Jul 12, 2019
Dr. Sandy Procter is an assistant professor and extension specialist focusing on maternal and child nutrition in the Department of Food, Nutrition, Dietetics and Health at Kansas State University. A registered dietitian and former coordinator of the Kansas SNAP-ED nutrition education program, she possesses a wealth of knowledge surrounding human nutrition that spans from pre-pregnancy all the way through advanced age. Our discussion was quite wide-ranging covering some more technical topics relating to maternal health and breastfeeding to the more social considerations of how to demonstrate healthy eating habits to children and provide recommendations to adults.
For more about Dr. Procter check out: https://www.hhs.k-state.edu/fndh/people/faculty/procter/
Improving Family Nutrition at Home and Abroad with Dr. Sandy Procter – Maternal and Child Nutrition
Something to Chew On is a podcast devoted to the exploration and discussion of global food systems. It's produced by the Office of Research Development at Kansas State University. I'm Jay Weeks PhD candidate in the Department of Agronomy. My co host is Scott Tanona, an Associate Professor in the Department of Philosophy, who specializes in the philosophy of science. Everyone, everybody, we're glad you're back. The field of human nutrition is fascinating, and obviously important. But as we all might imagine, very complicated. It seems like almost every day there's press coverage of a new study concluding that something like coffee or chocolate is good for you, or is going to give you cancer. Scientists and doctors have learned a lot over the years to keep us healthy. Yet many questions and seeming contradictions remain. So how do we make sense of all this? One way is that we can all buy all the books and read all the papers to make decisions for ourselves. But many of us, even if we would like to take on this endeavor, sadly do not have the time. Fortunately, another route is available, and that is that we can rely on specialists to spend their careers assessing all the information and distilling the findings down into recommendations that they then provide to us through various means. Our guest today is Dr. Sandy proctor. Sandy is an assistant professor and extension specialist focusing on maternal and child nutrition, and the Department of Food, Nutrition Dietetics and health here at Kansas State University, a registered dietitian and former coordinator of the Kansas snap Ed Nutrition Education Program. She possesses a wealth of knowledge surrounding human nutrition, the spans from pre pregnancy all the way through advanced age. Our discussion was quite wide ranging covering some more technical topics relating to maternal health and breastfeeding, to more social considerations of how to demonstrate healthy eating habits to children and providing recommendations to adults. Regardless of your background. I think everybody can find something interesting. In this episode, our Global Food Systems Initiative Coordinator, Dr. Maureen Olewnik, joined by Scott Nye for the interview as well. She has a strong background in serial chemistry and brought an additional perspective to the conversation that I think you will appreciate. Lastly, if you're enjoying the podcast, please tell your friends either in person or on social media. Word of mouth is an important mechanism by which we grow our audience. Also, if you wouldn't mind taking a moment to rate us and leave reviews on whatever platform you happen to be listening on. We will be most grateful. We want to continually improve the program and your feedback is a tremendous help. Okay, sorry for the long intro heavily. We now bring you Dr. Sandy proctor. Enjoy. Dr. Sandy Proctor, welcome to the podcast.
Thanks. It's good to be here.
So we usually start off with a short intro how before the podcast is even recorded. But we would like to get your perspective and your background and how you got here. So if you don't mind, could you tell us a little bit about yourself?
Sure. I'm originally got my bachelor's from K State in dietetics way back and started on a traditional what I thought was a traditional career path for dietetics in a clinical setting and progressed through a variety of different dietetics positions, each of them still long term care and then feeding college students and infant and child feeding programs. And each of them I realized I was sort of embracing the idea of moving further back, I wanted to move back further to make a difference earlier. And so I went from basically instructing patients as they were leaving the hospital about eating more healthfully to ultimately when I completed my PhD working with maternal and child nutrition and actually beginning to understand that we can can really affect change earlier than then before birth and and also beyond just a single generation through some of the the genetic differences that we know that adequate or inadequate nutrition can make.
Yeah, so I definitely want to get into the Maternal and Child Health things as it gets really important that a lot of people will be interested in that. To get you into that when you start moving closer and closer to childbirth were the things that you were noticing in society or in people that made you you know, sort of key on that or what got you interested in that specifically?
Well you know, as s in a role of nutrition or dietetics, or in health care, you realize that so much of what we do is focused on people's people's health or correcting something that's wrong with people's health. And so, so many of the chronic diseases that we deal with are nutrition, food related, that it is just a real goal. And I think of many people who are in nutrition related work, to catch that audience at an earlier time to to get to them and help them understand how valuable changes can be earlier in their life. So if you're a parent, how starting your child with that, right kind of food is, essential, or even earlier than that, talking with mothers about breastfeeding the minute that their baby is born. And so those were the kinds of nutritional interventions that really captured me as I sort of progressed through my early work career.
So most of your work now is an Extension agent with case date, correct? Extension specialist or specialist. Sorry. So what does that mean for people who aren't familiar with the extension system?
Well, and that's why I wanted to tell you why I corrected those agents are educators that are out in the field, and they are in Kansas, housed in every county, and they cover a variety of subject matters, topics, generally, they may be community development, or they may be agriculture, and National Natural Resources, family and consumer sciences. And then specialists are faculty members at the university level, usually or regional level, that are subject matter specialists. And we provide programming information, resources for those extension agents that are out interacting with local audiences.
Your specialty is maternal and child health, mainly us nutrition, nutrition. So what are some of those things that you're doing? What does the day look like for you? Or what programs are you working on?
Well, for many years, in this role, I worked as a coordinator across the state for two nutrition education programs, both the expanded Food Nutrition Education Program, and snap it and both of those are aimed at low income audiences, to help them better utilize what limited resources, they may have better feed their families, and to, to follow as closely as possible optimal eating information, helping them learn how to cook, if they aren't able to do that, to use some of the health foods that they may not know how to incorporate into their diet. So really complete sort of nutrition education for themselves, their families, how to shop, how to keep their food safe. So kind of all information around that. And so that really fit well with my my research or my focus area on maternal and child nutrition, because those programs really focused at the homemaker who was trying to better feed their family and and to make to stretch that food budget and to make better decisions that was going to, you know, affect the health and well being of the people in the family.
