By Dr. Preston Maring, Peter Jaret
Stop by my farmers’ market on a Friday morning at the peak of summer and you might hear Lone Oak Ranch’s Marlene Gonzalez, a fourth-generation organic farmer, describe what a pluot is (a cross between a plum and an apricot). Or Roberto Rodriguez, who grows some of the sweetest strawberries you’ll ever taste, reveal why he decided to switch nearly half of his 37 acres of fields to organic agriculture so his 6-year-old would not be exposed to pesticides. Nearby, at Nunez Farm’s stall, you might well overhear shoppers exchanging recipes for Japanese eggplant. If it’s late fall or winter, you might see a kid tasting a pomegranate or persimmon for the first time, looking wary at first, and then breaking into a broad grin. Everywhere you wander, you’ll catch the yeasty smell of fresh bread from Vital Vittles (a bakery in Berkeley, which mills its own flour) and the sweet perfume of fresh-cut flowers grown by Abel Fernandes. But what’s different about this market is that you’ll also see doctors and nurses racing out on their breaks to grab a bag of tender salad greens or a basket of colorful squash to take home. You may also see visiting family members pick up bunches of cut flowers for a patient’s room and armloads of fresh fruit and vegetables for the coming week.
If I sound like a proud father when I talk about “my” market, that’s how I feel. Six years ago, I was walking across the lobby of the Kaiser Permanente Medical Center in Oakland, California, where I work as a primary-care physician, when I noticed some vendors selling jewelry and purses. I remember thinking what a clever idea it was to set up shop where thousands of people come and go every day, even if hawking fashion accessories seemed a little incongruous at a major metropolitan hospital. And then I had another thought: if someone can make a go of selling purses and jewelry, why not use the space to promote something that really reflects the values of our health-care program?
Why not a farmers’ market? There seemed to be no reason not to and at least seven good reasons why everyone—patients, doctors and even you—should shop, cook and eat from a farmers’ market.
[header = 1. Get Inspired]
The truth is I’ve always loved farmers’ markets. I love to cook, and farmers’ markets are the best place to find the freshest vegetables and fruits of the season. The farmers’ market offers all the inspiration my wife and I need to make something special for dinner, whether it’s a homemade pizza with leeks, tomatoes, feta and prawns or an asparagus-potato frittata. Thanks to farmers’ markets, we’ve been introduced to fruits and vegetables we didn’t know much about before, such as kohlrabi (a Sputnik-looking relative of cabbage with a mild, sweet taste, perfect raw or baked into a gratin).
Farmers’ markets keep us in touch with the seasons in a way I have come to cherish—the arrival of asparagus and the first luscious strawberries in the spring, sun-ripened heirloom tomatoes and succulent fresh corn at the height of summer, a rainbow cornucopia of peppers and squash come fall, and winter’s citrus crop and savory root vegetables, which we love to roast with chunks of fennel, a recipe we discovered by hanging out at farmers’ markets.
As a physician, I know that a diet built around fresh, seasonal fruits and vegetables like these is the cornerstone of preventive medicine. I also know that like most people, my colleagues—doctors, nurses, staff members—as well as our patients, are so busy they don’t always have time to go to a farmers’ market.
Why not, I found myself thinking, bring the market to them? I didn’t know the first thing about running a farmers’ market. But it didn’t take me long to find the director of a local farmers’ market association who enthusiastically agreed to help. After months of planning, on May 16, 2003, a bright and breezy spring day, our first farmers’ market opened for business. It was like a block party. People poured out of the hospital. There was a palpable sense of excitement. I think everyone there understood right away the connection between good food and good health. People really caught the spirit of it. It was a day I’ll never forget.
As far as I know, ours was one of the first farmers’ markets ever established at a major medical center. To be honest, when it first started, I didn’t know whether or not it would survive. Five and a half years later, it’s still open for business and drawing enthusiastic crowds every Friday. As a primary-care physician, I take pride in having helped many people focus on the basics for good health. I’m also proud to have helped create our thriving farmers’ market—and not just because people love shopping here. I love what it says about our health-care program. And I love what it says about our community.
[header = 2. Follow a Better Diet]
Too often people think of hospitals as places that just care for the sick. That’s part of what we do, of course. But another crucial part is keeping people healthy. And there’s no better way to inspire healthy eating than a market packed with local, farm-fresh fruits and vegetables. I’m convinced that our farmers’ market has helped make the people who work here and those who visit a little healthier.
For 30 years I’ve watched one patient of mine struggle with a weight problem. But once she began to do most of her shopping at the farmers’ market, she changed her diet to include more fruits and vegetables and lost close to 30 pounds. And on the elevator recently, I chatted with a man who works as an engineer at the hospital who told me he’d lost so much weight that his work clothes were too loose. When I congratulated him, he said, “Hey, this is really thanks to you and thanks to the market.” I’m so convinced of the health benefits of basing your diet around seasonal farm-fresh produce that I’ve even written prescriptions for patients for arugula salad with lemon vinaigrette.
