Wednesday, April 6, 2016

2016 National Dietitian Day – Full Circle

What can I say? I'm (very, very) late to the party, again! However, tonight as I was searching for one file on my computer, I found another file, which is called "serendipity". I took that as a nudge from the Universe that I finally needed to put other things aside and dedicate the time to do my annual Dietitian Day post, which officially was March 9th. :)

Back in 2012, I was interviewed for a very nice article in Today's Dietitian called "Get to Know Diana Dyer, MS, RD". Many articles published in Today's Dietitian Magazine have links so that they can be read on-line, but not this one. I have a copy, but I was not able to easily share the article with my on-line readers or my students. However, bingo! I actually found a copy of the article in a computer file, so in honor of a late post for National Dietitian Day 2016, I thought I would share the article on my blog. As I read through the questions and my answers, it actually covered a lot of ground, the many ways I have worked as a Registered Dietitian. 

I hope you enjoy reading it, and I hope that dietetic students and new RDs find some words of wisdom as they embark on an interesting, fulfilling, and hopefully, fun career! The world urgently needs your knowledge, your skills, and your passion as you share your love of food and its impact on health in the widest sense possible with the widest audience possible, from the soil to the planet and everything and everyone in between. 


Get to Know….Today's Dietitian, July 2012, written by Juliann Schaeffer

Diana Dyer
From Cancer Dietitian to Garlic Goddess

Diana Dyer, MS, RD, describes her current vocation as  “CEO of tractor repair and weeding to bottle washer and barn sweeper,” yet looking back to her dietetics beginnings, you may never have guessed this one-time critical care specialist would end up trading in daily TPN feedings for a reign as “garlic goddess” (as named by one of her customers) overlooking a field of green. 

Dyer started out her nutrition career in the late ‘70s as a renal dietitian, then quickly took on critical care, at hospitals in Ohio, Illinois, Wisconsin, and Michigan. After two decades of caring for patients in ICU's, she mustered up the courage to make her first (certainly not her last) unconventional work choice “to leave behind my comfortable and rather insulated world as a well-respected critical care specialist for the complete unknown world in real life,” to instead focus on serving the cancer survivorship community. Having survived neuroblastoma as a child and two later bouts of breast cancer, Dyer felt the message of nutrition’s role in cancer prevention and survivorship wasn’t being heard by the masses—so she became that voice. 

Through writing A Dietitian’s Cancer Story, developing the website www.CancerRD.com, and speaking to audiences nationwide after her book received widespread praise by The New York Times, for roughly a decade Dyer brought her positive message of how nutrition and other complementary therapies can optimize cancer outcomes to Americans of all shapes and sizes.

In 2009, Dyer decided to mix it up yet again, with her husband this time. The team left behind their regular paychecks and returned to their roots, quite literally, to fulfill a longtime dream to become organic farmers, establishing The Dyer Family Organic Farm just outside Ann Arbor, Michigan, where today they specialize in all things garlic.

For someone who has been through so much hardship, you might think her life outlook would be a bit (understandably) hardened; this couldn’t be further from the truth. Instead of bitterness and bite, Dyer takes from her tribulations a good helping of graciousness and gratitude—and passes it on to whoever will listen. 

“I know for sure that neither cancer nor life is fair,” she says from what she’s learned from her three bouts with cancer. “So you have to figure out that in spite of the bad set of cards you have been dealt, you want to go on, you want to play this hand and do the best that you can, and that you can help write the script to your life—grabbing life, giving life everything we have, noticing everything, living everything, loving everything.”

For a taste of Dyer’s enthusiasm for nutrition and life itself, check out www.dianadyer.com, www.365daysofKale.com, or www.CancerVictoryGardens.com

TD: What’s your best advice for those new to the nutrition field?
Words of wisdom I have hoped to leave with new undergrads/interns:
"The larger the island of knowledge, the longer the shore of wonder." 
–Ralph Sockman. 

I used this quote on my last day teaching dietetic undergrads at Eastern Michigan University. I took time in class to let them tell me what it meant to them. One student found me years later to tell me that meant a lot to her. 

TD: What book has most positively impacted your professional life?
Dyer: Diet for a Small Planet by Frances Moore Lappé, which I read in 1974. This book opened my eyes to so many new ideas, vegetarianism of course, but also so many ways that food, nutrition, and social issues are related.

TD: If you could offer clients/patients only one piece of advice, what would it be?
Dyer: Please do not view cooking as ‘drudgery’; it is the deepest expression of love because it is creating a healthy body, a healthy family, a healthy home. Create and honor the time needed to cook simple meals, from whole foods, not convenience mixes or from ‘food in a box,’ and then sit down to eat a meal with friends or family on a daily basis.  

TD: What five items are always in your refrigerator/cupboard?  
Dyer: Only five? Here are eight, and I could easily list 20. Soymilk, tofu/tempeh, flaxseeds, kale, garlic, red wine, chocolate, green tea (all organic if possible).

