Five Decades: From Challenge to Acclaim
Publication: Canadian Journal of Dietetic Practice and Research
19 August 2016
Abstract
What can make your work as a dietitian so meaningful that you begin each day with enthusiasm, and if you so choose, retain that joy in your work for 5 decades or more? Three themes are: (i) doing work that profoundly makes sense to you, (ii) inspiring others (and yourself) to make healthful choices, and (iii) moving through challenges to success. Initially it can be challenging to make a living through work that is most deeply meaningful or closest to your heart. Yet it is well worth finding the balance between practicality and movement in the desired direction. Other challenges faced by dietitians involve helping others to adopt new, more healthful lifestyle choices. As health professionals, our attitudes towards plant-based diets have changed dramatically during these past decades. This article examines our evolving perspectives of plant-based diets, and uses this as an example of movement through challenges to success and acclaim. Vegetarian and vegan diets that were considered entirely inappropriate for many stages of the life cycle in the 1970s are now seen to confer health benefits. This applies to well-designed plant-based diets, thus offering a significant role for dietitians as creative leaders in this field.
Résumé
Qu’est-ce qui peut pousser une diététiste à commencer chaque journée de travail avec entrain et à conserver cet enthousiasme pendant un demi-siècle, voire davantage? Les trois thèmes abordés sont : (i) travailler en tenant compte de ce qui nous tient véritablement à cœur; (ii) motiver les autres (et soi-même) à faire des choix sains; et (iii) ne reculer devant aucun obstacle pour réussir. Au départ, il peut être difficile de tirer sa subsistance de l’exercice d’un métier qui vous tient autantà cœur. Toutefois, il vaut la peine de trouver l’équilibre entre agir avec pragmatisme et s’élancer vers la direction souhaitée. Aider les autres à adopter un nouveau style de vie plus axé sur la santé est un des nombreux défis relevés par les diététistes. En tant que professionnels de la santé, notre attitude à l’égard des régimes alimentaires à base de végétaux a changé du tout au tout au cours des dernières décennies. Cet article examine l’évolution de nos perspectives à l’égard des régimes alimentaires à base de végétaux et se base sur cet exemple pour illustrer un parcours professionnel parsemé d’embûches vers le succès et la reconnaissance. Les régimes alimentaires végétariens et végétaliens, jugés totalement inappropriés à bien des étapes de la vie dans les années 1970, sont à présent perçus comme porteurs de bienfaits pour la santé. Certes, ces régimes alimentaires à base de végétaux doivent être bien pensés, ce qui offre aux diététistes une tribune de choix à titre de chefs de file novateurs dans ce domaine.
INTRODUCTION
In 1965, as a new university instructor, I was focussed on undernutrition in developing countries and on a family’s severe diet-related challenges. My department head asked “Are you an altruist?” I discovered that altruist means, “a person unselfishly concerned for, or devoted to the welfare of others.” I thought, “I am not necessarily unselfish—but concerned for, or devoted to the welfare of others—maybe that is what dietitians are.”
Dietitians of Canada’s vision is to advance health through food and nutrition. Health is a cornerstone of life. Without it, our enjoyment of life decreases drastically.
Here I will share 3 themes that have made my career fulfilling, and continue to do so. I invite you to consider these in the light of your own journey. These themes, woven through this article are: (i) doing work that profoundly makes sense to you, in your case, to me in mine; (ii) inspiring others to make healthful choices; and (iii) moving through challenges to success (plant-based theme).
MY CAREER
My career spans over 5 decades and is expressed in many arenas, including:
•
being a consultant for British Columbia Corrections (menus, special diets);
•
working with industry: writing a cookbook with Yves on meat alternatives, helping Nature`s Path design Optimum Cereal, being the dietitian for So Nice soymilk, and writing web content for Grainworks;
•
consulting for individuals, including rock stars (who don’t permit use of their names), athletes, expectant parents, and those wishing to reduce risk of chronic disease;
•
speaking in Europe and across North America (to health professionals and vegetarian groups);
•
writing nutrition books that became best sellers; and
•
engaging with all types of media [1].
For over 3 decades my primary focus has been plant-based nutrition—and perspectives on this topic have changed dramatically! It is fascinating to step back in time and later see how far we have come. Four decades ago, Canada’s Food Guide had 4 food groups. Its top half consisted of Milk and Milk Products and Meat and Alternates.
A 1976 university text, Nutriscore [2], said “Adults, and only adults, can safely remove meat but nothing more, from their diets” and “Children and adults up to the age of twenty should not have any group of food eliminated from their diet.” Page 65 stated “We do not recommend vegetarianism during pregnancy or while nursing a baby” [2]. There had been a little Harvard-based research regarding vegetarian diets for adults. Prior to 1975, the text, Introductory Nutrition placed vegetarian nutrition in a chapter titled Food Faddism and Quackery. In 1975 the title of the chapter featuring vegetarian diets was changed to Alternative Food Patterns. To gain credibility, good research was needed and vegetarians needed to consume reliable sources of vitamin B12.
