Episode 127: Food as Medicine with Erin Martin

Hi friends, this is John. Welcome back to the Regenerative Agriculture podcast. Today I'm delighted to have a guest who I've been wanting to interview for a long time, Aaron Martin. Aaron. I've been wanting to talk to Aaron because For close to 20 years I have held the belief that we could produce food that had such strong nutritional integrity and microbiome integrity that we could have a legitimate conversation about growing food as medicine. And I think this foundational idea holds true from a perspective of mineral nutritional integrity. William Albrecht did some great foundational research work in that domain 80 years ago. And when we understand the role that zinc and selenium play in enhancing our own immune system, this seems like a very obvious direct connection. Then there's also the connection of phytonutrients and the phytonutrients that different foods contain in the medicinal benefit that they have. But the reality is there is very little research, very little systemic research, and there are many links in the chain that are missing in the literature on making the connections between soil health and plant health and livestock health and human health. It seems logical, it seems like common sense. I would contend that it is. And yet we live in a world where there is a lot of science needed to justify that and to rationalize why we need to do things a certain way, particularly when we start having conversations around policy and anytime money gets involved. So for all those reasons, I've really been wanting to talk with you, Aaron, about the work that you are doing and translating the hypothetical idealistic point of view of food as medicine into something that is practical and real. So thank you for being here. I've really been looking forward to this discussion. Tell us a bit about what you are working on and the progression. What has your journey been like around food as medicine and what is the scope of the project that you're working on today?

Thank you so much for having me, John. I've really looked forward to it as well. I have a very different background than a lot of people who kind of found themselves in agriculture. I came from the lens of long term care and seeing what the end of people's lives looked like, particularly in America and particularly in our long term care system. So I started working in a retirement community when I was 15 years old and from there I just started seeing the systems of aging in the healthcare system and what it paid for and what it didn't pay for. And by the time I was in my mid-20s, I had worked in all levels of long term care and I was actually completing My master's in gerontology, which is the study of aging at that time. And I took this course called the Physiology of Aging Process. And I started to learn about food as medicine and the differences between, like, large orange carrots that are highly produced and like little purple carrots. And they actually showed us a picture and started talking about that. And they actually talked about how vitamins. There's no double blind studies on, like, vitamins that you take, like in a pill form that are showing these big improvements. And they actually told us as gerontologists that we should actually take our clients off of all their vitamins, except maybe vitamin D. And it was very shocking to hear that. And they were reiterating that our nutrients should come from our food. And so I'm like, okay, so I have that kind of information from the number one school of gerontology in the world. That's science solid. And then I started studying the blue zones of the world where people age the longest in the world. The highest concentration of centenarians, there's about six or seven blue zones, maybe other kind of quasi blue zones. And I got to go to Italy and I studied death and dying there. And I started really paying attention to the food quality. And it was really interesting to me. And I kind of had this aha moment and still was understanding food as medicine. But the problem was is that I hadn't connected it yet to soil health. And so I got certified in soil advocacy shortly after, and I started reading the Science of Regenerative Agriculture, and I started reading about how depleted our food was. So I'm thinking, okay, they teach us in gerontology school that we need to be getting our nutrients from food, but if the food is depleted in nutrients, then what are you going to do? And so I really started correlating this depletion of nutrients in our food to the massive progression of chronic disease. And how I was seeing that in older people and seeing how this was such an unnecessary suffering that if we really restored our growing practice in our soil health, we could have nutrient dense food and maybe even more nutrient dense food than we've ever imagined and it has have had access to before. And so in 2021, right out of the pandemic, I had linked up with a doctor who had said, my patients are compliant with their doctor's visits, they're compliant with their medications, but they're getting worse. And it's the food. And so he wanted to prescribe food. And I first learned that there were other programs that had done this all over the country. And they were saying if you educate people and if you also provide them access to food. So a hybrid of both education and food that you can actually reduce someone's A1C level that they measure with diabetes by 1 to 2 points in. In a year, which can be the difference between an amputation or not, or kidney failure or not. And so we started with a pilot program in 2021 with 52 patients. We've tripled in size since then. We not only see patients from that original clinic that we launched with that doctor, but now see people from over 22 primary care clinics. And our record weight loss so far has been 117. That was a new information yesterday. One more pound 117 coming off of all her medications in eight months. So we're starting to see this kind of happen all over the country. And it's just become the light of my life and really connecting the dots of soil health all the way to human health and having the data to prove it.

Wow, Aaron, when you open a can of worms, you open it all the way and you dump it out on the ground.

Yeah, we've got to.

There's so much there for us to unwrap. But first, I want to just say, gentlemen, Gerontology school, teaching nutrition and teaching food as medicine. It's like I have many friends who are MDs and they describe how they get no nutrition training. So you're the first person that I'm speaking with who is a health professional who is describing that you actually were informed and received an education on food as medicine as a part of your formal training. That's the first time I've ever heard of that.

