Food Justice: Why Our Bodies And Our Society Are Inflamed with Dr. Rupa Marya and Raj Patel

Coming up on this episode of the Doctor's Pharmacy. Truly what we need to do is reimagine every way in which we relate to each other in the web of life. Because the ones that we've inherited, the ones that we have been handed to us through a colonial capitalist cosmology, are making us sick and making the planet uninhabitable for human life.

Hey, everybody, it's Dr. Mark. I travel all the time, so at this point, I have packing down to a science. I know exactly which grab-and-go food items and personal care products I like to bring. and I always keep them on hand so I'm ready for my next trip. I used to run around before every trip trying to find what I needed, which meant going to different stores, spending too much time packing. And now I use Thrive Market and I get everything in one place shipped right to my door. Here's a little snapshot of what I like to travel with. Food is, of course, first on my list. I always order some of the Ayoba grass-fed biltong jerky, which is so yummy. Royal Hawaiian Orchards organic macadamias because it's super full of fat and protein, and I love that they make me feel full. and easy to carry and don't go bad. And they're also super handy pouches of Thrive Market brand pitted green olives. I want to splurge and bring a treat, I'll grab some huge chocolate too. And in my toiletry bag, I bring some Schmidts deodorant, some all terrain herbal armor bug spray, a tin of raw elements SPF 30 natural sunscreen, and a bar of Dr. Bronner's peppermint castile soap. Thrive also carries so many other things that makes packing for a trip easier, and I'm sure you'll find your own personal favorites. Thrive has two different membership options. I went with a 12 month because it comes down to five bucks a month and I'm constantly ordering stuff plus it's 30 days risk free. But you can also sign up for a monthly membership. If you join Thrive Market today, you'll get 25% off your first order and a free gift. Just go to ThriveMarket.com/Hyman. That's T-H-R-I-V-E-Market.com/Hyman for 25% off plus a free gift. My main goal with diet is to use food as medicine. But even when we eat super well, most of us are missing out on certain essential nutrients. Our soils have become depleted and our digestive tracts just aren't working so great. They're compromised by stress and toxins and they just can't absorb nutrients as efficiently as they should. And that's why I always use, and I recommend to my patients, a multivitamin mineral as nutritional insurance. It covers the basics, for all our day-to-day body functions, all the things that we need that our food might be missing. But there are so many products out there I wouldn't go near because they contain artificial fillers or inactive ingredients, and you have to be pretty picky. The one I trust and take myself is Athletic Greens. They use high quality, highly absorbable forms of vitamins and nutrients from real whole foods. Athletic Greens comes in a powder that tastes great and mixes easily with water or smoothies, and specifically supports my gut health, immunity, energy, and recovery. And it's not just vitamins and minerals. It has phytonutrient-rich superfoods, and adaptogens, and pre- and probiotics, and even digestive enzymes. I love that they add the digestive support in their powder, since so much of our immune strength and overall wellness starts in the gut. It's really one supplement that covers so many bases, and you'd be hard-pressed to find something else in this comprehensive form in any single other product. I use Athletic Greens in the morning as part of my daily routine, and I love having it with me whenever I travel. I also love that it's diet friendly, whether you're vegan, paleo, keto, dairy-free, or gluten-free. Right now, Athletic Greens is offering my audience a full year supply of their Vitamin D3K2 liquid formula free with your first purchase. Now, these two nutrients are also so vital for a strong immune system and strong bones and many of us are not getting enough of them. I use the Athletic Greens Powder and their D3K2 formula to make sure I get extra nutrients that complement my diet. They're also going to give you five free travel packs as well. Just go to athleticgreens.com/hymen to get your free year's supply of vitamin D3 and K2 and five free travel packs with your first purchase. You'll get it delivered straight to your door and I promise you'll feel the difference Athletic Greens can make in your daily wellness routine. Again, that's athleticgreens.com/hyman. Now let's get back to this week's episode of the Doctor's Pharmacy. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with an F, a place for conversations that matter. If you care about the state of our food system, if you've been hearing about the ways in which food injustice affects so many poor, and indigenous and African American and Hispanic people in our country, you should listen to this podcast because you're going to learn a lot about the origins of our sick nation and the structural problems with our society that drive disease. And maybe, just maybe, challenge the idea that you can get well by going to your doctor's office. That maybe wellness and health don't really happen in the doctor's office or the hospital. They happen in the communities where we live. And and the environments that we grow up in. And I'm delighted to have two guests today. I usually have two guests, but our guests today are both extraordinarily esteemed folks who have inspired me and are doing extraordinary work in the world of food and food justice. First is Dr. Rupa Marya. She's a physician, an activist, a mother, a composer. She's a rock star, I guess. That's most impressive to me. And she's been in 29 countries, playing music for thousands and thousands of people, including the themes of social justice and many other things. So she's also a doctor and associate professor of medicine at the University of California, and she practices and teaches internal medicine. She looks at the impact of our social systems from agriculture to policy to policing and how all those things affect us and our health. She's a co-founder of the Do no Harm Coalition, which is a collective of healthcare workers committed to addressing disease through structural change. And we're gonna talk a lot about what structural change means, 'cause I think it's an important concept that's absent from medicine for the most part. And she's also at the invitation of the CLOTO Health Leaders committed to setting up the mini Mokony Health Clinic and farm at Standing Rock in order to change medicine and food for those cultures that have been so oppressed for so many years. Dr. Raj Patel also, his work has been a huge inspiration for me. He's a research professor at the University of Texas in Austin, Lyndon B. Johnson School of Public Affairs. He's a professor at the University Department of Nutrition and a research associate Rhodes University, South Africa. He wrote a book called Stuffed and Starved, which was a big inspiration to me as I wrote my book, Food Fix. And he's the New York Times bestselling author of the Value of Nothing, which I want to read. Sounds good. And a co-author of A History of the World in Seven Cheap Things. He's done so many wonderful things, including making films. He's helped with the Green New Deal. He serves on International Panel of Experts on Sustainable Food System and his advises.

Advising governments on cause and solutions to.

The crisis of sustainability worldwide. So welcome, Rupa and Raj.

Thanks so much, Mom.

Thank you, Mark. Yeah, it's really great to have you and I'm so excited for this topic. It's one of my favorites. And I thought about it, I've written about it a lot. And I've had the chance to work in underserved communities. I've had the chance to work in developing countries. I've had the chance to work on Native American reservations. I'm in this purse where I worked for four years in the Hopi reservation. And I've been to a lot of these places where you talk about these health disparities and these health issues. and the problem is that, you know, you talk about this idea that seems to be a little bit hard for people to digest and swallow, this idea of colonization, that our food system and our society has been colonized. And we're like, oh, well, you know, yeah, we were, the British had the colonies and we were colonizing America and, you know, we had India being colonized by the British and, you know, it was a huge era of colonialism, which essentially was taking and stealing all the natural resources from countries that were new and unexplored and using them for the the wealthy in these nations. But in our country, we don't really think of our country being colonized that much. But it really is. If you look at the extraordinary health disparities, if you look at the challenges in certain communities where life expectancy can be anywhere from 10 to 40 years less, we have the developing world statistics right here in America. I mean, the Pima Indians, their life expectancy is, I think, 46, right? And they get diabetes at the age of at 30 years old, about 80% of them have diabetes. You know, that's a symptom of colonization. And I really didn't to really fully understand this concept of structural changes that you talk about. And I'm just giving a little preface for everybody so they know the context before talking about them. I'm gonna start asking you guys questions. It's not just me talking, I promise. So, because I've experienced a lot about this and I wanna share my experience and then sort of take off on that. and I went to Haiti after the earthquake and I met Paul Farmer who wrote a lot about this idea called structural violence. And this is really what you're talking about. What are the social, economic, and political conditions that drive disease? And he found in Haiti he could cure TB and AIDS not by better drugs or surgery, but by simply having community health workers. He called it accompaniment. We accompany each other to health. And he dealt with the structural issues of poverty and lack of water and sanitation and lack of having a watch, they don't know when to take your TB meds, which you have to be on a certain schedule. And he really showed the world that this model of addressing the structural changes really works for infectious disease. And Bill Gates and the Clinton Foundation, all these have used his model. But what occurred to me down there, and I think you clearly have outlined this in your book, Inflamed, which really has just come out, incredible book, everybody should get it. You talk about the, the chronic disease pandemic being also one that's related to structural violence. And it's not just infectious disease and lack of water sanitation and poverty, but it's also all these obesity related issues, heart disease, diabetes, cancer, all these things that are really breaking our system and are causing economic havoc and making COVID so much worse. And you talk about that, you know, those are really structural issues. And that sort of got me thinking about it. And a few years ago, I was also on a, on a rafting trip on the Green River with a Native American Hopi chief and a Ute chief. And the Hopi chief was very overweight. He and his wife were severely overweight, diabetic, on insulin shots, drinking Coca-Cola, and just kind of, I mean, he was the head of one of his clans and did all these incredible traditional ceremonial rituals in his culture. and I said to him, you know, Howard, you can change your diabetes. You can reverse it. He's like, what do I have to do? And I said, well, you have to not eat sugar and all the starchy stuff for eating. And he's like, oh, well, that's gonna be a problem. I said, why? He said, well, because we have our traditional Hopi ceremonies and we have our traditional Hopi ceremonial foods. And I'm like, well, what are they? and he's like, well, Coke, cookies and cake and pies. And I'm like, those are not your traditional foods or the Indian fried bread, which is deep fried flour and trans fats and lard. And another woman was on that trip who was, was in the youth community. And so, you know, they have a word for people who become really large on these Native American reservations. They call it Kamad Bod, meaning they've eaten all the Commodities that the government Surplus has shipped to them. So the government, all the food that is just leftover food, flour, sugar, you know, Crisco, basically trans fats. they essentially the reservations and that's what they started eating and they became more obese. So these are the real changes and we cannot address our healthcare crisis. We cannot address our economic crisis, our social crisis, unless we address the food system issues that underlie the structural problems that are driving disease. So I can't tell you how excited I am by your book because it really is the first time I've seen this laid out so clearly and so well and in such a simple way to understand and calling out things that really need to get called out. So thank you for writing it. Thank you.

