Saturday, August 27, 2011

Reap and Sow

There are certain signs that indicate the end of summer. The days grow shorter with each sunset. The cooler night air lingers longer in the morning as the sun takes its time making its way up into the sky. Kids are everywhere as camp programs end and the mad rush to enjoy the last days of freedom coincides with back to school signs and sales. And while this is the first year of many that I will not be returning to class in September, I have new indicators of the impending fall now that I am working on a farm: the harvest of summer produce and planting of fall and winter crops.

In these first two weeks on the farm I have already been a part of this segue to the fall. During my first few days at St. Joe's I harvested the last of the cucumbers in the hoophouse before tearing out the bed and preparing it for greens. Each day we frantically pick the ripest tomatoes, which have only a few more weeks. Just yesterday we tore out the remaining basil - some of it already damaged by the early morning frost, and prepared the bed with a broadfork, claw and hefty amount of compost. Though I still spend my days out in the warm summer sun, our latest farm work provides a good reminder that fall is just around the corner.

This week we directly seeds carrots and transplanted scallions, chard and lettuce into the hoophouse. The harvest included different varieties of tomatoes (read my guest blog post about Sun Gold tomatoes here), peppers, eggplant, chard, kale, basil, beets and carrots. 

The physical demands of the farm are certainly new to me.  But the cycle of crops, the forecasting of what to harvest next, seems somehow intuitive, and I wonder how much of it is related to my Jewish roots. Although I was grew up in a city, I was raised in the Jewish tradition, whose calendar maintains a strong agricultural tie so that the year has always held a close relationship with the land and the major pilgrimage holidays throughout the year are all connected to the harvest cycle. As this synagogue's website nicely explains, Passover marks the barley harvest in early spring, Shavuot marks the wheat harvest in early summer and the final harvest of the season is celebrated on the holiday of Succot in the fall. With the month of Elul beginning this week, it is hard not to anticipate the Jewish New Year and Succot after that.

Each day I appreciate how lucky I am to spend my time on The Farm, around a bounty of beautiful produce and a healthy eco-system filled with life (also filled with mosquitoes!). I eat better, sleep better and am inspired by the work of so many professionals and volunteers I've met so far. And the work itself is hard. On a small farm where almost everything is done by hand, patience and determination are good skills to have. But there's something very satisfying about planting and harvesting in the same day, experiencing two ends of the farm cycle at once. Planting is the start of something new, an act of faith and anticipation while harvesting is the result, the yield and fosters a sense of gratitude. I am grateful to experience both.

Friday, August 19, 2011

Money Matters

Nutrition has a new spokesperson in the form of Bill Clinton. Yesterday CNN posted clips from an interview with Dr. Sanjay Gutpa, in which the former president discussed how changing to a plant-based diet has saved his life and transformed his health. And my first thought was how in those two minutes Clinton may have done more for nutrition, for making the connection between food and health than the ADA has done in years.

To be clear, I am referring to the American Dietetic Association and not the American Diabetic Association (ADA) nor the American Dental Association (also, ADA) and definitely not the Americans with Disabilities Act (again, ADA). But the confusion over their acronym is only the beginning. Even more confusing is their message: "If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet."

Founded during World War I, ADA initially sought to help the government preserve food and improve the public's health and nutrition. Over time its purpose and mission have evolved and currently it is "committed to improving the nation's health and advancing the profession of dietetics through research, education and advocacy." It is a professional organization, primarily of registered dietitians (RDs), the certification that is bestowed by the ADA upon an individual who has completed a CADE-accredited dietetics program (at either the bachelor's or master's level), an accredited dietetic internship program and then passed an exam.  Much of the organization's advocacy work is spent educating the public and the government about RDs, and establishing them as the authorities on food and nutrition. There are so many people posing as nutritionists these days that some qualifications and credibility are called for and I appreciate that there is a group committed to this task. But ADA receives significant funding from companies like Mars, ARAMARK, Hershey, Coca Cola and the National Dairy Council.  Isn't it a bit problematic when the organization trying to position itself as the unbiased expert on food and nutrition is sponsored by major food corporations built on selling the public on calories and food-like items they don't need and can potentially harm them? 

This appeared at the bottom of ADA's Knowledge Center email on 8/18/11

One day perhaps I could write an entire dissertation on the complexity of these relationships between health organizations and companies that generate most of their profits by saturating the market with high-sugar, high-calories, chemical-laiden, nutrient-poor products that contribute to the rise in nutrition-related chronic diseases.  Despite their "wellness" divisions, their corporate philanthropy and commitments to "healthy living" these ADA sponsors are best known for soda and chocolate bars (and not the high-cocoa content, fair trade varieties). Coca-Cola, for example, doesn't even pretend that its raison d'etre is to feed or nourish people. It's mission statement is simple: "To refresh the world...To inspire moments of optimism and create and make a difference." Remember those joyous ads? 