Yeah. And so some doctors do come over to the Gerontology school and who are going to become like geriatricians. There's a lot of caveats when it comes to older adults that are different in like the medical world, like just like taking their temperature, it can be a little bit different. There's all these differences. But the Gerontology school is a social work based school. And there are doctors that come over there and then there's entrepreneurs like myself that go through that school. There's other leaders that go on to be like heads of assisted living. So we get this wide range of understanding of the psychological changes of aging, the physiological changes of aging, and the social and cultural impacts of aging. And the particular doctor who taught this class and who teaches even UCLA doctors, he was the dean of the gerontology school for 17 years. So he's an MD teaching the physiological Changes of aging courses. And he tries to train other doctors about this stuff. And so it's really an elective, essentially, that doctors could take. And so you're right, MDs don't get a lot of that information. There's a lot of doctors working on getting that more included. But from the gerontology lens, that's something the gerontology school really pushes. So if MDs come over there, they would get that feedback. We also, that gerontology school is home to Dr. Valter Longo, who is famous for the Prolon diet, which is mimicking fasting. He also wrote the book the Longevity Diet, which I base a lot of my work in. And so that's another nutrition track within the gerontology school. So some nutrition gerontologists take that. But again, if it's a medical professional, they would have to kind of choose to include that in their education. And it shouldn't be an elective, but that is offered at the gerontology school. So I was really lucky to get a lot of experience to that.

You know, I find it intriguing that this is offered within the domain of gerontology because it reminds me of this quote. I think I've heard it most frequently from Arden Anderson. I'm assuming it originates with him. But he frequently, in his lectures, he will say that the problem from a healthcare perspective today is that we tend to live too short and die too long. And of course, he's referring to the rapid declines in overall health. Like there's not in many cases, there can be very limited life satisfaction and enjoyment of life in the last third of life, because everyone is on, or shouldn't say everyone, but many people are on half a dozen medications and they're not feeling well.

Yeah. And actually the. The average in the United States is if you're 65 and older, you're on an average of 50, 15 or more prescription drugs per year. Yeah. And I saw people on 15 to 32 prescription drugs, and the 32 would include, like, prescription ointments and additional things, but it was still 32 medications. And I really think a lot of that is making people worse. And so we're seeing that happen. And you're right, people are dying longer and they're having less quality of life. And actually, there's a myth that we think we're living longer. We're actually, our lifespan is decreasing. And people really need to understand that. We have 10,000 baby boomers turning 65 every single day who are on an average of 15 or more prescription drugs with at least two or more comorbidities, and food can pretty much heal it all. There's some, definitely some deeper healing that needs to happen. But it's so amazing how people in our program have been diabetic for like a decade, right? And then they come into our program and in 11 months or even a matter of weeks, they're lowering their A1C, they're lowering their weight, they're feeling better, they're not feeling as mentally unstable. Like it's the biggest ripple effect. And so it's really exciting to see that this is starting to become more mainstream. But we also want to make sure, you know, there's always, there's always people are going to take and say food is medicine, when maybe it's not really food is medicine. And it's amazing still how people even who are enacting food as medicine programs have never thought about where the food comes from. And there's still this disconnect even within food as medicine. And so I've been trying to be very vocal about that. And it's just a really important point to make.

Let's go back for just a moment. You said that our lifespan is actually declining. I've been aware, I've been paying attention to this data for the last decade and a half. And yet we still see this common argument being made that our lifespan is actually extending and that a century or two centuries ago, our average life expectancy was 35 or 40 years old. And of course, this is a complete obfuscation of the fact that we had high infant mortality. But once you made it past a certain stage, you actually could expect to live longer and have greater quality of life than we do today. When did this trend shift where we started losing quality of life, or not just quality of life, but also length of life?

Well, when we were studying it, this would have been like over 10 years ago when some of this data started coming out. And I think a lot of some of the data pertains, pertain to drug addiction and drug overdose with the opioid pandemic as well, and just the over prescription of meds. And I think polypharmacy, the idea of polypharmacy where we're over prescribing and it's just like this avalanche effect of like they prescribe a med and then there's a side effect and they have to prescribe another one. I mean, that's probably started happening much longer ago. And so I don't know exactly when that happened, but I'm sure It's been a progression over the last 40, 50 years. And I don't know if you have any other thoughts about that or when that maybe started happening, but we spend more on our health care in the last 72 hours in somebody's life than we do their entire lifespan. And we don't emphasize prevention. And so maybe when we started really producing all these medications and devaluing preventative care, that's when that kind of slope, I would guess would start because we started really interfering with people's quality of life and really valuing like emergency medicine or just keeping people alive for the sake of keeping people alive. And so I'm sure that has a lot to do with health care requirements and stipulations, and a lot of that goes back to the money. But I would argue that more prevention would create a more sustainable economy. So I think we've got it a little backwards there.

More than a little. We've got it completely backwards. And I do want to dig into that, but I'd love to get your perspective. I have the privilege and joy of working with many farmers and many growers from all over the world every day. I find it interesting that there is a large group of farmers who take a great deal of pride in growing food. To feed the world like that is a mantra that has been. There's been a lot of indoctrination around that and a lot of pride around that. When in fact, not only are they not producing healthy food, but their divorce from the quality of the product that they're actually producing is also reflected in their own personal life and their own personal health. So when I travel across the America Midwest, the Midwest is called a good food desert for a very good reason that once you're outside the major metropolis areas out in the rural countryside, getting high quality nutritious food is actually very challenging. And do you have any perspective on what is the relative state of health and the state of food quality in the rural countryside for farmers compared to the rest of society?