TD: How important do you believe having a basic knowledge of farming and ‘where food comes from’ is in the battle to get Americans eating healthy?
Dyer: My ‘reaching for the stars’ wish for a new Farm Bill would be the inclusion of funding designated to have every single school in the country have a school garden with an RD—a master gardener coordinator who would lead and coordinate a grade-appropriate curriculum and activities for each school’s students that includes gardening, how good food is important (vital) for energy, learning, good health, skills for cooking, the enjoyment of eating food raised and prepared at school in groups together, and even selling the food raised by the school children to parents, local neighborhoods, etc. 

In addition, I believe all gardening, but particularly vegetable gardening, is the most all-encompassing ‘alternative or complementary strategy’ for achieving health after cancer. This awareness led me to develop my www.CancerVictoryGardens.com blog, but the concept is probably equally applicable to the treatment of all chronic diseases such as diabetes, heart disease, hypertension, etc.

TD: Local or organic? 
Dyer: Local AND organic is the gold standard. In addition, knowing the practices of your farmers/beekeeper/animal raiser/etc is even an higher standard, platinum perhaps? Know your farmer, know your food.
  
TD: What foods do you crave?
Dyer: Would you believe kale and other, even more bitter, greens? Yes, I do.

TD: How has cancer changed your outlook on eating? 
Dyer: Oh I love eating, I love food, but food is so much more than nutrients. Because of food, I also love life. I knew all of this before my 1995 cancer diagnosis, but only on the surface.  Now I know all of this viscerally, even more deeply, because I believe it, I live it, I grow it, and I teach it. When we sell our garlic at the local farmers’ markets, we sell a food grown for flavor and grown with love. We sell a story of happiness and all ‘food with a story tastes better’  (Wendell Berry).

TD: Your best farming tip that can also be applied to life?
Dyer: Our farm’s mission or ‘tagline’ is “shaping our future from the ground up.” Take care of your roots, your soil, and your foundation and you will grow healthy food, a healthy body and spirit, and be part of a healthy community. The word “our” in our tagline is meant to be very large and continuous, from our soil to our community and everything in between. 

*****************************
I enjoyed re-reading this article. In fact I found myself smiling so many times, realizing that even though this was written 4 years ago, I can hear myself saying many of the same things today! 

One aspect of what I do on our farm not mentioned in the article is my enjoyment from having dietetic students and dietetic interns work on our farm as part of the School to Farm Program that I wrote for the Hunger & Environmental Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. These future dietitians learn first hand (with their hands in the soil) not only where food comes from (and the challenges) but that the starting point for health is "We are what (and how) we grow" versus the more typical "We are what we eat". 

I would like to share a few of their words as they have reflected on this experience: 

• It was not until I began working on the Dyer's farm during my dietetic internship that I realized I do not often think about where my food comes from. I now urge my patients to know where their food comes from, to ask questions, to get to know their local farmers, with farmers' market shopping being a great first step. 

• I learned the importance of dietitians being advocates for a fair and healthy food system along with viewing food, nutrition, agriculture, and health in a connected, holistic way. 

• "Lessons learned"........Where to begin? I learned so much, about taking care of the land's health plus the importance of being very connected with the local food community and constantly nurturing that relationship. 

• My experience on the farm opened my eyes to the "big picture" of health which I will apply during my career as a Registered Dietitian. 

• I left the farm with many bricks in my career's foundation plus the courage and inspiration to be a leader.

• I learned the critical elements of a healthy and sustainable food system and left with the desire to promote diets for my patients that contribute to human health and well-being plus ecological and planetary health. 

• My time spent at your farm shaped my career and the path I am taking in more ways than I think I even know. I reflect on our conversations almost daily! I am now confident about my professional choices and excited about the changes I can make in the communities I serve. 

And these words from a dietetic intern coming to our farm this summer:

• When I started the search for an enrichment site, I was looking for a unique experience that would challenge me and broaden my understanding of and perspective on the field of dietetics. As our world continues to change, a sustainable diet for both our planet and our bodies will become more and more crucial. I feel strongly that it is the responsibility of the dietetics field to be the leaders in this movement, and I intend to focus my career efforts on this goal. Farmer-poet Wendell Berry once said "Don't think you can fix all the problems. Learn as much as you can and then work with it to increase the chance that you will make a good example." During these upcoming two weeks, I am eager to learn as much as I can and hopefully, someday, use this new knowledge to create a good example of my own. 

I am very humbled as I read through the full "lessons learned" from these students, some are short, some are essays, all are heart-felt. I have only taken snippets from what they wrote me. 

I am also very hopeful as these young people embark on their careers, sharing their passions by connecting the dots in all possible ways between food and health. Quoting Wendell Berry again "To be interested in food, but not food production, is clearly absurd". My students have clearly learned that individual health begins with healthy soil, teeming with helpful microbes as the foundation of a healthy soil food-web in order that the food we eat is both nutrient-dense and healthy for us, our community, and the planet. 

