 17 of the most common wild greens. (However, it pays to be cautious. "Some wild greens have poisonous look-alikes," says Steve Brill, who leads foraging expeditions in the New York City area.) If you'd rather have someone else do the foraging for you, farmers' markets and upscale grocers are a good place to start. 

How to Cook Them

Wild greens can range in flavor from mild (lamb's quarters) to pungent (wild mustard) or bitter (dandelions). You can soften intense flavors by cooking the greens with sweet vegetables, like carrots or beets, or adding soy sauce or ham. Still, some greens pose unique challenges. "You have to wonder who first decided to pick stinging nettles and put them in a pot," says cookbook author Jesse Ziff Cool. "But they make a great soup." 

Here's a cook's guide to four common varieties:

Chickweed (far left): The tiny, delicately flavored leaves can be used as a substitute for sprouts. 

Lamb's Quarters (A.K.A. Wild Spinach) (second from left): Try tossing it into a salad; the flavor is mild enough to use in place of domesticated spinach or lettuce. 

Purslane (second from right): With a crunchy texture and hint of lemon flavor, it makes a delicious garnish for salads. 

Dandelion Greens (far right): Look for baby greens in early spring, when they tend to be more tender and less bitter. 

Green Impact

Dr. Daphne Miller Speaks @ Bay Area Open Space Council Conference

Did you know that only five minutes of exercise in nature can boost your mood and  improve self-esteem?

At the Bay Area Open Space Council’s 11th Annual Regional Conference yesterday, Daphne Miller, M.D., Associate Clinical Professor, Department of Family and Community Medicine, UCSF spoke about the “Park Prescription”:  prescribing to patients they spend time in nature. While the convergence of natural lands and health is still a fringe topic, it is a growing area of peer-reviewed research.

Miller explained that she has actually started to give park prescriptions in her office. By using two web-based resources, the California State Parks Find Recreation website and the Bay Area Open Space Council’s Transit to Trails website, she can provide patients a concrete “prescription”:  directions with maps and distances to open space areas.

According to Miller,

Nature has the possibility to be a health care intervention, a prescription, almost like a pill. In many of the studies, there is a dose response relationship.  The more you get, the better the outcome.

She points to recent research published in the Environmental Science and Technology journal. The research looked at people with moderate depression and found a minimum of five minutes outside in greenery decreased depression scores 40-50 percent, more effective than a typical antidepressant, which decrease scores around 20-30 percent.

“Here we have something that is low cost, with few side effects and the potential to deliver real benefits,” explained Miller.

She outlined three areas of focus for this work:

  1. Empowering health providers to prescribe nature: The National Environmental Education Foundation (NEEF) just a few days ago announced its Nature Champions program—a train the trainer program with 40 different health providers to teach them how to actually prescribe nature. The idea it to train health care professionals who will train other providers to refer families to parks, nature centers or wildlife refuges within economically, racially and culturally diverse communities.

  2. Urban planning: How do we make this more accessible and collaborate with urban planners and hospital planners, so patients don’t have to travel long distances to access nature?  UCSF’s new Mission Bay Medical Center integrates numerous green spaces and healing gardens, so patients and visitors can easily access nature.

  3. Viral marketing:  Miller envisions a powerful and viral marketing campaign to educate consumers, with the message, “Ask your doctor about the park prescription.”

So take five minutes and call me in the morning.

The New York Times, Style

A Strange Brew May Be a Good Thing

by Malia Wollan

NAOMI MOST, a devoted brewer of a fermented tea called kombucha, keeps her “big momma” in the garage. The big momma in question is a 20-pound pancake of gelatinous and, well, rather gross-looking bacteria and yeast floating atop a vat of kombucha, a drink that enthusiasts tout as a tonic for digestion, hair loss and all manner of bodily ailments.

It’s not for everyone.

“I live with my boyfriend and he finds it really weird,” said Ms. Most, 30, a manager for a nonprofit group in Palo Alto, Calif. “He doesn’t like the smell.”

Looks and aroma notwithstanding, kombucha is gaining popularity among those who favor organic beverages, and it is showing signs of turning into a gold mine for some companies. While the poor economy and worries about health and the environment have diminished the national thirst for soda and bottled water, sales of kombucha and other “functional” juices in the United States topped $295 million last year, up 25 percent over a two-year period, according to SPINS Inc., a market researcher.

In 2009 Americans bought more than a million bottles of GT’s Kombucha, the leading commercial variety made by Millennium Products. The chief executive, G. T. Dave, started the company as a teenager in his parents’ kitchen in Beverly Hills, Calif., but the drink has grown beyond the mom-and-pop scale. Recently major companies like Red Bull and Honest Tea (of which Coca-Cola owns 40 percent) began distributing their own brands.

In the Bay Area, many fans have taken to making their own kombucha, trading recipes and selling good brews. Craigslist, for example, is full of those selling fermented patties. Several foodie groups organize regular swap meets for fermented cultures.

