You know, I love that organic cooking. How old is ask for more and they call me. Mr. Natural calm down to the health food store. I only eat good C's so why children don't touch my lips and my friends is always begging me to take him on macrobiotic trips. And yes, they are there to keep under lock and key and I take it off to my closet where nobody else can see I open that door. So slowly take a peek up north then I pull out a Hostess Twinkie.Yeah in a daytime. I'm mr. Natural healthy as I can be but at night I'm a junk food. Junkie good Lord video on me. That song by Larry gross suggest just how hard it is. Sometimes to change our eating habits. We may swear off candy bars potato chips or that soothing scotch on the rocks one week, but the next we find ourselves right back at it again feeling guilty for not being able to control our wandering appetites during the next hour. We'll take a look at some attitudes toward nutrition and how they might be changed first was here is speech giving giving the middle of last month by dr. Phyllis Fleming at the annual conference of the Minnesota Public Health Association. Dr. Fleming who has studied extensively social attitudes on food is an assistant professor in the School of Public Health at the University of Minnesota following her recorded remarks. Dr. Fleming will join us in the studio for a live phone in segments during which time you'll have a chance to ask her questions and share your comments on the subject here now is a recorded portion of our program a speech by dr. Phyllis Fleming and titled nutrition and lifestyle how to change Behavior. Thank you. I'm pleased to see you all here this morning particularly when you're competing with golf courses tennis courts and Bert Lance testifying on TV. I've been checking around and I've discovered that a lot of people will you were out at 6:30 running the course at Dr. Elyria set up you're playing some of you I know we're playing tennis haven't gotten your tennis rackets out after 5 or 10 years and that's encouraging for me to see because it appears that behavior can be changed. There were others of us who are also providing examples that it's a little bit more difficult to change Behavior if we were sleeping in and having breakfast and so forth. So have both aspects of it. We have people who are showing that behavior can be changed. We also have people who are showing Behavior can be changed. I think some of the things that Bob has said a very relevant very pertinent to what I'm going to be saying, I'm actually going to be repeating some of the things we do need to change Behavior particularly nutritional Behavior an exercise behavior. I'm not going to give you a whole lot of Statistics except to say that if you're a typical American following a typical American diet you have drunk 6 cans of soda or pop as I think people in Minnesota call it during the past week and that has meant you will consume 945 empty calories. If you're a typical American following a typical American diet you consume 2 and 1/2 pounds of fat in the past week. If you're a typical American following a typical American diet, you've consumed 2 lb of sugar in the past week now you might say well that hasn't been me. I haven't been eating like that. And if you haven't been eating like that is some consolation to you, but just keep in mind that to get these averages somebody else is eating more than his or her share. How does public health people that's our concern as well? We have to go beyond our own individual health and become concerned with the health of others right now. The diet that Americans are following Bratayley the diet that children are being encouraged to follow a via TV particularly are a nightmare. We're providing well depending upon your perspective or providing a dream or a nightmare for epidemiologist. We know that. We have empirical evidence in the empirical evidence is growing every day that diet excessive consumption of calories, excessive consumption of refined sugars and fats are empirically connected with cardiovascular problems are empirically connected with hypertension with with diabetes with some forms of cancer. We do need to change the way we're eating. Now having said that how do we do it? I am willing to bet that almost everybody in this room at one time or another has had some experience with attempting to modify diet. Either your clothing is becoming progressively Tighter and you no longer can blame it on the clothes dryer shrinking everything for the dry cleaner or you've encountered symptoms of hypertension or diabetes or cardiovascular problems, or you've been pregnant and have a voracious appetite which out distances your energy consumption needs. I'm willing to bet that almost all of us have encountered some reason for changing our diet. And although the motivations for change have buried the specific reasons for change have varied. I'm also willing to bet that we have all encountered a rather common reaction in the common reactions. We didn't like it at all. We have spent Decades of Our Lives building up our eating pattern and by golly we don't really like to change it. It's painful. It's painful if you're a cake and milk per person or a beer and peanuts prisoner wine and cheese personal for bed. It's painful to stop doing that. It's painful to pass up a second helping of an eye on him and everybody else at the table is enjoy the sensuous the lights of their second helping it's painful to pass up the pie the lemon meringue pie. It's painful to do all of these things and I'm not being particularly sadistic when I say, I hope you experience that pay. I hope you experience some of that discomfort because if you have then, you know, something of the problem we as health professionals are up against when we had how to change behavior and what I'm particularly concerned about today is not so much changing the behavior of individuals but attempting to change behaviors of groups within communities and sometimes whole communities We haven't really come to grips yet with what are the motivational factors that lead to appetite to food pattern change. We do know that food is tremendously important probably primitive Man 8 to fill up to fill his stomach. He probably ate whatever he could get his hands on and in some cases to his detriment. She had a lot of experimenting to do and sometimes