Vol 90: The poison on our plate
This past week, I was fortunate enough to watch as one of my former summer interns walked across the stage at the prestigious University of California (UCLA) school of medicine to accept and don his white coat for the first time and recite the Hippocratic oath that all aspiring doctors take. The journey for him will be long and wrought with challenges like working long shifts that take their toll on mind and body, swallowing your pride when a senior surgeon chastises you or remaining silent when berated by frustrated patients. But standing on the other side, I can attest to the immeasurable value of staying focused and pushing forward.
Donning the white coat as a medical student to becoming a licensed physician is a road that no other profession walks along. Every step takes you closer to the awesome responsibility of caring for another human life, often when they are at their lowest, and most vulnerable. It’s a life-calling as noble as one can possibly imagine. One of the things that I always try to instill in my interns is the importance of treating the cause of the presenting illness and not just the symptoms elicited. Should he do so, while treating patients with compassion and respecting that each patient deserves the very best effort that he can offer, his future will no doubt remain bright.
I can easily recall some of the very first questions the summer intern-now-student doctor once asked me and even then, his mind rivaled that of an educated scholar twice his senior. One question that stands out vividly is, barring some unforeseen communicable disease, what was in my opinion the greatest medical existential threat on the Bahamian population. I answered without hesitation - our diet. And, years later, should he ask me the very same question my answer would unfortunately remain the same.
If food can be our medicine, then it can also be our poison. The food we consume daily, the poison on our plate, is slowly, silently killing us and recent national statistics fall in my favor. Year after year, deaths from cancers of all types are on the rise. Approximately one in every 500 Bahamians has been diagnosed with cancer. Equally as sobering is that The Bahamas currently ranks as the sixth most obese country in the world, ranking seventh in the world for deaths secondary to high blood pressure and the highest incidence of Diabetes in the Americas and the Caribbean.
The strongest parallel that can account for the rise in non-communicable diseases in the past decade is the marked deterioration in the quality of food we consume. Many people willingly acknowledge that the frequent, sometimes daily, consumption of certain fried foods, or foods loaded with fat, sodium and sugar can have deleterious long term health consequences. The focus of today’s report, however, is on the food choices we make and innocently give to our children believing they’re healthy but are actually hidden with enough toxic chemicals that their importation and sale is outright banned in several countries.
In The Bahamas almost half of the working population is made up of women. So, with less time available at home to shop and cook, fast food options have become the norm. To accommodate the increasing demand, increasingly attractively designed fast food eateries have proliferated in number year after year.
But grocery store offerings can be deceptively more dangerous. Sausages (links and patties) and cereals like Honey Bunches of Oats (among many others), instant stuffing and mashed potatoes for example contain an ingredient called butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA) to preserve freshness, a known carcinogen that can hinder blood clotting and cause tumor formation throughout the body. Its sale has been banned in Europe, Canada, Australia, New Zealand and Japan.
One of the worst options available in grocery stores also happens to be one of the most inexpensive. Purchased by the case in many Bahamian households, Ramen noodles is a nutritional nightmare. Not only does it contain an excessive amount of sodium (with one pack containing almost 90% of the recommended daily sodium allowance), it also has silicon dioxide (a major constituent of industrial sand).
Gatorade and Vitamin water contain potassium phosphates and Ritz whole wheat crackers contain calcium phosphates which may increase the risk of cardiovascular diseases and disrupt calcium metabolism and bone mineralization. Vienna sausages, hotdogs, packaged deli hams, bologna and bacon contain sodium phosphate and sodium nitrite which have been linked to stomach cancer and should be consumed with extreme caution, or avoided all together, in patients with kidney disease.
Breads made with potassium bromate (i.e., bromated flour) are heavily linked to cancer and kidney damage but still remain used in many American bread varieties while banned in India, the UK, Canada, China, Brazil and countries throughout the European union. Salad dressings loaded with food coloring and sodas, juices, ketchup, fruit preserves and jams with high fructose corn syrup should similarly be avoided because of their association with the development of Diabetes and cardiovascular disease.
Packaging labels are also intentionally misleading and it’s important to read them without being tricked into thinking you’re purchasing something that’s good for you and your family. Ignore the front of the package and instead look at the ingredient list on the side. Be wary of items with a long list of ingredients and focus of the first three, since ingredients are listed by quantity from highest to lowest and they constitute the bulk of what you’ll be consuming.
One suggestion that has been offered, though it can be challenging, is to limit your diet of non-perishables to foods that have five or fewer ingredients. Also, be wary of the nutritional data provided because it’s for a single serving size that’s almost always smaller than what individuals consume in one sitting. One serving according to product labels for example is half a can of soda or five chips.
In many cases, whole grain options, when listed in the first three ingredients are usually better than multigrain (often refined) options. Stating a product has natural ingredients doesn’t always mean it’s healthy, it just means that at some point during development, the manufacturer used a natural food source. No added sugar can indicate that the product is naturally high in sugar or harmful sugar substitutes have been added. Low-fat often means more sugar and/or salt has been added to improve flavor and fruit-flavored means it has a chemical added that tastes like fruit.
Admittedly, it’s tiresome and confusing and the average consumer gets lost in the humdrum of additives and preservatives and their potential long-term consequences. A common refrain I hear from patients is that “I ate it growing up and I’m fine”. But the world has changed since then and kids aren’t as active as they once were, choosing now to play with a tablet over any number of outdoor sports. They also don’t have the benefit of a regularly home cooked meal, prepared on the stove and not in the microwave then rewarmed in plastic containers.
The best advice that I can offer to patients where appropriate food consumption is concerned is to eat a variety of foods, particularly fruits and vegetables and when in doubt consult a nutritionist or dietician registered by the Health Professions Council. Another simple option, which I use consistently and highly recommend, is to download a food scanning app that allows you to scan the barcode of foods and immediately get a rating of that item based on the ingredients. Healthier food alternatives are also offered making the appropriate selection even easier. Food can either be medicine or poison and patients must decide which one they’ll put on their plate daily.
At the start of every medical student’s journey, you have what’s known as a white coat ceremony. There, you walk across a stage in front of family, colleagues and senior physicians and don your white coat for the first time. Then, in reciting the Hippocratic oath, you commit yourself to serving humanity for the rest of your life. This past week, my summer intern did just that and I couldn’t be prouder. He, like my cousin Devenney who’s currently interning at The Princess Margaret Hospital, show incredible promise and talent, which the country will need desperately in the years to come should we continue along our current trajectory.
Every hero needs a cape and the quintessential doctor’s white coat is ours. True heroism involves selfless action as displayed by front-line healthcare workers during the Covid-19 pandemic. But saving patients at their lowest isn’t enough. Helping them to enjoy longer, healthier lives should always be the ultimate goal and encouraging all Bahamians to make better food choices is a step in the right direction.
This is The KDK Report.
