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Things I learned in three years of our Nutrition Initiative: My Top Ten

[Cross-posted from Beyond Bread]

Somehow three years have gone by (actually flown by) since I started working at Bread for the City. As the go-to person for all things nutrition-related, I’ve been asked to reflect on how far we’ve come in that time and where we’re going next. I figured a Top 10 list might be a fun way to go about it (it could have been a Top 100 list, but…) so here we go, in no particular order:

10. My work day will never be boring. Our clients face many different kinds of problems, and we must always think creatively to support them in addressing them. This means we rely on our co-workers who have expertise in a variety of areas, and it also means that we need to be creative.

9. Building it does not necessarily ensure that they will come–even if they sign up to come. We’ve developed a lot of fun and free opportunities to learn cool things here in nutrition classes, cooking classes, and more. But our clients’ schedules are at the mercy of all kinds of challenging factors: they might not have working phones to receive calls; they might be dependent on unreliable public transportation; they’re often thrust into crises of all kinds; and sometimes are dealing with physical and mental health issues that make it challenging to keep commitments. How does this affect the programming we offer? Well, we try hard and then hope for the best. We make reminder calls, put signs up around the building, and then we cold-call all past participants of related workshops in hope that it might be a good fit for them this time around, as well. And then we divide by 2. If 40 people say they’re coming, we have learned to expect that this means we’ll have 20 people max, which might be the number we were hoping for anyhow.

8. Simply sharing stories can be transformative. This year, we explored struggles relating to food and health in a support-group setting. People share things in a group that they might not in a one-on-one consultation, and peers can learn a lot from listening to each other. We plan to start up the second iteration of our weight loss support group in the spring.

7. It is worth getting your hands dirty. At a client trip to a nearby urban farm this past summer, a regular cooking workshop participant turned to me with a fistful of mint and asked, “Is this mint?” Me: “Yes.” Client, smelling the mint: “I never tasted mint before the fish stew we made at the cooking workshop last month. I loved that stew and have been intending to make it. And now I get to pick the mint myself. I’m going to make it tonight! Just beautiful.” Sometimes it takes getting one’s hands enmeshed with the food to demystify it and motivate to try it at home. We hope to do lots more of this at our own rooftop gardens this summer.

6. Having the education doesn’t mean we have the answers. After getting a complete picture of a medical patient’s diet and exercise habits, I ask: “What do you think about how you’re eating?” and “What have been obstacles in the past that have stopped you from getting where you want to be health-wise?” and also, “What do you need to help you take better care of yourself?”

5. It’s hard to know what will stick and how things travel. For example, a few months ago I was talking with workshop participants about the disproportionate amount of starchy foods at a traditional Thanksgiving meal. When I asked the group if squash counts as a starch, one diabetic client, Ms. Johnson, said, “Is it winter squash or summer squash? You taught us a while ago that winter squash like butternut is full of starch and this matters for diabetes, but summer squash like zucchini is more watery and cleansing.” I knew that she was engaged during the workshops, but this was impressive recollection. Also, sometimes it seems that a client might not be ready to make changes just yet; but seeds can sprout later on, or get transferred to friends and family. You just never know.

4. Food can mask almost anything if someone wants it to. Lots of patients say they overeat because they “love” food, but they also describe eating as a numbing technique, a way to disengage from something deeper going on. When we love something, don’t we want to fully engage in it? When people overeat in this way, it’s often that first bite that they love, but then they love the mask that the eating creates. I’ve had the honor of witnessing some patients do the complex work of addressing what’s happening in that deeper place, and have seen them freed to truly love food, to eat it slowly and savor each bite.

3. Food is more complicated than we might imagine. In fact, there are more reasons than I ever could have imagined as to why people make the decisions they make around food. It never occurred to me that one of my patients would tell me that she can’t cook at home because she is too wide to turn around in her narrow galley kitchen. Or the pervasiveness of the story of those of us who are out of work, no longer on a schedule, and too depressed about it to try to come up with a plan. This is precisely why I don’t prescribe to one specific diet. Every body is different. Not only are we unique on a biochemical level, but our life circumstances also dictate unique approaches that can work for us.

2. Effective leaders initiate progress but are still grounded in their community. Being a leader means BFC needs to stick to its values and lead by example while also staying in close contact with the clients we serve. We have a serious responsibility to our clients and to the community overall, which means, among other things, being firm about not distributing high-sugar and high-sodium items that promote diabetes and heart disease. And it means having a continuous dialog with our clients about the food we provide.

1. There is much more to be done. When I started here three years ago, it was on a three-month contract. Still, I thought a lot could be accomplished in that time. Though I might have accomplished some of it, it was certainly a drop in the bucket. I think of that first year as the year of the low-hanging fruit. I started work in both the medical clinic and the food pantry; among other things, I started seeing patients individually, and the food program stopped purchasing unhealthy snacks, high-sodium soups and other canned goods, and we implemented a no trans-fats policy. With Glean for the City in full swing, as well as other projects in the works, I see years two and three as a time of programmatic innovation. I hope that at the end of this year, my fourth, I can look back on the meshing of some of our new activities into our overall holistic approach. I hope that our messages about food and health in the medical clinic and in the food program will be even more unified and that our complement of programs will offer all BFC clients an opportunity to access and explore healthy, tasty foods in a way that is fun, inspiring, and nourishing.