I would say it's much, much worse. Like the food is medicine programs that are going on. A lot of these are in metro areas. And rural America tends to be ignored. And that actually has become a big attention of mine is thinking about rural America and healthcare in rural America. And I've seen the same thing where even farmers who maybe are using regenerative practices, they're still not applying it to their own bodies. And so that's why when I spoke at no Till on the Plains a couple of years ago, it was Amazing to see how many even regenerative farmers were diabetic and obese. And most of those farmers were obese in the room. And we really need to be the reflection of our work. And it would just be like me going around promoting food as medicine, but being obese and eating McDonald's, like, no one's gonna really like, even subliminally or subconsciously, believe me. And it needs to align. And so I really want to see that happen more and more. But I think that there's all these misconceptions. I had a really interesting conversation with a congressman staffer when I was being interviewed to present before Congress. And I was trying to talk to them about how the food quality needs to improve in these food programs. And they were immediately like, whoa, it's not the farmer's fault. They're producing really high quality food. It's the processing that's the problem. And I couldn't help myself but correct this. I said, and yes, it's not the farmer's fault, but they've been incentivized and they've been supplemented to make lower quality food in higher quantity. And we have completely given up quality over quantity. They're incentivized and subsidized to do that. And so it's not their fault they're trapped in this system. And it's hard to change. And it's hard when your father and your father's father were doing that. But I had to make a point and say, no, we're not producing nutritional quality food from the get go, and then it's being processed and even worsened in that way. But there's both, it's both, it's. And exactly this and this are happening. And so rural America, I think, I think there's this huge benefit to food is medicine programs because if you source local food and you're going to source quality regenerative food on the backs of these programs. I argued in front of Congress that these food is medicine programs, when done properly and sourced properly, have the ability to resurrect rural economy. And that's what we need to include in policy, is not only, yes, there needs to be regular sustainable funding for her food is medicine programs, but there needs to be procurement requirements and incentives for farmers to be paid based on quality over quantity. And that's what will restore our local food systems in our health.

I completely agree with what you're describing. We have, for the last seven decades or maybe longer, we have not had a quality food policy. We have had a cheap food Policy. And, you know, I find it so fascinating that at this particular moment in our political history, I'm not even aware that we have a food sovereignty policy or a food security like we have. When you look at the proportion and the quantity of actual food that gets imported into this country, we import something like, I think the number is the neighborhood of 65% of our fresh food, fruits and vegetables at this point.

Right. Yeah. We're vulnerable. We're totally vulnerable. And we saw that during the pandemic. Yeah, yeah. And we should have these policies. You're absolutely right. And we need to elevate these policies. And we talk a lot about food insecurity and I'm trying to get people to stop using that term because if you have access to junk food, then you're not technically food insecure, you're nutrition insecure, and we're all nutrition insecure. And so changing this language and reframing, it's. Along with the reframing and defining nutrient density, I think is going to be really important. And making sure we have those policies. We should, we should have food sovereign policies and nutrition security policies. So I agree with you, John. That's a good idea.

So let's. We continue to go down all kinds of interesting rabbit trails that I'd like to pursue further. But I think it's important for our listeners, for us to continue create some clarity. Like what is the. Let's dig a bit deeper. What is the scope of the work that you were doing today? You mentioned that in 2021 you started working with 50 patients and that you've now tripled the scope of that program. What is it that you're doing exactly? What does it look like?

Yeah. So yeah, food is medicine programs. I'll tell you kind of how they're. They're all a little bit different, but we've kind of come up with a very innovative model that we use. Patients get bi weekly produce every other week for 26 deliveries. So they get the program for 12 months and every other week they get fruits and vegetables. Our intention is to increase their consumption of fruits and vegetables. We have like a curated CSA model where we have dignity of choice so we don't pre bag their food for them. So we're not just giving a food handout. They're coming in and they're learning about the food. They get correlating recipes and they get to pick the food that they're going to take home that day. At the same time, they get a cooking demonstration or a nutrition class or we also do some stress management where we include yoga, breathwork and meditation. And then we also have health metric checkpoints every three months where we measure A1C blood pressure and weight. And with our pre and post surveys of the program, we measure additional metrics that include pain management, socialization, mental health and other items. So there's basically three nuts and bolts to the program. It's the food that they get the whole fruits and vegetables every other week for a year, plus cooking and cooking and nutrition classes and stress management classes. They get about four to five of those classes a month. They're required to do two. There's also virtual options, so we have a YouTube channel. If you search FreshRx Oklahoma, you can see all our cooking demos and our nutrition classes. And we're starting this shopping series which is really, really cool, where we're taking the participants through a specific store. I'm excited for the dollar general one. Like if you only have a dollar general, how do you shop healthy there? What's the healthiest option within that option? Right. And sometimes that's people's only option. So we're doing these like fun, engaging classes. And I think we've really designed that curriculum. It's under an accredited curriculum, but it's also our own curated curriculum that's way more fun and engaging. So we really have this, this energy of empowerment and a lot of support and love that we provide our participants. And we build the door, we build the door frame, we build the door for them and we hand them the key, but they have to walk through it. So it is a commitment for them. And they get an enrollment kit when they start. They get some cooking utensils, a cookbook, produce storage sheets, and some other helpful resources. We give them some other social services resources. We give them a binder to save all their recipes through the program. And if the participant shows improvement over the year and they've been engaged, we do enroll them for a re. Enroll them for a second year. Because we've seen people, for example, go from. And just for listeners context, a 1C measure if they are uncontrolled diabetes, which means they're at extreme risk for heart attack, stroke, kidney failure, amputation or death. It's above a seven point and the scale is really small. So if you above a 6 is type 2 diabetes and it measures just to 14. So it's a really small scale, 6 to a 14. And we see people in the 1314 range and we say they're first in the program. They have like a 13 or a 14. They will drop down one or two points in the year. On average, we've seen people go from a 13.6 to a 5.4 in six months. That means they fully reverse their diabetes or went into pre diabetes or even beyond just to normal ranges very fast. And these are people again that have had these chronic diseases for decades. And, and we're just giving them the tools they need. So we do re enroll people. So we have seen in other studies like in North Carolina, they have seen increased benefit of re enrolling and continuing to enroll folks. So they could go from 11 to a 9 in a year and then maybe the second year they go from a 9 to a 6.6 and they're down to the pre diabetes range. That and it's way cheaper. So for context on ROI, if we reduce someone's a 1C by 1 to 2 points in the year, there's lots of different numbers on this, but it can reduce healthcare costs by 16 to $24,000 per year per patient 1 to 2 points.