Of course it’s hardly news that fruits, vegetables, nuts and legumes are good for you—they provide fiber, vitamins and minerals. Still, the evidence for just how good they are continues to amaze me. Study after study shows that eating foods from the garden helps keep blood pressure and cholesterol from climbing and lowers the danger of developing diabetes. A nationwide study published a few years ago and coordinated by Kaiser Permanente in Oregon showed unequivocally that reducing salt intake and eating a healthy diet rich in fruits, vegetables and low-fat dairy products significantly reduced blood pressure.
In one of the latest and most persuasive studies, researchers from Harvard gathered data from more than 72,000 women over two decades, as part of the well-known Nurses’ Health Study. Women who followed the so-called “prudent diet,” made up of many of the foods on display at farmers’ markets—fruits and vegetables, legumes, nuts and whole grains—had a 28 percent lower risk of dying of heart disease. In contrast, those who ate a “Western diet” rich in high-fat, sugary and processed foods had a 22 percent higher risk of dying of heart disease and a 16 percent higher cancer risk. For some of these women, the difference between these two ways of eating was literally a matter of life and death. I’m convinced it is for most of the rest of us as well.
The Mediterranean diet—abounding in fruits, vegetables, beans, lentils, whole grains and healthy plant oils, such as olive and peanut oil—has become almost synonymous with optimal health. With good reason, as studies from around the world continue to show. A study published in the December 2007 Archives of Internal Medicine showed that the Mediterranean diet reduces risks of cancer and heart disease and improves the odds of living a long life. A study conducted by researchers at the University of Athens also showed a strong association between a largely plant-based diet and longevity. And when researchers at the University of Las Palmas de Gran Canaria, in Spain, reviewed 35 studies, they found that the Mediterranean eating pattern improved cholesterol levels, boosted antioxidants, protected against insulin resistance (a risk factor for diabetes) and helped keep blood vessels healthy.
Several large studies have shown that people with heart disease can dramatically improve their health by making fruits and vegetables the centerpiece of their diet and replacing saturated fats (such as those you might get from dairy and meat) with unsaturated fats (such as those in avocados and nuts). That’s very good news, of course. But our real goal should be to prevent diseases in the first place.
That’s why I always find it a joy to see kids at our farmers’ market, and not only because they seem to be having such a good time. Starting healthier eating habits early in life is likely to offer the biggest payoff of all. Along with more physical activity, a healthy diet with nutrient-rich, low-calorie foods is just about the only prescription we have to end the epidemic of weight problems and diabetes among children. In many ways, a healthier diet will also help kids grow into healthy adults. Another study from Kaiser Permanente showed that a diet abundant in fruits and vegetables increased bone density during those critical teen years. I like to think the kids who come through our market and sample a fresh peach or a handful of cherry tomatoes will go on to make healthier choices for the rest of their lives.
[header = 3. Cook for Your Health]
The list of health benefits associated with a diet centered around plant-based foods goes on and on. If we could put all those together in one pill, we’d have a blockbuster drug. But it wouldn’t be as colorful or delicious as the prescription you can fill at a farmers’ market. So why do most Americans still fall woefully short on the optimal number of servings of fruits and vegetables—between 5 and 9 a day, depending on how many calories you consume?
There are many reasons, of course. But the leading one, I think, is that the choices closest at hand are those from fast-food outlets. And in some places, those are just about the only choices.
That’s why bringing the market to the medical center proved to be so powerful. If you make healthy food available and visible, people will try it. It’s a little like putting a bowl of fruit front and center in the kitchen so you or your children will grab an apple or a peach for a snack—except in this case we’ve put an entire farmers’ market on the street where people come and go. And we know at least some people are eating more healthy food as a result. In 2005 we conducted a survey and found that of our repeat market customers, 71 percent said they were eating more fruits and vegetables. Sixty-three percent were eating new and different fruits and vegetables.
Convenience is part of what our market offers. But I think people caught the spirit of it for another reason. It’s one thing for your primary-care doctor to say, “You know, you really should be eating a healthier diet.” But it’s a lot more convincing when your medical center hosts a farmers’ market where you can fill a bag with fresh, delicious produce. Our market proved that we, as doctors, not only talk the talk, we walk the walk. And that goes a long way toward convincing people—not just patients but everyone in our community—that we really believe in the importance of making healthy food choices.