he lost today. We don't eat that way how many of us really eat to reach the Tidy I don't think very many of us do food is a very important aspect of the culture that were living in it's really become symbolic and that's symbolism begins with an infant see infants very quickly latch onto food as a source RR as a stimuli which is accompanied by security and satisfaction and well-being or if they're not getting the food they need as the reverse of these food very quickly and infancy can become a means of power infants very quickly learned that they can demand that their food needs be mapped as noted by a whale in the middle of the night which doesn't stop until the food needs are met They may have learned that people around them who are supplying the food can also manipulate that food is power as sources of reward or punishment for attaining the kind of behavior changed that these others around them want. So the symbolism the cultural implications of food begin in infancy and they just build on from there. Suit food, we associate with Prestige with status and wealth if we can go. Well, I'm only familiar with the supermarkets in Minneapolis. But if we can go to Appelbaum and buy live Maine Lobsters, I'm sure everybody else and Applebaum know we are well healed. It just read it still is going on in certain cultures that if you can afford to buy white flour refined rice refined sugar, you are among the Upper Crust in that Society also to your depreciable detriment. We know that food can become a means of communication interpersonal relationships the old saying the Apple for the teacher didn't grow out of nowhere. Also. I was reading an article in a recent edition of The New York Times and which was talking about the vegetarian diet that are being prepared on various University campuses. The article was pointing out that in some cases people go vegetarian because they don't like what's being offered on the regular menu and think they'll be better off on the vegetarian menu some think it's healthier but a lot of them this article reported become vegetarian because I get to eat in a special vegetarian room and become a part of the veggie crowd. It's a socio-cultural happening. I don't mean to to Discount vegetarian diet, but there are cultural and social implications to them as well. Certainly many of us no food as a source of pleasure and gratification. We also know that it can be an expression of hospitality and friendship are never going to some friend or what I considered a Time some friend's house spent a whole afternoon was never offered anything to eat or drink. That I was thirsty or hungry, but I was incensed when I left they didn't offer me anything. It does have connotations of hospitality and friendship. It also has connotations of sympathy empathy. I recall being in a household in Winter funeral was going on in Boston was an Irish Catholic funeral and I have never eaten so well as the food just piled and it was it was a culturally accepted thing that you you show your sympathy you express your empathy for the people undergoing the loss with food. So food is a very complex part of our culture and if we don't recognize that when we go about attempting to change food Behavior, Not going to do so. Well, we really are not going to do very well. So food enters importantly into what we Define as normal, but we Define is good. What is fine with his idea and we must recognize when we said about modifying food habits were modifying culture and culture has a broad spectrum of things to see ideas the values the the Notions of what's good and bad the way we do things to have as the conditions that we have. All of those things are culture and I think it's a mistake to think of culture is being like a jigsaw puzzle with the food patterns being this little piece, but you can just pluck out and replaced by another. I don't think that's the way cultureworks. I think a better analogy for culture is to think of a piece of knitted cloth maybe with all the various aspects entertaining golden intertwined and if you start pulling one thread, you may have the whole piece of me to class unravel and if you start devastating certain aspects of culture carelessly, you may have the whole Culture begin to disintegrate and not function in the very positive since it was once functioning. So you do have to be careful. Not only is it difficult to change food patterns because they are part of culture, but you must be very wary when you are attempting to change food patterns because they are a part of culture. You have to be very alert to the unanticipated consequences of changing culture changing food habits. One of my favorite examples. I know some of you have heard this already but one of my favorite examples comes from a change in the food patterns of chimpanzees rather than humans and it comes from the work of Jane Goodall who worked studying essentially doing participant observation studies of chimpanzees. I think in Kenya, I was thinking about that last night and I can't remember if it's Ken you or not, but I think it may be well anyway, Jane Goodall work very hard to purchase to observe these chimpanzees and she spent 18 months just working up to the stage where she could get with it, and I don't know 6 or 10 ft close enough. Really have a good look and she really wanted to be able to observe them very closely without having distance interfere without having trees or brush interfere and she discovered that she could get them to come into her Camp if she gave them bananas. I'm so she made a bananas available to them initially as many as you want faces, then she found they are eating her out of the camp. I guess you would say rather than house and home and they were just eating too many bananas are becoming far too expensive. So she said no we have to limit the supply of bananas and she did that. She limited the supply. All she was doing was giving The Chimps a few bananas and you say so what what happens in the process of her giving a few bananas was that first all the strong males latched onto all of the bananas. Anna Banana became a symbol of status as perhaps the live lobsters from Apple bombs made they became a symbol of status for these big strong male females in the troop began prostituting themselves to the males who had the bananas. Intra-group intro within the group conflict broke out at