nutrition

How can dietitians learn from Indigenous food ways?

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Kelly Gordon is a Nourish innovator and is a Registered Dietitian currently working with the Six Nations of the Grand River. Kelly is Kanyen’keha (Mohawk), bear clan and a proud mother of two energetic children. Her current focus is working to integrate Traditional knowledge into her everyday practice, supporting community members on their journey towards wellness.

 

As health care providers, we need to address the social, emotional, mental and spiritual dimensions of the relationship that people have with food.

When most dietitians advocate for the role of food in health and healing, we emphasize the physical and nutritional impact it has on our bodies. However, as health care providers, we need to address the social, emotional, mental and spiritual dimensions of the relationship that people have with food.

I have been working as a registered dietitian for 15 years and as an regulated health provider, I choose to weave these dimensions into my dietetic practice. At Six Nations Health Services, I work to improve the community members’ relationships with food. When people are instructed that they need to choose ‘healthier fats’ or have to ‘eat smaller carbohydrate portions’, it can be irrelevant when they may present as food insecure or have been impacted by trauma. For me, it is about listening to and understanding them so that I can draw from their experiences to expand their relationship with food. This can be the starting point to highlight the kind of positive behaviour change that can co-exist with their needs.

My personal journey developed during my bachelors of science from the Nutrition and Dietetics program at McGill University. I ended up doing a work study placement at the Centre for Indigenous Nutrition and Environment (CINE) where they connected me with other Indigenous dietitians. My university years were deeply formative to me in connecting more deeply with my own Mohawk roots and learning about the importance of food in community health. However, the impacts of community health and food insecurity are not discussed enough at school. We didn’t talk about the environmental impact of how food is grown, or the relationship between food and land. This may be the reason why dietitians are prone to work in more clinical settings instead of working in community health, because we’re trained to see ourselves most fitting into a clinical environment.

With dietitians, this leads to an underlying expectation around the judgemental responses people anticipate us to give. I’m often sitting around people who exclaim “don’t look at what I’m eating, it’s not good!” when they find out I’m a dietitian. When people say things like that, I think about what their connection is with their food that triggers this fear of judgement. I also consider the kind of food and healthcare culture we have that reinforces this shame and stigma when it comes to what we eat.

As dietitians, we need to learn that we’re not just here to fix a ‘problem’. This is a colonial mindset in healthcare that is challenging to overcome. Our mandate to provide safe and reliable health information is inherently biased around a particular set of criteria that determines what is evidence-based and quantifiable. Why do we overlook Indigenous wisdom derived from generations of community-based and historical knowledge?

A lot of my learning comes from my interactions with the Six Nations community and following the direction and voices of Indigenous community members. As a dietitian, I don’t come in claiming to be an expert, but as a person who will listen, learn and support.

We need to learn how to shift the current perception around the dietitian’s role, and the role of the health care provider overall. This means moving away from dominant western biomedical care practices and establishing a model of care rooted within Indigenous practices and food ways.  It is crediting Indigenous wisdom as reliable and trustworthy information. A lot of my learning comes from my interactions with the Six Nations community and following the direction and voices of Indigenous community members. As a dietitian, I don’t come in claiming to be an expert, but as a person who will listen, learn and support.

We need to learn that even the term “healthy food” should be challenged. The idea of “healthy” foods has become limiting and is causing shame around what people should or should not eat. There is a role for Indigenous knowledge to inform a more holistic understanding around what is nourishing food, and to enable us to re-examine people’s emotional, cultural and spiritual connections to food, as well as food’s connection to land and the greater environment.

The way that we eat is a massive contributor to the environment beyond our physical selves. If we look at the ways that our ancestors have nourished their whole selves by eating the foods that grew in their local regions, and by eating in amounts that allow all to eat, we find practices embedded in the Seventh Generation teachings. How we eat and practice in our daily lives should be mindful of what the world should look like seven generations from now. Our teaching around food and foodways shifts us to being more mindful about the good energy we pour into how we obtain and prepare our foods, and to being thankful for our food and who prepared it. This allows us to cultivate a more meaningful and mindful relationship with food that nourishes our bodies, minds and spirits.

Self-awareness and understanding has to go hand-in-hand with the actions taken for true reconciliation to happen.

This kind of mindful work takes a lot of time and effort and it can’t be done quickly. Right now, I’m working with a team of dietitians and food service professionals from across the country on a project where we want health care organizations to acknowledge and provide Indigenous and Country foods. However, choosing to source and serve Indigenous foods cannot just be a checkbox. It needs to be about stepping back and gaining more self-awareness around why it is so valuable and important to include traditional foods and food ways. Self-awareness and understanding has to go hand-in-hand with the actions taken for true reconciliation to happen.

Myself and fellow Nourish innovator Shelly Crack at the Reconciliation Totem Pole in British Columbia.

Myself and fellow Nourish innovator Shelly Crack at the Reconciliation Totem Pole in British Columbia.

Recently, I presented at the Dieticians of Canada conference in Vancouver and visited the Reconciliation Totem Pole at the University of British Columbia with fellow Nourish Innovator Shelly Crack. This beautiful structure created by a Haida artist symbolizes a violent and brutal break in Indigenous culture with residential schools. This made me reflect on how like a bone, when culture is broken, it may never function the same way. However, the more important question is the one around healing -- when something breaks, what kind of physical, emotional and spiritual rehabilitation is required to nourish and build up strength again? I believe that food is a great way to nourish, but it is also a critical part of starting and continuing these kinds of difficult conversations.

