Would you agree with me that among many things, culture plays a big part on what features on your menu many a time? Probably we all know that the primary role of food is survival but beyond that food has a very significant role that it plays in the lives of human beings. Food is a pivot for unification across cultures and generations. Have you ever sat down and wondered what the food you eat everyday can tell you about where you come from? Have you ever wondered why people from different parts of the world eat different types of food? Or do you ever ask yourself why certain foods or culinary traditions are so important to your culture? These questions should by now indicate to you how there is more of a connection between food and culture than you may think. Food is considered to be multidimensional, something that shapes us, our identities, and our cultures and in the end, our society. Just as different clothes signify different things, for example the white coat for a doctor, the uniform of a police officer or army personnel, food too transmits a meaning.
Growing up, our mother used to always cook on special days, and by special days I mean the Christmas and Easter celebrations of this world. She was the main chef that day and no amount of convincing would make her relent no matter how tired she would be. Everyone who knew our home knew that the menu when she cooked would not miss to have millet bread (kalo) and boiled meat with mushrooms (always cooked in a special pot). This is something that was handed over generations down and this is one of the major foods in my culture (I am a munyoro from the Western part of Uganda), so there is no celebration without this. Be sure I will also pass it down, generations to come.
Meat is cooked in a pot like this
Millet bread (kalo) is always served in this special basket
Food is often used as a means of retaining cultural identity. People from different cultural backgrounds eat different foods with the areas in which families live and where their ancestors originated influencing food likes and dislikes. It is these food preferences that result in patterns of food choices within a cultural or regional group. In many countries, a case we see in Uganda too where rural urban migration is the order of the day, people find a way of maintaining and preserving culture by opening up native food business in the major towns. Here in Kampala there are specific places you will be directed to if you are looking for your cultural food. For example; Those that are coming from the Northern part of this country can find their ethnic food in places like Namayiba bus park and those from the central region can find theirs in places like Luwombo restaurant. People drive miles and miles looking for a connection to their origin through food. We also witness that during celebrations like traditional weddings, it becomes a showcase of culture not only in the wedding rituals but through the food served as well.
The meaning of food is an exploration of culture through food. What we consume, how we acquire it, who prepares it, who’s at the table, and who eats first is a form of communication that it has a rich cultural base. Beyond merely nourishing the body, what we eat and with whom we eat can inspire and strengthen the bonds between individuals, communities, and even countries, so we cannot talk culture without talking about food. This week I will attempt to highlight these and more aspects about food and cultures. I hope to interact with you and learn from you as well.
I started off this week talking about the new digital age or call it the Fourth Industrial Revolution which is changing almost everything in the world including how food is perceived, purchased, and used by the consumer. The dietetics industry is rapidly evolving too with the new digital age and the technology available to nutritionists and dieticians is undoubtedly accelerating the pace of this change. Is it just me but each passing day we get to learn about a new app, smart tool, software platform/ website offering to their consumers and healthcare professionals some kind of way of keeping in touch more so in these times when it is safer to stay many meters away from each other.
Talking of the changes technology has laid out for us in regards to food being perceived, purchased and used, the Internet of Things (one of the technologies I mentioned used by the Fourth Industrial Revolution) has more than 15 billion devices connected, enabling people to order groceries online from the supermarket, order food online, customize meal plans, and get countless recipes all by a single click on the phone. Now more than ever it is easy to track workouts, log in food and get personalized nutrition services with the aid of technology. The Internet has become a very powerful tool in Medical Nutrition Therapy (MNT). Medical nutrition therapy includes determining individuals’ specific nutritional needs based on their medical status and disseminating this information to them in a manner that enables understanding and adherence to the goals they set with other health care providers.
Personal wearable devices like smart watches have gained alot of popularity lately tracking levels of energy expenditure and other aspects of health, which in turn can provide device-supported advice about dietary needs if they are connected to their smartphones/devices. All this information is helping dieticians have easier ways of collecting continuous biometric data required to make good nutrition interventions for their clients. This also reduces client’s burden of having to provide more accurate, consistent data for a variety of health measures. In dietary analysis, the use of mobile phones to record dietary intake and photograph food prior to consumption is becoming an effective method compared to the recall methods that we have been using, making a more accurate dietary assessment.
This technology I am talking about goes far beyond using social media platforms used as a marketing vehicle to support the practice and brands of dieticians. Technology can fundamentally reshape the way both dieticians and recipients of nutrition based services relate. To my fellow colleagues in the profession, recognizing the importance of emerging technologies for nutrition science will be the corner stone for your practice especially in these changing times.