Thank you, Rebecca.

So that was a long-winded introduction. I'm sorry about that. But I'd like you, you know, we're going to talk about the two decades you've spent studying how these social structures, these structural violence, predisposes these marginalized groups to illness and how is health and these, how are these two things connected?

Yes, so I think you hit the nail on the head when you're looking at the Kamad Bod. But I just want to emphasize that this isn't just a problem of marginalized people, people who are suffering under the brunt of colonialism, the worst. So our Indigenous friends, our undocumented community, Black community in the United States, people who are suffering the worst social oppression have the most profound expression of inflammatory disease. But in fact, everybody in industrialized nations is subject to getting these diseases. And what we looked at in this book is really, you know, going back 600 years to where a cosmology of thought came from Europe to this land to what was, you know, was now called the United States of America. this understanding of, or the misunderstanding of life, as humans over here and everything that's wild in nature over here, us being separate from the web of life, or man over here and woman over here, or mind over here and body over here, these errors of Cartesian dualism that were part of the ways of organizing structures of power in era of colonial conquest of the rest of the world. So it's much easier to take someone's land and take their wealth and take their resources and enslave them if they're seen as subhuman or actually they're not really doing anything with that land in the first place. So let's just go take it over. And so that error of thought really has set us up to having very shallow medicine, shallow ways of addressing how we're getting sick and why we're getting sick. So when someone who is part of the elite or wealthy or white, let's say, gets diabetes, we offer medicines, we offer insulin, we offer injections, pharmaceuticals. We don't offer an analysis of all the ways that critical relationships that support our health and well-being have been disrupted by colonial capitalism. And that is what we're looking at in this book, is really the root causes of the rise of inflammatory disease around the world. And that is, you know, when you're talking about diabetes and obesity and cardiovascular disease and Alzheimer's and cancer and even depression and suicide, all of these things have been tied to inflammatory phenomena in the body. And so we see that in our research and analysis, Raj and I, what we have seen is that the social structures and the environmental structures around the body are the place where the disease is. And the body's immune system is just reacting in an evolutionarily conserved way and a proper way to damage and the threat of damage. And that response is the inflammatory response. So it's not like we're doing something that's abnormal or wrong. The body is simply trying to correct itself in the face of this damage. Whether the damage is coming from glyphosate in our cereals, whether the damage is coming from payday loans, whether the damage is coming from historical trauma of having your land stolen, such as the Pima folks, that these toxicities in the world around the body are the damage that is provoking an inflammatory response in the body. And so usually the inflammatory response when there's damage is activated to correct the damage, to restore what we call homeostasis, the body's optimum working condition. and then it turns off. Unfortunately, in a colonial capitalist society, all of us are subject to ongoing damage because the air is polluted and because the water, the groundwater, even if you're growing organic wine, you're pulling from groundwater that's been contaminated by glyphosate. So there's actually no way to avoid the insinuations of environmental poisoning that has happened through the corporate control of our food system and our policies. And so this is what we looked at very deeply in this book is the summation of exposures, whether it's police violence, whether it's breathing the air here in East Oakland, whether it's being able to afford healthy food. These kinds of things add up into a toxic combination. When you talk about the Pima folks, 80% of them having diabetes. It reminds me of the impact of colonial expression in Lakota Dakota territory where I'm working to help set up a clinic with the community there. The Mini Wiconi Health Circle is what we're calling it now. It's a clinic and a farm.

Which by the way is a radical idea. Bringing healthcare and farming together should be universal, but it's something that's really radically new.

Well, it's actually radically old. And so for these.

Sure, but not, not in America.

Well, yeah. Well, so these folks, you know, when, when the mini, when the Missouri River was dammed, so when that, that Dam went up, it flooded the Cottonwood forests that the Lakota, Dakota, Nakota people used to get their food and medicine from. So they used to go and have this relationship with these forests. and once they were flooded, they became completely dependent upon the commodities that were sent by the state. So they became more sedentary. They didn't go out and harvest. The Buffalo were exterminated, I think something like 60 million Buffalo, the largest genocide on this land. And so they lost those crucial contacts with their food and medicine ways. And they always knew that medicine and food were connected. It was never separate. And so that is really an exciting, you know, thing that connection to see that it is actually in the literal changing of the flow of rivers. So it's not abstract, it's not metaphorical. It's the literal changing of the way rivers run has changed the way our bodies are responding. And Indigenous people and, you know, have been most impacted here in this land.

Yeah, it's so true. And, you know, you talk about the idea of inflammation. I mean, the same story happened in the Hopi's where the Colorado River was damned and all their ability to grow food and their traditional food ways were all disrupted. And again, they're so obese like, like the guy met on the rafting trip. But, you know, you talked about the inflammation and how it's actually a natural response to what's happening. And so, you know, when you cut your skin and you get bacteria, your body sends an army of your immune system to go, create inflammation and redness and swelling and tenderness. That's all a good thing to deal with an acute injury. The problem is that we're constantly injuring our bodies in the same way as we're for cutting ourselves by the food we're eating, by the stresses we're under, by the structural environments of poverty and disenfranchisement and lack of a sense of a locus of control and other traumas that are even worse, you know, sexual trauma, physical traumas. All these things get really written into our genes. They get written into our biology. in ways that you're describing in your book. So Raj, what was sort of unique for you as you began to sort of think about this from a medical perspective? Because your focus has been on capitalism and colonialism and food systems from a sort of political and structural view at a very high level. Although you talk about the health impacts, how did this sort of change your thinking about what we need to be doing around our food and food systems?

Well, thanks for asking, Mark. And I mean, part of the journey for me was realizing that there's There are so many pathways to and from health, and learning how these circuits work within the body helped me to make connections between the circuits that I was seeing outside the body in terms of flows of life and flows within the economy. So, for example, through the sort of work with Rupert, I was able finally to sort of wrap my arms around a statistic around debt for example, in the United States, there's a vast explosion of consumer debt. And right now, as we record, there's the end of the eviction moratorium, which means that a lot of people are going to be finding themselves either with much higher rent or on the streets and unhoused. Now, the debts that come with that are an acute form of capitalist stress. And Who should swoop in? But the financial, the sort of Robert Barons of finance offering things like payday loans, for those who don't know, if you have a payday loan of, say, 300 bucks, you probably end up paying at payday loan rates about $800 back. Those kinds of loans are incredibly stressful to manage, and they manifest in all sorts of ways. Isn't that called usury and illegal in.

What organized crime usually does?

Well, yes, that's it. You see, in other parts of the world, it's illegal. And in the United States, it's licensed.

And.

That'S because we are at the apex of this kind of predatory capitalism. But what I didn't fully appreciate was how that stress works through our body, through our microbiomes, through our guts, through our skin, and through our endocrine system, and finally drives us towards despair and stress. And so a statistic that I came across when we were researching this, that certainly blew me away. I think Rupert was less surprised because she understood the mechanisms. But if we were to abolish payday loans, the suicide rate in the United States would drop by 1.9%, and the fatal overdose rate for narcotics would drop by 8.9%. Now, one can trot that out in an economics discussion or in a medical discussion. But when you do it in both, I think you get the full kind of span of how The bodies, our bodies, everyone's bodies are stressed by the kinds of everyday rough and tumble of capitalism. And we, you know, unless medicine opens its eyes to saying, you know, a good medical intervention here would be to ban payday loans, then we are, you.

Know, stopping short of how it is that we might heal one another. No, that's what we're so bad at in medicine. So what Raj was just describing that an actual structural change. So we've gotten good at now noticing the structural determinants of health. but we have no training in how to understand where those structures came from, why they were put there, and then how to dismantle them. And that's what we see with COVID As soon as we saw the racial disparities, everyone's talking about it, but no one has come forth and said, let's do universal basic income so all of these folks can just stay home and ride out this wave. Instead, it's been the cattle prodding of black and brown workers back to serving the interests of Jeff Bezos so he can go on a joyride. so that's the kind of grotesque lack of care for each other we're seeing manifest here. So we have the ability to notice and to describe in medicine, but we don't go that extra step at prescribing a change because modern medicine is a part of that colonial capitalist project. That this land was colonized by medics, missionaries and military. And so that, you know, that we have to understand that what we are a part of so that we can actually effectively leverage and push on points of pressure to change the things that would actually bring real population level health outcome changes.