So you mentioned sort of supporting agents, but these could you say something more about these programs that you're working on there? This isn't all just sort of, for agents out there? Are you contacting the public? Are you working writer on your own to write
Those two programs I mentioned are both USDA programs that are delivered in Kansas through extension. And so we are the the sole teachers, the sole delivery agents have both of those programs, and they're delivered in about 80 counties for SNAP Ed and about 10 counties for the smaller program, F snip, and so as the specialist supporting that, and the coordinator was really a lot of just program management across the state. And there are there of course, it's both of them are based with the information that comes out from USDA. So my plate and the nutrition information that is developed my plate is that the basic pictorial embodiment of the Dietary Guidelines for Americans. And so both of those programs are based on getting that type of information out to audiences and in a variety of different ways in different curricula. And so specifically, what I did is as coordinator of those programs, and this was until 2018 was to really coordinate the effort And the the direction that our programming took in specific areas identified by the the local programming, but then facilitated through the state and supporting the the agents and the educators with the tools and the information that they needed in the training to keep them so that they were able to deliver those programs soundly.
So one of the benefits of it being on a county by county basis is you can target specific programs to benefit the people in that specific county. Correct.
That's one of the beauties of of Kansas and the extension in Kansas, it's very locally driven it if you were to compare what a specialist does in Kansas versus other states, in many states, from what I understand, it's kind of top down, we would decide at the state, a program that we wanted to send out over the state and everyone would do a program on on this topic in in Kansas, because it is locally driven. And there's that local funding, and that local board that is really driving some of the direction that extension takes place in those local needs are going to be identified. And then as specialists, we help agents realize what resources might be available to meet that through a series of lessons or through information provided to stakeholders or whatever they might identify that they need. So it really, is challenging for both, I think, maybe specialist for sure, agents, probably, but hopefully is a much more flexible system for the stakeholders. And the people of Kansas.
You had mentioned a local board. And I don't know that I may have missed the definition of what that is. So who would be on that board? And is that true? Is there a local board in every county, working with the agents?
There is a local Extension board that supports every extension office, and there are extension offices in every county, and now districts and so that may be a district board if there are counties that have gone together. And that even is through a change in Kansas law that they would join together as an extension district. And then there's a board that guides those there, their work and the hiring and the oversight of those programs. So our extension agents are they have input from the state, but they also have input from local stakeholders.
And then that board, that local board who makes up that board is local people who are elected to elected and people who are interested in what extension has to offer. And you know, extension, oftentimes people only know maybe about four h as part of the extension. And so there are people who are interested in youth development and people who are used to interested in and focused on community development or health or water. The Global Food Systems is one of the grand challenges. But probably one of those at least challenges is going to be a focal area for people who are interested in serving on the sport or people who are just really interested in seeing a vibrant service in their communities for the well being of what can happen when extension is really involved and informed.
Could you just say something about the way like what extension is doing here in Kansas versus like in other states, you described? How just different terms of the locality. But is this, I guess is anything like this is like everywhere, in across the whole United States, like every state has universities working, you know, with Extension agents throughout the state? Or is this sort of just in our, you know, breadbasket areas or like how does that work?
That's an excellent question. And I should broaden my description here. We are in Kansas, the land grant university, there is one in every state that was set up by moral just immoral, I think is his name back in the 1800s. Is when he first started off 1860s I think it was Abraham Lincoln's idea to have land grant universities he thought it was important that the average person out without that was not able to necessarily go to a university have the benefit of the excellent work that was being done at a university. And so he had this idea of land grant university and then Morell was the person I believe he was a senator. He was definitely a congress person that was involved with many times proposing this and getting it to actually come to fruition and getting a piece of land in every state put aside for land grant. universities and now in many states, there are Sea Grant air grant, lots of other types of universities that do that same research, and then make sure that that research part of that research challenge is to disseminate that out to the people of the state.
And it's a key part of Kansas State's mission, right.
And we find ourselves in today's conversation, oftentimes, you'll find us packaged into the discussion around engagement, because in extensions worked, is truly engaged work. And so getting back to the topic today, with the global food systems, it is important that we look at the role that key state has, with all the amazing research and the connections out across the globe. As far as developing the information and discovering all the amazing science, that's that's there. But it's also, at least in our estimation, that engaged part that taking that information out to the consumer, whether that be individual families in in, you know, the most rural part of Kansas, or if that is some sort of community setting where we can change the environment and, and really make it a healthier situation, because we have agents that are working as part of the school wellness committee, and they're going to have healthier food served at at vending opportunities, all of those types of opportunities that engaging and changing step by step, the possibilities moving toward toward health is is what the role of extension is either directly or indirectly, but aiming at those sort of components set that allow us to have a healthier life.
And I think, you know, you were talking about kind of education and providing information a lot. And I think it's really easy to see, like the the job of the land grant and of extension is sort of serving that role. It's kind of core, right, you know, sort of information. But, but, but I like the way you're focusing on engagement there too, right? Because there's a lot, there's a lot of this that isn't just about here's some information, let me give it to you. It's about, like you said, working with people and getting them interested in involved. And, I mean, yeah, agents are doing things to besides just providing information.
Absolutely. That's the classic model, when you think back to it. Let's take it, you know, around the 30s in the Dust Bowl era, and those agents out there teaching people how to, and I'm out of my element here, but circular plow, say and prevent the, the wind blowing in the erosion in some of the things that were the real. One of the real parts of the problems to the problems with the decimal. And part of that was education. But part of that was application to it wasn't enough just to say, oh, I need to, I need to eat more fruits and vegetables every day, but an understanding of not only do you need to eat more, here's how it could happen. Here are some samples, and you can tell your kids really like it. And this is a recipe that makes it really easy for that to happen.