I'm actually more moderate than I sound. Last year I started working with an organization called Cooking Matters (formerly known as Operation Frontline), a nationwide program that provides cooking and nutrition classes to low-income populations. While the program and its curriculum are sponsored by ConAgra and Walmart, the classes are taught by volunteers chefs and nutritionists and as a volunteer I was free to take some liberties with the program. (During the week that focused on calcium, for example, I provided lists of non-dairy dietary sources.) True the funding came from major corporations, but the program was very effective - in some cases truly transformative - without supporting any corporate agenda. We live in a time when corporations have money - let's use their money for good. 

My gripe with ADA's sponsorship is not really that they take money from these companies, it's that they do not address it or demand accountability. ADA constantly comes under attack for their ties to big industry and has never issued a statement explaining their position. In fact, back in May the president sent an email to ADA members stating:
Levelheaded criticism is different from deliberate misinformation, which ADA and many other credible organizations are occasionally subjected to. Blogs and other communications that contain falsehoods about our Association are easily written and – with a click on a keyboard – posted and re-posted the world over. I want to assure members that ADA will not be distracted by engaging in point-by-point rebuttals of disparaging untruths and insults every time they appear on the Internet.  ADA will not issue formal responses to ill-informed attacks or outright lies. Such responses would only lend credibility to erroneous arguments and baseless charges and elevate their authors. This is the intent of our detractors.

First of all, I'm not sure which "falsehoods" they are referring to, since their ties to the food industry are posted on their website. Secondly, to disparage blogs and communications that are "easily written...posted and re-posted" makes them sound as dated and out of touch as their detractors claim. Finally, to defend a position that has come into question does not lend credibility to the argument, it allows an organization to reiterate, clarify and hone its stance. As a card-carrying member of the ADA, I would appreciate a position paper of ADA sponsorship policies. Their website does say:

ADA’s procedures and formal agreements with external organizations are designed to prevent any undue corporate influence particularly where there is a possibility that corporate self-interest might tend to conflict with sound science or ADA positions, policies and philosophies.

Personally I would feel more comfortable if I understood how they get around the "possibility" of corporate self-interest with their current sponsors (for amusement, see the page on "What Our Corporate Sponsors Think").  Additionally, I would like to see more statements calling upon these companies to employ more responsible and honest marketing practices, including the elimination of advertising to children. I don't feel ADA needs to refuse their money, but should use their relationship with Big Food to push an agenda of their own, namely one that promotes public health nutrition, education, greater transparency and increased access to healthy foods. 

It may sounds optimistic, but I do believe the ADA has the potential to be a more potent and effective change leader in national nutrition discourse. Maybe I'm just rationalizing how I could accept scholarship money from the ADA Foundation toward my internship while I criticize ADA for accepting money from corporations with dubious intentions. Can the ends justify the means if the money is going toward quality nutrition programming, toward the training of future nutrition professionals, toward the education of groups that would not otherwise be reached?  I considered this for a moment when I received notification of the award but quickly realized it did not for a moment change my beliefs about nutrition practices, science or politics. If anything, it encourages me to cling to my position, continue doing what I'm doing and work toward changing the field of dietetics from within so that Bill Clinton is not the only harbinger of dietary changes in this country.

Wednesday, August 17, 2011

Market Day

Some people think of Wednesday as hump day. For the next month Wednesday is also Market Day - the day I arrive at the farm early to harvest greens, pack tomatoes into pints, arrange the beets and carrots and peppers in an old fashioned wooden wagon in the main hall of the hospital where I am working on the next rotation of my internship. The hospital is one of the first in the country to start its own farm that now boasts two hoophouses for year-round growing.  Just last week the ADA posted a link to a Food Sleuth podcast interviewing the RD who developed the project that turned 15 acres of hospital property back into farmland last April (a great podcast!). Then in July the farm began to sell its produce at a farmer's market in the hospital. The hours correspond with the hours during which most patients are discharged (11am) and also during staff lunch breaks. The idea is not only to sell fresh, local (!) produce, but send a message, linking farm and hospital, food and health.