a level. She had never observed before as they struggled over these bananas. So simply bringing bananas in seems like a fairly innocuous. She had changed aspects of their social structure change aspects of their Enter chimp relationship and see how I hesitated to use interpersonal and she had changed aspects of their culture. She was all she also became concerned about their ability to forage for food for themselves, which is a fairly serious responsibility. I think she had and she was working with them and all this because she just simply wanted to get a closer look at the Champs when I was thinking about talking here today. I happened across an article. Written by a fellow named John Castle husa Public Health person who was a medical officer in charge in the full alif Reserve in South Africa in the flurries. There was some reserve of Zulus. The reserve was characterized by several public health problems, poor environmental sanitation infectious diseases, certainly inadequate diets, like leading the high incidence of kwashiorkor, pellagra and other manifestations of malnutrition. And his charge of his challenge was to improve conditions on this reserve. And in what I'd like to talk with you about today are particularly his attempts to change the diet. He took dietary surveys and the dietary surveys reveal that the primary food on this Reserve was corn prepared in a variety of ways. Some dried beans very small amounts of milk amounting to less than 1 tbsp per person per day in the best milk producing seasons and I'm going to say a few a little bit more about that because I know it was not just to be equitably because of cultural reasons. He also found that interesting whatever funds would allow that would go out and buy white sugar and white bread. They also had Millet which which is sorghum and they use that to ferment into some brew and they use that primarily for the fermentation rather than treating. He was astounded by the eating patterns. That was a very apparent to him that what what the people were eating or very definitely affecting your well-being. So following his first inclination, he went out there and he gave those people the facts your diet is leading to malnutrition. If you would eat better you get rid of your kwashiorkor pellagra several others of your problems, and I think you should change your your diet. And what do you think response was? They said our ancestors have always eaten this way. Our ancestors ancestors were strong and virile and we shall continue to eat this way. As a typical response to giving people the facts as we like to give them Bob message matches just don't hand out pamphlets. It doesn't work people have a way of not hearing the facts ignoring the fact that they do hear them of changing the facts around fit what they're doing but giving people facts is not a very effective way to change the behavior in most cases. What he proceeded to do with the investigated to that the dietary patterns of his of the Zulu ancestors and found. In fact that this was not the title but died that they are typically found they had tended to have herds of cattle which were sources of meat and milk. They tended to have access to its largest supplies of wild game Wild Greens and so forth. And so when he decided what really needed to be changed the three changes he was going to go for was first of all to get them to eat more green vegetables cycling to get them to eat more eggs thoroughly to get them to consume more milk. When he decided that was what he was going to do when he realizes giving these people the facts wasn't going to be affected at all. What he decided to do was investigate the history of the of the Zulus ancestors and then propose and inform them about this history. Saying you might be wrong about what your ancestors ate. It doesn't appear that what you're eating and it doesn't appear that their virility was due to the same kind of diet. You're following their diet really was different and what he began doing was to have small groups meet together. Give him this kind of information. He particularly tapped into the leaders the elders the respected people who would serve as Gatekeepers and influential sources of information. He also tapped into certain aspects of their interests are fantastically interested in how fetuses were nourished in utero, and he tapped into that interests have long discussions with Lewis would go on for hours, but he found that interesting maximize that interest And eventually he was able to suggest to them that Foods could make you fat which was something they valued a value being fat. Some foods could make you strong and some food could do a whole host of things for you besides filling up your stomach. Once he started with that approach once he convinced them in this was over a period of months and years. He convinced them that Foods really did have other functions than feeling one stomach. He was able to go on into his specific change programs in the first change program that he got into was getting people to eat more wild green to go out into the forest and find these green he attempted to raise their motivation the level again, you've heard this from Bob by suggesting that they would be healthier also it would be cheaper if they could get these Wild Greens as opposed to going to grocery stores and so forth and and buying food, then he made the foods available to them already tried to facilitate the availability of these Foods another important thing. You don't just go out and tell people change unless there are asked but unless you change aspects of their environment to make a change possible, so he had his staff developer Gardens and so forth and eventually the people began to develop Gardens in a penny had his staff give demonstrations on how to cook these vegetables and eventually Gotham to be consuming more vegetables the problem with milk was far more serious because it was deeply intertwined the milk drinking patterns were deeply entertainment wine with a culture. It was a belief of the Zulus at a man's link with his ancestors was through his cattle that these were the cattle of his ancestors. Well, these were the ancestral products of his ancestors cat ancestors cattle and so he didn't you didn't go messing around with the cattle and their products so that if you belong to one family, you didn't drink the