Wow.

And it only costs us anywhere between like three to five grand a year to serve someone. So the ROI is huge. And so it actually behooves us to continue to enroll them and to continue to pay for these programs. And these programs are applicable not only to diabetes, but they are serving people who not in our program currently, but other programs are serving people with some cancers. They're serving people with basically any metabolic disease. And so we're really excited about the development of the lifestyle medicine doctors and how that's kind of becoming more prevalent. And there's a local lifestyle medicine doctor here that is wanting to do a partnership. So we're really excited to see doctors who are champions for this work and, and that this is applicable to all sorts of metabolic disease. Our program is still grant funded. We get grant money. So it's a free program to the participants. We target underserved, low income areas that are food insecure and in a food desert, but also have high mortality rates of diabetes. So we're going into these highly needed high cost areas as far as healthcare. And we're going in and we're like fixing this problem. And so we're excited eventually other programs in other parts of the country. We've actually seen 15 states include food is medicine as an insurance benefit through state Medicaid. We're trying to do the same thing in Oklahoma, but we are seeing health plans are really interested in this. They need to, they need to save money. They're overburdened by these frequent flyers as they call them, they're always going back into the hospital, and so we're saving them a ton of money and we want to contract directly with them. So we're excited. We are hoping it's coming soon.

Wow. So many things to unwrap here. But when you were describing your impact in the ROI on diabetes and your ability to reverse diabetes with diet, isn't the official mantra of. I forget who the official rule makers or policymakers are supposed to be, that the FDA or the NIH or who is it exactly? It is. But isn't the official policy still that diet has no impact on diabetes?

Well, I think that was the belief for a long time. I'm hoping that's kind of changing.

But I still see these. I still see these clips coming up all the time, like the. The official narrative.

Yeah, they still talk about how you're supposed to manage your diabetes, and instead of, you know, they're not using really the words like reverse. I think we have seen studies that say you can reverse with diet and exercise. But again, you're right. It's the overarching message that patients are getting. And you know what's really amazing, John, is that, you know, like I said, these people have had diabetes for a decade, right? And then they come to us and we help them. When we first enroll them, we start talking to them about all their ailments, all the things, my neck, my back hurts, I feel depressed, you know, blah, blah, blah. And we say to them, food can help with all of that. Like, that's the first time they're ever hearing that. And they've been seeing doctors for their diabetes for a decade. But we're the first ones to tell them that. And we're the first ones that have the time. We have the funding to handhold them and explain all these things to them, or the doctors don't have that time. So the doctors love this. They love the fact that they can send them to us. And it's not an extra shot, it's not an extra prescription, and it's. It's a program that's going to have it going to handhold and support these folks. So the doctors love it. And then, of course, the doctors benefit because they're able to reach their goals for their patients through us. So you're right, there's still. There's still people who don't agree that diet fixes anything or has anything to do with it, which is amazing to me.

I would have to go back and dig up the exact reference, but I'm still seeing clips of officials from the FDA saying that sugar has no impact on diabetes. It's like this is like fundamental 101. But when you have a question that I have for the people who are coming into your program, where are they coming from and who are they? What are the types of parameters, who is sending people to you and also what are the specific ailments or illnesses that you are working with?

With. Yeah. So most of these folks we launched out of the North Tulsa area. So North Tulsa is predominantly a black community. Many of those black community members are also Native American. A lot of these folks were displaced and pushed kind of out north of Tulsa because of redlining and also the history of the Tulsa race massacre. So there was a big divide between North Tulsa and south Tulsa. And in fact there at any time there's been anywhere between like an 8 and 10 year lifespan difference between people living in North Tulsa versus South Tulsa. The chronic disease that we focus on is type 2 diabetes. Although our participants also have COPD and heart disease, high blood pressure, high cholesterol. Many have been diagnosed with depression and anxiety as well. So they have all these different chronic diseases. Also this area did not have a grocery store for 14 years. So this has been a food desert area. So they're not only they're of color, they're low income and they're in a food desert. So they're food insecure as well. And they have comorbidities. So those are the folks that we're seeing. We get referrals in two different ways. People can self refer through our website. We have a pre screen or where we're trying to make sure that they're really prepared for the program. So one of the things is like they have to have a working refrigerator in order to store all the produce. Right. They need to have a way to cook the produce. So if someone is kind of quasi homeless, then the program probably wouldn't work well for them. The people who excel the most are the ones who do have transportation or can carpool and get there. We find the people that come in person who can be engaged in classes and be engaged with our team members. They have the most success. It's not to say that the people on delivery can't have success and they have. We just don't see as much success with that. So the folks with transportation and that's a big challenge is the transportation. So we've seen people carpool or maybe use non emergency medical transport to get there as well, kind of maybe through their health plans or our state Medicaid. So those are the kind of folks we predominantly see, mostly females. It's predominantly older adults. We do have some younger folks, maybe in their 30s and 40s, but I say predominantly anywhere from 52. We've had a 93 year old in our program. So predominantly older adults, predominantly women. We do see women and their husbands enroll that both have diabetes. So we sometimes have kind of couple family units that come in or there's an aunt and a niece that are coming in together that both have diabetes. So a lot of them, since it's in a 13 zip code area that we serve per our grant funding, a lot of them are neighbors or went to school with each other. And so they're really creating community around their healing journey. So those are the types of people that we serve.