Thank you for supporting us along this great journey.

Healthy Holiday Helpings


Most of the food in Bread for the City’s pantry is purchased directly by us from the Capital Area Food Bank – putting your donated dollars to great bulk-scale use. (And it’s not too early to give to our Holiday Helpings campaign, which starts next week!)

We also receive private donations of food, through organized food drives and individuals’ pantry-purging — especially during the holiday season.

We truly value the generosity of our donors. Yet because we also highly value the health of our clients, we hope to channel the energy and commitment of our donors to ensure that clients receive foods that best support their health.

This year we want to remind our community that not all foodstuffs are nourishing – and there are some that we simply cannot accept.

Research shows that there is a much higher incidence of diabetes and heart disease among populations that include our clients . These diseases are largely preventable through lifestyle changes like diet and exercise. By contributing foods that do not contribute to these diseases, donors can help Bread for the City be a part of the solution to this community health crisis.

With this in mind, we respectfully share our updated nutrition guidelines for donations.

Please keep in mind that we cannot accept the following:
• canned or boxed soups that are not labeled low-fat, low-sodium
• ramen noodles
• pastry items, candy, other sweet snacks (cookies, Jell-o)
• drinks that are highly sweetened or artificially sweetened (sweetened fruit juice, soda, sports drinks, sweet tea)
• cake and brownie mixes
• boxed macaroni and cheese

Instead we encourage:


• canned vegetables and beans that are labeled low-sodium or no salt added
• olive oil
• dry beans
• fruit canned in natural juices
• canned salmon, tuna, sardines, or chicken, especially unsalted and packed in water
• 100% pure juice
• whole grain flour and cereal that is whole grain, not highly sweetened (plain oatmeal, original Cheerios)

And we discourage but will accept:
• canned vegetables and beans that are not labeled low-sodium or unsalted
• fruit canned in light or heavy syrup
• sweetened cereal (Raisin Bran, Honey Nut Cheerios)

Thank you for joining us in this broad effort to improve the health of our community! To sign up to run a Holiday Helpings drive in your workplace or community, please contact Nathan LaBorie at nlaborie@breadforthecity.org or 202.386.7611.

We’re so over salt

[Cross-posted from Beyond Bread.]

Last month, Gary Imhoff of DC Watch had some salty words to say about health and nutrition. Just as the innovative, promising Healthy Schools Act was making its way to become law, Gary objected to the efforts to reduce the consumption of sugar and salt in our schools. These ingredients, Gary claimed, “pose no real dietary or health dangers to the average person.”

Unfortunately, one third of Americans are far beyond average: they are either overweight or obese. A major factor in this health crisis is overconsumption of sodium, which contributes to heart disease among other illness. The Washington Post recently reported that the Center for Disease Control estimates that an average of 77 percent of our sodium intake actually comes from packaged food — the canned, boxed, and bottled foods we buy at the market. That article also reports that the federal government is taking this health threat seriously with a new effort (not yet officially announced, but planned to span a 10-year period) to curb the amount of sodium in processed food and restaurants.

It’s great news, and I hope the federal government follows through. Indeed, here at Bread for the City we’ve already started down that path. In the past few years, we have greatly reduced much of the sodium in the items in our food pantry.

Yet Gary objects to “food police” who he says wants us to live in “a world without flavor.” The good news for Gary is that ours is a wide world full of flavors, with many ways of preparing food that is both tasty and healthy.

Here at Bread for the City, we’re able to go beyond the pantry to explore this world of healthy food. Each month at both the NW and SE sites, BFC holds nutrition and cooking workshops, geared toward helping clients make tasty, easy-to-prepare, healthful, inexpensive foods at home.

Just a few weeks ago, I gathered with Bread for the City clients from age 3 to about 73, as we spent an hour peeling, chopping, stirring, and laughing. We talk a lot about salt in these classes. With chili pepper flakes, vinegar, garlic, onion, and lemon as the seasonings on these dishes, the flavor was plentiful — all without using any salt. Participants knew that if they chose, they could add salt to the food on their own plates. But, remarkably, every participant declined to add any.

Won’t Drink the Water?

During the two years I have seen patients in Bread for the City’s medical clinic, I have heard innumerable patients tell me that they won’t drink the DC tap water. They say that they are scared that the tap water has lead and other contaminants, and they don’t trust that it is safe. After some bad publicity in recent years about traces of pharmaceuticals in the water, and a history of withholding information from the public regarding lead in the water, fears of unhealthy tap water are not without reason.

Some people say they are okay with drinking the water if it’s filtered with a Brita, PUR, or other relatively low-cost filtration system, but many claim that they only feel comfortable drinking bottled water.

Last week I spoke with a patient who doesn’t have kitchen access in his basement apartment. “I won’t drink tap water, so I buy some bottled water and have about two bottles of juice and two bottles of Arizona Iced Tea a day.” We did the math, and at about six dollars a day in drink expenses, that amounts to roughly $180 a month.