In 1987, researchers examined maternity care records of 775 vegan women in a community in Tennessee and found that their diets did not affect birth weight [3]. In fact, their risk of pre-eclampsia, (a serious condition that could involve high blood pressure and kidney damage) was <2% than that of the nonvegetarian population. Physicians noted “It is possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of pre-eclampsia.” [3]. These women had prenatal care, took vitamin B12 supplements, and had diets of soy foods, other legumes, grains, vegetables, nuts, seeds, and fruits. In 1989 The Farm Study, by the Centers for Disease Control, was published in Pediatrics journal, establishing that the hundreds of children in this same community had attained heights and weights within the normal range on entirely vegan diets [4].
I often note how young our field of nutrition is in relation to some other sciences, with the first vitamin identified just over a century ago. In Winnipeg, Home Economics began in 1910 with a 5-month diploma course that was soon extended. It was available to young women aged 18 years and over who could prove evidence of a good moral character [5]. (It is not made clear how they did this!)
My interest in human nutrition and foods was inspired by my parents in different ways. My father was a postgraduate physiology student in the lab of Sir Frederick Banting and Dr. Charles Best, who first used insulin on humans and received the Nobel Prize. Mother taught early childhood education; we had fun making meals together and our birthday parties were participatory, food-creating parties.
My career became a delightful intermingling of culinary creativeness and solid science. I had less lofty motives too. I noticed that high school boys hung around the door of the Home Economics class when tempting aromas of fresh baking escaped into the halls. I completed undergraduate and graduate degrees in nutrition at the University of Toronto and qualified as a dietitian. In 1965 I began teaching human nutrition at the University of British Columbia’s then School of Home Economics. I also had the honour of doing research with physicians and pharmacologists on the inborn error of metabolism, homocysteinurea. Our team pioneered a low methionine dietary intervention, and working with a family, prevented the mental disability that is the usual tragic result of this condition. We published the results in the Lancet in 1968 [6].
While my son and daughter were growing up I became a provincial health department nutritionist, a job I loved. We experimented with healthy food in schools. In British Columbia’s fruit belt, we installed refrigerated apple vending machines in schools. As reported in the Journal of the Canadian Dietetic Association in 1977, apple sales actually led to a 23% decrease in chocolate bar sales [7]. Public health nutrition allowed me to explore writing, television, and to collaborate with physicians and other health professionals.
By a quirk of fate, I made enough money on the stock market for us to travel around the world, including 4 years in India and Nepal. This experience brought me in contact with cases of undernutrition. At the same time, India provides the best vegetarian cuisine in the world. Nepal proved to be a good place for epiphanies and for clarifying themes for my career. When I returned to a frozen job market, I opted for private practice.
WORK THAT PROFOUNDLY MAKES SENSE
Finding work that profoundly makes sense seems fundamental to working hard and enjoying it. It is a privilege and deeply satisfying to discover and follow a career path that aligns with your passions. I read, took courses, talked with people. What is right for you emerges from the forces that shape your life and inspire you; it is very personal. Generally, one must earn a living on a somewhat different wavelength, while the career path that is closest to one’s heart takes shape. Yet the energy invested in balancing both is worth it.
While being in private practice, I have had a continual sense of leaping off a cliff into a rather hopeful unknown. The arms that welcomed and kept me safe were sometimes those of a colleague, my husband, a friend, the media, or publishers. Dietitians of Canada has been very supportive of my trying new endeavours.
At times it was challenging to make ends meet. Being paid by a client for a specific piece of work is quite a different experience from having a job. After leaving the salaried world, when my first client was in my barely furnished office and about to pay for an hour of my time, I could barely get my mouth to work to ask for the fee. It was like I had lockjaw. She just whipped out her chequebook and paid a suitable amount without flinching! Yet when a client booked and then cancelled, it could be devastating. So I kept a few part time jobs—as a dietitian in a nursing home or college teaching—to cover the necessities of life as private practice slowly grew.
Sometimes we must invest before we know that there will be a return. In the early 1990s I did my first one-day workshop for dietitians. The topic was plant-based nutrition, a topic not fully addressed by university courses. It preceded a Dietitians of Canada convention in Victoria, and 45 people enrolled. After 6 months of intense preparation I made a net profit of $500! This wasn’t a get-rich-quick scheme—but I was thrilled to have a positive balance. This gave me courage to keep going.