Tomatoberry variety of cherry tomatoes

Working at the farmer's market earlier today made me feel like a local celebrity. People's faces lit up when they saw the cart. Shoppers commented on the fragrance of the basil, the colors of the chard stems, the perfection of the tomatoes, and they began to swap ideas on how to use the produce, recommending recipes, sharing what they grow in their own yards and asking me for suggestions as well. Some customers were bold enough to try something new, some were returning to buy the Sungold tomatoes after trying them last week (my favorites!). 
A bunch of Bright Lights rainbow chard

I'll be spending the next month on the farm and I'm sure I'll have plenty to share. It's the most exhausting work I've ever done but it's exciting to be onboard with a hospital that is committed to investing in preventative care through food and nutrition. 

Monday, August 15, 2011

Lessons from LTC

I was not looking forward to my rotation in long-term care. And when I started, I was relieved that it would only last for two weeks. But by the end I had gotten so comfortable there, so used to the smells, the sights, the residents that had scared me at first and I was sad to leave behind the routine, the meetings, the familiar faces to start all over again at a new site.

My time in long-term care (LTC) was mostly spent on my feet. While the dietitian I worked with had an office, she was hardly ever there unless it was to update residents' meal preferences or enter quarterly and annual assessments. Otherwise I tried to keep up as she breezed through the halls, whipping in and out of patients' rooms, checking up on them, tracking their weights, seeing how they were eating - did they need a speech or an OT consult? Were they have swallowing problems or difficulty holding their utensils? Were they able to meet their nutritional needs through oral intake or did they need liquid supplements? Were they getting their meals as they ordered it, and if so, was the temperature appropriate by the time it arrived from the kitchen? These were just some of the dietary concerns at the facility where I was working. Through these daily tasks I got to know the residents and their mannerisms, the ones who liked puzzles and the ones who ordered takeout food, the ones who spoke inappropriately to women and the ones who would grab your hand and not let go if you got too close. I learned who had their own set of teeth, who wore dentures and who preferred not to wear their dentures. I learned who was 105 and who was 85 and who was 55 and who must always always always get two cartons of chocolate milk at every meal or else. Then there were the harder parts.  I sat in on meetings with families of residents who were recommended for hospice care. During my two weeks there two residents died. I observed wound care on a patient whose foot had bad gangrene and pressure ulcers but refused amputation despite doctor recommendations.

During my first week I was focused on the sad parts, the decaying people, the empty shells of what were once vibrant lives - or were they? Many of the residents were homeless or alcoholics or, as my supervisor said, "had made poor life choices." A number of them had mental disorders and acted out and threw their trays and had temper tantrums. But there were lighter times too, and by the second week I grew to appreciate these even more, adapting in the ways people do who work in this environment for extended periods of time without losing their minds or their faith in humanity.  I joked around with the staff before the morning meetings and worked the tray line in the kitchen, hairnet and all, and laughed with the head of medical records and helped out with the Hawaiian staff bbq. I smiled at every person I made eye contact with and tried to learn the residents names to say hello to them every day. I learned that treating people with respect and dignity is paramount. I realized that everything can change in the span of two weeks.

Saturday, August 6, 2011

Running DMC

My first week at a long-term care rotation left me feeling physically and emotionally exhausted. I have a great supervisor who exposes me to all sorts of different conditions (colostomy, anyone?) and personalities (paranoid, bi-polar). We're on our feet all day and the breadth of her work provides a broad experience of dietary work within a long-term care setting. But when I get home I just crash.  I was determined to break this cycle of somnolence over the weekend. And so, in effort to keep up my running I finally ventured over to Motor City for a 10k race.

Going to Detroit felt like a big deal. The big city. A strange feeling for someone raised in New York City. But the way people here speak of Detroit has instilled in me a fear I can't quite shake. Stories of white flight, abandoned building, crack houses. "Just avoid those areas," I'd been repeatedly warned. But without any sense of the city, I wondered how I would know where to go and where to avoid. Then the voice of reason would kick in.  "People said this about New York City for years," I would remind myself. Still, I waited for a good "safe" excuse to check out the city for myself. I was in for a treat.

As it happened I had signed up for the inaugural race benefiting the Detroit Tigers Foundation, so the 10k started and ended at Comerica Park, home of the Detroit Tigers. Now it's been awhile since I've been to a MLB field but this is the first one I've ever seen with a carousel and ferris wheel in the park. Pretty cool.  Security seemed to be pretty lax and runners were allowed to wander around, so I made myself at home.

The 10k course went downtown, where the city's impressive architecture took me by surprise. Further on we hit the waterfront and ran along the RiverWalk, which continues for several miles and reminds me of Hudson River Park in New York, except across the water is not New Jersey, but Canada.  Perhaps the best part was the last leg which took us out onto right field at Comerica Park, around and along the first base line to cross the finish at home plate. Even without 45,000 screaming fans filling the seats, it was a thrilling feeling.