I look forward to hearing what interesting, challenging, and meaningful work they are doing as they go forward in the years and even decades to come! 

I hope it is not another full year before I post again on this blog, but that is possible and likely. 

Feel free to keep up to date with our farm via our farm's website, including information about our farm's new book Get Going with Great Garlic: Recipes from your garlic farmers' kitchen (ordering info is at the link) and our farm's email newsletter. Recent shorter updates (with photos) about what is going on at our farm are regularly posted up on our farm's Facebook page and Instagram. So in the meantime, feel free to check us out there, too. 

Lastly, to come full circle, most of my readers likely follow me because of my advocacy work (that began back in 1997 with the publication of my book A Dietitian's Cancer Story) to include nutrition assessments and information from a Registered Dietitian who is an oncology nutrition specialist (CSO) as a proactive and individualized professional service of true comprehensive cancer care, from the day of diagnosis forward to optimize treatment efficacy, survivorship health, and overall quality of life. 

Short story, I (and many others) am still working on that goal. It is a long road, but the need for and benefits from this goal have been given some long-overdue national attention at a recent workshop held at the Institute of Medicine in Washington, DC on March 14, 2016. All of the presentations from the full day-long workshop are available to the public to view on-line along with the slides

Although I was not involved with the planning committee for this workshop, I was involved in other ways behind the scenes. In addition, I was deeply honored to be invited to speak at this important workshop as an advocate, representing everyone who has had a cancer diagnosis along with all Registered Dietitians working with this patient population. My remarks were brief (less than 10 minutes) and can be viewed within the Session on Models of Care, moderated by Kim Robien, PhD, RD. They start at approximately 57 minutes into this video. 

This workshop is a step, an important first step. If you are at a point in your life where you can speak up (with your oncologist, the medical director of your cancer center, your insurance company, your place of employment), please ask when the professional services by a Registered Dietitian are going to be included as a component of comprehensive outpatient cancer care along with payment coverage that professional care. Feel free to be the squeaky wheel......we need all voices, all hands on deck, and don't take "no" for the final answer! :)

So yes, while I am now farming full time, I am still involved with cancer, right where I started back in the 90's, working now with more of a focus on prevention of cancer and other food-related diseases (versus my previous focus on cancer survivorship) by growing healthy food to nourish and educate my community. 

My message to my students: no matter how different our various paths and efforts as dietitians look, or the places where we work, my vision is that we are all working toward the same goal, which is the creation of healthy communities. I will end my 2016 Registered Dietitian Day post with a Swahili word that I (try to remember to) teach my students and have surely used in past blog posts:

Ujima - a Swahili word meaning "collective work and responsibility"

To build and maintain our community, to make our brothers' and sisters' problems our own, and to solve them together.                                                                                        

Two thumbs up for healthy communities, shaping our future literally from the ground up! 

Cultivate your life - you are what you grow - inch by inch, row by row,
Diana Dyer, MS, RD

Monday, April 13, 2015

Organic vs. Conventional - Which is better?

I was recently interviewed for an article recently published in Today's Dietitian about organic foods. Each person interviewed was asked the same questions with selected responses included. The full article is viewable here.

All the questions were good ones. Each of my responses was as short as I could make it and keep my thoughts coherent. I knew that most of the content would hit the cutting room floor so that their resulting article was also coherent when combining the responses from each person. So I add my full responses here in case my readers would appreciate reading the wider view of my thoughts about each question. 

Of course each of these questions could merit a full blog post, a full essay, and I could easily have a conversation around each one. However, it will be of interest to see how others also answered the same question. 

I apologize in advance for the formatting and font, which always seems to be odd when I cut and paste into this blog. There seems to be nothing between small and LARGE - arghhh. So I change the font to make it a bit easier on the eyes, but again, I deeply apologize if you need to put on your reading glasses, or worse, actually get out a magnifying glass! 

QUESTIONS: 
(1) How would you summarize the nutritional differences between conventionally grown versus organically grown foods, and what complicates this comparison?


Most individual research studies evaluating nutritional differences as a primary outcome when comparing foods grown conventionally (i.e., with synthetic chemical inputs - fertilizer and/or herbicides and pesticides) versus organic farming practices (i.e., biological inputs - agroecological methods) will typically show variation from year to year, crop to crop, field to field and thus are very difficult to interpret. 

The most recent meta-analysis (see reference below) does show significantly increased anti-oxidant content in organically grown produce. What is as important for public health, if not more so, is that this meta-analysis also showed that overall the organically-raised produce had reduced pesticide levels plus reduced levels of the toxic heavy metal cadmium. 

