Demand for nutritious food in low income neighbourhoods

An explanation I often hear as to why there is so much processed and fast food available, whether it be here in Moose factory or in underserved neighbourhoods in cities, is that there is simply not a demand for fruits and vegetables. This is a phenomenon I have struggled to come to terms with for some time.

A recent report from the Food Ethics Council out of the UK, provides an explanation as to why sustainably grown food still represents the minority of products on grocery store shelves. The report also explains why processed food thrives and nutritious food struggles to find shelf space in some communities.

First of all, while there may be a perceived lack of demand for fresh produce in low income communities, it is likely more to do with purchasing power than there being a lack of desire to consume healthy foods.

Excerpts from the report in italics:

This is not to say that people don't want to buy sustainable products – they do, but they don't see why they should have to pay more money for them, and many cannot afford to do so. Society's attachment to, and dependence upon, cheap food is a critical barrier in moving towards a sustainable food system.

Looking at Northern communities in particular, the quality of fresh food adds another dimension to food choice. Fresh fruits and vegetables often arrive in poor quality, and are sometimes left to rot on the shelves.

The other issue, raised in the food ethics council's report, is that too much responsibility lies with the consumer. Consumers are relied upon to pick which foods are available, but most consumers are more interested in price, than sustainability or health. That is not to bash people's food choices, it's just that our current food system is tilted heavily towards cheap processed food.

As things stand, there simply isn't sufficient demand for sustainable food to drive the required transformation in the food system. Price, quality and value are still the most important determinants of food purchasing decisions. So there is a problem: business and government both look to consumers to lead the way on sustainable consumption, but consumers do not want to assume this responsibility.

A recent study suggests that purchases of fruits, vegetables, non-fat dairy, and other healthy foods will increase by as much as 10%, following 25% price reduction. Making fruits and vegetables cost competitive with processed food may lead to increased consumption of healthier food.

What both business and the public need is a level playing field. A food system that internalizes the costs of food production and health outcomes. Unfortunately that is the role of neither. Government needs to step in to allow citizens to be able to pick healthy, sustainable food that doesn't make them ill.

Most damagingly, government has not provided the coherent, joined-up, long-term food policy that businesses – and other sectors of society – require in order to develop their own strategic responses to the challenges confronting the food system.

While increasing the availability and accessibility of nutritious food is an excellent place to start. It may not be enough to entice people to buy nutritious foods. If people are not accustomed to eating these foods, do not have proper cooking equipment/facilities, or cooking skills, then food may still lie untouched. No one solution is a panacea, but incorporating multiple strategies may increase the consumption of nutritious food.

The bottom line is people do not want to be sick. Unfortunately our food system gives some people no other option.

Diabetes and depression

This past few days being on diabetes "medication" has been a humbling experience. I did not realize the upkeep involved, and even for someone with a half-decent understanding of nutrition, it was not a walk in the park. I screwed up so badly on Saturday that I wrote the day off to start anew on Sunday. That's the fortunate part of only pretending to have diabetes. People really living with the disease can't just decide to do it tomorrow, it is a burden you live with everyday.

There were a few times I forgot to take my "Metformin", and carbohydrate counting, though I did get better, was a tedious experience. I found myself estimating a couple times, which may have been sloppy, but I was either in a rush or just didn't feel like doing the extra work.

I was actually really surprised that I grew more tired of doing a finger prick, than the insulin shot. Pricking my finger is not fun! While the insulin shot gave me the most angst the first time, it was the finger prick that I truly despised in the end. I was able to give myself the insulin shot relatively quickly and with less mess, while pricking my finger gave me more pain, and a few times I had to repeat it as the glucometer read an error.

All these issues of managing diabetes add up, and this all just in a few days. Living with the condition would reveal even more issues that I'm sure would cause a lot of anxiety and frustration for people.

 Studies have shown that depression is twice as likely to occur in diabetics than non-diabetics. This is related to physical, psychological, and genetic factors. The burden of managing a chronic disease on your own, is thought to be a contributing factor to depression in people with diabetes. This highlights the need for a strong social support network, to ease the burden of the person living with diabetes.

While depression can lead to poor diabetes control. Depression has also been shown to double the risk of developing diabetes, so it is difficult to determine how depression develops. Certainly it is not hard to believe that a diagnosis of diabetes would exacerbate depression. Either way it is a vicious relationship.

Understanding the burden of chronic disease is crucial for the delivery of quality healthcare that respects the client. People may struggle with managing their illness, but it does not necessarily mean they are a lost cause, just that they need care to be tailored differently.

Insulin dream

As part of an exercise to better understand what someone with diabetes has to go through in terms of managing the disease, I was set up this week with an insulin pen, blood sugar meter, and "medications" of someone with diabetes. I was also given a schedule to follow, and a chart to track how many grams of carbs I've eaten.

So my schedule looks like this:

-1 unit of Humalog (fast acting insulin), for every 10g of carbohydrate I eat, at meals.

-20 units of Lantus (long lasting insulin) at bedtime.

-1 "Metformin" (oral medication to increase the body's sensitivity to insulin) 3 times a day.

-Test blood sugar first thing every morning, and two hours after every meal.