That's really true. I think we have to go back. And I know in my electronic medical record at Cleveland Clinic, you know, we now have this new feature which is your social determinants of health and you kind of feel like, but then it's like, well, now what? Like, what do you do? We still are seeing one-on-one patients in the office hoping we're going to fix them when what happens in the office isn't really the main determinant of Health. 80 of our health happens outside the clinic. And I'm not going to cure diabetes. In my office, it's cured in the farm. It's cured in the grocery store. It's cured in the kitchen at the restaurants. That's where it's cured. And I think we don't even talk about that. And as doctor, I'm so shocked that you actually have gotten this because we basically learned the exact opposite. Right, we can fix everything, just come to us, we got you, just follow these instructions and go home. And it's just a farce and it's why we're seeing escalating costs, escalating rates of all these inflammatory diseases. And it's something we don't really talk about what to do. And I want to get into what to do about it because I think that the concept of how do we solve this is really challenging because it's a big problem. Hey everybody, it's Dr. Mark. I've recently found a new drink that fits into my Pegan diet and it's something I always look forward to when I need a nourishing pick me up. It's Sun Goddess Matcha Green Tea from Peak. It's the best tasting, smoothest mixing matcha I ever tried. I'm sure you heard me talk a lot about using food as medicine, and matcha is a great example of this. It's full of polyphenols, which are essentially powerful plant chemicals that are good for your gut bugs, they're great for detoxification, for cancer prevention, and so many great antioxidants that support better aging, a balanced blood sugar, digestion, and a good immune system. I love blending the Sun Goddess Matcha powder with some hemp or oat milk into a creamy latte as part of my morning ritual. But I've also used it in my recipes like matcha poppy bread or various smoothies, and it works great every time. It's also the only matcha that's 100% organic, ceremonial grade, and quadruple toxin screened for purity. Matcha makes a great alternative to coffee because it provides sustained clean energy without the jitters. L-theanine is a powerful amino acid in matcha that helps you feel calm, focused, and clear so you get a boost without the crash. Peak's Sun Goddess matcha actually contains more L-theanine chlorophyll because they shade their matcha plants 35% longer than other brands. I really do feel awake and focused and balanced after enjoying my matcha every morning. Right now you can take advantage of their limited time special offer on your first order of Sun Goddess matcha and the other delicious teas from Peak. Just head over to peaktea.com/hiiman. Use the code hiiman and that's P-I-Q-U-E-P-E-A-K-T-T-E-A dot com slash hiiman with the code hiiman for 5% off and free shipping when you purchase two or more cartons. You may also get a free bamboo whisk while supplies last. Now, let's get back to this week's episode of the Doctor's Pharmacy. But Raj, you said something I want to sort of push back on a little bit. You talked about this idea, both of you sort of touched on it, and I just want to push back around this idea of colonialism and capitalism. One, are they the same thing? And two, Is capitalism inherently the problem or is it a corrupted capitalism that is causing the problem? Meaning it's basically rigged and geared for the wealthy but not for everybody. And it's not really truly free market because if it was free market, then all the externalities and costs would be built into the price of the goods you're buying. So, the price of Coca-Cola would be probably $100 looking at the impact on soil, on pollution, on the degradation of our water systems and air quality and climate and health. And I mean, we'd be paying for this stuff four times. That would be the price. So, how do you do sort of frame it in a way that, you know, people are listening, well, you know, what are we expecting communism? Like, what's the answer?

You know, let me take a stab at that first by just sort of explaining, look, there are lots of different kinds of colonialism, and there's long histories in the history of human civilizations of, you know, one civilization coming in and displacing or altering another. You see that throughout Asia. You see that even on the land that I find myself on, it used to be Tonkawa land, and then it was invaded by the Comanche Empire, and then it became part of, temporarily part of the Spanish Empire, then part of Mexico, and then now the United States. So there's a palimpsest on the land. So colonialism is one thing where just one power comes in and occupies and bombinates another. And then capitalism is this sort of tendency not towards competition and to free markets, but actually to monopoly. And I think that that's the the important thing to remember here when we're talking about capitalism is that, you know, and you know this well, Mark, I know that this is a kind of softball question, but you know this well through your work in your study in food fix, for example, and thinking about how food corporations work. The way that capitalism has worked in the food system has not been to generate an abundance of free markets and competition and true costs being revealed. But exactly the opposite, right? If we, you know, the report came out from the Rockefeller Foundation a couple of weeks back saying, look, the United States spends $1.1 trillion on food every year. But the damage caused by these corporations, which they haven't been managed to make other people pay for, is $2.3 trillion. So for every dollar we spend on food, more than $2 need to be spent cleaning up what these capitalist corporations have created. So what we're saying is, look, Capitalist colonialism is a way of breaking relationships between people and between people and place and the rest of the web of life. It's a way of concentrating power in the hands of a few people rather than democratizing it. And so what we're excited about is actually, you know, what would it be like to have free exchange? What would it be like to have people be sovereign over their decisions in a way that pure economic theory suggests they might one day be? And we kind of like the idea, for example, of competing ideas, and that's why we like science a great. We like the idea of level playing fields, but unfortunately, colonial capitalism has kind of prevented those from happening.

It has. And you're right, the monopolies are true. You look at the food industry, we see all these brands, literally hundreds, thousands of brands, but there's nine companies that own all the brands. If you look at the chemical and seed NAG companies, they were 100, like 20, 30 years ago. Now there's like six that does provide all the chemicals and seeds. and we see this, the consolidation, the monopolization, the structural changes that really undermine the ability to actually start to create change. Because all of a sudden it was like, there really was democratization of our food system, then new ideas could bubble up and change could happen and people would be able to sort of implement alternatives. And now it's very, very tough and these behemoths, you know, like Nestle and, you know, Mondelēz and, all these giant Pepsi, Coca-Cola, all these giant companies are so dominant that it's very hard to get them to shift. I mean, they're thinking about, they're looking at, they're feeling the pressure from our culture, but it's really tough. So as you guys have come to sort of understand this and understand the structural violence and understand the colonization of our society in general, how have you understood the food colonization, because I think it's something that's new. And these terms have been tossed around like food apartheid and food colonization and the decolonization of food and medicine. What is that and what does it mean and what do we do?

So I just want to take a moment to point out a couple of the things that you've said, Mark, that hit on because I was trained in the same medical system that hit on kind of the errors of thought that we are trying to move away from in our book. One of them was talking about the immune system as unleashing an army, right? So what we talk about in our book is that the immune system, these metaphors that we use as in, you know, the invisible enemy, that's COVID, and, you know, we're fighting disease and we're off there with these, you know, these armies of white blood cells. The militaristic imagery is coming from that same time of colonial conquest. We think about self versus other. And that's an error of thought of how the immune system actually works, which is to repair damage. That is what our bodies are trying to do. We're not out there fighting an internal epic battle in our bodies. Our bodies are simply trying to restore the optimum working condition. So that. And then to posit that the opposite of the violent system of colonial capitalism is communism. And to use the language of like red.

I knew people were thinking that. That's why I know.

I know. And that's why I want to address it. I want to address it. because we are, again, this is not a dichotomy, that we are sophisticated, highly imaginative, amazing creatures that have a whole repertoire of ideas and creations and experiments and expressions that go beyond the dichotomy between, you know, an economic system that is currently destroying the planet and everything that supports human life on it. another economic system that we've seen exist in authoritarian models that doesn't feel particularly inviting. So I just want to share that. In terms of what decolonizing medicine and food means to me, it starts with the concept of deep medicine, which is what we have conceptualized as being an analogy to deep ecology. So deep ecology is the understanding of ecology beyond and outside a human centered approach. That life around us is vital and beautiful and amazing and deserves to be respected regardless of its utility to human beings. It's not simply there to be used by us. It's to move away from the Judeo-Christian framework of humans up here in life, the rest of life all down there.

The word in the Bible was dominion, which means to rule over, as opposed to the word which really wasn't in the original Hebrew was stewardship.

Exactly. And what's interesting, which is more of.

Care and not you don't own it, you're basically a steward of taking care of it.

It's a very different framework. Exactly, a kinship. And that's what, you know, in that beautiful book Braiding Sweetgrass, Kimmerer's book, she looks at the myths, the stories of Sky Woman, who was that creation story is a story full of relationship as opposed to Eve, which is the severing of relationship and the banishment from the garden. And you don't get to eat anymore from here. And now you get to menstruate and be in pain, you know? So just the whole framework is, you know, what kind of reality, what kind of story do you want to live with? And what we're saying is that, you know, deep medicine is understanding it's those relationalities that were actually interrupted through a colonial capitalist framework. And we joined those two together because it's the way that capitalism spread. And it was the architecture of cosmology, the way of understanding who we are in relationship to things. Things needed to be severed in order to exploit them. You needed to be able to see the mountain as inanimate in order to mine it and riddle it with holes. You needed to see the river as not a person. in order to pollute it. You needed to see the salmon as a commodity in order to not sing to it. So you could club it over the head and rip out its eggs, which is how they farm salmon. I mean, it's the most grotesque thing I've ever seen. And so I think that deep medicine is understanding that health cannot be pursued on an individual level, that health can only be attained in proper relationship to each other and the entire web of life. And so those activities that we can do around our food system that reawaken, rehydrate our ancient relationships to seeds, to water, to soil, to each other, are going to be a part of that practice of decolonizing our food system. And it is directly anti-capitalist it is saying there's no place in this for turning profits and, you know, consolidating power and, you know, having dominion, you know, as an executive, having dominion over the workers in the fields. So it's about honoring and respecting our dignity and the dignity of all the entities around us that support our health and that are vital for our health. And I feel like for me as a doctor, nowhere is this more exciting. So this shows the gap between the practice of medicine and how we're being educated in medical schools and the Even the cutting edge of the science right now, there's like a 30, 40, maybe 60-year gap. So we're still being taught of the digestive system as this tube that goes from your mouth to your anus and like food goes through the digestive system, right? But it's in fact a whole rich forest and that forest needs to be tended like an ecologist. And so that's, you know, deep medicine is really understanding those relationships and putting them into good practice.