However, by focusing attention only on possible nutrient differences between organically-grown and conventionally-grown foods, Registered Dietitians miss the opportunity to learn about our profession’s much larger and critically important role as advocates for the development of healthy sustainable agriculture and food systems that promote healthy soil, healthy food, healthy people, and healthy communities. Focusing only on nutrient differences is a distraction away from issues of deeper concern that are even more important for the protection of our public and environmental health. 

Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: a systematic literature review and meta-analyses. Baranski, M., D. Srednicka-Tober, N. Volakakis, C. Seal, R. Sanderson, G. B. Stewart, C. Benbrook, B. Biavati, E. Markellou, C. Giotis, J. Gromadzka-Ostrowska, E. Rembiałkowska, K. Skwarło-Son, R. Tahvonen, D. Janovska, U. Niggli, P. Nicot and C. Leifert. http://csanr.wsu.edu/significant-benefits-organic-plant-based-foods/

(2) Are there significant health risks of the pesticides, technologies (such as genetic engineering) and/or additives used in conventional food production?

I focus my attention and advocacy on our farm’s soil health and ecosystem’s vast and interconnected biodiversity and the community that it creates (both above and below ground). Conventional (i.e. industrial agriculture) consists of practices (including the use of GMO seeds) that are intentionally depleting our planet’s vast biodiversity, which includes the incredibly diverse, complex, and extensive microbial life in our soil that is only beginning to be discovered and is only barely understood for its role in overall health (from the soil to the planet, including human health). 

The population of the monarch butterfly has dropped precipitously in recent years, related to the use of pesticides directly and indirectly to the herbicides that are killing its main source of food, the milkweed plant, growing in among the vast acres of mono-crops planted in soy and corn. In fact, the monarch population in North America has decreased to the point of it potentially adding it to the list of endangered species. http://monarchwatch.org/blog/2014/09/02/commentary-recent-petition-to-protect-the-monarch-butterfly/

What is a significant health risk from the use of these synthetic chemicals, and to whom? We know SO little about this community of life, this diverse ecosystem to which we belong and are connected. Think of the monarch butterfly (along with the recent increase in honey bee colony collapse) as “canaries in the corn field”. 

It’s time that RDNs learn about and incorporate The Precautionary Principle into their thinking and professional food recommendations in order to protect both the public’s health and the environmental health of our communities and planet.  http://www.sehn.org/precaution.html


(3) There’s been debate about the healthfulness of organic pesticides. Some people use this as an argument against organics. Are organic pesticides healthier than conventional pesticides? If so, how so? If not, why not?

This “debate” is another distraction for a variety of reasons. 

The organic farming community has been saying for years that it needs (and wants to participate in) more research into best practices so that organic farmers can continue to reduce the need to use any herbicide or pesticide, even if it has been approved for use in USDA certified organic products (OMRI).  Research dollars have consistently been disproportionally awarded to study conventional (industrial, synthetic) agriculture. The 2014 Farm Bill has increased the dollar amount, and fully funded this section, for research dedicated to “specialty crops” (not necessarily organically-grown, but this is a start), the term given to fruits and vegetables. http://sustainableagriculture.net/blog/2014-farm-bill-outcomes/  

Several studies have shown in both adults and children that eating only organic foods for a relatively short period of time significantly reduces the body levels of potentially harmful pesticides:          (a) Cynthia L. Curl, CL , RA Fenske and K Elgethun. 2003. Organophosphorus pesticide exposure of urban and suburban pre-school children with organic and conventional diets. Environmental Health Perspectives doi:10.1289/ehp.5754                                                             (b)     http://www.sciencedirect.com/science/article/pii/S001393511400067X  Reduction in urinary organophosphate pesticide metabolites in adults after a week-long organic diet, Liza Oates, et al. 

The President’s 2008-2009 Cancer Panel Report - Reducing Environmental Cancer Risk: What we can do now (published April 2010) recommends “choosing, to the extent possible, foods grown without pesticides or chemical fertilizers, antibiotics, and growth hormones…….” (page 112) to reduce the effects from environmental exposure on cancer risk.  http://deainfo.nci.nih.gov/advisory/pcp/annualReports/pcp08-09rpt/PCP_Report_08-09_508.pdf
  


(4) How might age or genetic differences of people impact the body’s response to pesticide contamination or technologies used in conventionally-grown foods?

Our children are the future of our country and society at large. The American Association of Pediatrics has developed a policy statement calling for reduction of prenatal and early childhood exposure to pesticides, being associated with pediatric cancers, cognitive function, and behavioral problems. http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Makes-Recommendations-to-Reduce-Children's-Exposure-to-Pesticides.aspx



(5) Many consumers are familiar with the Environmental Working Group’s “Dirty Dozen” and “Clean Fifteen” as shopping guides for produce. What is your opinion about the “Dirty Dozen” and how much of an impact has this guide made on consumer shopping decisions?  

I was thrilled when this list first came out in the mid-90’s. I personally used it and have included it as a resource in each edition of my book A Dietitian’s Cancer Story. However, now I personally don’t use it all, and only recommend it as the proverbial great first step. Why not?  It limits one’s thinking to only “me”, i.e., what’s in it for me? 