milk of another family that was part of the culture also any pregnant woman or any menstruating woman was likely to put a curse on the cattle and so women we're not who are menstruating or pregnant. We're not allowed to even pass by the cattle. And what's more they were not allowed to drink some milk now here you have a really serious problem. To the point where girls who were Beyond poverty because they couldn't keep tabs and when they were menstrating when they weren't menstrating simply were never allowed to go near the cattle were never given any milk in the same thing was going for married women and it was part of the culture to give those people the facts and say Hey you women your women really have to be drinking more milk. If you're going to have off healthy Offspring didn't work the way he got around this I think was very clever and it shows a lot of initiative that we are probably going to have to use if we're going to change people's behavior. He said well what you're concerned about is drinking milk from other people's other kin groups cattle. How about if I bring in powdered milk? Who are which comes from cattle some way somewhere way out there has nothing to do with you or Kim group so that be all right with you and yes, it would be. So he began having them drink powdered milk, and at first I didn't like the taste of it, but eventually they got used to that as well and wants milk drinking by the women became part and parcel of the normal everyday run of things eventually women began have access to their to the milk in the family. They began shifting away from powdered milk toward cows don't know you might argue and it's the case as he had actually changed an element of culture and he had but had left the rest of the culture in Taft and I think that's a rather important thing and how do you not approached it as he did he might have devastated aspects of a culture initially as Jane Goodall did with her bananas. I think from this example of castles we can come up with some general guidelines. And I think that's why we're here today come up with some general guidelines of the kinds of things. We might do to change Community dietary patterns the first thing and I've already alluded to this and so has Bob is at giving people the facts simply doesn't work advertisers found out a long time ago and advertisers don't give as many facts. It was interesting to know if that in a recent Democratic primary for the position of Mayor in New York that the two people who came out to Democrats who came out with the highest number of votes. First of all, we're hardly known when they started 32 million dollars of advertising they quickly became known and what's interesting at this is that this $2000000 of advertising was not devoted to issues. It was devoted to image building. And you may argue that image building is not very helpful in making a decision in the voting booth. But an advertising executive would probably counter that argument by saying maybe not but it sure does word it gets votes and certainly the food advertisers of cereal the Saturday Morning cereal advertisers are not giving our kids good nutritional information and there has been work done in our Public Health Nutrition program at the University which indicates that very nicely but they sure are selling images when Tony the Tiger roars. That's a good cereal. And so what's going on is giving people the facts doesn't work advertisers know that they build images and perhaps we should become concerned a little bit without as well. We're dying to give these people good nutritional information. We have to consider how we give it to them. We have to I think we have to sleep in the back door. II principal I think we can pick up from the flail example is that we have to begin with where people are information. We have to start where they wear their level of information is we may want to go and give them the most fantastic lecture on nutrition principles that we have ever dreamed up and it will probably not mean anything to them unless we start where they are in for Layla. He realize that people thought you ate to feel your stomach and that was it answer a series of discussions particular tuning into the interest in how the fetus is nourished. He was able to get across certain other points of information which eventually prepared for further Behavior change that was coming. So begin. You must begin where where people are informationally certainly we must begin where people are culturally Honest a very difficult thing to do because we're all pretty and entwined involved in our own cultures appropriately. So we think our cultures other our habits and our Traditions are the best ways of doing things in this is not a negative thing if we didn't think so our culture's wouldn't survive we have to have some vested interest in our cultures. So it's not a bad thing. However, we must attempt to set aside our own cultural biases when we deal with the communities and groups that we will deal with and we should also be wary of assuming there is a general American culture. I defy you to tell me what that culture is. I shouldn't say I defy you I challenge you to tell me what that culture is. In the Twin Cities alone, you could probably identify. At least eight separate subcultural groups based on social class based on ethnic racial origin based on regions of origin and so forth. So be getting more people are culturally is tremendously important. The fourth point that I think we have to be aware of and I think this is often times overlooked is that we have to work with the social at the social structures and the power structures of the groups were involved with if you're attempting to change our families food behavior. For example, you would do wise to find out who determines what's eating in that family is it the male's father's preferences is at the way the mother shops is at the kids who demands certain kinds of food, what determines what food gets into that house. What determines how it's prepared? What determines how it's served in essence you're asking or I'm asking what is a social structure that family and certainly if you're dealing with groups you would do well to ask who are the information Gatekeepers for these groups a colleague of mine in Florida who has done a lot of work in Central America and Cuba and I can't remember the