It's ecological medicine.

Well, it's beyond the ecologies of our social ecologies, our political ecologies, our biological ecologies. And that, you know, those are ways of thinking of medicine that are so exciting. And my medical students who are especially Black are coming up to me wanting to quit medical school because they know the science. They're like, what we're learning in medical school is not Scientifically, it's not actually based in the real science that's here right now in front of us.

Well, it's 20th century.

It's not 21st century thing. It's enlightenment. It's even beyond, I mean, it's so far gone and it needs to reassert itself because the lines of power within medicine and those hierarchies are recalcitrant to change. And that's exactly what decolonizing medicine is, is to change them, to move that.

It's so true. I actually, my daughter's starting medical school in a week from today. And I said, look, I said, you,'re gonna get brainwashed. Here's what they're gonna teach you. Here's the real story. And I'm not paying for medical school unless you read these books. And I'm gonna put your book on the list of what she needs to read. And you should, you know, for everybody listening, we're talking to Raj Patel and Dr. Maria and they have written an incredible book. really an incredible book that changes our thinking about why we're so sick, why we're so overweight, why our health care system is so burdened. And this book, I think, is going to be a pivotal shift in our thinking. It's called Inflame: Deep Medicine and the Anatomy of Injustice. And in terms of the anatomy of injustice, I'm going to switch over to you, Raj, for a minute because I think you've given a beautiful explanation, Rupa of Deep Medicine. what is the anatomy of injustice? And what are you talking about? And how did we get the food system we got?

Well, I mean, the reason we chose the idea of anatomy of injustice is because we've structured this book as a kind of anatomy. It's an introduction to the immune system, to the respiratory system, circulatory. And we go through a number of bodily systems as one might in one's first year of medical school. so, you know, the idea of presenting things anatomically is something that we're sort of taking from the world of medicine, but we're transforming it. And we're along the journey trying to really delve into precisely the kinds of histories you're asking about, Mark. Well, how do we get here? And a lot of the error comes in thinking that there's one entity of society over here, and that society was initially populated by white men who had property, and the, you know, working class and women and indigenous people and enslaved people were firmly outside that alongside nature and the rest of the web of life. And then gradually more and more humans were sort of invited into society after having fought for that right. But what that sets up though is, as Rupert was saying, the possibilities of being able to exploit and take things from the land. And so really the sort of first moments of what we understand now as the world food system were birthed in the 1400s with the island of Madeira and sugar plantations in the Atlantic. And then really, you know, the ball gets rolling in 1492 with the arrival of Columbus in the Americas, in the Western Hemisphere. But then also with the clearing of Jews, for example, from Iberia. The sort of arrival of the modern nation-state and its technologies of finance and exploitation and racial purity happened in the same year, and it's not an accident. And it's food corporations in particular who are very interested in this rolling colonialism of a frontier of where can we find the best land, where can we find the cheapest labor, where can we find the cheapest food products? And you know, the first products of colonialism are precisely the food that comes back, or the cotton, or the tobacco. It's all about agriculture. And that's important to bear in mind because when we think now of, well, of course the United States isn't colonized, au contraire, the wealth of this country was made possible through food and agriculture, and there's still a fairly large debt to be redressed. And again, as we mentioned earlier on, those debts are amounting every day because the corporations that now run our food system have 600 years of practice of making other people pay for the costs that they generate.

It's so true. The true cost of food concept that the Rockefeller Foundation put a report on recently is staggering. It's actually how I started my book, which is talking about what is the true cost of the food we're eating in our human community and in the natural resources and our economic resources. So what are the real costs into our social our natural capital and our human capital. I mean, those are real phenomena that we're not really addressing at all in our thinking about how to solve some of our biggest problems. So, I want to sort of get into a little bit about the, you know, before we get into the sort of link between systemic inequality, trauma in families, inflammation, immune system, chronic disease, I want to sort of talk about, you know, what do you mean by the colonization of our food system? Give it examples of what that looks like. Is it all the bodegas in underserved communities that are only serving junk food? Or is it more than that?

Well, I'll take a crack at this just because I grew up in a bodega in Britain. That's why my parents did. And for folk who are not watching this, I speak with a posh British accent because my ancestors were colonized by posh British people. and, you know, I found my way back to Britain. Oh, yeah, but again, you know, my parents are from Kenya and from Fiji. So again, outposts of the British Empire. And, you know, there's that sort of long history of sort of direct exposure to it. And of course, now, you know, my parents were the canaries in the coal mine for the British food system, you know, as we transitioned to the standard American diet. sad, as I'm sure your listeners will know, is referred to in the literature. But the standard American diet came to Britain and who was in the front line, but folk who had been exposed previously to poverty and therefore were more predisposed to developing type 2 diabetes and heart disease and had histories of that. And so the British Asian community has far higher rates of type 2 diabetes, for example, than white British people. Now, a colonized food system is not just about crap sold from stores that my parents had, for example. But also, I mean, it's about a severed relationship to understanding where that food comes from and what counts as food and what counts as medicine. I mean, I think that this goes back to something that we began our conversation with, which is, how do you know that something is a medicine? The way you know is because a doctor has told you that it's medicine. But how do you know that something isn't medicine? Again, A doctor has told you, well, you know, that's not out, you know, it's not licensed, and therefore it isn't a medicine. Now, one of the ways that we are trying to sort of pierce that is by saying, look, there's a cosmology in which, you know, under colonial capitalism, you know, food and medicine was split up. But actually, there are lots of healing traditions in which food and medicine are.

You can't draw a line between them. Almost everyone except ours.

Everyone except ours. if we have that as a reference point then Mark, that ought to serve as an indication of how broken our understanding of food and medicine is, and that's what it is to be colonized, is to think, oh yeah, this thing where half the ingredients I can't even pronounce is food, whereas this beautiful plant, which I have not recognized yet, which grows around me every day, I don't know whether I can eat or not, that is a colonized food system.

Yes, and I think that, so Lakota elder Candace Ducheneaux, who we quote in our book, she would say to me, you know, we have a concept of medicine where everything around us is medicine. You don't just get medicine when you're sick. Medicine is what you interact with every day, several times a day, to keep you well. So, reaching out for that plant is medicine, that sage is medicine, being with the buffalo fur, that's medicine. I'm singing a song, that's medicine. And, you know, we can look at that as, oh, how trivial and cute that is, those savage natives, you know, the way that colonial thinking organizes indigenous knowledges and wisdom and then, you know, scientific truth. But in fact, when you look at the data around singing, for example, and vocalizing and chanting and what it does to your vagus nerve and how it's activating the parasympathetic nervous system, it's actually driving down inflammation. It's an anti-inflammatory to the anti-inflammatory experience. And so what we've seen is that a lot of the indigenous from the tribes that I've interacted here in Ohlone territory, where I'm speaking to you from today to Lakota territory, is that a lot of the things that they call medicine are actually things that are quite anti-inflammatory.

That's right.

Which is fascinating. And so, you know, is it a surprise that many of those societies were organized in a way that didn't have the hoarding of resources that we see with our society? Or did they understand that somehow that hoarding might be inflammatory or might lead to more disease? And so I think that one thing that surprised me in writing the book was understanding, not surprise me, but it was nice to see it written and examined. That what we call indigenous knowledge or traditional ecological knowledge, for example, is a kind of a science. And it's a science that occurs over millennia. It is peer reviewed, but it's transmitted through oral history, and it's peer reviewed in a different way. But that doesn't mean it's somehow less valid or more effective. Exactly.

It's not just a quaint throwback to the past. It's actually a Addressing the question of why are we sick and how do we get better?

So, when you look at the microbiome science, for example, so this great paper came out by the Sonnenberg lab in.

Stanford saying that, you know, if you-.

Now you're talking my language. Poop. I like to talk about poop. Poop. We like to talk about poop. Well, here this is like interesting things. So, you know, if you eat fermented foods for 10 weeks, you know, the more you eat, the more biodiverse your gut becomes. And then 19 different levels of markers of inflammation will fall, right? that's great, that's grand, that's helpful. But the same Sonnenberg is off trying to commodify the crap out of the indigenous people who've actually protected their microbiota. So when you look at the rates of biodiversity of the gut microbiome, the urban US dweller has the least biodiverse guts on planet Earth. The most biodiverse guts are indigenous people whose cultures are still intact, hunter-gatherers whose cultures are still intact. And the more biodiverse the gut are, and we're still trying to understand the science behind this, but what we found is that a greater biodiversity of the gut is associated with lower levels of inflammatory disease, from everything from inflammatory bowel disease to depression and diabetes and obesity. And so this guy Sonnenburg is off trying to, you know, take the poop and, you know, turn into a rewilding of the gut. And here's your indigenous poop. Here's your poop from a biodiverse gut. Go and take it. But the problem is-- that's why I'm.