Buying organically-grown food is about so much more than just nutritional benefits, i.e., just “me”. People are becoming aware and choosing to purchase food grown organically, particularly grown by farmers within their own foodshed (i.e. a regional food system), because doing so promotes: 

- healthy soil, 
- biodiversity, 
- clean water, 
- reduced soil erosion plus regeneration of productive topsoil, 
- clean air, 
- reduced production of atmospheric gases causing global climate change along with being an effective sink for capturing (reducing) atmospheric CO2, 
- increases and stabilizes a local economy, 
- helps to define and maintain a local food culture and community, 
- reducing the personal intake of hormones, antibiotics and other drugs, 
- prevention of the development of antibiotic resistance, 
- choosing animal protein foods from farms focused on animal welfare which includes appropriate food for an animals specific anatomy and physiology, 
- reducing risk of pesticide/herbicide exposure to farm workers, 
- increased nutrients (polyphenols, other antioxidants, healthy fatty acids), 
- increased flavor (and what is food without delicious flavor?), 
- reduced risk of an increasing variety of illnesses (including autism, Parkinson’s, diabetes, cancer, heart disease) and lastly, 
- recognizing and celebrating the culture in agriculture. 

RDNs need more education about their important role in the development of sustainable regional agriculture and food systems that truly can deliver “good food and good health for all” (my email sign-off). 


(6) What about food categories not included in the Dirty Dozen, such as organic animal products and grains—how should consumers approach these?

Buy organically every place possible. However, buying organic animal products is not that easy because some organic animals are still fed organic food (i.e., organic corn in CAFO feedlots) that is not appropriate for their anatomy and physiology or welfare.


(7) Some experts contend that people may skip certain foods altogether (such as fruits and vegetables) if they can’t afford organic, thus lowering nutritional quality of the diet. Is that a real concern?

“Experts” are often journalists or headline writers who love to (and need to) stir up controversy without offering meaningful suggestions for change to their readers. As an RD, I would help a client look at their time and total food dollar spending for a week (including all food eaten away from home, processed convenience foods plus expensive JUNK, which I do not give the dignity of being called “food”) and help them make goals and a plan to negotiate choices in order to have the money for healthy organic foods and time for food prep. And I would add that grabbing organic energy bars, organic cookies, organic JUNK would not make it into my professional recommendations or my own grocery cart. 


(8) What are the pros and cons of organic farming practices versus conventional farming practices on the environment?

See Question 5 above. 
In addition, I subscribe to the tenents and practices of the field of Agro-ecology: http://www.agroecology.org

The application of ecology to the design and management of sustainable agroecosystems.
A whole-systems approach to agriculture and food systems development based on traditional knowledge, alternative agriculture, and local food system experiences.
Linking ecology, culture, economics, and society to sustain agricultural production, healthy environments, and viable food and farming communities.



(9) If organic farming were the norm, would organic food cost the consumer less? And, if so, how would we support a move in this direction?

Organic foods from small local farmers will not and should not cost less. The real question is not “Why is organic food so expensive and when is the cost going to come down? Instead, the real question is “Why is cheap food cheap and what are the hidden costs to our communities of the cheap, processed food that is the norm?” It is critical that we as society start to address the multiple costs of cheap food to each of us personally and to society at large. 

I know several small organic farmers who qualify for SNAP (food assistance program). I don’t know any single small organic farmers who are making so much money that they need an off-shore banking account. 

Communites and individual organic farmers together need to continue to increase awareness and appreciation (value) of the three pillars of sustainable regional food systems, which are economic, environmental, and social benefits, all of which together create vital, thriving, and desirable places to live.  (these pillars are also often described as the 3-P's = Profit, Place, and People) 


(10) For a consumer who wants to eat more organic foods, what are strategies dietitians should recommend to make them more affordable? 

See my response above (#7) about working with the client for planning the total time/food bought. In addition, it is important to help the client (an individual or institution) make change in small steps with achievable and measurable goals - I use “A Good Food Checklist for Eaters”, developed by Angie Tagtow, MS, RD at http://www.extension.umn.edu/food/farm-to-school/docs/good-food-checklist-for-eaters.pdf)

I also suggest that RDNs use Angie Tagtow’s Good Food Checklist for Dietitians first in order to see what they need to learn and put into practice themselves (i.e., walk the talk) before they can be effective community leaders and teachers for their clients. http://www.iatp.org/files/143_2_102827.pdf



(11) What trends do you foresee in production and consumer interest in organically-grown foods over the next 15 years, and how would you recommend supporting or reversing these trends?

The consistent recent and projected growth of the organic food production and purchases compared to the rest of the food industry is important. http://www.foodnavigator-usa.com/Markets/US-organic-food-market-to-grow-14-from-2013-18  As a relatively new farmer who has chosen to pursue both organic production and marketing via the USDA Organic certification program, I obviously support this growth.  The most important point for RDNs to understand is that this growth is resulting from many larger societal concerns than just individual nutrient differences, as important as that is. 