In your opinion, what are some of the best ways to engage the public?
Well, I think, you know, I think that's a challenge that is ongoing with us. And when I first started being interested in extension, I was just a kid I was in four h and to me it was just fascinating to go to the extension office and see all those brochures that were written. Most of them in you know, in food nutrition were written by the same person is like, Who is this amazing person with these credentials that can write all this amazing stuff. And it all fits, you know, it's color coded fits in these these little holders and it was just the coolest thing well, that you know, that has changed obviously we don't do a lot of print information anymore, we do some because that's still a way that works for people but we do a lot of electronic information and we do you know blogs and and all sorts of of more modern we in with some of our young pregnant moms in some of our nutrition classes, we we do tweets or we do YouTube Live or whatever the form is that can really make sure that it is effective because it's just like nutrition isn't nutrition until it's eaten. Information doesn't do any good until it's received communication is two way so it has to be received as well as sense so the best way is what is going to work best for the two that are communicating whether it's the sender, but the receivers as well. So we'll find sometimes that we have multiple ways in the middle of programs and Depending on if something spans generations, that's not atypical at all. Or it could be that we start everybody off with face to face, because that's going to really build some, some rapport and some trust. And then we may go to online so that this young mom can, you know, get that last two or three lessons after she puts the kids to bed, but we still have that, that face to face touch with her. And she knows this and knows who to contact if there's questions. And so I think extension works really hard to identify what those best methods of communication and and information delivery are.
So K State does a lot of work internationally, with through the Feed the Future labs through many other activities where people are traveling, how does that affect the extension side of K state's outreach? Do we have any overlap or any, any connection between some of those international activities,
We do have some and I imagine there are more in agriculture proper than I'm even aware of. But I can give you an example of one that I was really fortunate to take part in just a few years ago, and I was approached by Sajid Alavi, with the Feed the Future work that he was doing and he was developing interested in developing a new food for very young children. That would be replacing the corn based food that they were had used in aid programs. And it was going to be sorghum based. And so there was a lot of work being done on what that would look like, and what all else that would include and, and the recipe for that. But also, it they were interested in information of you know, how can we work with these young moms? And how can we, you know, build their trust? And what do we need to know about, you know, we're brain scientists, we're not that familiar with young children nutrition. And so I was brought into that, that project very early. And I have a background from an earlier project of working in Kenya with doing some nutrition education. And so I thought that maybe some of that information might be transferable, as we started to learn about working with rural families in Tanzania, for this, Feed the Future project, and also with the community health workers who were sort of our, our go between sin and made it all possible, they could translate, they had relationships already with the families. And so that sort of that extension role developed for us. So we weren't just walking in there, like the experts and, you know, trying to change things or offer them, you know, food for your babies, you'd be very distrustful if you're given a food for your baby, but we worked with the local health educators to build that trust, and they could start to see a real benefit to their kids, they they really showed health benefits right away. And so then we had a role at the end, to work with those same health educators to make sure that the moms knew what to do next, because when the project ends, and the food source goes away, the moms want the health benefits to remain. And so to have those discussions with folks who worked as our outreach people, you know, we had some sound nutrition information, but they had knowledge of local plants and inexpensive fixes that maybe families didn't typically use to feed their family. A lot of times historic plants are so nutritious but our thought of is poor people's food are fed to the animals and not not eaten the way they were even a generation ago. And so when you have a child who's in a really healthy situation, and looking good, you have a health educator who's saying you can keep your child this active and healthy by adding these things, these simple things to his diet. You have a a motivated, engaged listener that's ready to say I can make these changes because I see how it's going to work and I'm I moved to keep my child healthy.
To drill down into this project a little more, what were the health challenges that were presented? And then you know, how did you move into correcting those?
I was part of a big team and so I need to talk about that because it was a really, I thought, really visionary group of people. We had Sajid whose work is with of course with grains and extrusion he was learning he was extruding the grain, meaning that it was being pretreated. So it cooked faster. And one of my experiences was in Kenya is that one of the things that is extremely hard on the natural surroundings, but also expensive is fuel cooking fuel. So if it cooks more quickly, that's a real bonus to the family, they don't have to go and collect wood, they don't have to buy food, they don't have to spend a lot of time cooking. So those that was a real benefit. So you had this extruded product. And then we had also from our Food Nutrition Dietetics and health department here at K State, we had sensory specialists who were able to do all kinds of testing to make sure not only was this a nutritious food that they were going to get, but it was by far one of the tastiest things that they'd ever come in contact with. And it really helped because when you're trying to get people to try your food and to taste your food, you want to make sure that it is even more attractive than what they're used to eating. And then another one of our group, also from our department was Brian Lynch shield, working with the the lab the basic nutrition and finding out how can we formulate this food so that it has increased nutrients. It's very digestible. Sorghum is historically not real digestible, but when you extrude, it that helps the digestibility and then mixed with some of these other products that increases some of the attributes, and then the whole micronutrient array that was added to it to make it so it overcomes some of the main problems, which were vitamin A deficiency and iron anemia, iron deficiency anemia, so lots of efforts went into it, even looking at the feasibility of with some of the agricultural economics folks that we worked with Nina Lilya, and her students doing a study on the feasibility of making this this extruded product, because it was USA ID in addition to USDA, yes, we can make it here in the United States and ship it but what would be the feasibility of making it in country and making it a sustainable type foods at some time in the future? So there were multiple aspects to it. And so seeing what the costs of those grains either grown or purchased, and did you know that they had extruders in I think it was in, in Kenya, not in Tanzania, but right next door. So just learned an awful lot and found out so much about working with our partner and in country was a non governmental organization, NGO, and the ability to get an IRB through a foreign government, when you're working with young children, is not to be missed, if you think you've done science. Yet. That is a lengthy, lengthy product process. But those who don't know an IRB is what, oh, internal review board the permission that you get from, in this case, the government and all the layers of the government in Tanzania and the health agencies, as well as our university to make sure that every step of what we're doing treats, people and processes and all parts of the system with respect and very aboveboard, so that ethical, ethical research is being done all the time.