Encouraging people to shop at farmers’ markets also encourages them to cook, and I firmly believe that’s another key to good health. When you prepare your own meals, it’s much easier to take charge of exactly what you eat. Take the example of salt. Too much of it can raise blood pressure, which in turn increases the risk of heart disease and stroke. Where does most of the salt in the average diet come from? Processed foods. When people cook their own food (as opposed to relying on these processed foods), they typically consume less salt without even having to think about it.
Also, when you’re in charge of the menu, you can easily serve a more modest-sized portion of meat and add extra servings of fresh vegetables to a salad or a stir-fry, for example. You can also make smart choices, such as serving a whole grain like quinoa or brown rice instead of a refined grain like white rice. You can experiment, as my wife and I have, with fruits and vegetables you weren’t familiar with and might just learn to love.
I’ll admit, we’ve been lucky that our son, who trained as a professional chef before enrolling in medical school, taught us some tricks of his trade. When he was home for the summer, we cooked as a family nearly every night and had the tastiest meals I’ve ever enjoyed. My son showed us how to wield a chef’s knife correctly and how to slice and dice quickly. You don’t need to go to culinary school to cook at home, of course. And if you want to learn more, many larger farmers’ markets are sponsoring cooking classes. Even if yours doesn’t, it is a great place to meet other people who truly love good food—a place where you’re more likely to learn about how to choose, store and prepare produce than almost anywhere else.
[header = 4. Support Your Community]
The benefits of supporting farmers’ markets go beyond individual health to something larger: the well-being of an entire community. Prosperous farms help ensure green spaces between towns and cities and conserve land for agriculture. For many small growers, a thriving local market offers the opportunity to make a decent living from farming, pay their workers a fair wage and plan for the future. At farmers’ markets, they can sell directly to customers, earning close to 80 cents on a dollar, on average, compared to just 20 cents if they sell to food distributors who ship their produce to grocery chains.
In large metropolitan areas, such as the San Francisco Bay Area, Chicago or New York City, many small farmers sell exclusively through farmers’ markets. They wouldn’t be able to survive as small business owners without them. For example, my friend Mr. Rodriguez began selling his organic strawberries at our farmers’ market and soon we began offering his spectacular berries to patients at our 19 Northern California hospitals. Now, each season he provides 130 dozen pints per week and, to do that, he has had to hire five new farm workers.
Also, when you buy from a farm or a farmers’ market, you are helping ensure that the farm is economically viable and that local produce will be available year after year. I can’t speak for everyone, but for me it’s worth a lot to know that every spring I can help myself to several different varieties of exquisitely ripe and sweet berries, and that early fall will arrive with fresh figs and beautiful heirloom tomatoes by the basketful. Small farms have played a leading role in reintroducing many unusual varieties of fruits and vegetables that were virtually abandoned when large-scale agriculture came along. Among these so-called heirloom varieties are hundreds of different kinds of apples, pears and tomatoes that were in danger of being lost, fruits and vegetables you would hardly ever find at supermarkets.
And of course there’s the simple fact that these local markets are just plain fun. They are places where people can come together to shop, talk, sit on a bench and watch the world go by, listen to music and exchange recipes. Local markets are as old as the oldest human settlements, and they have always been about more than just the buying and selling of goods. They are the heart and soul of a community. With the rise of big-box stores and shopping malls, we’ve unfortunately lost that feature in many parts of the country.
But today it’s being recaptured in the growing number of farmers’ markets cropping up in towns and cities large and small, with their colorful stalls and handwritten signs, their bins of hand-picked produce that was often harvested just hours ago.
[header = 5. Encourage Sustainable Agriculture]
Farmers’ markets help keep not only our communities healthy but our environment too. Small farms have been leaders in adapting sustainable agricultural techniques that protect water and build healthy soils. They have revived growing techniques that don’t require as many chemical fertilizers and pesticides as some large operations do, and adapted to specific local growing conditions. Their hard work has helped prevent contamination of rivers, streams, lakes and oceans and often prevented farm workers from being exposed to chemicals that are known to pose health hazards.
Many small farms, whether they are certified “organic” or not, use sustainable approaches: the farmers you meet at these community markets often have only 20 or 30 acres or less and don’t have the option of moving their operations to new locations when the soil becomes unworkable. Their livelihood, and the health of the towns they live in, depends on sustainable growing techniques that preserve and replenish the fertility of their small patch of soil. Local growers protect our communities in another way. They typically plant a wide variety of crops, in contrast to some large industrial farms, which grow hundreds or thousands of acres of the same crop. Crop diversity is a good defense against the spread of damaging insects and plant pathogens. If a problem arises in one crop, it’s unlikely to spread to others. That’s not true of monocropping, where the spread of a pathogen can be catastrophic.