I suggest that all RDNs (in addition to the dietetic students and interns who come to my farm or Mary Jo Forbord’s farm when participating in the Hunger & Environmental Nutrition Dietetic Practice Group’s School to Farm Program) read the following resources provided by the HEN DPG and AND:


Healthy Land, Healthy Food, Healthy Eaters, Sustainable Food Systems: Opportunities for Dietitians, A. Tagtow and A. Harmon,                                                                                                 http://www.eatright.org/HealthProfessionals/content.aspx?id=8632#.UHh7ZY7sfnY  
ADA Position Statement: Food and Nutrition Professionals Can Implement Practices to Conserve Natural Resources and Support Ecological Sustainability (June 2007).  http://www.eatright.org/About/Content.aspx?id=8360 (compare and contrast to 2013 practice paper)
AND Practice Paper: Promoting Ecological Sustainability within the Food System  (March 2013). http://www.eatright.org/Members/content.aspx?id=6442475081
Standards of Professional Performance for Sustainable, Resilient, and Healthy Food and Water Systems – JAND 2014;114:475-488

Some additional resources:

Beyond Eating Right: The Emergence of Civic Dietetics to Foster Health and Sustainability Through Food System Change, J Wilkins et al, JHEN 5(1) 2010 -                                               http://www.informaworld.com/smpp/section?content=a919883004&fulltext=713240928#references
The Food-Climate Relationship: The Registered Dietitians’ Balanced Approach to Positive Change - http://www.noharm.org/lib/downloads/food/Balanced_Menus_Reg_Dietitians.pdf

2010 State of the Evidence: The Connection Between Breast Cancer and the Environment - http://www.breastcancerfund.org/assets/pdfs/publications/state-of-the-evidence-2010.pdf

The President’s Cancer Panel Report 2010 Reducing Environmental Cancer Risk: What We Can Do Now – has a section on agriculture, food, and water - 

A Generation in Jeopardy: How pesticides are undermining our children’s health and intelligence – Pesticide Action Network of North America, October 2012  

Fair Food: Growing a Healthy, Sustainable Food System for All, Oran B. Hesterman, PhD, Public Affairs, 2011. http://www.fairfoodbook.org

Eat Local: Simple Steps to Enjoy Real, Healthy, and Affordable Food, Jasia Steinmetz, PhD, RD, New World Publishing, 2011. 


I know this post is another long one, so I will not continue except to say that as an RD, I have clearly attached our collective future to developing healthy, sustainable regional food systems (with the occasional luxury of buying food not grown in the Upper Midwest like orange juice, avocados, olive oil, salt, black pepper, turmeric, etc etc etc - you get the idea). In fact, the visions statement for our farm is "Shaping our future from the ground up" where the word "our" is intentionally very wide and inclusive starting with building a healthy soil-food web for optimal nutrient content of the food we grow all the way to a healthy planet, and everyone and everything in-between.

Lastly, I will also just add that our organic certification is our public promise and gift to our local community demonstrating our farm's commitment to both nourishing and nurturing our community's health. As I mentioned above, "Good food and good health for all" is my email sign-off.  Working for and advocating for anything less is a compromise I am not willing to make as a true front-line health care provider proudly practicing both as a Registered Dietitian and an organic farmer feeding my own community. :)

Please feel free to read the full article, then decide for yourself "Which is better?". There are many valuable responses. Hopefully you will find one bit of information that helps you see and commit to a better, healthier, organic, sustainable future for all of us, our common good. 

Cultivate your life, you are what you grow – inch by inch, row by row,

Diana Dyer, MS, RD – your Radical Dietitian blogger :)  

Wednesday, March 11, 2015

2015 National Dietitian Day - Should "Radical" be the New Normal?

Blogging "rules" tell you to limit blog postings to 300 words or your readers won't get the message. Sorry. I don't subscribe to the "fast food", "grab-n-go" mentality of our society that is constantly pushed on us. So,  I am just giving my readers a heads-up. This blog posting will be much longer than 300 words, so if you are still interested in reading what I have to say, I suggest you wait until you have time to read my full posting, that you have the time and mental space to think, and perhaps even savor what I have written. I would like to envision you having made a pot of organic, fair trade tea before reading this. :)

Ok - enough lead in. Good news! Another year has gone by, and I'm still "healthy enough"! So here we go for National Dietitian Day 2015. :)

Forty years ago at this time in 1975, I was finally applying for a coveted spot (even then) in a dietetic internship. Once I had finally made the decision to become a registered dietitian (RD), I then worked so hard to fulfill the prerequisites and had been so focused on this path during the previous two years that I honestly never thought about what I would do if not accepted. So surprise! shock! when I learned I had been rejected. I was able to learn that I was rejected not because I didn't meet the rigorous academic requirements, but because I was a childhood cancer survivor. Pause ……. Yes, you read that right.