So just to clarify I'm not actually taking insulin or any diabetes drugs, I'm injecting air into myself, and taking sugar pills. I must admit though it is a little freaky jabbing yourself in the side with a needle, even if it is only 4mm long. I usually have no problem with needles, I'm all screamed out from childhood. Checking my blood sugars also took some mental strength the first couple times. The first time I bent the needle, which didn't make me feel any better about drawing my own blood.

The most difficult part, however, has been taking my insulin based on what I'm eating. It has forced me to plan my meals, and how much I eat, ahead of time. Usually I don't pay much attention to meal times, and just eat and cook whenever I am hungry. To avoid a "low" blood sugar, I'm forced to eat soon after taking my insulin, this is something I am not used too.

In no way do I now understand what it's like to live with diabetes, I know that I'm going to go back to my usual routine in a couple of days, and I don't have the weight of an actual diagnosis on my shoulders, nothing will happen if I don't take my "insulin".

As a dietitian-to-be I'm struggling with some of the carbohydrate counting and meal planning, and I've had to ask my supervisor many questions; yet these expectations we have of our clients. While I would get better at managing with time, I could only imagine the stress the diagnosis would put on someone.

Also I'm not appreciating the red needle dots on my mid-section.

Traveling up the coast...

This past week I had the opportunity to travel up the coast to visit a couple other communities. Taking the flight up the coast seemed more like taking a train. Even though we were traveling all the way to Peawanuck, the furthest community up the coast, you still have stops at all the other communities. So to get to Peawanuck you’re going up and down 4 times with stops in Fort Albany (20min), Kashechewan (5 min), Attawapiskat (30min), and then 45 minutes to Peawanuck. Apparently the flight between Fort Albany and Kashechewan is the shortest commercial flight in the world, as it is only a 10 minute drive on the ice road.

Peawanuck has a different feel than the other communities. It is more isolated than the others, and people rely more on traditional food systems, such as fishing, trapping, and hunting. Unlike the other communities it seemed as if the community had their dog population under control, if you’ve read my blog post “It’s cold and there are dogs” you understand why this is one of the first things I noticed.

While the community has many positive attributes, delivering health care services to an isolated location still has its challenges. The nursing station has a high staff turnover, with nurses usually staying for only a couple weeks at a time. The current nurse in charge of the station had only been there for a few days, and only found out he was the charge nurse the day he left for Peawanuck. Physician services are few and far between, even though there is supposed to be a doctor in the community every month or so, it is rare when it is that frequent, and for anything beyond basic care people need to be flown south to Moose Factory, Timmins, or Kingston.

I had a chance to visit the grocery store in Peawanuck, which had a produce section slightly better than a 7-11 back home. Alongside the moldy limes and lemons, was a sad head of broccoli for $13, while instant noodles sold for 95 cents. Some people order directly from stores down south, to bypass the retail mark up, but the situation is far from ideal.

  

Another highlight of my trip up the coast was doing home visits in Fort Albany. This also provided me with the unique opportunity to counsel through a translator, as many of the elders speak Cree. At first it was an intimidating experience, but after realizing how unique and limiting the situation was, I started to relax. Using plain language is something you always keep in mind, but it is especially important when communicating through a translator, and you always wonder what has been lost in translation. I also felt pretty useless, offering someone who speaks Cree English language resources. 

What I found the most important was keeping in mind you should speak directly to the client and not with the translator, and secondly to keep a sense a humour about the situation. It is certainly not something I was trained for, but that’s what makes it fun, it forces you to stretch.

Why vitamin water sucks!

There have been a couple situations lately with vitamin water that have really irked me.

The first was from my supervisor who is part of the diabetes program. She mentioned a client had been drinking vitamin water not realizing it contained sugar. Now for most people this would not be a major issue, other than empty calories, but for someone with diabetes this a potentially dangerous situation.

The second was a client who had been feeling tired and ill, and she mentioned she was drinking vitamin water to help her feel better. The client asked about the claim on the bottle suggesting to drink 1 bottle a day for best results. The way vitamin water markets itself is as a health product, which is totally misleading.      

Vitamin water, which is made of  water, sugar, artificial flavour and colour, and fortified with vitamins, markets itself as a health product to great effect. Everything from the label, to the name itself is designed to resemble a prescription.




While vitamin water does contain water and vitamins, as you can see from the label above, it also contains sugar, flavour additives, and some varieties contain artificial colour. Vitamin water is essentially flat coca cola fortified with vitamins, but coke isn't drunk to relieve illness or to be healthier.

The other tricky thing with the vitamin water label is the serving size. For sugar and calories the nutrition information is based on an 8oz serving, where the bottle itself contains 20oz (2.5 "servings"). I think it is fair to say that most people will drink the entire bottle. While a 12oz can of Coke contains 42 grams (~8.5 teaspoons) of added sugar, a bottle of vitamin water contains 32.5g (6.5 teaspoons) of added sugar.

While it may seem obvious to some that vitamin water is not going to make you healthier, it has a subtle affect. Especially in our fast paced lifestyle where it is not uncommon to experience days when you may not eat nutritiously. So why not grab a bottle of liquid vitamins?

But the fact of the matter is you would be better off taking a multivitamin down with tap water. This would save you both money and calories. But really your body will survive one day of poor eating, and you really shouldn't be relying on added vitamins anyway. There is little to no evidence that taking vitamins, most of which have been extracted from corn, will make you any healthier. While there is plenty of research showing a healthy diet will reduce your risk for chronic disease and improve your well being.

My first rant. Feels good!