To make kombucha, brewers rely on what’s called a starter — a bit of already fermented tea—passed between makers and referred to reverentially as “the mother.” Once the mother is added to sweetened tea and allowed to sit in a glass jar unrefrigerated for 7 to 14 days, a glop known as a symbiotic colony of bacteria and yeast grows over the surface.

This “mother” will expand and split into smaller patties called “babies,” which brewers often give to friends or sell online. “I have kombucha babies available in several different types of tea (pu-erh, oolong, white tea, some others),” reads a post by Ms. Most on the Kombucha Exchange, an online forum catering to kombucha brewers worldwide who want to exchange recipes, fermentation techniques and viscous offspring.

Ms. Most gives her babies away free with an explainer pamphlet. Similar offers can be found from Argentina to Luxembourg.

The rise in kombucha’s popularity is part of a larger trend in “probiotic” foods containing bacteria, which some studies suggest benefit digestion and boost the immune system.

“It’s become incredibly trendy lately in the 20-to-30-something, foodie, intelligentsia set,” said Dr. Daphne Miller, a family practitioner and professor of nutrition and integrative medicine at the University of California, San Francisco. “Kombucha is like their Coca-Cola.”

Kombucha is said to have originated in ancient China, but various forms of fermented tea exist in many countries, said Dr. Miller, who traveled the world researching healthy traditional diets while writing her book, “The Jungle Effect.” Some medical professionals, however, think the drink is dangerous.

Dr. Andrew Weil, a doctor and leader in alternative health writes on his Web site: “I don’t recommend kombucha tea at all. I know of no scientific studies backing up the health claims made for it.” He goes on to warn of home brews contaminated with aspergillus, a toxin-producing fungus, and cautions pregnant women, the elderly, children and anyone with a compromised immune system against drinking it.

This most recent growth in popularity is actually the tea’s second act in the United States. In the early 1990s, before commercially bottled varieties were available, the drink became popular with health food enthusiasts and those with H.I.V. and AIDS who believed it would help compromised immune systems and increase T-cell counts. Several mail order companies shipped “mothers” across the country.

In 1995, the Centers for Disease Control and Prevention issued a report linking kombucha to the death of an Iowa woman and the illness of another woman. Both experienced severe metabolic acidosis, excessive acid buildup in the body that health officials thought may have been related to their daily use of kombucha. Though the federal center did not definitively cite the tea as the problem, the incident put a damper on kombucha consumption.

But kombucha has cycled back into vogue. The tipping point in the tea’s return came around 2003 or 2004, pushed by the low-carbohydrate craze that had those people on the Atkins diet looking for a healthy, fizzy drink to replace sugary soda and juice.

In 2003, orders for GT’s Kombucha surpassed the company’s production capabilities. The next year Whole Foods supermarkets began distributing the tea nationally.

These days in college towns and cities like Portland, Ore., around the country small-batch kombucha brewing has become something of a cottage industry.

The Bay Area has at least a half-dozen kombucha start-ups, selling their products at farmers’ markets, health food stores, yoga studios, on blogs and on Twitter. Flavors range from cayenne and mango to fennel and watermelon jalapeño. It’s not uncommon to overhear people talking about their devotion to the products, all of which prompted a San Francisco food blogger, Tamara Palmer, to say recently that kombucha was on its way to becoming “the new bacon.

But the drink’s standing as the cure-all of the moment was not the attraction for some..

Lev Kilun, 51, was an unemployed telecommunications engineer when he bought his first bottle of kombucha several years ago. He immediately recognized the distinct effervescent tang. “I called it tea kvass,” said Mr. Kilun, who emigrated in the late 1980s from what is now Uzbekistan. “In Russia it was very popular. It was like an old women’s drink. My grandmother used to make it.”

Seeing a business opportunity and feeling something akin to a birthright, Mr. Kilun started his own company, Lev’s Original Kombucha. He now bottles and sells six flavors brewed with green tea and distributes kegs to restaurants and cafes around the Bay Area. Mr. Kilun says the tea is thought to help cure a hangover, which he says makes for brisk sales in liquor stores.

Kombucha’s popularity has also attracted home brewers. Tim Anderson, founder of a 3D printer technology company, moved from Boston to Berkeley, Calif., with his “mother” — passed on to him from a friend who got it, as the story goes, from gypsies in Russia.

Mr. Anderson, an advocate for all things do-it-yourself, made step-by-step kombucha brewing instructions complete with videos for Instructables.com(one of over 200 tutorials he has made on everything from tire sandals to wheelchair shopping carts). Nearly 60,000 people have viewed the kombucha guide to-date, according to the site’s page-view statistics.

“I’m surprised people would pay to get this stuff,” Mr. Anderson said. “The kind you can buy tastes vinegary and dry, whereas the one you can make yourself is so incredibly delicious.”

Mr. Anderson has given kombucha culture to dozens of friends and strangers. Recently he put out a call to get some back after he neglected his brew and let the fermented patty dry out. “You can’t go around saying you killed your mother,” he said. “It freaks people out.”