I'm going to make a long story short here. I got in, that year, to the same internship that had first rejected me, in fact discriminated against me based solely on my medical history. This was not the first time I had found myself going against the grain, needing to advocate for myself, doing something differently than the usual path, speaking up, speaking out to solve a problem. Nor would it be the last.

The simplest way to explain my thinking and subsequent actions is to say that having survived an illness in which doctors involved did not even offer my parents any treatment ("just take her home and make her comfortable"), let alone offer hope, I was not going to let anyone easily tell me "no" for anything. Having survived what was considered hopeless, my modus operandi very simply had become "finding a way to yes". And finding a way to yes to find a solution for a problem I decided to tackle has often involved seeing things differently, asking different questions, being persistent, and simply not giving up! 

So, again to make a long story short, I finished that lengthy and rigorous internship combined with a Masters degree, which included a complicated research project and thesis, presented my research (which actually changed best practice for children born with the inborn error of metabolism called PKU) at an international conference, had my first child (with a complicated pregnancy, delivery, birth, and my baby's stay in a neonatal intensive care unit), and then passed the national registration exam (to permit me to use RD after my name) on the first opportunity after my graduation with a MS in Nutritional Sciences. The only thing I didn't get done during this 5-year period - which I still regret - was to actually walk to get my MS diploma, which I had worked so hard and long to achieve.

Whew! 

But I was just getting started. :) I have written about all the meaningful work I have done as a Registered Dietitian (RD) in my previous National RD Day posts starting in 2008. (here is the link to last year's post, which also includes the links to all previous posts I have written for National RD Day).

In a nutshell, I am SO glad I spoke up and didn't just walk away, accepting that initial rejection. 

However, here is the most important lesson that I learned with that initial rejection. In order to solve a problem, rather than just patch it up, or hope it would somehow solve itself, you must first identify and understand the cause or the root of the problem. 

Which leads me to the title of this post. "Should 'Radical' be the New Normal"? 

Huh? Here is the connection. 

Was what I did, challenging the initial rejection into my dietetic internship based on a decision that was clearly discrimination, considered radical? Maybe yes, maybe no, but in either case I don't know that I would have worn that word comfortably back in the 70's as my husband and I had arrived at the University of Wisconsin campus shortly after an anti-war bombing of one of the campus buildings, an action that was clearly radical to the extreme in my mind. 

Indeed, looking up the word radical, the first definition typically includes the emphasis on "extreme":

– Advocating or based on thorough or complete political or social reform: 
representing or supporting an extreme section of a political party.

However, as I have been thinking about what I am doing now as a Registered Dietitian who is also a certified organic farmer, in addition to many things I have done over the past decades that I have been an RD, I have been thinking about this word "radical" more and more. 

Synonyms for the word radical include revolutionary, reformer, revisionist, progressive (among other less appealing words like die-hard, bigot, militant, etc). 

Digging further (oh, I like that pun!), two additional definitions I found for the word radical that ring true and deep with me are the following:

– Adjective: Coming from the Latin radix, of or going to the root or origin; fundamental

– Adjective: Forming a basis or foundation 

Thus, I have come to use the word radical in a meaningful, positive, and powerful way, taking the word radical back to its roots, literally and figuratively, i.e., radical meaning "going to the root" of a problem to find solutions, back to the fundamentals in order to actually understand the cause of problems and then work toward solutions or reform in a thorough and complete manner, rather than a quick, easy, short-term fix, just putting on band-aids, or kicking the can down the road, over and over and over again.

And thinking of the word radical in terms of the word root leads me as an organic farmer to first think about healthy, organic soil as the "root" requirement (i.e., the absolute basis and foundation) for growing healthy, nutrient-dense food as the starting point that leads to solutions for nourishing personal, public, and planetary health.  With that awareness, I realize that I am a "radical dietitian" because I am committed to this "radical vision" of a food system that starts with healthy, organic soil as my touchstone, my roots, the basis for defining my professional responsibilities, which then guide my professional influence and actions.

Should "radical" in that sense be the new normal? Should all RDs be "radical" dietitians, no matter what area of practice they choose? In my opinion, yes, if "radical" means that everywhere possible RDs are making food and nutrition recommendations and/or even direct purchases that lead forward to the development of healthy communities and a healthy planet and also go backward to start a healthy food system with healthy soil.

I often tell my dietetic students that the basis, the starting point, for health is not "we are what we eat" but is instead "we are what we grow", because striving toward health should be larger than just personal health. No matter what narrow focus each of us may choose within the many opportunities our profession offers to apply the appropriate medical nutrition therapy (MNT) learned to become an RD (i.e., diabetes, cancer, sports, eating disorders, GI, intensive care, long-term care, wound care, food services, managing, consulting, research, policy, business ownership, education, and on and on and on and on!!), also using our expertise to work toward the larger picture of healthy environments and healthy communities should be the fundamental, underlying, root reason for choosing to become an RD.