We need more nutrition education in medical schools

By Dr. Margaret Rundle

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Dr Margaret Rundle is a Family Physician practicing at Malvern Medical in Scarborough. She completed her BSc in Nutritional Sciences, (UofT’85), Undergraduate in Medicine (UofT’89), followed by Family Practice Residency(UofT’91). Dr. Rundle founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education, which is a part of the Food as Medicine series at the University of Toronto. She, her husband and two boys, ages 27&24, enjoy very active, healthy lives.

 

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As physicians, we share a basic understanding about diet, but food remains under-appreciated as an intervention point to empower patients about the treatment and prevention of disease.

There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more cutting edge research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education on the role of nutrition and lifestyle has been a blind spot in the Canadian medical school system for a long time.

I have spent the past 27 years as a Family Physician, and I make it part of my clinical work to motivate and educate my patients around the role of nutrition in their health and well-being. My interest stems from my early school years when I participated in a variety of athletics and wanted good nutrition to support my involvement.  I completed a four-year undergraduate degree in Nutritional Sciences with the intention to go into Medicine afterwards. In my four years of medical school, I was surprised to find that we were exposed to only about 20 hours of nutrition education. I recall it being primarily about knowing what are vitamins, minerals, carbs, fats, with nothing about the role of dietary interventions.

When I first started practice, I still cared a lot about the role of physical activity and nutrition but it was easy to get caught up in the day-to-day handling acute problems, making diagnoses, and writing prescriptions. What had happened to my passion in preventative medicine? It was after I attended a series of conferences that focused on advances in scientific research around food and nutrition that my passion was renewed. I literally got tingles as I sat in the audience. I was back! Since then, I’ve changed my practice to spend at least 15 minutes of a 45-minute physical talking to, and enquiring about, nutrition, exercise and lifestyle.

However, from the treatment point of view, many physicians still do not look into what we can do with nutrition. We share a basic understanding about diet, but food remains under-appreciated as an intervention point to empower patients about the treatment and prevention of disease.

 

Weaving food and nutrition into medical education

One problem is that in most medical schools, physicians are not being taught the latest concepts in nutrition science. Research shows that doctors currently don’t feel confident enough to counsel their patients about their diets; in fact, more than half of graduating medical students rate their nutrition knowledge as “inadequate”. Nutrition education simply isn’t prioritized enough in the medical curriculum in North America. Another study in Academic Medicine shows that only 27% of 105 medical schools in America met the minimum requirement of 25 hours in nutrition education.

In fact, 87.2% of the Canadian students surveyed in a study said their undergraduate medical program should dedicate more time to nutrition education.

There is demand from Canadian medical students for more nutrition education.  In fact, 87.2% of the Canadian students surveyed in a study said their undergraduate medical program should dedicate more time to nutrition education. While a lot of these students said they were somewhat comfortable in their knowledge about the role that nutrition plays in disease prevention, they felt ill-equipped to counsel patients on dietary requirements across all stages of the patients’ lives.  They also said they have trouble identifying credible sources of nutrition information.

Medical school faculties need more staff who are qualified to teach nutrition. I believe that understanding the role of food as treatment should not be relegated to a few more hours or as a separate course, but woven into the entire medical curriculum. We should talk about nutrition when students study pre-natal health, pediatrics, ophthalmology, oncology, or orthopedics. Fortunately, this has already begun at the University of Toronto thanks to the guidance of a team of physicians including Dr. John Sievenpiper, and to the very generous donation from Johanna & Brian Lawson for the creation of the Centre for Child Nutrition at the university.

 

A trusted and reliable education resource for physicians and patients in nutrition

What about the physicians who are already practicing? I’m currently working with the University of Toronto on accredited nutrition education for practicing MDs and have founded the Rundle-Lister Lectureship in Transformative Nutritional Medical Education. This lectureship is part of the Food as Medicine Series and provides an annual award to a clinician recognized for providing an outstanding contribution to the role of nutrition in patient care. The conferences help to address the knowledge gap in continuing medical education in nutrition; for example, our first Food as Medicine conference focused on the impact of gut microbiome in health and disease. There is a saying that “we are what we eat”. While there is truth to that, I also believe that as more research is tackled, we will further understand how the foods we eat affect our microbiome and consequently, the impact of those changes on our health.

Patients and physicians alike also look to the internet for educational assistance. For doctors who do not have the time for nutrition counseling, or wish to refer patients to reliable and trusted websites, I envision a day when we can refer to a University-affiliated “go-to” web hub.  The University of Toronto is one of the few Faculties of Medicine that has a Department of Nutrition under its umbrella. By developing such a website, the University of Toronto would be in an excellent position to become known as the place for physicians to update their knowledge and for patients to get safe, reliable information about nutrition.

I’m not asking doctors to become dieticians. But physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate.

I’m not asking doctors to become dieticians. But physicians are in a unique and powerful position because they can provide advice to patients during annual check-ups or at times of acute illness when it is most likely to resonate. For long-term change to really happen, the opportunity sits with redesigning medical education for future physicians. They can be taught about the value of nutrition in their clinical practices, and to position dietary approaches as a complement to traditional medicine for the maintenance of health and prevention of chronic diseases.