country of origin where this example comes from, but he talked about going into a community and attempting to change agricultural practices. I think it was trying to People to use more fertilizer and he did everything he thought by the book he went the the officials of the town. He got them on his side. He had to community workers come into the community had small group discussions that education programs. He made fertilizer available. He did all of these things and nobody was changing anything and he noticed every time he came into this community. There was an old old man what kind of watches and follow her around and sort of smile at him and deal with him in a rather Superior fashion. Finally when nothing was happening in his level of frustration with extremely high this old man came to him and said when are you going to come and talk to me? Am I calling several who are you know, you're this person was tagging me for a long time. But who are you and it turns out he was an elder and Elder person in a very influential family group and nothing went on in that Community unless it went through him so find out who the community leaders are. They maybe the elected or appointed officials. They may be somebody else but work with the power group and the social structure group of the community. The first thing I think we have to recognize it that way when we're trying to modify diet. Consider the effect. The modification will have on the individuals were going to be modified whose diets are going to be modified. Can they for example justify it to their community and filet like women initially have Justified drinking milk to their families or would they have been ostracized chances? Are they would have Consider what are the effects of on the individual and can the individual justify what's going on to his or her community? Also in terms of the individual? You should really work to find out are you violating? Are you going against certain psychological and emotional needs of the individual? I think one of the finest weight reduction program approaches are is coming out of some of the behavior modification programs which work very definitely with finding out what food means the individuals were trying to lose weight. How many people simply police calories does no good if they are eating because they're angry frustrated and so forth. So find out where the individuals are as well as where the group is. the six principal is that all we must specify simple goals realistic object object is that can be attained and we should try to work at them sequentially rather than simultaneously we try to change the world all at once will probably have no change at all again drawing from the flail example Castle began working with the greens the green vegetables moved on to eggs, but we didn't talk about and then on to milk eventually, but he didn't try to do it all at once. A set of tenant is whenever possible try to involve the group that you're working with and setting the goals and planning the procedures for reaching the goals. Again, the philately case history provides support for that. We can draw a lot of other support from throughout social psychology price particularly relevant and World War II began working with how to get people to eat little eating food such as organ Meats when there is threatened food shortages. He tried three methods. He had Margaret Mead no less lecture two groups of people. He had some group simply meet and discuss the possibility of eating organ meat and he has some groups meet discuss the possibility to eating organ me along with the group baking a commitment to try them and his third kind of change was by far the most successful. I was presented with an example somewhat related to this from the sea. Paul school system recently in which the point was made that when children were involved in the preparation of their school lunch, even though the man who was not change when they were simply involved in his preparation. It was likely to be less plate waste so you get people involved with what you're doing. Are you work with their culture with their groups rather than against them and he want people to eat green vegetables and make sure they can have access to some green vegetables make sure that they have Financial access make sure that the culture has these things accessible make sure that the political social economic environment are not making this impossible. Recently in his country the Senate Select Committee for human nutrition human need published dietary goals. And essentially the dietary goals said we should decrease the amount of fat. We consume physically saturated fat. We should decrease the amount of sodium. We consume we should decrease the amount of protein. We consume we should increase the amount of complex carbohydrate be consumed. Interestingly enough when they when the committee made recommendations for how we wear these kinds of changes were to be implemented. They had very heavily on upon various forms of education and an education. We would consider that they were thinking of giving people facts and motivated him at the same time. Norway has set up a national nutrition policy with very similar goals interested only in Norway. The policy was coming out of the committee on agriculture. I think that's what it's called and they said up changes in the economic structure to manipulate diets to achieve the goals. For example, they wanted people to consume or margarine less butter. So they decrease cuz I have consumer subsidies that decrease and increase consumer subsidy than margarine to get people in their pocketbook and you're likely to be effective are more effective. If they wanted people to consume more potatoes. You give people subsidies for potato consumer subsidies for potatoes. They wanted people to eat less sugar. They decided to have it the policy working toward eventually having no sugar production in their country pretty drastic change of the wherever you are philosophically on this. What are you put the responsibility for change with the individual will you put the responsibility for change with manipulation of the social and economic and political structure wherever you are philosophically on that. I think you should recognize that it's easier to facilitate change it to be meddling in some of these macro things as well. Find me the knife