Here are a few emerging technologies you can take advantage of;
There are kitchen gadgets nutritionists/dietitians can offer clients like smart scales and smart plates that can obtain information which is automatically uploaded to an electronic portal. This will improve adherence and compliance to meal plans, and also make it easier than ever to measure progress.
There are lots of free electronic resources (apps, websites, and more) with credible educational materials that you can recommend to your clients to support a healthy lifestyle.
Nutritionists/dietitians can leverage “gamification apps” to create healthy competitions in workplace settings to encourage healthy living thereby promoting corporate wellness.
Nutrition providers can connect with their clients in between appointments through online food journals, messaging apps, and client-provider portals, like HealthifyMe many of these found on play store and google play. This promotes continuity of care in between appointments and building closer relationships with nutrition providers and clients which translates to more adherence to recommendations.
Nutrition providers can make use of practice management software to reduce the time spent on back-office tasks like scheduling, billing and charting, thereby increasing time spent seeing clients and building business.
Technology is sure flipping everything in the world for the better part mostly. When used properly, technology is making patient care more efficient and effective. We encourage everyone to think about how they can include technology in their care. For patient care service providers, learn how technology can help streamline your services while saving you time and money?
It was the smell of the clay for me that held me captive for so long. Was I pregnant? Oh not all. Did I know its effects? Of course. I remember my supplier of the clay blocks, some elderly lady finally finding her voice and managing to ask me why my stomach was not increasing in size for all this long (She believed I was expecting). This is when it dawned on that I had taken this dirt for so long and I began to worry for my appendix. It should be working overtime collecting all the small stones from the clay as my body struggles to digest this non food delicacy of mine so I reasoned. Given my knowledge in nutrition, I knew that my body was signaling something, a deficiency of some sort and as anticipated my iron levels were wanting when I finally took the blood test. It could have been worse if I had not given myself a self check thanks to my curious clay distributor but what happens to someone who has no idea that it is a problem or has become so addicted to it that they don’t even realize it is eating them away.
I once read an article of a girl who was addicted to eating hair and had to undergo surgery and guess what! a hair ball as big as a melon was removed. This was after the parents noticed a drastic weight loss in the girl as the hair in her system made it impossible for her to eat and she kept throwing up. (https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/130717/melon-sized-hairball-removed-from-stomach-of-girl-addicted-to-eating-hair.html) This is how bad this habit or say disorder can get and this disorder has a name, Pica
Hair ball that was removed from the girl who was addicted to eating hair. – Internet picture
Bulimia and anorexia nervosa are the eating disorders that have been talked about the most and I still wonder why pica has not received the required attention it so deserved given its dire effects. So let us explore a little what pica is.
What is Pica
Pica is an eating disorder in which a person eats things that are not usually considered as food. These people compulsively eat items that have no nutritional value like dirt, clay, rocks, paper, ice, hair, paint chips, chalk and even feces (poop). This disorder is most often in children and pregnant women although it’s usually temporary for them, however we have other people with this disorder that are addicted and are struggling with it.
Talking about what causes pica, it is said that in some cases, a deficiency in iron, zinc, or another nutrient can be associated with pica. For instance anemia, usually from iron deficiency, has been known to be the underlying cause of pica in pregnant women (in some cultures it is a common practice for pregnant women to eat clay and some even go further to put medicinal herbs for them in clay to ingest throughout the pregnancy period). So your unusual cravings may be a sign that your body is trying to replenish low nutrient levels reason for you to find out.
People with certain mental health conditions like schizophrenia ( A disorder that affects a person’s ability to think, feel and behave clearly) and obsessive compulsive disorder ( A disorder is characterized by unreasonable thoughts and fears that lead to compulsive behaviors) can adopt pica as a coping mechanism. Some people may even enjoy and crave the textures or flavors of certain nonfood items. I have been with quite a number of people who are obsessed the smell of soil as it begins to rain.
Signs and symptoms
This is the condition where no laboratory are done to diagnose but instead, the diagnosis is made from a clinical history of the patient although this diagnosis is accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of the substances consumed for example lead in pencils, paint or crayons, bacteria and parasites from dirt or stones from the rocks. These are the signs and symptoms to look out for.
There is persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value.
The ingestion of a substance(s) that is not a part of culturally supported or socially normative practice for instance there are some cultures that promote eating clay as part of a medicinal practice.
Typical substances ingested tend to vary with age and availability. These may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.
The eating of these substances must be developmentally inappropriate. In children under the age of two years, mouthing objects or putting small objects in their mouth is a normal part of development which allows the child to explore their senses. Mouthing may sometimes result in ingestion so this can not be categorized as pica.
Last but not least, those with pica are not averse to ingesting food.