Were there any learnings from that experience that you were able to bring back that had some impact here in the states?
It's really interesting that you asked that because obviously, there were, you know, the bigger project ones were the huge ones related to the brain and the sensory, and I think it's gone on and sort of continued growing. But for me, personally, one of the things I learned was, then coming back and working with those low income programs is, you don't know what low income is until you try making connections and finding support systems outside of this country. Because the support systems that we take for granted, whether it's, you know, the WIC program, or and I shouldn't say that we take those for granted, but that are here and part of our structure are so non existent food stamps or snap as we have those those things that are there, when a family simply isn't able to have enough money to feed themselves. There isn't anything there in other countries. And you know, so just finding out that, that ability to to depend on some of those resources and build on those and really help people maximize what's available to them is key because we forget to be extremely grateful. I think for some of those things that are available, that are not in other countries structure.
Could you talk a little bit about how important those programs are for getting people out of poverty, right because there's not but necessary that people are sitting on these, you know, for a lifetime, right. But by having these programs to help people through tough times, you know, that helps them move further up in the in the income ladder.
I can do that. But I don't have the facts and figures in front of me. So this is just sort of rough. But I do know, that snap itself, the Supplemental Nutrition Assistance Program is one of the great indicators of economy writing itself. And that is because if you look right now, the use of SNAP has gone down. And it continues to go down. It was at its height, I think, in 2010, which reflects the 2008 economic disaster, I guess it's fair to call it and it was at its height, but is has continuously and appropriately worked its way down, because more people are able to support themselves and their families and move away from that, that support system. And so there's lots of discussion about is that really accurately what that reflects, but best estimates are that, it really is a really good inverse relationship to the economy. And that it kicks in when it is when it's left to, to being delivered as it was originally or subsequently designed. It is most responsive, when the need is high, and it fades back into less need when economic times are better.
So what are some of the ways the besides, you know, at a macro scale on the economy and things like that? What are some of the ways on a local scale, you assess the effectiveness of some of these programs?
Well, the one of the ones I mentioned that the expanded Food Nutrition Education Program is one that is really a hallmark it was in in created in 1969. It was Orvil. Friedman was the Secretary of Agriculture at the time, and he wrote a letter to Lyndon Johnson, who was president and said, Mr. President, there are people in this country who do not know how to feed their families, and they need the information that and this is his words, that extension, Homemakers would, you know, give them at a meeting, but these people are not likely to go to meetings. So we need these educators to go into the homes and to work with the families one on one. And that's the way that program was started back 50 years ago. Well, the beauty of that program, and the reason it's still alive after 50 years, in my opinion, is because in the 80s, before anyone was calling for evaluation, we developed we I was not in it, but they the program developed a very complete evaluation system that is looks at a family's practices pre program, and then post program and also addresses other aspects of their behavior that change over time. So instead of just how did you like the program, it really is these are the changes that that we have made as a result of the program, and that has been able to allow our program to, to really sort of continue prove its impact through the years. So that's one example.
It's really obvious, I think, Well, maybe it's not obvious, but it should be obvious to people like how nutrition matters for health, right, you know, but could you say something more about like, the the the other impacts, right, sort of what what, what difference is there for a family, right? So when they, when they improve their nutrition, it's just like in terms of just calories in terms of sort of, you know, vitamins and micronutrients? And sort of like, what impact does it have on people overall, in terms of the well being?
Some of the micronutrients are simply, I mean, all of them have ability to change life, but some of them are truly intergenerationally life changing. And what I'm thinking of is iron, the capacity to learn is increased exponentially when a child has enough iron in their diet during the formative times in their life. And so we talk a lot in maternal child nutrition about the first 1000 days, and that is during pregnancy during from the time of conception during pregnancy to their second birthday, and that is really key for optimal nutrition. So, and there's lots of nutrients that we talk about folic acid because we know that if it's missing, and that's most typically found in fruits and vegetables, but it can also be added to lots of grain foods. It's a B vitamin that's going to prevent many of the neural tube defects that we see still in other developing nations. And so that one is really key. So having a very diet with with again, one of the main things we talk about is increasing fruits and vegetables because nobody no matter what, nobody, nobody eats enough, it doesn't matter, it's not a message that's targeted at this audience or that audience, it's like, you can be safe if you say more fruits and veg. So there's, there's folic acid and vitamin A, which is either beta carotene as a precursor in fruits and vegetables, or, in the actual form version in animals is one of the main causes of blindness, lack of vitamin A, in the developing world. So, you know, some of these, nutrients that are not that difficult to obtain in foods are really lacking across the globe. So when you're talking global food systems, you know, it's like, yes, the, the macro giant, commodity type, making it work, and even down to the farm and making, you know, the farm, the farm prospers, but down to the individual and down to the, you know, the whole cross ability to, to, you know, just figure out the necessary foods to be on the plate is is a key part, I think about what I think when I think of global food systems, it's it's that that mega, but taken down to the mega number of individuals that benefit from it, and I don't think I answered your question completely. But iron, vitamin A, are two of the biggest ones. And probably those are some in then there's different populations and different ones that are specific to, you know, where they are, but those are two of the ones globally, that are particularly an infant and maternal.