And you spoke to this a little bit earlier, but I'd love for you to just expand this. What are the types of health outcomes that you're observing? You've spoken a little bit to the diabetes improvement. There's, there's health outcomes, there's, there's a broad range of diabetes and additional outcomes. What's the deep dive?

Yeah, so we've been measuring three major health metrics every three months. So we get a baseline measurement before they enroll in the program and then we get four quarters of data. So we really have five data points throughout the program just with the health metrics. And we measure A1C weight and blood pressure. And what's interesting is we don't actually see the weight loss correlate with the A1C. Now some of them do correlate, but people's A1C, their blood sugar and their insulin resistance can reduce without necessarily their weight reducing. So we see huge shifts, especially with people with uncontrolled diabetes. We have about 80% stay in the program for the full year. So we do lose some people due to multiple different reasons. And about 80% of those people that complete the program, they have an average reduction of about a 2.2 point reduction in their A1C. See. And then we've had the largest reduction, like I said, was from a 13.6 to a 5.4. And with the weight, we've seen kind of an average weight loss of anywhere between 9 and 12 pounds. Our first year, the largest weight loss was 72 pounds. And then as I mentioned earlier, our largest weight loss this year has hit a record as of yesterday for 117lbs. We have seen people's blood pressure kind of equalized. But I don't think we see as much there. We really would love to start looking at cholesterol because there's some correlations there with insulin resistance that we could see more change in people that maybe have an A1C that's more controlled. And then also with our pre and post surveys, we're seeing are they changing their diet? So we do a nutrition screener. So we're seeing how many people are increasing their consumption of fruits and vegetables. And statistically what we've seen a significant change in is we've seen a significant increase in consumption of garden salads and vegetable soup. And then we've seen as a direct byproduct, we've seen a statistical significant decrease in consumption of soda. And so that's been really cool to see. And then we have also seen with our statistics that of course their increase in consumption of fruits and vegetables directly relates to to the improvement of their overall health.

That's one of the next pieces that I want to get into is what is the food that you're providing? It's fresh produce. It's fresh fruits and vegetables. You described how you learned about the differences in gerontology school between small purple carrots versus large commodity produced orange carrots. How are you incorporating that perspective of nutritional integrity into the produce that you're providing?

That's such a great question, John. And it's become like my favorite question. And so I'll tell you a little bit of a backstory about this because it's really fun. There was a community committee that was kind of putting this program together. And originally the doctor who wanted to do this program, he said, oh, we'll just source from Walmart or Amazon. And I said, whoa, whoa, whoa, wait a second. I said, if you want me. So they wanted me to fundraise for the program and execute it and staff it and like carry the torch, right? And I said, if you want me to do all that, I'm going to source only local and regenerative Lee grown produce. And the committee was like, good luck. Like, there's no way that you're going to be able to do that. And there's no way you're going to, number one, do it at scale and number two, you're not going to be able to do it year round. And I said, okay. I like a challenge. I love when people say I can't do something because I'm like, all right, watch me. So when I started, I started by finding the farmers and talking to them about their practices and visiting their farms and slowly over A few months I built a small cohort of growers that really cared. They actually many of them, surprisingly, which is not average, they were younger farmers who had quit their corporate jobs and said no more like we care about the health of our families, we understand these practices are better, we're done with this. We want to grow our own food and we also want to be farmers and sell it to the community. And so I was able to find some really extraordinary growers. I started at the farmer's market and I would interrogate all the farmers to see what practices they were using. And a lot of them may not have identified as regenerative farmers, but they certainly were using regenerative practices or at least on the spectrum of those practices. And so we definitely don't work with farmers or source if they're using pesticides or herbicides. They're using very little to no till practices. Many are incorporating cover crops, some are incorporating livestock integration. And so now I've built a Cohort, we've certain 27 small scale farmers that are using regenerative practices. We source directly from those farmers, we pay the price they want. It's a little bit cheaper than farmers market rate, but it's not cheap. We want to pay for the quality and we want them to kind of dictate their pricing. And so we have really seen them grow economically from sourcing from them. When we first started with those 52 patients, I just had to buy everything they had available and now I'm having to keep up with them. So now they've grown so much that we need to enroll more people so we can keep up with the quantity that the farmers have available. And we've seen the farmers increase their growing areas dramatically by being stimulated through this program. We've estimated about a 1.5 million investment in local economics through purchasing locally through our program. And we've also helped farmers get funded for things through the USDA and the nrcs like high tunnels to extend their seasons. So we have provided food to 150 people twice a week and then before that when we had less participants. We've provided food year round since July of 2021 and we've never stopped. And like I said, now we have more produce than we can handle and we've got to scale our program side so we can buy more produce. The farmers.

So you are prioritizing sourcing locally and from farmers who are using regenerative practices. But I'm going to ask the, the purple carrot question again. Are you asking farmers to specifically grow produce that is genetically capable of producing higher nutrient concentrations, like a purple carrot instead of an orange carrot.