Going to write a book called Paleo Poop.

But I don't-- Right. The problem with that is that you can't take just the poop without taking the entire cosmology. You cannot separate the biological thing from the whole system of relationships that supported that ecology. That ecology is intact and biodiverse because of the ways in which those people are in relationship to the web of life. And that cannot be approximated, it cannot be bottled and sold. And that is what, you know, that we, it's important to name that as a part of the same capitalist sickness, is that you cannot do that. You have to re-enter these relationships. There's no easy way out. And that's exciting because there's people on planet Earth, okay, they're 5% of the human population right now, They're stewarding the most biodiversity inside and outside of their bodies, but they know how to live on this earth without destroying it, and they know how to live on this earth without inflammatory disease. And they've been doing it for 30,000, maybe since time began. They've been doing it forever. And so that's, to me, as a person on this earth working in health and concerned about the future of our planet for my children and grandchildren, that's extremely exciting, is to enter relationships with those folks. reciprocal, respectful relationships, and to help the Indigenous people in my community reclaim that land, that knowledge, that power that's in their lineage, and to support them in that work. So that is, you know, I feel like the future of medicine.

Because what you're really intimating here is that as a society we have a soul sickness. and that our souls have been disconnected from the origins of life, from our land, from our food, from our communities, and that we're seeing this epidemic of both mental health issues that you talked about earlier, Raj, from the suicide rates, or was that you? I can't remember. And the sort of the disconnection and the isolation and the sort of this social disempowerment as really being a soul sickness that needs to be healed by finding our place in the family of things. And that's what you're talking about. And I think it's a beautiful I notion, a beautiful idea. And for someone who's been working in the food system for years and thinking about it for years, the challenge to me is I don't have any argument with the framework of what you're talking about. But given the way our society has been completely dominated by this colonialist capitalist model and the way in which our populations have been so disenfranchised and aren't even aware that they're disenfranchised. They internalized racism, the internalized structural violence. How do we emerge from that? Because other than just radically changing our society and radically changing our policies and radically changing our economic structures, how do we begin to address this pandemic? Because as someone who's on the front lines of chronic disease, it's a staggering phenomenon. I can tell you, I started doing this 25 years ago and I look at my slides from like 1996 and then, and I'm like, wow, I keep having to change the slides because it was, you know, 30% obese, then 40, then 50, then 60, then 75, then, you know, diabetes, chronic disease should be like maybe three out of 10 people, and then it's four out of 10, then it's five out of 10, then it's six out of 10. Every year I have to change my slides and it's getting worse and worse. And yet we understand it more and more and somehow we're not able to bridge that gap.

How do we do that? I would say, first of all, I just want to give a shout out to- Everybody read your book. No, to Jack Forbes read another book called Columbus and Other Cannibals. He was a Native American scholar here at UC Davis. And he talks about the spirit sickness, which is called, he calls it wetiko or windigo, which is an Algonquian word. and it's literally the spirit sickness of colonial society and societies that dominate each other. He calls it like a vampire, that you're sucking the soul off of other living creatures or other entities in a non-reciprocal non-respectful way in order to support your own life, in order to support your own. And that this Society is sick. He calls it a spirit sickness. And so the cure, Mark, is a radical re-imagining of our society. And the good news is that will address not just the rising rates of inflammatory disease that you've noticed, but also the burning of our planet. And so there is no tiny tweak we can do. There is no little, you know, just to move this around. There are things we can push for right now, Medicare for all, a Green New Deal, there are large policies we can try to move with. But truly what we need to do is reimagine every way in which we relate to each other in the web of life. Because the ones that we've inherited, the ones that we have been handed to us through a colonial capitalist cosmology, are making us sick and making the planet uninhabitable for human life. And it's urgent that this happens soon and that we start to see- She.

Seems like the world leaders have no idea that chronic disease has anything to do with our, you know, political and social structures. Like they're just, they're just, well, disease happens over here, and, you know, the economy happens over here, and they're not really related. But it's, it's, it's just, it's really such a profound connection.

And you'd think the pandemic would kind of nudge people into the right direction. You know, having spent a year under lockdown, you would think that there'd be some sort of rising consciousness between, you know, the origins of zoonotic disease, the way in which industrial agriculture spits out more and more of these zoonotic diseases at rates that have already created outbreaks in other parts of the world. And where in 2007 we had the H1N1 outbreak as a result of a pork processing facility. These kinds of things are ongoing. And there are small things that we can offer as promissory notes. Like, for example, buy organic and sustainable and go to your farmer's market, find out where your food comes from, have conversations about how workers are treated, find out about the land. But don't think that that's the work. That's just a reminder to yourself that you've got to, in the same way that instead of saying I'm fighting something off, which I said the other day, I sort of corrected myself, like, no, I'm learning to live with something. And that, just little sort of twists in the way that you think about things are important not as a substitute for the big work of change and for working together in movements and in organizations. but you know, they're little things to remind you that the world isn't the way it should be. And therefore, you know, eating organic is not a protest, it's not a way of making sure your body is a temple and the rest of the world burns to the ground. But instead it's a way of saying, no, you know, everyone's body ought to be treated with respect that I'm treating mine and the workers in the field are being treated by not being, you know, exposed to pesticides. But we can do better. And it's a reminder we can do better.

And that, you know, there are so many movements we chronicle in the book that are doing better. so Raj, you are not a lightweight when it comes to understanding food systems and the global food system and agriculture and the industrialization of it and the consequences it's had on humans, on the earth, on our water systems, on everything. And you sound super optimistic, which is exciting to me, but I just want to sort of ask you from your big tent framework. What are the practical steps that we have to do to move this forward? I mean, it just seems we're so stuck in a polarized society where we can't even agree on the most basic things. The injustices that are blaringly obvious, we can't even get Congress to agree that the insurrection at the Capitol was a problem. I mean, we're talking about just the most obvious things. Yet we're talking about here much more subtle ideas.

Well, I don't know about, I mean, it's important to have a pessimism of the intellect as well as an optimism of the will. One can't think that just by putting daisies into the mailbox at Nestle, everything is going to be fine. That there's clearly a lot of work to do. But there is quite a lot of agreement, if not in Congress, across America and the rest of the planet, that things like monopolies are bad. Regulating them is a good thing. No one likes to be shafted by a big company. It doesn't matter what your political orientation is, unless you are the owner of that political company doing, you know, this large corporation doing the shafting, then you're unhappy about the situation. And there is quite a lot of anger around the ways that food companies are treating us. And that is turning into certain kinds of legislation. Of course, it's been fought tooth and nail by the industry. One of the other things about this pandemic that I learned about and that bolstered my sense of possibilities for change is precisely what happens when governments are good at saying no to things. We should be getting them to regulate and to reduce the levels of freedom that food corporations have so that the rest of us have more freedom. But in the meantime, there are amazing organizations that are in the frontline battles for climate change and equality and food is a central part of the story. I mean, listeners may not have heard about the big protests in Colombia, but the first demand of student protests in this violent protest in Colombia was food sovereignty. In Peru, we've just been seeing some contentious elections there, but communities that had zero cases of COVID the indigenous communities, were sending food out to the people who had, you know, where food was in short supply because the government failed, the private sector had failed, People are capable of taking care of one another in ways that the food company prevents, a food industry prevents, and sometimes government prevents too. So I think there is, the good news lies in the fact that government can change and saying no to corporations is something that governments seem increasingly ready to do after this pandemic. And also, you know, just injecting cash into the economy, which didn't seem thinkable, you know, two, three years ago, now is something that governments recognize they can and should have been doing all along. But then the other thing is recognizing people power and recognizing around the world that people are taking care of each other under COVID through gifts of food and exchanges of food in ways that aren't getting reported in the New York Times, but are certainly happening on the ground.

Yeah, it's staggering when you look at the implications of our food system and COVID. I forget the food insecurity, lack of access, the fact that we throw half the stuff out and half the people are hungry. But when you look at the recent trial, I mean, analysis published From Tufts, 63.5% of all hospitalizations from COVID and probably the same amount of deaths proportionately are related to poor diet and the consequences of that diet creating inflammation, hence your book, Inflamed, that predisposed people to more severe COVID. And that's an entirely preventable thing. When you look globally at the threat of COVID the threat of COVID is a threat of hospitalization and death and overwhelming our healthcare system. that's the real threat. And yet that threat is almost entirely mitigated by changing our food and food systems. So I don't think we're grappling with that. Well, I mean, it's. I'm working on policy stuff, but it's hard to even get the government to pay for medically tailored meals for diabetics, even though we know that food is the treatment for diabetes.

Right.

And yet there's no lack of evidence or data on that. It's such a simple thing, and yet.