principal and this is in keeping with all good behavior modification programs be there at the individual level or the community level is you got to show people that it's worthwhile. You have to make a change somehow reinforcing to them in Vallejo. The whole program Castle was reporting and went over. Of 12 years and he found that infant mortality vastly decreased malnutrition symptoms fast is the weight of 1 year old children increased by 2 lb, and this was a desirable change in case he was able to show them the benefits of these changes and we must be very careful coming to change behavior that we make the benefits are obvious. We make an apparent we ask are there really benefits for these people and can we demonstrate the benefits to him? Finally Justin summarize and I'd like to suggest to you threefold. Summary of how to go about changing diet Behavior, which is proven effective in many areas first while you work on motivation you get people to want to change and you do that by working through the culture rather than against the culture II when you make it possible for the change to occur if that's increasing supply of various Foods you do that. It is decreasing supplies of various food will be nice to do that. If you can't do that, you may have to work on motivation little bit harder and thirdly you give very concrete concrete demonstration of how these changes can be incorporated into the people's lives. They must be shown very completely. We all must be shown do I can treat me how to achieve these changes? And the last thing I'd like to say is just to re-emphasize what I mentioned earlier about the ethnocentrism. I think it's setting a realistic goal for ourselves. We should not say in our own personal approaches to behavior change. We shall wipe out all of our ethnocentrism. We work on setting realistic goals. I suggest that is not a realistic goal. Probably more realistic is just a little bit of sensitive. Where we are culturally they always say the fish is the last discover the water around him and we are the last to discover what our culture is really like in the influences that culture is having on us and what I'm suggesting he was just a bit more sensitivity to the effects of our own culture on on the kinds of recommendation that were making two other people. Thank you. That was dr. Phyllis Fleming who's in the system professor at the University of Minnesota School of Public Health and she spoke the middle of last month that the annual conference of the Minnesota Public Health Association at the Reedy Point Lodge near Brainerd. And dr. Fleming is in the studio now with us this morning to answer questions. If you'd like to ask her a question about the something she said in her speech about changing nutritional habits, you can do so by calling us at 2 to 11500. That's 221 1500 in the Twin Cities area, or if you live outside the Twin Cities area. You can call us toll-free 1-800 652-9700. That's a toll-free watch line number and I'll give it again. It's 1 800-652-9700. Welcome. I'd like to start this morning before while we're waiting for for a phone call and ask you something about the something you mentioned in your speech and that had to do with substituting foods are least. It'll go away. I interpreted it with substituting food at certain occasions. You mentioned an Irish funeral that you went to I think in Boston and a very well and the I come from a German community in central Minnesota and food is a very big part of the funeral situation to afterwards. Everybody is fed. Can you suggest alternatives to things like that or or or are we tampering with a very very important thing if we talk about substituting the big meal at a funeral or or big meals at other occasion? I'm not sure in that case. I would recommend substituting anything else with food. I think food really does have an important symbolic place in our culture, and I'm not sure we should begin tampering with it. It also seems to me on occasions like that when people want to fix their fanciest cakes and their riches pies and so forth. Perhaps we should let them it's it's not those occasions unless there are number of funerals in a low in a row that cause bad nutrition and problems. It's the day-to-day junk food eating the the day-to-day refined carbohydrate high fat eating high-calorie eating. It really causes the problems and it's not it's not the funeral that's not the weddings and so forth then and certainly if if food and preparation of food and giving of food is playing an important part in a cultural event. I I would hate to tamper with it. Well, I see the phone lines are blinking here. So let's go to our first caller. Good morning. Dr. Fleming is listening to you that's been bothering me for a while the diet that is now being advocated by the nutritional profession is as far as I can tell roughly indistinguishable some diets that were considered to be quiet guys, 25 years ago and funniest for Dennis Burkett published his things about dietary fiber and there were people pretty much attributing a lot of the illnesses that we now tribute to five in the diet do that and they were ignored my question is what's an attritional profession to do with the Senate conservatism. When you say that, the diet said that the nutritional profession is advocating now work. Is there a quack ties 25 years ago that what you're saying? I'm referring to the high fiber 12 know I'm referring to minimizing refined carbohydrates and calories are in one respect you that there is a certain innate conservatism in the nutrition profession and I think it has to do with wanting empirical evidence for the benefits or banana benefits of particular diets. And in in one respect I would tend to agree with you on the high-fiber diets. I think also though if we looked into the history of various dyes, I've been proposed we would find other diets suggested 25 years ago that in no way are Are being advocated by anybody today and have in fact been shown to be empirically not appropriate and simply no good. So I would say that yes, there is some conservatism and kind of waiting around for the evidence to come in on all issues. I I think there might be a couple of problems with a high fiber diet, you know the problems with absorption of certain diving buy valent minerals that we mustn't Overlook in the process of advocating high-fiber at