If he felt comfortable drinking the water from his sink, how much less money would he be spending on beverages? How much more money would he have for purchasing healthier food with less sodium? How much money could he save each day to put toward renting a place with kitchen access?

In the meantime, what can we do to combat the fear of water and the idea that it’s preferable to drink sugar-laden bottled iced tea than some of the clear stuff from the tap?

If the water is safe, as we are assured it is by DC government, the Washington Aquaduct, and the Washington Sewage and Water Authority, then I think they need to make a concerted effort to better explain the steps they have taken to ensure safety. Too many people are still afraid to drink it, and it is unacceptable that a significant part of the public, including those with a limited income, feel forced to spend their money on beverages, many of which end up being unhealthy. This issue will not correct itself.

For more information about water quality in the District, go here. For more information about the downside of bottled water, go
here.

Put Our Money Where Our Mouths Should Be

I have a view on fresh produce that might not shock you: Everyone should be able to buy it.

But for many low-income folks, that option doesn’t exist. The cost is simply too high. As Bread for the City’s nutrition consultant, many of my patients tell me that money is the leading reason they don’t make healthier choices.

Corn field

Why not level the playing field a bit more? What about subsidizing produce like broccoli, watermelon, and garlic? Or what about bulk government purchasing of these foods, an approach many farmers prefer?

A Healthful Thanksgiving

Everywhere we turn, we’re reminded that Thanksgiving is here. Most conversations focus on setting a beautiful table, cooking a moist turkey, making side dishes that could stop conversation, and baking pies to match.

And these things do matter. It also matters that the holidays, like all days, are healthful.

So at a recent cooking workshop here at Bread for the City, I participated in a conversation with our clients about how to make Thanksgiving healthful, without compromising flavor or tradition.

To get started, we talked about our various Thanksgiving table traditions, and came up with a list of what the clients called “Thanksgiving must-haves.” It included: turkey, ham, brisket, and/or a roast; gravy; green beans; macaroni and cheese; stuffing; sweet potatoes; corn; mashed potatoes; rice; cooked greens (collards, kale, spinach, mustard greens, etc.); bread; cranberry sauce; and of course dessert.

Now, as part of our Nutrition Initiative, we are working with our clients to identify other ways to eat healthfully even with limited resources. For example, last year Bread for the City scrapped canned gravy from our holiday menu (as it not only has super-high sodium, but it’s also expensive!), and instead passed out recipes for how to make your own gravy from the turkey’s drippings.

This time around, we sorted many of the Thanksgiving must-haves into two categories: non-starchy vegetables (e.g., lettuce, tomatoes, cooked greens, garlic, asparagus) and starchy vegetables and grains (e.g., sweet potatoes, corn, rice, and bread). Having had quite a few cooking classes under their belts by now, the people in my class noted that, ideally, the non-starchy vegetables on one’s plate would take up more space than the starchy vegetables and grains. But when we looked at the list of Thanksgiving must-haves, the starches/grains appear to have overtaken the non-starchy vegetables.

Our solution to this problem? Add vegetables wherever possible. After I offered some suggestions, the class participants really ran with the exercise, and came up with the following suggestions themselves:

  • For the green beans: Cook with onions, garlic, and/or broccoli.
  • For the macaroni and cheese: Add spinach, cauliflower, and/or tomatoes.
  • For the stuffing: Include plenty of celery, garlic, onions, pepper, and/or carrots
  • For the mashed potatoes: Mash in garlic, celery root, rutabaga, and/or cauliflower.
  • For the rice: Add plenty of fresh herbs, like parsley and mint.
  • For the greens: Don’t forget the onions and garlic.
  • And make a salad, as well!

Bread for the City client Gail prepares Thanksgiving dinner in her home.

We then made a healthier macaroni and cheese with low-fat cheese and milk, loads of chopped spinach, and whole wheat pasta. The clients couldn’t believe how good it was. Then they were wowed by our fresh cranberry relish, an addition or alternative to highly sweetened cranberry sauce.

And it’s easy to make. Here’s the recipe:

2 ½ cups of fresh cranberries
1 ½ cups of walnuts
1 apple
2 cans of pineapple rings in their own juice
3 stalks of celery

Directions:

Finely chop cranberries and walnuts.
Mix them together in a large bowl. Then pour in the pineapple juice from the cans.
Chop apples, celery, and pineapple rings and add to bowl.
Mix well.
Feel free to adjust the proportions to taste.  (I make mine a little different each time.) Enjoy!

Meanwhile, by the end of today, more than 5,000 DC families will have received Bread for the City’s Holiday Helpings feasts (including a turkey and all the trimmings; low-sodium stuffing; pasta; and fresh produce from our Glean for the City program). Few, if any, of these families could otherwise have afforded such a feast. For readers who would like to support our Holiday Helpings campaign — just $28 for a family of four — please visit www.breadforthecity.org/holidayhelpings

Happy Thanksgiving! 

 

Sharon Gruber is Bread for the City’s nutritionist, and founder of the Glean for the City program.