It'S not reimbursed, and it's a challenge. Well, we're giving a talk, I'm going to be giving a talk in San Francisco to the Board of Supervisors around this work we're doing in Ramaytush and Ohlone territory here. So we are, I started a non-profit this year called the Deep Medicine Circle and our work is to heal the wounds of colonialism through food, medicine, story and learning. And one of our first actions or projects is the rematriation of 38 acre farm to the original people, to the Ramaytush Ohlone people, and to farm under their leadership using agroecology, where we hire farmers as health care workers. Essentially, they're being paid as much as the doctors to grow food that is then liberated from the market economy and goes straight up to San Francisco to give to urban people who are being oppressed by hunger. and that if we take our food system and we just remove the profit motive and we just say, okay, we are going to pay these farmers to steward our soils, to steward the water, and to grow the food that is gonna be given to improve people's health. Now there's discussion in the public health department meeting with folks there about, well, why aren't we doing this on a large scale in San Francisco? Why don't we have a people's farm? so that if you live in the city of San Francisco, no one ever goes hungry. So I think like this study from Tufts, COVID is a great opportunity to reframe, recast, and demand our rights to be healthy and our rights to dignified healthcare, both for our patients and our workers. We should not be seeing nurses in trash bags because they simply don't have enough PPE. As healthcare executives are making record profits, and we're being forced on the front line to be, you know, in less than safe conditions. And so the push for Medicare for All here in California, we have AB 1400. I'm on the Healthy California for All Commission. I was appointed by the governor to reimagine financing in the state of California for our health care system. And it's a really hard time for people to get up and say, yeah, we really need those health care insurance companies because people are fed up with the financial abuse. that is an extractive system where the money that's put into it is extracted for executive salaries and not going directly to benefit patient care and provider safety and well-being. And what's happening right now, Mark, in the hospital where I'm working at UCSF and in the Bay Area is nurses are leaving. They're leaving the job. So now we're in the midst of this delta surge and we don't have a staffing shortage. So what does that mean for the workers that are there? They're working even harder. And so this is truly, so like with this farm, we were calling the initiative Farming is Medicine. I'd love to tell you more about it as it goes up and live. We're doing the same thing on the largest rooftop farm in the West Coast is in Oakland. So all that food will be given to a food pharmacy at the UCSF Pediatric Clinic right next door. So we have doctors and farmers hanging out together. We have community workers who have occupied housing for the sake of mothers not being homeless in Oakland, Moms for Housing. Dominique Walker is one of our interns on that rooftop. Those interns are teaching the doctors. And so that's the exciting milieu of cross-pollination and systems-level thinking that only these kinds of creative collaborations can create, can bring.

That's so true.

And that's because we're dealing with systems-level failures, systems-level problems. We need more minds than one. We need all of us in there together. And we're extremely creative. That's where my optimism comes from, the deep creativity of human beings, we can do this.

So you think it's going to well up from the bottom as opposed to being legislated? It has to.

Well, it should be legislated, but it should be legislated from the ideas of those who are the most impacted.

It's true. You know, this all reminds me of this summer program I went to when I was in college called the Institute for Social Ecology. Oh, you went to that? Yes, I did. You heard about that? Murray Bookchin. crazy anarchist guy, post-skeptic anarchism. And he, we had courses in biological agriculture. Now we call that agroecology, you know, energy efficient shelter, holistic health, all these concepts, you know, anarchism and women's studies. And, you know, we, we actually went down to Brooklyn and, I mean, the Lower East side, we built rooftop farms and rooftop, before anybody was building rooftop beds on the, on the, in New York City. And we cleared out all the band in parking lots and made farms and gardens in the cities. And it was just like, you know, to hear these ideas, this is not new thinking, really. These are ideas that have been around. And it just, we've had this juggernaut of the food industry getting more and more consolidated, the ag industry more and more consolidated, and disrupting our health in tragic ways that has almost been invisible. And now, suddenly it seems like we're waking up to go, wait a minute, like what just happened here? This is 40 years ago. It wasn't like this. You know, when I was growing up, we didn't have those levels of disease and obesity. I mean, when I was born, I think, you know, it was like, other obesity rates were like, I don't know, like 4% and now they're like, you know, 40%. So it's really a staggering change and it's almost happened so fast that we can't accommodate to it. So going back to this idea of the colonization of our food system, You've described that pretty well. The other concept you mentioned is food sovereignty. Food sovereignty seems to be the antidote for colonialized food systems. How do you define food sovereignty? And how do we get there?

Food sovereignty emerged from peasant movements in the 1990s, who said, look, food sovereignty is the opposite of food security. People may be familiar with the idea of food security as being this thing where you have enough food to lead a healthy and productive life. That's the definition of food security. You know where the food's coming from, and you're able to access it. But as critics point out, you can be food secure in prison. Food security says nothing about how you get your food, it says nothing about your power to control the pipeline of what it is that you're eating. So you can be given prison food and a bag of vitamins and everything's going to be fine. And in some ways, the sort of crazy end of the medicalization of our food system wants to do just that. Keep things as they are. Perhaps we'll substitute meat with oatmeal or some other kind of crazy invented synthetic protein. But then add vitamins and continue exploiting the environment until we arrive at the sixth extinction in its full glory. or we can move to something that involves much more democratizing of our food system. And the data suggests that when you democratize the food system and when you put power in the hands of communities that are sovereign, they're much better able to take care of land and it's much more carbon sequestration, climate resilient and welfare increasing than if you let either the government or the private sector take care of it. So food sovereignty is an attempt by communities to own the policy process around food. And a good example of that comes from the Los Angeles Unified School District. They're the largest school district in the United States. They decided that they wanted to change their food system to do five things. We want to pay workers better, improve the local economy, improve animal welfare, and improve nutrition and a measure of sustainability as well. All of those five things become a non-dollarized way of counting change. So rather than-- Changing the metrics.

Yeah, exactly.

And so rather than dollarizing, which was a mistake that actually anti-tobacco activists made in the 1970s, they said, All right, tobacco industry, let's put a dollar value on the number of people you killed. And the minute they did that, they lost the moral high ground, and they had to convert suffering into dollars. And in that conversion, humans always lose, and corporations always win. So instead of making that conversion, you stick with multidimensional indicators that you can track over time. So you're measuring your progress. And now all of a sudden, you have a non-dollarized but measurable and actionable framework for making sure that your local economy and animal welfare and all the rest of it gets better. And their good food purchasing policy now is about community control for over 5 million students.

Yeah, I mean, the good food purchasing strategy is a great way to think about changing our food system. But that's all for those who are, yeah, and for those who don't know what that is, it's a program developed to look at how schools purchase food based on certain values that you spoke about. But they're looking at how do we do that for corporations who buy food, for the government, who's probably one of the biggest food purchasers. When you look at all the federal agencies and institutions that government runs in the state, local and federal hospitals, hospitals, schools, prisons, I mean, we literally, I mean, I don't, I had a friend who was Japanese and she told me this incredible story of how in Japan, in the prisons, they feed the prisoners whole foods. They feed them a macrobiotic like diet which is known to calm them down, to regulate their behavior, to equalize their mood, to lessen violence. I don't know how they figure that out. Here, we know that if we swap out the diet of kids in a juvenile detention center, that the violence goes down by over 90%, restraints go down by 75%, suicide goes down by 100% just by getting kids off of junk food and eating some real food. Probably not even the best food, just not the crap and a little bit of good food. That's the power of this model. And we have to start to reimagine our approach to thinking about this that doesn't keep us stuck in the lack. I actually, you know what? I think Even if we have food security in America, we don't have nutrition security. And they're quite different. Food security is, I'm on food stamps. I can have a two-liter bottle of soda and a giant bag of Chips Ahoy cookies and I'm food secure because I have enough calories. That's going to cause you to feel sick and not be functional, not work and be depressed and be inflamed. It's not nutrition security, which is access to real whole foods that's going to promote health and well-being and help you advance. I think the structural changes we're seeing in our society that are from the food system and the way you describe it is really driving some of the worst challenges we see around social justice, around racism. I mean, just the life expectancy drop that we saw in the last report of three years in Black and Hispanic communities, we should all be going, wait a minute, why is this happening? What's going on? What's the cause of it? And yes, it's more than just food. It's the traumas, it's intergenerational issues. but food is such a central piece of that and it perpetuates a cycle and seems to me one of those levers like Archimedes lever to actually change the whole dynamic of what's happening in our society from sickness and the consequences of our food system to one that's more able to create a healthy society. And we just are so far from that. But I have rays of hope. I see these things happening on the margins. I see what you're doing, Roopa, and the things you've been talking about, Raj, and I get really inspired to think, wow, there are a lot of people thinking about this and working on it. And I think you're doing the hard work, which is fantastic. I want to sort of change the subject a little bit and talk about how as a doctor, you've somehow figured out that farming was medicine and that we can't separate healthcare from food cultivation and how we grow our food and the agricultural systems.

Well, I married a farmer. There you go. That helps. But before that, I actually made a, when I was single, I said, okay, I either want to work with someone who's saving seeds or they're a computer hacktivist. And that was my, like, I had it nailed down to like the- Computer hacktivist? Yeah, computer hacktivist. I don't know. When I was touring around the world, what is that?

I don't even know what that is.