That’s a great answer my question, I think, great, because, you know, it's, it's, again, it's just not about, it's not just about calories, right? Right. So there's so many things that are important,
It's so important to get out of this country, and no offense to this country, but to talk to people who really, until just recently, and most of them still don't talk, there is no talk of obesity, because people are struggling to get enough of, of, you know, enough. And so it's really hard for people to get their head wrapped around, buying an eating, or growing and eating a variety of food, because more to them means more of the starchy, you know, center of their plate food, whether it's maize, or, or whatever that rice, whatever that food is, that gets them that full tummy feeling that they are able to have enough to eat and their kids are able to go to sleep and so to introduce a concept of very diet is, is really beyond the scope of a lot of a lot of people's thinking at the individual local level. And so having some of those, those local educators that can put it in perspective that resonates with those families is key.
You talked about sort of getting some of these nutrients from you know, variety of sources. And obviously, the varied you know, fruits and vegetables is a great way but, but supplements to grains and stuff, right. And so, you know, in this country, we've got a lot of experience of additives, right, you know, vitamin D and milk and you know, the list is long, right? Sort of what, what's your view about? Or? I don't know, if you have a specific view about this, but what do you think about the difference between adding essential nutrients to food, like through the, you know, through a manufacturing process, or like improving, you know, shortening the cooking time through extrusion, like, ahead of time, versus like, trying to get these nutrients, you know, and your calories and sort of increasingly cooking, you know, getting getting, making things easy, more easily available, like through other methods, right. So, like, basically, you know, should we just be trying to eat more fruits and vegetables? Or is it okay to sort of set up a system where, you know, hey, we need certain things, let's get it into other parts of our food, so we don't have to worry about the fact that we're not eating enough fruits and vegetables.
You know, I think, I don't think it's one or the other. I think it's I think it's a mix I remember it seeing in Kenya, and they stopped the bus after about the fifth time I made him stop. And so I could hang out the window and take a picture of this sign that said, Ken salt, and it's iodized salt. And it's like, that is huge. And in we are the one of the only developing nations that doesn't require that iodine be in all our salt. We have the option of it, but we have the freedom to not pick iodine too. So we do have in some cases, reoccurrence of goiter indeveloping nations where they have iodine added to the salt. It's a simple fix relatively simple fix for problem that is a health issue forever and ever. And not only is it goiter, but it's also cretinism. In developing in infants, you know, it takes a different form when it's birth and young children. So it's, it's, it's a simple fix and it needs it's an inexpensive and complete coverage of people to get that, that nutrients that they need. I feel the same way about folic acid, it really corrected a lot of things, I think we're we're starting to find out now I think that there are some sort of individual age related, you know, folic acid more is not always better as you age, there's some some issues, it looks like that there can be too much and it may affect heart health. And so to have it across the board in every you know, every cereal or bread may not be the best solution. But it's certainly solved one of the huge problems that we saw in our country, and worldwide too, so it wasn't just the US. So I don't really think there's, as a dietitian, I'm programmed to say if we can get it through our diet that is probably best. But we know population wise that there are several nutrients that we cannot get adequately, easily through our diet, even in this country. During pregnancy, it is difficult, if not impossible to get enough iron to for women during pregnancy, at the level that is needed. So that's one of the main things that's almost always included in a prenatal vitamin. And it's simply because diet wise, it would be very difficult to do that at a time when many women aren't feeling like eating enough, let alone more to support that particular nutrient. So I think it's a mix of if we can get it from the diet, great. But if there are ways that we can affect health of populations, in through appropriate supplementation, then I think those need to be pursued.
And fruits and vegetables in particular fresh ones are expensive, right?
They are. They're seasonal, I mean, we got issues we can we can talk about that across Kansas, and you may be able to get him in the southeast corner, but the Northwest, you know, and when we talk about fresh, how fresh is fresh, it's different if you live in California, and it truly is grown right there versus you know, it's shipped in and brought in and so you can have fresh, you know, something at your western Kansas grocery store.
So how quickly do things lose their nutritional value?
Oh, a lot of them will are losing like vitamin C. And some of those are really volatile, they'll go away shortly after they're harvested. And so ideally, we'll tell people that canned food may be inexpensive, but it's picked at its peak. And it's captured, the nutrition is captured at that point. And so we encourage people that instead of thinking that everything ideally is fresh, that you have a variety of food and that you not worry about it being we have a healthy, very complete food system that you not worry about it necessarily being organic, and it doesn't necessarily need to be fresh because foods are are picked and and packaged at at a real optimal nutrient level.
Could you say a little bit more about food access. In Kansas? I think a lot of people thinking that, you know, in the United States that food is accessible to pretty much anybody, right? Because a lot of people have cars and that sort of thing. But you know, depending on your situation, your access to a grocery store might not be possible, right?
Yeah, exactly. Yeah, and this is something we talked about a lot and again in our programs and extension, but I think food access is a really big part of it. And in Kansas we have areas and even in our county here in Riley County, we have areas that food access is not easy. And when you think about that, there's two components to it, there has to be a place where food is provided like a grocery store, but then you have to have the financial support to be able to to access the access and so you may be you may be several miles away from a grocery store but it's not a food desert if you have a car and you can hop in your car and go to the grocery store as many times a week as you need to but if you don't have access and there's not public transportation, and you don't have the money to make that happen or you're working hard to get the money so you have two jobs and you're the store closes while you're you know so it works and the same is true. If you even count in the pantry only serves people in one county and you work in that county but you live outside the county because the cost of living is less there. And so you've got access problems that, you know, we best intend to fix things and help things, but we create some of those as well, sometimes with our systems. And so, it is not that difficult to identify what we call and now I think they're starting to develop new terms, but food deserts where food access is more limited than you might ever think, in a country with this much to offer.
Yeah, and you said even here on campus, you know, hidden hunger is a real issue more than you would think, you know, university in a relatively prosperous area around.
Yeah, and that's, that's something that that people much smarter than me have been aware of for a while. But the we have a case cat's cupboard as a food pantry that has been a male vailable for last couple of years. Because it was identified that as costs go up for college students, they may be able to, you know, live in, in a very expensive area, or they may be able to hold down a job or to to make their tuition and books. But sometimes that last thing that that is covered is his food, and they'll go without the variety, or the quantity of food that they need to stay healthy. And it was identified in several different ways from several different directions. That was not only an issue here on our Kansas State campus, but on many campuses across the country.