Complications
Complications from pica typically range from posing a few health risks to life-threatening risks. Some of the complications that occur include; choking, poisoning, damaging the brain from eating lead or other harmful substances, developing ulcers, breaking teeth, gastrointestinal problems such as constipation, diarrhea and bloody stool as well as harming the digestive system like causing injuries to the throat.
What to do about Pica
Pica can occur during pregnancy, especially in women with nutrient deficits so let us begin here, women with unusual cravings during pregnancy should consult with a doctor for an iron test. It is important that pregnant women with pica resist the temptation to eat nonfood items as this could have harmful effects to the ‘bun’ in the oven. Finding distractions, such as chewing on something else preferably a food item, finding foods with a similar texture to eat, or doing something relaxing can be of help.
The truth is persons struggling with pica may realize that their cravings are unhealthful or unusual, but the urge to eat those nonfood items can still feel overwhelming which may cause frustrations if they are not able to act on these cravings. The right treatment is to deal with both the physical and psychological aspects of pica. Adults who come to the realization that they are struggling with pica or parents who identify this in their children are advised to consult a physician for professional help to change this behavior
Do you know someone who enjoys a behavior like what we have described? Share this with them and you could save a life.
Milk is a delicacy for many, it is the first meal for almost everyone from birth through breastmilk but it is sad that for some, milk does not choose them. Ever seen or heard people present with diarrhea, gas and bloating after eating or drinking dairy products? Such persons could be having a condition that we refer to as lactose intolerance.
If you are wondering why this happens to people like these, here it is. People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. When milk ingested, it is broken down by an enzyme called lactase and lactose intolerant people have too little of this enzyme. During digestion, the enzyme lactase turns milk sugar (lactose) into two simple sugars (glucose and galactose) which are absorbed into the bloodstream through the intestinal lining to be put to use in the body. For persons deficient of this enzyme or have low levels, lactose in the food moves into the colon (large intestines) instead of being processed and absorbed. In the colon, normal bacteria interact with the undigested lactose, causing the signs and symptoms of lactose intolerance which we talk about here later.
Although one can still digest milk with low levels of lactase, having levels that are too low will lead to symptoms after you eat or drink anything dairy. The best and most common way of managing lactose intolerance is to take out diary foods from the diet although there is also another way someone with the condition can manage without having to give up all dairy foods by adding a liquid or powder of the lactase enzyme to milk to break down the lactose. The signs and symptoms of lactose intolerance usually begin from 30 minutes to two hours after eating or drinking foods that contain lactose or diary foods. The common signs and symptoms include diarrhea, bloating, stomach upsets, Nausea and at times vomiting.
We have three types of lactose intolerance. Different factors cause the lactase deficiency underlying each type and we get to dissect each one of them.
Primary Lactose Intolerance
This is the commonest type. Naturally infants are born with enough lactase and are able to digest breast milk comfortably but when this is replaced during complementary feeding the amount of lactase produced normally drops, but usually remaining high enough to digest the amount of dairy in a typical adult diet. In primary lactose intolerance, lactase production falls off sharply by adulthood, making it difficult to digest milk products.
Secondary Lactose Intolerance
In this form of lactose intolerance, it occurs when small intestine decrease lactase production after an illness, injury or surgery involving the small intestine. Diseases associated with secondary lactose intolerance may include intestinal infection, celiac disease, bacterial overgrowth and Crohn’s disease. The beauty about this one is that in most cases treatment of the underlying disorder might restore lactase levels and improve signs and symptoms, although this can take time.
Congenital or developmental lactose intolerance
This type is genetical though rare where a child is born deficient of the enzyme lactase. For this to be passed though, both the mother and the father must pass on the same gene variant for a child to be affected, a pattern of inheritance we call autosomal recessive.
So the next time you notice a pattern especially after consuming diary products, before you conclude that it is ulcers or food poisoning, you may need to check in with your doctor to rule out lactose intolerance.
One researcher said “Body weight is of physical and psychological importance and is associated with health status, physical activity, body image, and self-esteem,” (https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-4-S1-S5) and I could not agree any less.
Talking about self esteem and body image, many girls and women have this ardent desire to find that ‘perfect’ body/weight which has led them to take some bizzare measures only to cause more than good in the long run. Weight prejudice has been around for so long and this differs for different cultures. There are cultures that will promote and or advocate for one to be ‘fatter’ because it is associated with ‘good’ feeding, being or appearing wealthy and it is their way of good looking like in many parts of Africa yet other cultures like in the West will promote for slimmer sizes which puts a different kind of pressure for many. Whichever culture you subscribe to, it is important to aim at having a healthy weight that is unique to you.
What does healthy weight refer to?