But for me, because of my work in music and my where music has taken me as a socially conscious artist and the life I've created for myself insisting upon my role, my work as a physician artist. Because it was in the touring and the curiosity of my own mind as I was reading works like Raja's work, when as I was traveling to Athens during the financial collapse of 2008 and '09, hanging out with the anarchists there who were taking over the botanical gardens and turning it into tomato fields and growing food and putting up pop-up clinics to address how people were committing suicide in the streets. And so I was in grateful to be welcomed through my music into communities who were, are continuing to do what we're calling deep medicine, that they've made these connections, that they've understood them and that their organizing practices around these connections to advance health. And their advancement of health is far beyond in terms of impact, what we're able to do in the hospital or as an individual with individual patients. And so that was really inspiring to me as a healer, as a thinker. And it was through my music and that, you know, I was invited to accompany the Frisko five hunger strikers who were protesting police violence in San Francisco on the steps of the Mission Police Department with a hunger strike. And, you know, I walked up to them and introduced myself and one of them was like, oh, you totally played on stage with me in Golden Gate Park. Do you remember like five years ago, eight years ago? I was like, oh, yeah. So they knew me through the music scene. And that, that knowledge of what I was doing through music said, you can come here and be our doctor, come and help us in the struggle. And from that was the invitation from California natives to go out to Standing Rock during the pipeline protest because they saw that I understood these links between social oppression and racism and state violence and health and long-term impact on community health. And so for me, advice I give to the medical students of the Do no Harm Coalition, our organization of now over 2,000 healthcare workers committed to structural change through to address health problems is to not silo themselves in medicine, to allow themselves to be broad, to insist upon their artistry and those things that bring them joy, vitality, and also to work directly taking orders from communities that they love and to become a part of working with those folks. And so that has been beautiful. And as we're putting up the greenhouse on the Ramat Shiloh farm, Every week, every Sunday, there's a whole handful of medical students who come down who are like learning how to use a wrench. And, you know, they're like, this is fascinating. But it's beautiful for them because they're getting to see the connections directly. Like what happens when land is rematriated? What happens when Greg Castro, one of two families who are Ramat Tisholoni because the genocide was so successful on the San Francisco Peninsula, the first land holding in 250 years. what is it like for him to be back there singing those songs? What is it like to plant those oak trees in the middle of these agricultural fields because that was California natives food? What is it like to bring back the hazelnuts? And so I recommend that you look at the work of Martin Reinhardt. He's up in Michigan or is it Minnesota? He's in Anishinaabe territory and he is a native scientist who did the decolonizing diet program. and he was looking at how following a decolonized diet, so by some of it was actually gathering things from the reserves, some of it was going and shopping for buffalo meat as opposed to chicken, but he was able to get himself off of biological agents for inflammatory bowel disease, and he saw some real changes in blood pressure and for indigenous people. So there are exciting projects happening this is a movement, it's a growing movement, it's an exciting movement. And we hope that this book can just uplift the good work that's happening around the world.

It's so powerful. It just reminds me of a story where I was visiting my daughter in Utah, where she was a park ranger in Arches National Park. And we were canyoneering one day, and there was a few other people on the trip with us. And we rappelled down into this kind of area where there's this giant arch. It was kind of a little tricky rappel. But as we were rappelling, there was a like a flash flood. And so, it was a completely dry thing became this waterfall and we got stuck down there. The other people got separated and I was stuck with this guy who was a First Nation man from Canada who was a doctor. And we started chatting and he's like, you know, my family's from this island off the coast of British Columbia and I kind of, you know, became westernized and went to medical school and started eating, you know, western food. And I became diabetic and overweight and high blood pressure and I was feeling terrible. And then I sort of started to pay attention to what my grandfather was eating. And my ancestors were eating the fish and the berries and the hunting and gathering. And his I started to eat that way and everything went away. All my, all my diseases went away. And I, there's another incredible study from Australia where they looked at the aboriginals and they, it's nutrition scientists years ago. It wasn't the 80s, I think. They found a number of aboriginals who who'd been urbanized and who ended up in the cities and had developed all the Western diseases, you know, overweight, high blood pressure, diabetes, heart disease. And they still remembered how to hunt and gather. And she took them from their cities and just threw them back in the outback and said, okay, do what you used to do. And within like six or 12 weeks, everything went away. All their diseases went away. So while it might take decades to get these diseases, often these problems can be reversed within weeks or months. That's amazing. By dealing with the root cause of the inflammation. And, I love the title of the book, Inflame, because it speaks to not just the biological inflammation but the emotional inflammation, the political inflammation, the sort of inflamed nature of our divided society and the chaos that we're seeing now. And, it addresses a lot of those issues in a way that are really fresh and new. And, I think anybody listening to this who really wants to have a fresh perspective on how do we get out of our crazy situation we're in now with burgeoning chronic disease, this COVID epidemic that's crippling the world with the economic stresses on society, and we didn't even touch on this, and I want to spend a few minutes touching on this on the ecological, environmental and climate impacts of our food system. You should read this book because it sort of lays it all out, and I think it's really an important contribution to our thinking, and I hope every political leader in this country guess that book, and I, I know a bunch of them, and I'm going to give it to them personally. So I think it's important. Let's pivot a little bit and talk about the, the environment and climate and, and the way in which our food system has disrupted our natural relationships just, and with nature, and has also led to massive ecological environmental damage and, and in climate change. And it's been, it's been said that climate change may be mostly the result of our food system, up to third to a half of all greenhouse gases can come from some degree to be drawn back to the food system.

Well, that's exactly right. I mean, Mark, you've written about this so eloquently over the course of your writing that the food industry is precisely in the business of turning rich, diverse, ecological zones into dead, sort of green deserts, I think, is the best way of describing it, right? one thing is allowed to live and any other intrusion from the web of life is annihilated chemically, whether it's weeds, whether it's insects, whether it's whatever else, that it must die. And that's the way that monoculture proceeds. And as a result, we're seeing catastrophic declines in insect populations and in biota across the web of life. I remember when I was a kid, reliably when you go outside for a bike ride, come back with flies plastered on your teeth, because that's what they, you know, the world was alive with them. And it's been ages since I've experienced that in just a range of settings because, yeah, the, you know, the biosphere is so widely contaminated.

Wait, wait, I just gotta stop there. That's such a huge statement you made. And I remember my job used to be washing the windows in the car. Yes, I was a gas station jockey. And you know, to scrub your window.

With all those supplies. Oh my God. And they were big too.

And I just, I never occurred to me, but I realized, I don't remember the last time I've done that. I don't remember the last time I drove overnight or long distance and had my window covered with bugs. Like where have all the bugs gone?

That's not a good sign. That is one of the indicators of, you know, there isn't an industry behind that other than the agriculture and the vast arsenal of pesticides which are in our bodies right now. If we've been anywhere near a field or anywhere near the food system, we carry a lot of these chemicals, which are, in some cases, will last for generations in our bodies. That is one trace of industrial agriculture. But the clearing of forests to grow soy to be able to feed pigs, or to be able to feed livestock that then become our burgers, there's a vast amount that industrial agriculture does to the food system. And it is certainly one of the reasons why we have these sort of catastrophic, you know, we're seeing catastrophic weather events. But then there's just the straightforward loss of our relationship with the natural world. I mean, the other side of the term inflamed is that fire is healing, that, you know, inflammation is, as Rupa mentioned, a natural process of the body trying to restore homeostasis in native and indigenous food systems. Fire is part of a Swidden food system. I know that the term hunter-gatherer is one that people will have grown up with, but actually a more precise term is Swidden, because hunter-gathering is one of these colonial terms to describe what the colonizers saw. They didn't see all the tending that was happening after you burn through and after you replant. And so, you know, the idea of the Swidden agricultural system is something that is incredibly rich and knows how to live very well with biodiversity and is misidentified as being, oh, you know, people walking around picking up what they just saw, as opposed to being responsible for cultivating that stuff over generations. So, you know, all of this is to say there are other ways of thinking about fire and about how to live with the things in the web of life. And industrial agriculture not just doesn't just annihilate the locales for that happening, but the knowledge behind how it is that we might live in those locales more sustainably.

Yeah, incredible. How about your perspective on that, Rupa?

Oh, everything that Rog just said. You know, we're working with at our farm this incredible, incredible woman, Sage Lapeña, who's the daughter of Frank Lapeña, a California Native scholar. And Sage was raised with all the traditional ecological knowledge keepers here in California. She's Namtipamwintu, she's Pomo, and she works as a plant medicine woman in one of the tribal health clinics in Sacramento. and she's coming out to the clinic or to the farm. She and I together will be seeing patients together in a decolonizing medicine clinic in Ohlone territory. So just south of Half Moon Bay, in two years we'll have that clinical work up and running. But when Sage, who also was working for the EPA and watershed restoration, so on this 38 acre farm, 22 acres are riparian woodland corridor, and there are alders and cottonwoods and the biggest nettle I've ever seen. I mean, towering at like nine feet high, beautiful, huge nettle, which is an incredible anti-inflammatory food and medicine.

You don't want to walk through it because it'll prick you.

No.