One thing I wanted to make sure that we covered what we have you what we have you here, you talked about for young mothers and young parents and child nutrition and things like that it's important for them to get things like iron and folic acid and whatnot. Is there. What other things do you think young parents should keep in mind or you wish more people understood about child nutrition?
Oh, you just touched on it. Now we're here for the rest of it.
That's great, as long as you need.
One of the things that I've been partnering with another extension specialist, he's in family child development and nutrition is I've had a real focus for a while on parenting through feeding. And I think that's a real important aspect of it is that the whole idea of adequately nourishing your child's not only nutrition, nutrient needs, but their whole, their whole, just educational and emotional support, oftentimes happens through parenting and parenting is always on display. If you think about it, during feeding, it's a given a take, and so I early subscribed to the idea, of an educator. She's a registered dietician who's also has a master's in social work and, and has spent her life counseling families on feeding problems with children. And her name is Ellen sadder. And she has developed what she has come to call the division of responsibility in feeding. And basically, she's saying it's up to the parents to, to, to choose the to, you know, to provide healthy foods in a safe and dependable setting for the child, but it's up to the child to decide how much food to eat, or if to eat it all. And so thinking about that, and working with parents, if if the child has the responsibility of how much to eat, and whether or not to eat at all, that means that instead of prodding your child to just take two bites, just just take a bite, clean your plate, or whatever the current dialogue of the day is from parent to child. Instead of doing that we trust the child's appetite, and the fact that they are programmed to grow. And we do other things. So we make this the setting. You know, I'm not saying that it's an entertainment, you know, everything's always perfect. It's not that at all, but it's a functional, very positive time, where kids feel supported, as they learn to navigate food and their own eating capability to become eaters that are capable. And we work a lot with parents through programs, to to sort of instill that, that strength in them and then to also understand that what they're looking at may not just be, you know, picky eating, there are other things that it can be around and how To how to sort of arm themselves with information and and some tools that might help them pass through some of those, those challenging stages.
Is there some research out there the sort of shows, if you allow the child to make these decisions over time that they do develop us, are they given the adequate nutrition that didn't need rather than trying to force it on the child at any particular time?
It's not that they develop faster, it's that they become competent eaters. And so they trust their own ability to start and stop eating, to have the ability to say, I don't care for that, or I don't feel like eating now, I'm not going to eat anything. And that's not a time for mom or grandma, or granddad to freak out. It's, it's, it's, the child has that responsibility to be able to say that, because we know as parents that they're going to eat when they're hungry. I mean, there's a few ground rules that we understand about how they're going to eat when they're hungry. And that, you know, if they go on a, let's say, they go on a food jig, and they only will want to eat one food for a period of time, you offer a food that you know, that they like, in addition to new and different foods, and you continue to offer foods, you don't make a big thing about it, if they're only, you know, going to eat one food. And so you kind of yes, there is research, and that's, that's the whole point, there is research that shows that by doing that, you let them know, kids know that there are boundaries, you know, that they can be cranky and obstinate, and food is still going to be on the table, they're still going to have that interaction and that support from their parents. And so it really gives them sort of this, this framework for success and, and it shows that there's all sorts of research on this. But there's it shows that when children are very little in their brought to the table, and they have this this sort of responsive parenting feeding, they develop their vocabulary, better they interact, they learn communication skills earlier, as teenagers, they're less likely to have delinquency behaviors, there's less likely to have drug use less likely to have nutrition. Like food disordered eating. And so there's, there's a ton of research out that shows that if people develop young people, kids develop into competent eaters, that a lot of the issues that come along with that have a food sort of framework to them can be avoided.
So this is interesting on so many levels, but this is all about the social part of delivering food, right? It's not about what you're delivering as much as how you're delivering and everything like that is interesting, because, you know, when so much of what we're talking about with global food systems, you know, production and then sort of, you know, whatever, but sort of food is food is complicated, right? And sort of, and it's so social, right and cultural. Right. And this is I think an important part to be you know, highlighting and man, you know, battles between parents and kids around food or jobs. Yeah, right. Yes. Right. Yeah, it's always gonna happen. Yeah, so obviously, you know, you said no, you know, food doesn't become punishment, I heard you say, right, that's always gonna be there. Alright, so it was always hard for me as a parent, right, not to sort of do a little bit of that forcing. I mean, we, I think we tried to do something that was kind of like this, we said, our kids aren't gonna starve, they'll, you know, they'll eat right? You know, and, and we're not gonna make something just for them, we're gonna make what we're gonna make, and they can choose to eat or not. And so, you know, we felt pretty good about that. But man, there's so many times I'm like, No, you got to eat this, right?
You know, and, it's built into us, you know, it's like, I made this for you. And it's sort of, you know, it still comes out. But I think, just, even if you are only, you know, cognizant of it, and 90% of the time you try to do that, it's just remembering that the, for lack of a better term, the clean plate club, or the to Bike Club, which is interesting. You know, they're well meaning books coming out from all different directions that talk about that, but that's infringing on the child's responsibility is to decide how much to eat or if to eat at all. So if we can just say, you know, here's, here's what I'm offering today, and you can have, you know, you can have this or this. So there's choices involved, but you control that the food is healthy, you control that it's offered regularly, so the child doesn't have to wonder where their next meal comes from. And you keep the you know, the discussion, it's not about, you know, punitive and you keep the discussion light and positive, that those are very positive aspects not only of eating competent Stephen A parenting.
I was just gonna say it's fascinating to listen to you describe that and to the impact that has the effect that has as the child grows. Expanding that out just a little bit. What are the guidelines if the child 30 minutes later comes back and said, I'm ready to eat now?