We are trying to ask them to grow more like indigenous varieties of foods and also heirloom varieties of foods. And they already have an interest in that. But I think I'm excited about kind of as we move forward and kind of honing in on that a little bit more. So, John, that may be something you can even talk to as well. But, yes, I think the varieties have a lot to do with it. We do have access to some indigenous seeds for, like, some watermelon and squash and some corn that is more nutrient dense. And so our farmers have been kind of experimenting with that. We've done some Haney tests, some soil Haney tests on some of the farms to see, you know, what their soil organic matter looks like. But I think there's so much more testing that we could be doing to prove our program. Because the argument I get and the pushback I get all the time is that is it really correlating? You know, is this way you're sourcing really making the program better, or could any fruits and vegetables do that? And I would say I haven't measured it exactly, but I would say that we have better engagement in our program because the food tastes better. I would say they're probably more satiated because the food is more nutrient dense. But again, I would love to be able to show the nutrient value of our food that we're providing versus maybe a program that's just providing conventional fruits and vegetables. And, John, that's where, you know, the work is kind of happening now around nutrient density. And that's the big question. And so I'd love for you to add on. On what your thoughts are that on that and how much more we could improve nutrient density and why that's so important.

Well, based on people's anecdotal evidence and personal experiences who are specifically focusing on growing very nutritious food, we know that it can be much more satiating and it's much more nutritious, and that there are remarkable health outcomes. But it is such a broad field, and there's such a tremendous scope of foundational research, basic research that needs to be done that has not been done. It's. It's a question of where are the hundred places that you begin? There's not even one place to begin. There's a hundred places that we need to begin from.

Right.

Lots of open questions that need to be answered. A bit ago in the conversation you were describing the ROI and the the impact that you were having from an economic perspective. And so I have kind of a two part question ROI for who and who is paying for the program? And also how do you see this developing and scaling like this is. Diabetes is an epidemic right now. You have tens of millions of potential patients all across the country. Where does the drive come from to scale the work that you are doing?

Yeah. So on your first question, the roi, so the return on investment on these programs are extraordinary. In the 16 to $24,000 per 1 to 2 a 1c drop that I was mentioning before is based on like how many visits they're going to the doctor. It could be reduction of their medications. There's all these savings that are happening and who's saving that money? Right. And that's a really good question. And that's kind of where I think the financial model needs to adjust a little bit. But, but say the people that we're serving are on SoonerCare, which is Oklahoma State Medicaid. It means the state is saving that money. So we're helping the state and we're grant funded. So there's foundations or also we're partly funded through the USDA under the farm bill. So essentially somebody else is footing the bill to benefit the state Medicaid or if we have also other people that are on maybe Medicare or other commercial plans, then they're also benefiting from that. Now I would say the community is benefiting from that. If you have people that are healthier, there's other ripple effects of ROI is about local economy. And maybe people can like with the farmers, why there's economic impact there is that they're able to hire people, so they're creating jobs. So it's more like workforce development. But again, the health insurance is saving that money. And for example also hospitals are saving that money because what happens now if someone's readmitted within 30 days for the same problem at a hospital, the hospital gets deemed like around $20,000 as a penalty fee. And so if we're preventing people from being readmitted into hospitals because we're controlling their diabetes or even reversing it, the hospitals are always also saving that money. And so I think as we involve and engage with health payers and health systems, it's going okay, we're helping you achieve these goals that you all have been supposed to be achieving for a long time. And in order for this to be a financially mutually beneficial arrangement and relationship, then we ought to share in those cost savings. So in health payers, they get a capitated rate per month per member to provide all their health care. And if they're under that amount, then they get to save that amount. And so let's just save for generalizations. They get $1,000 per month per member and say they contract with us and they only have to spend $500 a month per member. And so there's this $500 difference that they get to save. So not only should the organization who's providing food as medicine share in that cost savings, my argument is some of that should go back to the farmers because they're the pharmacists. And so I think rearranging this financial relationship will really create sustainability in the programs that are actually achieving these health outcomes. And we have to start seeing these food is medicine programs as a care plan, as a care model that are not to be just used. And like health plan shouldn't just benefit off the backs of these struggling community based organizations. Like these community based organizations are producing these health outcomes. And that's how this scales financially and that's how we scale regenerative agriculture and that's how we scale getting people healthy. And I think we've got to scale it, but we need to, it needs to be localized and scaled. And that could happen in rural America, everywhere. I think it's just a matter of aggregating food, providing education, and having a pickup spot in these rural areas. Done and done.

You know, 20 years ago, Dan Kittredge and I used to sit around a campfire. We had a group of colleagues who would sit there and ask us questions and kind of encourage us and prod us. And we got into these deep, deep conversations around the dysfunction of our food production system and what the potential promises of nutritional, high nutritional quality food, food as medicine, and how we implement that and how we get that to scale. And 20 years ago I said that I believe the leverage point for facilitating changes when people really understand, when people really get the health implications of what food as medicine can mean and can provide, then the people who, the organizations who would really drive this change would be the insurance companies because they are the ones that stand to benefit and stand to make a lot of money from reduced health care costs.

That's right. So that's right.

How do you see this evolving?

Well, I. We're already seeing health payers contract with these organizations. You know, one of the first states to do this is in Massachusetts. And of course we've seen, what's great is we've seen states in either really red states or blue states, so very Bipartisan. We were seeing this in Florida and Kentucky. We're seeing this in like self insured in employees. There's a lot of conversation around employee self insured models. What's interesting is like in hospital systems, the staff, they're also. It's all self insured under the health system. And we actually see some of the worst health outcomes in employees of Health Systems and Appalachia.