all interested in accumulating empirical evidence why I really disagree with you on that. I think the evidence is being collected all of the time. I think we won't the nutrition profession will not jump at every published diet and and endorse it because certain of many of them don't deserve to be endorsed when the evidence comes in though. I think the nutrition profession is not afraid to say We will take a second look and perhaps indoors that are investigated further. Thanks very much for calling. We have another caller on the line. Dr. Fleming is listening for your question. Go ahead what you say. Dr. Fleming. It's a large very important subject. I think the first to be educated are the doctors to be educated as far as a proper foods to eat. But the one thing that bothers me is this thing about milk. There are many people in the world are Jews Africans Oriental to have a lactose intolerance. I am one of those people and did not find out until just recently about that intolerance. And then there was an article about the importance of milk is how many overstated because even some babies. I have a grandson who is intolerant to milk and they did not find out until it was about four years old. But milk importance I think has to be within 2, you know much more deeply because some people haven't got the enzymes in their bodies are not lactose right eyes. I sank currently there's a lot of litter of a lot of research being done exactly that top again and I think you're perhaps correct in suggesting that some lactose intolerance has been overlooked in the past. However, I think you can also understand the reason for the importance placed on milk physiologically mammals are prepared to feed their young milk and in many circumstances. This is the only food that not only young humans, but not that many young man was get for a long time. So I would hate to come out and I would hate to endorse a position which says milk is not an important food because it's certainly has but I would agree with you and saying that we must also develop a sensitivity to the indicators of lactose intolerance because certainly if we're talking about good nutrition leaving to Leading to thrived thriving development a lactose intolerance will not lead to that question for you. That's a spin-off from that last question has to do with nutrition classes in medical schools. I just heard a physician talked last night and say that he had a total of 3 hours nutrition lectures during his four years of medical school training. Is that changing at all as much as we'd like to see a change Physicians tend to be the first people are some of the first people that people that clients and patients go to with nutritional problems and questions positions are the ones who are asked to recommend or endorser critique all the fad diets that come along and so forth and they're really not prepared to do it necessarily there is some growing recognition and some medical schools and nutrition courses are important. I know we're working on a continuing education program in nutrition for physicians in the state of for December. So there's a recognition of the importance of nutrition information button. Becoming an important structured part of the medical school program. I don't think that's really changed a great deal. We have another caller on the line right now. Go ahead. Dr. Fleming is listening for your question. I'm calling from Cold Spring area. I'm also going to ask about the school lunch program. I understand that there are some federal guidelines for the lunch program. But I've also noticed it's very high in fat and very high in carbohydrates answer. My question is what are the federal minimum and how do you go about changing policy since the response I get is the children don't eat the food then put on the plates, right? I don't know specifically what the federal guidelines are for school lunch. If you wanted to contact me at my office I could get those recommendations to you often times. It's my understanding at the school lunch programs. Not only do the school lunches follow the federal guidelines, which they must do but they are free to add other things and it may be in the process of adding. The other things about high fat High carbohydrate are introduced. That's a possibility. I'm not certain if that's the case in terms of a specific guidelines. I know there is recommendations like a cup of fluid milk and their recommendations for vegetable and protein food and cereal grain products and so forth. I don't know specifically what they are social contact me at my office. I'll be happy to get that to you just write to you if you're right. My tooth that had to do with kids in the Saint Paul School District 2. Once they had a hand in preparing their own school lunch. They started eating a lot more of it school system in terms of nutrition was doing some fairly Innovative things and I think still is doing some Innovative things one of which was having the kids prepare help repair their lunch is not change the menu but prepare the lunch and when they began doing that there was less play twice now that can obviously only be done in a small scale. So that's not the solution but certainly in the home when children Participate in preparation of food are far more likely to eat it. Then if it was given to them after the vulgar Eaters Anonymous in changing address, no behavior and also under high carbohydrate or high protein and carbohydrate diet. You tell me what that is what the self-help organization on a national scale that made sense in local groups to follow the principles of Alcoholics Anonymous in determining the people are powerless over food and that they could try to recognize within the group why they eat to explore their behavior in terms of their needs that. They also recommend a very strict abstinence from all carbohydrates and sugars right group support. Give me tremendously help. In helping individuals conqueror eating problems and I think eating problems as opposed to weight problems because often times the weight problems are simply an offshoot of of some more basic eating problems. And while this kind of approach may not work for everybody certainly for some individuals to have this kind of support to have this kind of sort of Watchdog and I would assume would be beneficial that is what you report when you've been