Well, according again to Ellen Sattar, that's one of the things that you do is you can say, okay, you don't have to eat this. But your next opportunity, you know, you'll have a snack it at three, like we always do, and then there'll be supper, so find the ground rules. And yes, that Yeah, and so there won't be the opportunity to come back and, and, you know, demand something in 30 minutes, or dig in the snack or whatever it might be. And, yeah, so it gives, it gives parents a break, too, because you have sort of this set of things that you can, you know, because nobody wants to screw up their kids eating. But when kids aren't sure that where the next meal is coming from, or that they, you know, can trust themselves, let's say that somebody is so worried about some child's weight that it's like, no, don't eat that you or don't, don't take more, you know, you've had enough or something like that, when you're over doing that part of their responsibility. It undermines their ability to trust their own satiety. And so there's instances in settings where kids will just eat meat and eat and eat, because they're not sure that, you know, they will get a chance again, because you know, it's been restricted or something. And so, there's lots of cases like that, where, and that that can be normalized, but it is then you know, there's there's feeding clinics and parenting, feeding clinics and all sorts of, of manifestations of trying to get that message through to parents that it's really, and and you know, when you think about it, it starts at the very beginning, if a child is breastfed, they can't be forced fed, they are able to say I've had enough and I don't choose to eat right now, from the very beginning. And so if an infant that's just born has that capacity to do that, we need to nourish and support that, as they grow to be competent, older eaters, too.
So are there other trade offs there? Is there evidence that also like that trying of different foods? increases their palate longer term? So that like, actually, if you, right, sort of, if you force some new foods on them, does that actually have benefits?
Or no, no, I think trying enforcing is the key right there. You there are, and I, this changes all the time, so I can't tell you, but there, there are windows, where offering different foods are less likely to be rejected. And so try a variety of foods on a regular basis, and to re offer and to be okay, if, by trying this food today, I'm going to look at smell it and you know, set it really close to my face and look at it for a while, but I may not eat it till next time. Because the senses all come into play at the same time. And so it's not necessarily taste is the one that's going to win out. But yes, by offering a variety and then being real calm about the way that that food is offered, or that you know that it can be rejected without upsetting mom, I can reject the food, but Mom's not gonna reject me because of that. And so being able to to feel confidence in making those choices and not upset that family relationship is key in a child's development.
You mentioned the role of breastfeeding and sort of setting up healthy child development and you did your PhD on the effects of breastfeeding. Correct. Could you say a little bit more about the science behind that and the importance of it?
Well, if we weren't gonna be here all day, before we are now. Yeah, it's just pretty amazing. All the things what I particularly looked at with my research was this was back in, like, early 2000s was the effect of prolonged breastfeeding on child overweight. And there's a lot of research and we used big data from WIC and looked at datasets for Kansas infants and those who who are breastfed at least six months started to show some real protective effect against overweight at age four, and h four we use because it's the nature before they introduce in schools and get other outside food things and so and since that time, it's it's been repeated and reaffirmed in a lot of different places. And that was actually taking Kansas and looking at it because there had been a nationwide study that didn't include Kansas and so it you used, it used WIC data, looking at that audience where we knew that we had at one time we had a higher incidence of, of child overweight in WIC audience than in a generic across the board. zero to two, audience and so on. Yeah. So there's that. And then there's all the nutrition support that's much stronger. And the fact that, you know, so many things are available through breast milk that we're just still struggling to continue to find what it means in should it be added to infant formula even to this day. And so, yeah, and then the whole, nurturing and the child's ability to be in charge of their eating, there's just a myriad of benefits to it.
What are the mechanisms to protection against being overweight?
Is that oh, that's yeah, and that has changed over time to they used to think that it was, I need to check these again, they used to think that it was was something enzymatic, I think, or something, but now they're starting to think that maybe it actually is a some sort of genetic or DNA sort of programming early on, that's a programming thing. And I, I am not as up to date on the information as they used to be, but they have started to have more. More thinking, and I think that it's actually their thinking that programming for satiety sets in earlier something about that.
I mean, it's got to be really, really complicated. I'm sure we don't like, like you said, we still don't really understand everything.
That's it. That's the beauty of nutrition, you know, it's really relatively young science. And so a lot of this stuff, just like the biome, and I was just going to ask Mike, yeah, they're just starting to figure it out. And to really attribute some of the science to some of the changes and, and the, you know, the autoimmune diseases and things that that come up, they're just starting to really start to put some of that together.
So it’s which is another whole aspect of food that sort of it's not then just even about the nutrients, but it's about sort of what else are you getting when you're eating right, sort of what other microbes right are you getting?
And what did you get once it's in there? And yeah, it's crazy. It's, so I wanted to ask, I keep on talking here, I'm sorry, but asking you questions, but I'm sure other people say things too, but sort of, you just said something about nutrition, being a young science and sort of Alright, so one of the first things I think people think about when they I don't know, but sort of with nutrition science, one of the things that I hear when I talk to people about science communication, right? You know, nutrition comes up as one of these examples. Well, first, they said it was this, it was bad for you. And now they say it's that and then insert it. And then you know, this is fat and sugar, and it's sort of butter and margarine, and it's all these things and sort of, they don't know what they're talking about. Right? So what do you think about this?