But we're about to harvest the seeds this weekend, which will be really exciting, really high in omega-3s, really great for vitality, balancing hormones. And Sage, you know, the first time she came and we were cutting a trail through this riparian corridor, There was so much medicine everywhere. There was elderberry, there were nettle, there was all these native California foods. And the forest had been completely neglected. People, you know, what we're calling conservation, this is our conservation zone of the farm, is a place of great neglect. In reality, when Portola landed at the mouth of the river that runs through the farm, all of his, this crew got sick. They were looking for Monterey, California, and they ended up finding San Francisco, but they were there at the mouth of the river for four or five days. And it was the people who lived on that river who came and healed them with the food and the medicine from that watershed. And so I think that, you know, to, to imagine a food system that is an actual tending and relationship as opposed to an extracting is something that Western society has very little concept of because all of our economies are based on extraction. It's not just the fossil fuel industry. You just, you know, even organic industrial agriculture is an extractive phenomenon. And right next door to our farm, there's an organic farm. It's a beautiful farm, but it's one of these ones that, you know, where they're, they are, you know, treating the soil as as a substance on which food grows, as opposed to a living being that you have a relationship and a duty and a responsibility to. And that's a very different framework. So what we'll be doing on this farm is a blend of TEK, traditional ecological knowledge, mixed with agroecology from the West and experimenting with how do we create, bring the wild into the farm, how do we create these fingers of interface between where we're cultivating foods and where we're tending the wild. and what does that do for the health of the workers and the health of the foods we produce? And so it's a very exciting project for me to be a part of, because I'm learning more than I ever had about farming and the food system and soil and also California Native culture and how deeply wise it is around health. And to realize that so many people, so many tribes were pushed to, it was a genocide here. And so the reimagining, reawakening of those relationships, the re, the contending with the trauma and the processing and composting that trauma, the crying, the grieving, the reawakening to our duties now, you know, one of our elders, Greg Castor, said to me, he's our farm elder, he's Ramatoshaloni. He says, you know, when we talk about giving land back, we're not going to be like, okay, now we got the land back, you guys all have to leave. It's like, we need your help. We need you to help work with us and, you know, make this better because it's been so deranged and we need to work together. And how do we do that? We do that under their leadership. And for Greg, you know, he's like, we don't have our songs. We have 400 words left of our language. So for us, that means supporting our Indigenous people and giving them the resources and the protection they need to do that work. that reimagining, that reconnecting, and that revitalization of their food systems and their cultural and knowledge ways.

I mean, clearly from the Native American perspective in this country, we've watched it. First, it was the actual physical genocide. Then there was the destruction of their food through the decimation of the buffalo, like you said, the 60 million bison that were killed. Then there was the damming of rivers and disrupting of their ability to actually grow and tended their food the way they were. But then there's the commodification of food that has led to them to be so sick. So we understand this in the Native community very well, and we have disrupted their indigenous traditional systems. But there's populations in America that have been brought here from elsewhere, such as African Americans, who were ripped out of their traditional ways, although they did bring a lot of those. And a lot of the foods in America were braided in the hair of the slaves who came over, and when they brought their seeds with them to grow the food that that now has become part of our culture. But how do you, because that's a much bigger population and the Hispanic population, much bigger population. And they're, they're suffering almost to the same degree, I would say, as the Native Americans. And what, what do you see as, as, as a pathway for them to.

Reclaim their food sovereignty? Well, what's so, it's quite different. What, it's quite different. But it's also quite the same because they're, they are the, again, the victims of colonial terror from the other side. The reason I was born in Ramatisholoni territory is because $42 trillion was stolen from my country. And my parents couldn't imagine a life without abject poverty unless they left. And so when you say we bought, so you're basically a refugee from colonialism, essentially.

All of us are.

All of us diaspora. I mean, so many of us diaspora people are. And so I would say that, you know, first of all, we botched, when you say we botched Native American, like what's happened with Native American, I'd say we are botching. because Line 3 is still being built and the Dakota Access Pipeline is still putting water through the drinking water of the Mnisose, the Missouri River. So these are active colonialism and the violence towards Indigenous people is an active daily experience that's ongoing today. It's not a fait accompli, it's not in the past tense. And so that means there is an opportunity to get involved and stop that violence for all of us, especially healthcare workers. that we actually have a duty and an obligation to step up and stand up and stand in solidarity with those people putting their bodies on the front line right now in front of line three. And so there's that. But then, but what's been beautiful is seeing the partnerships that have happened between Black and Indigenous people around food sovereignty and the recognition and the generosity of Indigenous people to understand the connections of colonial terror that other marginalized groups are suffering under the same system. And so the work that Sage and I are doing in this clinic is to offer free medicine to the healthcare workers who are being exploited by the conventional farming operations on the San Mateo coast of California, and to offer it through a decolonizing perspective that will help them in a different way than maybe just going to the free clinic. And so I think that the opportunities are to build transnational solidarity, between all of us who've been impacted by colonialism. And that includes Europeans, because where did the original colonial terror started? It started in the enclosure of the commons, the advent of private property in Europe. It started in the removal of women from their positions of authority around herbal medicine and medicine systems and the tending of the commons. It started through the same kind of severing of these critical relationships that maintained our health. in order to advance a capitalist agenda. And so there's, what I'm trying to say is there's room for everybody in this work. We all have different kinds of work to do, but we can all roll up our sleeves and get involved.

That's so great. So as we sort of come to close, and I literally could talk to both of you for like a week, and I'm planning on hunting you down and finding you wherever you live, and I'm gonna come to the farm. I'm gonna come to the farm. and I'm just so thrilled to be able to meet both of you. But in the conclusion of your book, share with us your vision for the future and what are the steps that we need to take to reimagine our food system and the kind of inflamed world we live in at all levels?

I think part of the journey is the journey that you pointed the way to Mark, which is to recognize that food and medicine are co-extensive. And to decolonize is to reconnect. And the way that you reconnect is not to care about something, but to care with. We're big on the idea of care. And so far, you know, the limits of our, of what appears to be caring, for example, in the food system, is to you know, buy local and organic and shade grown and dolphin friendly and possibly tuna friendly and whatever it is. But that's not caring with, that's just a kind of patrician worry about the little people or the small things or the other sort of individualist approach that severs the self from the rest of community. So caring with is and the idea of a care revolution is one that you can see not only in policies like a People's Green New Deal or the Red, Black and Green New Deal, which is also a really important intervention linking Indigenous and Black communities in the United States around how it is we're going to survive the climate emergency. But at their heart are ideas about how we need to repair our relationships. I mean, that involves reparations, but it also involves repairing our broken relationships with the planet. And the idea there is an agroecological transformation. So not just what happens on the farm, but what happens to enable things to happen on the farm and on the plate and back again, these reverberating relationships from farm to fork and back again throughout society. And, you know, the upshot is precisely the kinds of work we're all three of us are journeying towards, a world that is whole, that is healthy, where we have reconnected with one another through the pleasure of our plates in community. Again, not individually. but together. And if that means we get a few more insects stuck in our teeth on the way there and back, that's a good sign.

It's good when I'm biking, but it's not good for the planet. How about you, Rupert? What do you see as a way forward to de-inflame our world?

Yeah, I think it's to center care. It is the care revolution. And it's the care of the planet, the care of each other. and COVID is giving us an opportunity. And since we didn't learn it last year, now we have the Delta variant. And I have a feeling we're going to keep seeing this until we start, you know, actually caring. And I see it as being a dismantling of colonial systems and a creating of different social norms and being a guest here on a stolen native land. and really living as a guest with other communities of people from different nations who are guests on this stolen land and honoring the Indigenous people who are still here and taking care of their lands. It means stewarding, like you're saying, being in a stewarding and taking care. And I can see it, and I can see it, and I have seen moments and glimpses and spaces where this is occurring. And what was most exciting for me about writing this book with Raj was the opportunity to share so many examples with other people so that they might see it and they might venture out of what they think they know to these other places where these experiments are happening, these bold and beautiful experiments. So I-- that's so great. Yeah, I feel very hopeful I, I've never been afraid of hard work and, and this is going to be hard work, but it's not going to be harder than my last few shifts with COVID patients.

So, no, for sure. And I'm just so thrilled that both of you're doing this work. And it is hopeful. And I, I'm going to buy your book for my daughter who's about to enter medical school because I think she, she will love it. She goes down every Thanksgiving to Black Mesa in the Navajo reservation to, you know, just help them with basic stuff. And then listening to her stories, it's just heartbreaking. They don't have heat for the winter. So if they hadn't, like, if I hadn't donated five thousand dollars for her to get a truck and get the wood and bring it to this old guy in his little Hut, he would have frozen it. Like, it's the difference between life and death there for them. And they're, they're so, they're so marginalized. And I think we, we see this in extreme examples in those communities, but It happens everywhere. All of us are disenfranchised, disconnected, and suffering from the soul sickness. And what you're promising is a way to not just deal with social injustice, but to reclaim our souls as a species. And, it just touches my heart. I'm so grateful for your work. And, thank you for being guests on the Doctor's Pharmacy.

Thank you so much, Mark.

That was wonderful. Yeah. And, everybody make sure you go out and get the book, Enflamed. It's a fabulous read. And, It's really one of the most important books of our time calling out things that really haven't been called out in the way they have. So, it's Inflame Deep Medicine, the Anatomy of Injustice. Check it out. And, if you love this podcast, share it with everybody because it's important and subscribe where you get your podcasts. Leave a comment, where have you found a way to reclaim your food sovereignty even as an individual? Share it with us. We'd love to hear. And, we'll see you next week on the Doctor's Pharmacy.

Hey everybody, it's Dr. Hyman.

Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing which is called Mark's Picks. It's my weekly newsletter and in it I share my favorite stuff. from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S. and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Hi everyone.

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