Healthy weight refers to your Body Mass Index falling within a weight range that is not associated with an increased risk for weight-related diseases and health issues. What is body mass index you may ask? Body Mass Index (BMI) is determined by your height and your weight. BMI doesn’t measure body fat, but it often correlates with direct measures of body fat meaning a higher BMI tends to indicate higher body fat, and a lower BMI indicates lower body fat. Body mass index is for sure an easy way to monitor and get a general idea of a person’s body fat, but should not be used as a diagnostic tool for disease risk. Remember your BMI weight category isn’t an indicator of your overall health and being within a healthy weight range doesn’t necessarily mean that you’re healthy. Being underweight or overweight either doesn’t necessarily mean that you’re unhealthy either.
BMI weight categories
What should my body weight be?
There are a lot of concerns that arise around body weight and arguably the most question we receive as nutritionists/dieticians is around how much one should weigh? However, there is no straight answer to this and there is not one ideal healthy weight for each person, because a number of different factors play a role such as age, sex, height, muscle-fat ratio and body fat distribution, or body shape. Did you know that body weight is regulated by several mechanisms? Oh yes it is, mechanisms like genetic, physiologic, and behavioral factors. Let me give an example before I lose you, in obesity, an imbalance occurs between food intake and energy expenditure, which leads to an excess fat accumulation and negative health consequences.
How to maintain a healthy weight
Depending on where you lie right now there are things you may need to do to acquire a healthy weight. If you are overweight and obese, you may need to slash some bit of weight in order to achieve your healthy weight and if you are underweight, you may need to pile on some calories to reach your desired healthy and both these require a detailed explanation which I will put together and share with you soon or later (So be on the look out). Today let us focus on how to maintain this ideal weight. I like to believe that losing weight and or adding weight may be easier than maintaining an ideal weight. It almost feels like balancing on a thin wire and having to walk a great distance making sure you do not fall off the line. Maintaining a healthy weight not only benefits your overall health but also boosts your confidence in your appearance greatly, your self esteem and body image are greatly enhanced. So I will share some easy tips that you probably don’t even think about but could be the key to maintaining your healthy weight. Remember healthy weight is individualized and will be different for everyone even when you are members of the same family.
Tips on maintaining a healthy weight
Mind what you eat
With this you will have to pay attention to what you eat, not only in the quality of food but also the quantity of the food eaten. Portion sizes are important to avoid under or overeating. Pay attention to the nutrition facts on food labels listed on packages and make an informed choice. Make use of smaller plates and bowls as this will help you choose smaller portions at meals. Prioritize meal time and eat slowly, with focus on your meal. Listen to your body ‘s physical cues to stop eating before you feel overly full and let fruits and vegetables be a good part of your diets. Remember an apple a day keeps the doctor away.
Physical exercises are your friend
Try to exercise as often as you can. This does not necessarily mean that you have to sign membership at some gym; sign up for membership if you can afford, however you can also make use of the simple exercises at home. Let the goal be to break bouts of sweat as regularly as possible. Your body weight is significantly affected by the amount of energy you take in and the amount you use. Now the secret is in striking a balance, to maintain a healthy weight, you will need to use as much energy as you consume. Find a good exercise routine that includes both cardio and strength training (luckily YouTube is littered with many of these lately). The benefits of daily exercise are more than just keeping your body weight in check; they are also for building muscle, strengthening your heart and helping your body function at its best.
Sleep Sleep Sleep
You must be wondering why sleep has appeared on this list but let me tell you, getting a good amount of sleep helps your body to reset and rejuvenate really well. In this era, it is very easy to enter your bed very early but keep on your phone only to realise that you are left with just 3 hours of sleep which is not good for your health. Make a conscious decision to have at least 7 hours of sleep each day.
Increase your water intake
Hydration is very important because the body systems require water to function seamlessly but also water is very important for maintaining a healthy weight. In addition to aiding digestion of the food you are eating, water will enable you to avoid overeating because part of your stomach will be filled with water which in turn will significantly reduce the amounts of food you consume while leaving you satisified.
Have regular medical check ups
Let us normalize the culture of having medical checkups with or without pain. Many of us only check in with a doctor when the body responds with pain whereas if we had routine medical check ups we could catch something before it gets worse. Many times radical changes in body weight are a signal of an anomaly that needs to be addressed. Arrange to have a medical checkup at least every quarter.
Reaching and maintaining a healthy weight is important for overall health and will most certainly prevent and control many diseases and conditions the reason why maintaining a healthy weight is so important. Always remember that ideal weight is not an absolute target for either appearance or health as it may not take into account factors like muscle mass or health conditions that affect weight. Check in with your dietician today and get to know what your ideal weight looks like.