Cuz I'm sure the reason I got into the field is because it's so interesting, and it's still evolving. It's like, yeah, you know, I think we're at our most boring when we think everything is solved, and we figured it out. And let's move on. And so I think that's a perfect example, when I, when I first started out in dietetics, we actually, you know, fat was the, the evil. And, you know, if I would have ever thought that I would get to the point where I would think that, you know, dairy fat now, it's got some really sort of very positive properties that they're starting to find out about. And, you know, avocados and nuts and all these things that weigh back, you know, it's like fat. But such healthy types of fat and the effect of different kinds of fat and what it has to do. And yeah, and the one of my favorite ones to use an example of that, and I love doing it when I'm talking to an audience of seniors is like, member eggs. Member her eggs used to be the criminal, you were right, eggs are back, you know, they're positive. And so and then just the other day I saw something, it's like, well, maybe dietary cholesterol is a problem. And it's like, man, don't go there. Because we're finding out now all this stuff about choline and eggs are one of the best sources of choline is like this nutrient that's been around since the 1860s. But they're just starting to figure out that it may reprogram some of the biome and have you know that we need different levels at different times during our life, depending on you know, whether or not we're making estrogen is women in childbearing years. And so it's like, this is really fascinating stuff. So yeah, so eggs. They're good right now, you know, and I love talking to people about that, but I like getting them to the point where they understand that it is a young science, so you're just figuring out vitamins back in the 20s and 30s. of you know, 1920s and 1930s. So it's stuff is really relatively young. And I just threw out a textbook. I think I told you this, that it was 2000 and it was saying, don't try to attribute anything to To choline, because it really is a nutrient that doesn't have any, any use in the body. And it's like holy cow, somebody gets a hold of this. That is so not where the research is now. So, yeah, to me, that's the fascinating part. But I do understand that it frustrates people. But I think, you know, since the fact that we eat every single day, many times a day, most of us to be able to sort of tweak our eating pattern, as nutrition changes shouldn't be that foreign. It's not like, we're going to find out that we got a bad car, and we have to live with it for 10 years, you can make adjustments to your nutrition as you go along. And it shouldn't be that sort of much of a jolt to people to sort of learn and adapt as they go along. But again, I guess that's sort of job security for nutrition educators for you.
Yeah. So, this is a you know, there's always uncertainty, right? You know, there's uncertainty Now, like all science, right, sort of like, all right, and we make mistakes, right scientists. So that's important. So the but one of the things this brings up is sort of the question like, when do you turn the science into policy? And when do you as a extension specialist, turn the science, it's out there into a recommendation? Because that's kind of where some of this can go wrong? Sometimes, right? Sort of, we've got the science, it's uncertain. Oh, you know, so eggs, maybe, maybe not, you know, fat, whatever. But so then it comes down, like, reduce your fat. And I think one of the issues that you just hinted at was that sort of too often, we take those directives, way too seriously, too extensively. We don't tweet or like all of a sudden, too early, we're gone. But sort of how do you balance that to sort of, like, How soon do you start to make a recommendation? How confident are you in recommendations? You know, how do you handle that?
Also, to add to that, I mean, we're all genetically different, right. And we all have very different backgrounds. We have different childhoods. You know, how do you think about that, too, because there probably isn't one policy right? For everybody. Right?
Yep. And I think that one is just really, it's just really starting to unfold. I think we're really just starting to learn about that. And I think that, for example, choline is a perfect example of that. And I think gluten may be another one, where it's going to react with different people, and they're going to have different, you know, different sort of reactions, or reprogramming, actually from some of these nutrients. And so do you get a lot of questions about gluten? Oh, yeah, that's one of the lessons I wrote a few years back was on gluten when, when it was going from, because again, when I was in school, they talked about celiac, very few people have celiac, this is something you may need to know about. If you're in a clinical setting, learn about this. And then to the point where, oh, let's all try it. It's a great weight loss diet, and everywhere in between. And so I, just a few years ago, felt like it was time and there was lots of stuff being developed out there to write this lesson on. Okay, here's all the reasons that we know of today, why you might need to talk about gluten restricted diets, and it's there's allergies and additions to you know, and intolerances. In addition to celiac, and there's all these things, and then, you know, does it is it effective for weight loss diet? Well, in extension, we try to, you know, really not be black, white, you know, we weigh the science we talked about, and it's like no, it doesn't seem to really be effective just for weight loss. And it's super restrictive, you lose a lot of nutrition in the offing while you, you know, throw the baby out with the bathwater, as far as you know, getting rid of gluten. So, yeah, we get a lot of questions about that vitamin D is another one. There are people and research out there that say that vitamin D is the solution to a lot of things that whether it's autoimmune diseases, you know, all sorts of things that are being attributed to vitamin D, at some level, but the research supports only bone health right now. That's where the science is most complete. We've had recommendations that we increase it during pregnancy, it's pretty exciting stuff, but they're not there yet. So what we end up doing what I think we are bound to do in at least in these two programs, and I think it's just good sense is we follow those US Dietary Guidelines for Americans, those are put together by really strong appropriate groups of people who look at the science, see if there's enough weight to the science at the current time to say, you know, we can now say this about this, if we can't see it, we can see it's looking like this. But you know, we the science isn't there yet. So this is all we can say like about vitamin D, they really can say bone health, there's all those other things that they are starting to attribute to it and depending on who the scientist is, there's tons of pressure to make some of those changes. But you have to weigh the science and make sure that you know and that's when something becomes you know, research, even applied research versus public health policy. And so it's a continuum.
We want to be respectful of your time. Maureen Scott, do you have any further questions? Do you have anything else that you would like to say before we sign off?
Um, no, I think I appreciate the opportunity to talk about more things than I ever thought we would be talking about today. I hope I've done well, by extension extension is a very huge and complex system. And I my slice in family consumer sciences is part of it. So, you know, to talk about extension and their focus on the grand challenges, one of which is global food systems, I think really merits a bigger look than what I was able to share with you.
Well, if people want to get in contact with you, how might they do that?
Oh, I’m just Proctor@ksu.edu.
Great. Dr. Sandy Packer. Thanks so much. Thank you. You're welcome. Thanks. If you have any questions or comments you would like to share check out our website at https://www.k-state.edu/research/global-food/ and drop us an email.
Our music was adapted from Dr. Wayne Goins’s album Chronicles of Carmela. Special thanks to him for providing that to us. Something to Chew On is produced by the Office of Research Development at Kansas State University.