Finally, local farmers are a small but important part of the solution to the largest environmental challenges we face. We’re just beginning to understand the environmental consequences of shipping food long distances. Energy independence has become the rallying cry. Well, every time you buy something locally grown rather than shipped from halfway around the world, you reduce the amount of oil being burned and the amount of carbon emitted into the atmosphere. All in all, you end up getting a lot from your food dollar when you spend it at a local farmers’ market, and that dollar goes right back into your community.
[header = 6. Eat by Season]
I sometimes linger at our market simply to listen in on conversations between shoppers and farmers. I learn something new almost every time about how food is grown or how to prepare it, about the vagaries of weather and the details of our local climate. Before we started our market, I didn’t know all that much about where the food I ate came from or how it was grown. Now I know many of the local farmers by name. I have new respect for how hard they work. I follow the local weather reports, knowing that too much rain in the spring or an unexpected freeze can endanger their crops. I’m much more aware of the many challenges they face. I understand that farming is by its nature a precarious business, at the mercy of weather and fluctuating prices. But I’ve also seen firsthand the deep satisfaction farmers take from planting seeds and watching them turn into the foods that nourish us.
By their very nature, farmers’ markets encourage us to buy seasonal produce. As every chef knows, the most beautiful, best-tasting and most economical foods are the ones that are in season. Eating with the seasons is all about anticipation and then savoring what is ripe at the moment—the first tangerines of the winter that light up the market, the season of stone-fruit, then the arrival of heirloom tomatoes, followed by the wild shapes and colors of squash in the late fall. The bounty on display at a farmers’ market at the peak of the season is the very opposite of fast food. It’s food that a farmer has spent months nurturing to the moment of perfect ripeness. It is food to be cherished and savored.
[header = 7. Change Our Food Systems]
When a good idea comes along, it takes root and begins to grow faster and more vigorously than even its biggest advocates ever imagined. Certainly that was true of our small market. We were open for business only a few weeks when I started getting calls from people at other Kaiser Permanente facilities who wanted to start their own farmers’ markets. Within a year, five farmers’ markets were up and running. Today, our health-care system boasts some 30 markets in four states. And of course, many other hospitals and medical centers have launched their own.
Meanwhile, the success of our farmers’ market inspired us to look for other ways to encourage the people we serve to eat healthier foods. One obvious place for a hospital to start is with its patients. The same values that inform our outdoor market, after all, should guide the choice of food we serve to our patients. That means using as much food as we can manage from small local farms growing in sustainable ways. Over the past few years we’ve been working hard to introduce more locally grown fresh produce onto the menu and to plan around foods that are in season. It’s a big undertaking. In 2006 Kaiser Permanente bought about 25 tons of produce from small family farmers to serve at our hospitals. In 2007, we were up to 60 tons.
Building on the enthusiastic reception our market received, we’re also experimenting with other ways to get produce to the people. We’ve started “best of the market” programs, where we put together bags of produce from the market and bring them to people who may be too busy caring for patients to be able to shop themselves. We’re investigating ways to grow vegetables on unused land at a few of our medical-facilities.
Around the country, farmers’ markets are booming. According to the latest tally, there are more than 4,600 farmers’ markets in the United States. Almost anywhere you go during the growing season, you’ll find one. Each and every one, in its own way, reflects the special character of the places they call home—from the sizzling chiles in Arizona to the tropical fruits on Maui to the wild mushrooms displayed at the Portland Farmers Market in Oregon.
More and more markets are working to make sure that people at every economic level can take advantage of fresh, locally grown produce. Several states are experimenting with wireless devices that allow people on food stamps to use their swipe cards at local markets. Many neighborhood food banks are forming partnerships with local farmers, arranging to buy up food that might otherwise go to waste in the field and serving it to those in need—a win-win arrangement for everyone. A wonderful group called Urban Farming has been converting abandoned lots in Detroit into small garden plots tended by volunteers, who turn their produce over to local food banks and other meal-assistance programs—an idea that has taken root in dozens of other cities around the country.
Chances are there’s a terrific farmers’ market near you. Or a community-supported agriculture program that allows customers to buy a certain amount of produce from a local farmer each week—providing farmers more stable revenue and consumers the best of the harvest. I urge you to support them. As a physician, I know there’s nothing more important to health than what you eat. As an avid home cook, I know there’s no better place to find the healthiest, freshest and best-tasting food than at a farmers’ market.
Enjoy it in good health.
Dr. Preston Maring, the associate physician-in-chief at Kaiser Permanente’s Oakland (CA) Medical Center, is a crusader for local, healthy food and a national advocate for the small family farm. Peter Jaret won a James Beard Foundation journalism award for his article “The Search for the Anti-Aging Diet” (EatingWell Magazine, November/December 2007). His most recent book is Nurse: A World of Care (Emory University Press, 2008).