In my view of our professional expertise and responsibility (and yes, it took me a while to see and appreciate this wider and deeper view), this larger picture of healthy environments and healthy communities is a goal that all RDs should support and pursue (where possible) by advocating for healthy food, healthy soils, water, and air as the starting point for health, i.e., back to the starting point "we are what we grow".  

Is my thinking "radical"? Is it "too radical"? What could possibly be "too radical" (in the negative sense that the word is often used) about envisioning and working for solutions that lead to healthy soil, healthy food, healthy people, healthy communities, and a healthy planet, i.e., true sustainability for all?

 What could possibly be "too radical" about directing our professional influence and recommendations to the promotion and support of systems, policies, and practices that preserve, protect, and regenerate healthy soils in addition to clean water, genetic biodiversity (both above and below ground), pollinators, intact diverse ecosystems, and promote carbon sequestration in our soils that can mitigate (even reverse) climate change


                                                                         
Maybe I'll trade in my "Eat More Kale" bumper sticker for one that says "I LOVE Soil" :) 

Before I end this blog post, I will just pause to mention that I am grateful beyond words that my parents challenged the first medical opinion (and even a second) and that they shared my earliest story with me (which I was too young to actually remember). As I grew into young adulthood, trying to piece the world together, I slowly appreciated the significance of their actions, which showed me the importance of thinking clearly when faced with a problem, looking for solutions outside the norm, finding courage, speaking up, creating a way to yes, going against the grain when necessary, being atypical, even being radical (at the extreme) when that was the only possible solution, as my parents were by challenging the authority of a medical system that first said "no", at a time when questioning a doctor's recommendation was never done. 

I am also grateful beyond measure for the one person on that internship selection committee who saw things differently and helped to move the Universe in ways that ultimately got me back on to the acceptance list. 

Just a few more thoughts before I sign off this year's blog post for the 2015 National RD Day. Maybe RD can also be a professional abbreviation for "Radical Dietitian". :) Probably not, but I am quite comfortable wearing that word now. In fact, I like to envision all future registered dietitians (RD) also thinking of themselves as being "Radical Dietitians", making "radical" professional food and nutrition recommendations that seek to address root causes of problems wherever they can in order to promote effective solutions within every component of the health care spectrum, solutions that support healthy, microbe and humus-rich organic soil as the non-negotiable beginning, the foundation, the root of healthy food systems, healthy communities, and a healthy planet.

I like thinking of that training and commitment being the "new normal" for my profession, and I am happy thinking about and working toward that along with other RDs who share the same vision and values.

If you're already an RD or an RD2B (still doing an undergrad program, already in a dietetic internship, or just starting to think about becoming a registered dietitian) and you'd like to jump on board to help shape the future in this "radical" direction, my best and most enthusiastic advice is to join the Hunger & Environmental Nutrition Dietetic Practice Group (under the Academy of Nutrition and Dietetics - AND). You'll be in good company with the values held by other HEN members along with HEN's mission to empower its members to be leaders in sustainable and accessible food and water systems, which is the foundation of our professional responsibility no matter where you apply your expertise and passions about food and nutrition. (Note: student members of AND can join HEN DPG for a reduced fee!) 

One last thought - I have just turned age 65. With that milestone, I also just received my Welcome to Medicare card, which is no small feat for a childhood cancer survivor who was first given zero chance of survival at age 6 months in 1950 and has had multiple additional cancer diagnoses and significant medical problems secondary to cancer therapies since then. Although age 65 and Medicare are often still synonymous with "retirement" in this country, I have not even looked at the criteria for continuing membership in my professional organization in a retired capacity.

I am still "healthy enough", and I think I still have some work to do for my profession as long as I am able, perhaps mostly planting seeds and nurturing others' careers through my opportunity to touch the future via the dietetic students and interns who participate in HEN's School to Farm Program.

I am both happy and grateful thinking about that, too, as that work means that I am also still able to carry the torch forward representing and advocating for both cancer prevention and a healthy life for all cancer survivors.

Paraphrasing the title of an inspirational book I just read, Good Morning, Beautiful Business by Judy Wicks, every morning I say:

 "Good Morning, Beautiful Life!"

Yes, adding an exclamation mark. :) I hope all of my readers (whether you are an RD or an aspiring RD, cancer survivor, or one of my many general readers) also have a way to greet your new day, every morning, thinking about or creating some part of your day, some part of your life, where perhaps wearing the word "radical" is comfortable and also a beautiful part of your own new normal. :)

Cultivate your life - you are what you grow - inch by inch, row by row,

Diana Dyer, MS, RD (radical dietitian) :)

PS - This blog post (the last time I checked) is 2,202 words.  Might be more by now. Thanks for reading this far. :)