When shaping our work around our interests, we do not know what will be a fit for us or what the world wants enough to pay for. At first we may work for very little, yet eventually we need to be paid well, reflecting our expertise. I experimented with what would work for me and for the consulting world I was entering.
Eventually a mix evolved that was a fit for me, and that suited our culture’s growing fascination with plant-based diets. My food and nutrition classes caught the attention of national media (the CBC National News and Maclean’s magazine). By 1994 the handouts evolved into a book that became a best seller in Canada and the United States, eventually published in many languages and the start of a series [1].
One foundation of my work is a practice of collaboration. I appreciate teamwork with dietitians, physicians, other speakers, writers, students, chefs, and our publishers. No one will care to create a good product as much as one who shares in the royalties or other outcomes. If you feel stuck in some aspect of your career, how might you collaborate with someone?
For 23 years I have had the privilege of writing books with dietitian Brenda Davis. We keep up to date with science, make sense of it, then write for health professionals and for the public. For each new book, each of us becomes a primary author on half of the chapters. We give and receive strong, repeated feedback and editing of each other’s material. After writing, come interviews and talks; otherwise few people know that you have an excellent product. Recently we took courses in social media and food photography. Lifelong learning underlies our success.
CHALLENGES
When you are on the cutting edge, people are likely to resist. Though your endeavours make sense (at least to you), and can help people lead healthier, happier lives, you are likely to face challenges. We have had our fair share. When our first book, Becoming Vegetarian, came out, an industry-connected dietitian wrote and distributed a 45-page booklet against our book. Brenda and I were shattered, initially. We recovered, countered with a strong rebuttal, and were applauded by colleagues. The net effect was, to our astonishment, greater recognition and better book sales.
Another challenge was that our favourite publisher asked us to co-author, with a chef, a nutrition and recipe book on raw foods. We didn’t want to, giving as reasons: the raw foods enthusiasts have so many unfounded, unscientific beliefs; we were already alternative enough and unwilling to compromise our credibility; and this would be unfamiliar culinary territory.
Our publisher challenged us. “It is time that someone did a scientific evaluation of the claims of the raw food movement, and helped people distinguish fact from fiction. Who better than you?” We listed conditions without which we would not consider the project. Nothing without scientific foundation could be included in the book. Our chef co-author must host one of us at her gourmet raw chef school in California for 3 to 4 weeks. To our surprise, every point was accepted! Raw vegan nutrition became an area of interest that we could explore. Something astonishing happened. Answers emerged for questions that had eluded us; raw enthusiasts had discovered clever food preparation techniques that increased mineral availability. While we exposed unfounded claims and did not become 100% raw converts; the experience was rewarding.
While at the school (rawfoodchef.com), I learned about chef skills and how to create delicious raw recipes. With chef Cherie Soria, we wrote the Raw Food Revolution Diet [1]. We uncovered so much valuable information that our publisher proposed that Brenda and I write a second volume. We investigated controversial topics: food combining, enzymes, toxic by-products of cooking, effectiveness of raw vegan diets for rheumatoid arthritis and fibromyalgia, nutritional adequacy of 100% raw diets for adults, including athletes, and whether such a diet is suitable for children (the short answer is no). We developed simple, delicious recipes and nutritionally adequate menus. Becoming Raw is unique and a bestseller among raw foods enthusiasts and among dietitians [1].
One possible challenge for dietitians is that of bringing healthful food into our events. The experience of tasting food brings events to life. Even without kitchen access, I have made the third evening of a course into a potluck event. For individual clients, I place a few items for tasting in a fridge near my office. This gives people the confidence that dietary changes are possible. Including samples can challenge our creativity; it may be an opportunity to collaborate with companies, restaurants, or caterers.
HEALTHFUL LIFESTYLE CHOICES
To inspire others to make healthful choices, we need to keep ourselves keep fit; to be examples. My co-author Brenda Davis goes to the gym or is outdoors every day, with a mix over the week of aerobic, strength, stretch, endurance, and balance exercise. She inspired me to do the same. It is not about being perfect, but about living the active lifestyle that we so enthusiastically promote. Dietitians of Canada`s website says “In 2020 dietitians will be champions of healthy eating” [8]. Looking around the national convention at the fit and glowing members of our profession and finding healthful foods at breaks I find that we are making great strides.
More and more we understand the connections among diet, exercise, and health. Statistics Canada shows us that among boys aged 5–11 years, 20% are overweight and a further 20% are obese [9]. They report that in the 4 years between 2010 and 2014, Canadian youths had a 24% increase in numbers with type 2 diabetes [10]. Large epidemiologic studies such as the Adventist Health Study 2, with over 60,000 participants show rates of diabetes fall as the diet becomes more plant-based. Adjusting for all lifestyle factors, vegans have 62% lower risk of type 2 diabetes than nonvegetarians [11].