Hey wait, wait, wait, wait, hang on. We see the worst health outcomes in employees. Self insured employees of health of health systems.

Yes.

I think they have the wrong name. Then they can no longer be qualified to be called health systems systems.

Sick care. Sick care. Yeah, yeah, sick care. So right now we're kind of throwing the darts at the, at the map and just seeing kind of where it lands. There's all these pathways, these funding pathways that can happen. They can be through state Medicaid, which is for low income folks at the state level. And we've already seen 15 states pass this. Alaska is about to finalize theirs. We've actually seen Hawaii do it and also include local procurement policies along with that. So that's associated in with the healthcare piece. We're seeing commercial insurance is doing this. So I would say within the next three to five years this will be federalized. And of course there's going to be people calling themselves food as medicine that don't really source medicinal food. But if we can echo each other and we can kind of keep people's feet to the fire on this and we can continue to show examples like FreshRx, Oklahoma or Recipe for Health which is in California that sources regenerative produce for their model. They're scaled to a thousand people. They've contracted with health payers. But I see health insurance paying for these things. I see them paying for more things outside of clinical care because actually 80% of health care actually happens outside of clinic care and that's with housing, transportation, food and mental health. And so I see health insurance kind of switching from this fee for service model paying for things that are really not working to paying for those things like housing, food, transportation. We're already seeing that in states like North Carolina and they're improving health dramatically. So I see the health care model really shifting to this value based care, this value based outcomes that people are paid for outcomes they're not going to be paid any more for. Just every time they see somebody they not fixing anything, they're not going to be paid for that anymore. It's going to be based on outcomes. And the health insurance I Think now needs to invest in the farms and then we're going to be really getting somewhere. But I wish I was around that campfire with you guys 20 years ago, but I would have been. I would have been in my rebellious teen years, so maybe you wouldn't have wanted me then, but it'd be great to get back together and talk more.

But we're probably in the same age range, so we were still in our rebellious teen years at that point.

Oh, good. Well, maybe it would have been fun then. Yeah. I've talked a lot about Dan Kitcher's work. His presentation around the nutrient variation in our current food supply has been really great to point to and talk about. And then, of course, David Montgomery's book what yout Food Ate, that's really kind of furthered some of the discussion. And these are things I can kind of point to people and say, hey, these are reasons and these are correlations that we're seeing about why this really matters and why sourcing this way really matters. So hopefully we'll continue to have some campfire discussions and kind of see how this will evolve.

Well, I have a constant. Ready campfire ring. You know, when we think about nutrient density and nutrient variation, of course, Dan's research and what he has been speaking widely about is variation in phytonutrient content, which is significant and very important. But we actually, in our work at advancing eco agriculture, with our use of SAP analysis, we do have insight and perspectives into mineral variation. So this is not phytonutrients, but the. The mineral variation of crops, and it varies much more widely than people would expect. Now, of course, in any given nutrient crop combination, there's always a bell curve, but the opposite ends of that bell curve. The bell curve is much wider than people think, and the ends of the curve are much farther apart, I think, than people generally realize. So. And of course, there's varietal and genetic components. There's a lot of pieces that play into this. But on tomatoes, for example, you can have a 10x variation of calcium content in a tomato fruit quite easily. It's not difficult to pick out two fields that have 10x variation. One has 800 parts per million, one has 8,000. And when you start talking about trace minerals like zinc and manganese and boron, et cetera, the variation can be even greater than that. So there is much greater variability certainly than the consuming public is aware of and even than most farmers are aware of.

Right. And I think we have to figure out, like, what do we want to Prioritize. And I think what I go back to, when you can go down that rabbit hole and there's all these layers of nutrition and nutrient components that you can measure, I kind of go back to, well, if the growing practices are more holistic than great, the odds are they're probably going to have more nutrition potentially. And then if it's local, it won't have lost all that nutrients from being prematurely picked and artificially ripened. And so I go back to also just the freshness component of the food is harvested on a Monday or Tuesday, and it's in the hands of our participants by 10am on a Wednesday. And so that's also something that I use when people are doubting this is I say, well, you know, spinach loses 90% of its nutrients in 24 hours or whatever, and the average vegetable, like 30 to 50% of its nutrients is depleted in 72 hours. Or there's just little statistics like that that I say, like, you know, if you don't believe the regenerative stuff, whatever, but there's also this freshness component and the food is lasting longer for these people. And so I think it'll be really enlightening. And I'm really excited to see more of, like, your studies on this, John, and other people's studies that are working on this to see, you know, what are we really correlating to health outcomes? What are the components of nutrient testing that we really need to look at that correlate to maybe these different measures? Like, maybe it's not going to correlate directly to A1C, but it correlates to reduced stress management or oxidative stress, or it reduces inflammation, and then that would eventually affect like these larger, more macro measurements or something like that. I mean, I think that's still what we don't know, and we're not super clear on, but studies kind of like Stevon Von Filet and his studies, you know, seeing what happens with conventional beef versus regenerative, when that comes down to human health, I think we just need to see more of that and really understand what the impacts are.

Well, what I'm hearing you describe when, when you say that you anticipate we're three to five years away from this approach being federalized and mainstream payers really getting on board with providing food as medicine, if I were one of those players, then I would want to source food with known nutritional integrity and known nutritional variation. And all of a sudden it occurs to me that actually, you know, what, most farmers have no idea of the nutritional integrity and nutritional quality of the food that they're producing.