I had considered spending more time in the city, but soaked with sweat and doused with water at 9am, I was ready for a shower.  I left Detroit knowing that I'd be back. There's a pulse and energy there despite the empty buildings and demolition crews. And after spending a full month in a small town, I was reminded how exciting the city can be.

I hope that future outings to Detroit will include more arts and culture and eating (not that I'm complaining about the post-race Sabra hummus sample). Right now within the food movement, all eyes are turning to Detroit as a model city for community farms and gardens farming, food justice work and local food initiatives. And with a rich history and lots of determination it's not hard to imagine that in a few years the empty buildings will be converted to pricey lofts and condos, that young people will flock there in droves on their bicycles to raise chickens and goats. Or maybe it's already happening.

Monday, August 1, 2011

Women, Food and Nutrition

Most of the students in my nutrition graduate program were women. I graduated with one guy in my class, am one of thirteen female dietetic interns and am supervised by female dietitians. Nutrition is traditionally known as a "women's field." But my interest was piqued when I received this email from the American Dietetic Association (ADA) earlier in the year:
Over 84 percent of food and nutrition professionals are white and over 94 percent are women. How do you feel about this? What should ADA do to increase diversity? ADA wants your opinion.

Well it may be a few months late, but here are my thoughts.

I am proud to be part of a profession that is working toward the betterment of health and wellbeing of all citizens, regardless of age, race or gender. I firmly believe in the power of nutrition, of food and eating and nourishment, of the potential for improving quality of life through prevention and management of chronic disease.  I can only imagine that others who go into this field do so out of similar conviction, since I have learned that there isn't a whole lot of money to be made helping people in this way, unless you plan to create a functional food, write a fad-diet bestseller, manage a large scale food service site or sell a lot of supplements. Most insurance companies do not cover nutrition services unless a patient is diabetic or perhaps has renal impairment. Even morbidly obese patients who qualify for bariatric surgery are only entitled to one to two nutrition education sessions, when clearly nutrition plays a major role in the success or failure of their surgery. And so while nutrition may have played a key role as a mode of early intervention to prevent disease progression, most patient do not qualify for such benefits until they have fully developed a condition that needs to be managed. This is simply unjust.  And I believe it is largely because nutrition is viewed as a nice but nonessential "women's field."

I could surmise the origins of this phenomenon. Perhaps working in dietetics is a natural progression from working in the kitchen, so it was reasonable for women to flock toward this field. But such an argument  collapses when you look at the statistics on male vs. female chefs who actually work in the kitchen. Women are underrepresented in the executive chef category overall and they tend to earn significantly less than their male counterparts. A better comparison might be to the medical profession, where nursing reports similar gender statistics (only 5.% of nurses were male in 2009), or even the case of female physicians who earn 40% less than their male counterparts on average.

So why haven't men and minorities been flocking to the field in droves? Looking at the numbers, why would they? It is extremely competitive (in 2009, only 52% of nutrition graduates matched for dietetic internships, required for credentialing). Internships are almost a year long and not only are they unpaid, but most require tuition (ranging up to $40,000), typically without financial aid eligibility.  For the most part nutrition services are not covered by insurance. See below for the Department of Labor, salaries of dietitians vs. nurses, just as a point of comparison:

Registered Nurses Wages, May 2010
Dietitians and Nutritionists Wages, May 2010

Gender studies is not my area of expertise, and my rationale is not evidence-based.  But the numbers speak for themselves. There are financial barriers to entering the field and it's not a very lucrative profession. I haven't even started my career and yet I fear that my outrage will continue to grow and then eventually fade into apathy.  At the end of the day, most nutrition jobs tend to have more flexibility for working moms and that is an important feature for many women. A few months ago, a friend posted this TEDTalk on Facebook and I found it hit the nail on the head. Discussions of women in the workplace inevitably involve complicated questions of childrearing and priorities and failure to fight for a "place at the table." I have very mixed feelings about the American Dietetic Association but I am happy there is an organization in place to advocate for my field.

So, ADA, what can you do to increase diversity? Might I offer the following:

1. Remove the insurmountable barriers to receiving dietetics credentials by reinstating alternate routes to the RD that would allow competent, educated graduates to practice in the field and offer financially viable ways to complete the credentialing process.

2. Advocate for expanded insurance coverage, relying on the data supporting nutrition as a crucial mode of prevention and treatment of chronic disease, reducing length of hospital stays, healthcare costs, employee absence and improved quality of life.

3. Boost your own credibility by displaying greater transparency in regard to sponsorships, demanding more accountability from the food industry giants who fund your nutrition initiatives by profiting from the sale of food-like items that undermine the very dietary guidelines you espouse.

A white, female nutrition professional