When processed meats are classified as Group 1 carcinogens by the World Health Organization [12], we may, for example, want to replace hot dog sales for school children, or replace processed meats in cancer fundraisers. But can we help parents groups and authorities discover and provide more healthful alternatives? Will the public accept and even enjoy it? These are the kinds of challenges that face dietitians today.
CHANGING PERSPECTIVES ON PLANT-BASED DIETS
Just 4 decades ago, dietetic associations, dietitians, and textbooks expressed what were reasonable doubts about the suitability of plant-based diets. Yet as research accumulated, dietetic associations could state in position papers “Well planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle” and that such diets “…provide health benefits in the prevention and treatment of certain diseases” [13, 14]. I am a co-author of position papers on vegetarian nutrition for Dietitians of Canada and for the American Academy of Nutrition and Dietetics and I assure you, these documents are the most difficult things I ever have done. Every sentence is challenged and must be extremely well backed up.
In 2016, epidemiologic studies clearly indicate that plant-based diets can greatly reduce our risk of hypertension, cardiovascular disease, various cancers, cataracts, and renal disease and give an extra 6–10 years of life [15, 16]. Changing habits is not easy, and it is not necessary for everyone to go vegan. Yet wherever they are on the spectrum of nonvegetarian to entirely plant-based, we can help our clients simply increase intakes of vegetables and fruits [17]. We can work with those who are somewhat motivated. What people gain is so much more than what they give up. Healthy people have more fun and experience a better quality of life.
In hospitals, we can help the administration understand how important healthful food is for sick people. Right now we have a more drug-centred mode of care. Yet some dietitians are making dramatic changes in institutional food service—with cost savings.
We get similar messages from so many quarters. The United Nations Environmental Program recommends a significant shift to more healthy, sustainable, and specifically plant-based diets [18]. Potential benefits cited include food security for millions who now go hungry, and avoidance of the worst impacts of climate change. The Food and Agriculture Organization of the United Nations proclaims 2016 as the International Year of Pulses [19]. They give key messages about the nutrition, low cost, health benefits, and sustainability of lentils, beans, and peas. These are strong Canadian crops! Find great recipes on: www.lentils.ca and www.pulsecanada.com.
Dr. Mervyn Hardinge, a Harvard-trained MD and noted pioneer of vegetarian nutrition said “Attitudes toward vegetarian diets have progressed from ridicule and skepticism to condescending tolerance, to gradual and sometimes grudging acceptance, and finally to acclaim” [20].
I began on this path facing some criticism and skepticism. I’m so thankful to all who were encouraging along the way. Brenda`s and my books are now a series, with 10 titles in print, over 750,000 copies in English, plus more in an additional 10 languages. Publishers are vying for our next titles. Our recent Becoming Vegan: Express Edition for the public and Becoming Vegan: Comprehensive Edition, for dietitians and other health professionals (twice as long, fully referenced), are award winners [1]. We received star rating from the American Library Association for “the go-to book” on vegan nutrition, two Book of the Year awards in the Untied States, and a Canada Book Award. Who could imagine that two Canadian dietitians would get multiple awards for books on vegan nutrition? And I am grateful for the opportunity to help shape a movement whose time has obviously come.
You can initiate a shift in a direction that profoundly makes sense to you. We have the ability to change the face of health care. It is time we dietitians take our rightful position as creative leaders in this field!
Acknowledgements
I would like to acknowledge my nominators for this award: Registered Dietitians Claudia Lemay, Karol Traviss, and Brenda Davis.
Conflicts of interest: I have no conflict of interest to declare.
References
1
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2
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3
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4
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5
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6
Perry TL, Hansen S, Love DL, Crawford LE, and Tischler B Treatment of homocystinuria with a low-methionine diet, supplemental cystine and a methyl donor Lancet 1968 2 7566 474 -8
7
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8
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9
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10
Statistics Canada, CANSIM, table 105-0501 and Catalogue no. 82-221-X. Diabetes by age group and sex [cited 2016 Jun 22]. Available from: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health53a-eng.htm
11
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12
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13
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14
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15
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16
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17
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18
The International Resource Panel, United Nations Environment Programme. 10 key messages on climate change [no date] [cited 2016 Jun 22]. Available from: http://www.unep.org/resourcepanel/Portals/50244/publications/COP21_Messages.pdf.
19
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20
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Canadian Journal of Dietetic Practice and Research
Volume 77 • Number 3 • September 2016
Pages: 154 - 158
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Version of record online: 19 August 2016
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Vesanto Melina MS RD. 2016. Five Decades: From Challenge to Acclaim. Canadian Journal of Dietetic Practice and Research.
77(3): 154-158. https://doi.org/10.3148/cjdpr-2016-015
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