Right. And, and they would love to know.

Yeah, this is an opportunity, I see a tremendous opportunity here for leading and innovative farmers to produce food that is of known nutritional quality and that is measured and actually be paid for those outcomes.

Yes, yes, I totally agree.

We have this narrative in the countryside that farmers aren't being compensated very well and they're not being paid. And I think that's arguably partially the case. As we said at the beginning of this conversation, we have a cheap food policy and we don't really have federal policy that is there to support farmers so much as it is there to support agribusiness corporations. And just to be clear, those are two very, very different things. But I think, you know, there is. If we look at this from a philosophical perspective, we can ask the question, do farmers deserve to be paid for quality? I believe the answer is yes. I think most farmers would agree. And so if we agree that they deserve to be paid for quality, does that also mean that they deserve to be commensurately compensated when they produce crap? I asked this question in a keynote presentation. You could have heard a pin drop to it to a group of, in front of a group of farmers. But the reality is, as farmers, we think we're growing quality because that's what we've been told. But are we actually measuring it? Oh, we're measuring protein content in wheat. Oh, but protein content in wheat isn't actually an index of nutritional quality. It's an index of baking quality, but it's not an index of nutritional quality. Nutritional quality. Wheat is much bigger than probably content. It's phytonutrients, it's a lack of anti nutrients, it's mineral content, the list goes on and on. And we don't actually know because we're not actually measuring it. And so therefore, if we're not measuring it and we're not making a point of producing high quality, then why would we get paid for it? We haven't earned the right to be paid for quality.

Right. And the health payers need to have this distinction. I think, like later down the line. One of the reasons why we're hosting two events this year called Advancing Food is Medicine. One in September in Colorado and one in October in Tulsa. And I'm happy to share those links with you, John. One of the reasons that we're doing that is to help healthcare professionals know and how I like to put it, they need to know the difference of programs that are sourcing Something with nutritional integrity and programs that are just sourcing from food banks or what have you is that health professionals don't know. They know the difference between a, you know, high quality drug and like a generic, for example. But they need to start differentiating these food as medicine programs based on that nutritional integrity. But like you said, we're going to have to have the testing to be able to show that. And I think that would be. That's the next step, John. That's what we need to work on. We need to help prove that there's nutritional integrity and why health payers should contract and prioritize programs that have nutritional integrity because they're going to save more money and there's going to be better health outcomes. And we've got to link all that together and it's got to be strong and it's got to be clear.

Well, that's where I'm really excited about some of the technology that working on it that we are working on at AEA is to be actually able to measure quality of plants in the field before they're harvested and manage accordingly.

So amen to that.

Lots of great things happening. Well, Erin, this has been an exhilarating conversation. What have we missed? What are important items or important things that you enjoy speaking about that we haven't talked about yet?

I think we've pretty much hit all of it, John. We talked about the great health outcomes. We've talked about how we're stimulating these regenerative farmers. We got a team of lawyers from Harvard last year and we formed the Oklahoma Food is Medicine Policy Coalition. And one of our goals is prioritizing local growers. I'm working on educating not only people in my state, but people nationally around food quality and food procurement and regenerative agriculture. Trying to kind of like hybridize regenerative agriculture and food is medicine like bringing those movements together because I think they'll further the fire of both of those missions. I think ultimately the goals are the same and making sure that there's integrity in these food is medicine programs. This work has taken me to like 22 states in the last three years. Speaking. I love speaking. So if anyone's interested, you can certainly get more information on our website, freshrx okay.org or send me an email. It's Erin. Erin okay.org or check out our YouTube channel. You can find me online somewhere on LinkedIn. So love to share. I've become kind of an evangelist of Buddhist medicine and its connection with soil health. And I've really talked a lot about. One of the titles of my talks has been the Farmers are the Longevity Heroes and they should certainly be supported and honored for that work. And so I'm just excited to see where this journey takes us. I feel like so much momentum has built. The Food is Medicine movement is changing every single day, so I'm just trying to keep up. We're all learning and I'm excited for new studies to come out. So if you're one of those people working on this stuff, thank you so much. Let's just keep moving together. I think this is something we can really unite in when polarization has gotten so bad on the news and in social media. I think food is medicine and regenerative agriculture is a great way to unite and to heal together. So thanks for having me.

John thank you, Aaron. That was an incredible ending. Thanks for all the work that you're doing for all of our listeners. We will include the links that Aaron provided in our show notes so you can find those on the podcast website at the Regenerative Agriculture Podcast. And please give us feedback on the podcast. Please let me know how you're liking the short episodes and all the work that is happening generally and what you would like to see more of in the future. Aaron, thank you for being here. Thank you for your work and I wish you tremendous success and I hope to speak with you again sometime in the next year or two and hear about the rapid momentum that has been occurring for you. So thank you.

Thank you, John.

The team at AEA and I are dedicated to bringing this show to you because we believe that knowledge and information is the foundation of successful regenerative systems. At aea, we believe that growing better quality food and making more money from your crops is possible. And since 2006 we've worked with leading professional growers to help them do just that. At aea, we don't guess, we test, we analyze and we provide recommendations based on scientific data, knowledge and experience. We've developed products that are uniquely positioned to help growers make more money with regenerative agriculture. If you are a professional grower who believes in testing instead of guessing, someone who believes in a better, more regenerative way to grow, visit advancingecoag.com and contact us to see if AEA is right for you. Thank you for listening and we look forward to working with you.