Digging Deeper: Seven Questions with Dr. Daphne Miller

How is our external ecosystem linked to our internal one? How is the biome in which we live connected to our own microbiome? Dr. Daphne Miller, a practicing family physician, author and associate clinical professor at the University of California, San Francisco, offers answers to these questions in her talks, teachings, articles and books. She goes beyond the idea of “food as medicine” to look to the farms where food is grown for the source of remedies. Imagine practices such as crop rotation, rotational grazing and integrated pest management being part of the prescription for good human health.

Stone Barns spoke with Dr. Miller about what farmers and doctors can learn from one another. Edited excerpts follow:

SBC: What is health ecology?

Miller: I am focused on exploring how our own health and our internal ecosystem is linked to the health of other ecosystems. With recent breakthroughs in DNA mapping, electron microscopy, statistics and so on, we are able to look at natural systems on many different levels—from the micro to the macro—and understand how they interrelate. It’s really exciting. I sometimes refer to this work as “health ecology” but this is not an official term. Anyone have a better one?

SBC: What is the single most important thing farmers can teach doctors about human health?

Miller: To practice what Aldo Leopold called “intelligent tinkering.” In other words, to intervene gently and judiciously in the natural cycle of birth, growth, death and decay.

SBC: What about the other way around? Is there something important that doctors should be teaching farmers?

Miller: I am going to give the same answer but from the medical side. Medicine, at its best, starts with the principle of “first do no harm”—Primum non nocere. Traditionally doctors have applied this thinking just to individual patients, but farmers need to consider all the ramifications of an intervention—not just for humans but also for the larger ecosystem—as they make their decisions.

SBC: What are the barriers to choosing a farm-driven diet—one that considers the health of the farm and its ecosystem—within our current food system?

Miller: Oh, so many! Each step of our food chain from soil to eater is fraught with challenges. For many it’s hard to even recognize real food because food and farm corporations have clever media campaigns that are designed to confuse us. Next, it is hard to source healthy food, much less afford it. Preparing the food poses a whole other set of challenges—both in terms of time and skills. I was just speaking with a student group in Grinnell, Iowa, which runs a farm and gives away the produce. They told me that people were not taking their beautiful veggies until they began giving out recipes showing how to prepare the produce. Universal cooking lessons could go a long way toward encouraging a better connection between consumers and healthy farms.

SBC: How can we facilitate a conversation between farmers and doctors to improve both our food system and our health system?

Miller: In academia, business and government, we need more collaboration between our agricultural system (and earth sciences) and our health care system. Too often our research questions and our method of valuation do not span the arc from soil to human. By taking this broader view, we can begin to find solutions and design programs that truly give us a healthier planet. For example, when considering the value or return on investment of a commodity crop such as corn or wheat, we have to calculate not only the environmental implications but also the cost of treating the diabetes associated with eating these foods. Or when considering the value of produce from a diversified organic farm, we have to measure how this farming system might increase nutrient availability for consumers and how it impacts water quality, air quality, wildlife abundance, etc.

On a practical level, I see health workers and farmers as sharing the responsibility for maintaining a resilient, healthy population. It would be great to have more professional collaboration between these two groups. For example, how about a joint training for ag extension workers and public health nutritionists? Or continuing education programs designed for family farmers and family doctors?

Doctors giving prescriptions for farm boxes or hospitals and clinics making contracts with local farms are practical places where this work can begin.

SBC: What role does taste play in diet and health?

Miller: A huge one. Food, because it is tasty, is the one medicine people seem happy to ingest at least three times a day. This works in our favor when we eat a flavorful real-food diet but to our detriment when we eat highly processed, high-calorie, low nutrient-density foods that are specifically engineered to hack our limbic system.

SBC: What is one of your most memorable food experiences?

Miller: My mother’s stuffed wild grape leaves. She used to make them on the farm my family owned in upstate New York. They were an early summer treat because they required the tender, young leaves of a rogue vine that grew up the walls of the farm’s icehouse. She stuffed them with lamb, rice and veggies from the garden and she used North African spices (Ras el Hanout) to season them.


On April 7, 2016, Dr. Miller joins us as the second annual Kirschenmann Lecture speaker to address the invaluable connection between our farms and our health.

Learn more and get tickets.