successful and get praised you report when you've not been successful and look for encouragement and that kind of thing with regard to the high protein low carbohydrate diet. I really hate to see those kinds of diets being used on a large scale basic. I think they have to be monitored very carefully particular if they're used for any length of time. I would far rather see more basic nutritional approach which has people eating more food to developing good positive basic eating patterns with bulky. Play with them for a lifetime. I would certainly not recommend the high protein diets for a lifetime and they simply are not appropriate. Okay. Thanks very much. The time now is 9 minutes before 11 and you're listening to a live phone-in programme. I guess this morning is dr. Phyllis Fleming who's a nutritionist with the University of Minnesota School of Public Health. And if you'd like to call and ask her a question, you can buy darling 221 1500 in the Twin Cities area. And if you live outside the Twin Cities area, you can call us toll-free at 1 800-652-9700. I believe we have someone else on the line. Go ahead. We're listening for your question. Well, there have been several things written about that many attempts May the died for a small planet kind of approach is is an important when I think and basically what the approaches that rather than giving our grain and carbohydrate to animals who converted into protein we take it as humans and consume it. I think it would certainly be a healthy diet from the standpoint of increasing the intake of complex carbohydrates, which usually has with it the increase of vitamin and mineral intake it would also lead to an increase of fiber intake which is generally a good thing. It would lead to probably a decrease in consumption of fats particular saturated fats would also be a good thing. I think we must recognize though that meat play the very important part in our dietary pattern and it's not likely that we're going to achieve that kind of change if it's to be achieved at all over night. I think meat as a source of nutrients. Also a very important source and for many of us, it will remain an important source, so perhaps a little discretion and perhaps decreasing meat consumption increase in consumption of grains vegetables complex carbohydrates for right now would be a realistic goal. We have another listener on the line. Go ahead with your question. Dr. Fleming is listening put on low calorie low triglyceride diet. Would you care to comment on the value of lecithin as a supplement to counteract saturated fat understand? Of course, I laugh and I don't know what it's found in besides fruits and fish but could you help me on this is really beyond my area of expertise. I could get an answer for you on that. If you wanted to contact me at my office, I guess Public Health Nutrition unit University of Minnesota. You work more with with behavior changing on a sort of a wide-scale rather than individual nutrition problems. And another person I believe is on the line. Go ahead with your question, please thank you wondering how do you how would you describe the difference between synthetic and rich food and unprocessed Whole Food? Well in what sense do you want do you want the difference? I want one obviously has a synthetic Lee enriched vitamin soon and so forth in it. I'm not supposed to synthetically and Rich things at all. I'm not sure that there's any evidence that synthetic vitamins are in and so forth are any better or any worse than naturally occurring know some people. Etiologically are more attuned to the naturally the natural food kind of diet, but certainly the synthetic enrichment programs have contributed a great deal to the nutrition of the country because we eat so poorly vitamins and and what not the other person on the line. Go ahead with your question doctor Fleming is listening program for daycares in this high school, and we have trouble starting problems that state laws about packaging. Limiting the types of snacks that can be given and I'm kind of wondering if the public health department could offer booklets encouragement for a very sound nutrition for children snacks and lunches with nutritionist throughout the state. I know that some of that kind of work has already been done and there is some information available on that. And again if you contact me at my office, I'd be happy to get that to you. Maybe we should give people in your your office address again, just so that they can shout it down. If you're listening School of Public Health University of Minnesota 55455. Hello. Yes, go ahead. You're on the air country is the sweetened cereal that kids practically drive on their breakfast are mean Staples breakfast for years. There they have synthetic vitamins added to the refined carbohydrates with some went after they take it if they don't have the brain as it was and that would have been my spare mean this is really one of the outstanding problems and I think nutrition because kid in all kids. It's the whole thing of getting kids. Got it off on good teacher children good dietary patterns in the cereals aren't the sweetened cereals aren't necessarily doing that and there's growing National considering the recent Senate select committee on human needs and nutrition has address the problem of decrease in consumption of refined carbohydrates, and certainly the breakfast cereals are fall into that category of time for just one more very quick question with about a minute 45 seconds left. Go ahead with your question. I read this week's up the American Medical Association hooking up the senate committee report. Can we get the doctors to realize how important nutrition is? Oh, that's awesome. A good question. It's very difficult. I think there is some growing concern and certainly I think to be responsive to that concern when it occurs as a good thing as patients. I think to go asking questions to supply Physicians with information that to Fred to request from the more expert information would certainly give some impetus to that also. That's all the time we have this morning. Dr. Fleming. Thanks for being with us from the from the Luxor of all of the phone calls that came in in the many that we're still on the line before now that we have to go off at the piers if people are still very interested. Maybe you can come back sometime again.