I appreciate Deborah Whetherill's comments about the challenges in determining who decides and what gets disseminated to families about nutritional advice.  Having a PhD in Nutrition has humbled me completely about the complexities of diet and the challenges of figuring out what changes will or won't help.  I also find much of the information in detailed nutrition advice to be opinion based, highly speculative and far too focused on good and bad foods.  The emotional setting and pleasure in savoring the foods while connecting with people is often lost in these discussions.  I think many of the chefs are far more adept at really assisting people to understand and savor really good tasting and good quality foods than nutritionists.  And the term for "nutritionist" is for me the same as "lactation consultant".  Anyone can use those terms and it doesn't say anything about their training, knowledge, or ability to assist mothers to make healthy changes in diet. 

Since Deborah asked about what happens when you have a limited amount of choices available -- the answer is, you simply eat what is there.  I lived for two years on a diet that was:

* completely organic (except for one binge on coke -- see below) 
* almost sugar free
* almost gluten free

Food processing consisted of:
* fermentation
* soaking
* pounding (let me tell you this practice creates arms that Michelle Obama would be jealous of)
* grinding
* smoking
* salting
* and my favorite, putting the food out the in sun to kill the bugs (or let the chickens eat them)

There was no refrigeration.  If there were maggots on the smoking meat, they were brushed off.  

The mold on the peanuts has been suspected in causes of kwashiorkor and liver cancer.  

There were no beans.  I once bought beans imported from some other country and had to routinely put them in the sun so the chickens would eat the bugs.  

Bread was rare and expensive and the flour was mostly rancid.  No sugar.  So, not really something you wanted to eat anyway. The Portugese had a few boxes of cereal that had probably been on the shelf for 10 years and no one could afford to buy them.  I certainly couldn't afford them on a Peace Corps salary.

They did make "cassava flour" beignets (basically donut holds) which were sour and boiled in hot palm oil.  

I bought charcoal in the market and had a little "stove" that was made from scrap metal and sold in the market.  It pretty much too me all day to cook a meal.  If I wanted chicken, I had to bribe the next door kids to kill it for me and then pluck it.  If I bought fish, the salt had to be soaked out of it. The beans needed to be soaked and it would take a day to cook them so they were soft enough to eat.  The peanuts had to be roasted first which was hard over that little stove.  Rice was expensive and only bought in big sacks and I never managed to cook it without burning it.  So, I ate plantain bananas.  The cassava had to be soaked for days and then pounded and then made into a gluey ball so I only ate it if I went over to someone else's house.  Sugar was sold in packages of 5 g.  Yes, 5 g, wrapped in a little piece of paper.  The only salt was very coarse rock salt.  In the heat, it would melt and then mold back into a solid block.  So you had to chip it off.

I almost starved.  It took all day to prepare and cook my food and I this was after teaching all day in 90 degree heat with 90 percent humidity and no fans (let alone air conditioning).   I ate once a day.  I would sometimes visit the Belgian nuns to see if they'd invite me to breakfast. Then I would spoon tons of sugar into my coffee just like any of the Africans that were ever invited to eat with the nuns.  We have such an overload of sugar in the US that I think it is almost inconceivable to actually feel that same sensation that I had there of not having enough carbohydrates to fuel my body.  It was a very intense unpleasant sensation.  Later when Peace Corps sent me another volunteer, we had a week when they actually had coke in the town AND canned tinned milk.  In a total binge we put the milk powder in the coke and it would fizz up like a root beer float.  No dessert I have ever eaten was as good as those cokes after a year of almost no sugar.

I also ate anything offered to me and stopped asking any questions about it.  I could eat termites and caterpillars easily.  I had more trouble with palm grubs.  I ate game from the forest and didn't ask what it was.

I could always tell when I needed to eat more because I would get malaria more frequently.  I think I weighed about 85 pounds  by the end of that first year.  Then I hired a cook and got back up to 100 pounds (which is a little light for me when I'm in developing areas -- I've learned I stay healthier when I'm at a 108 when I go to areas that have amebas and ghiargdia).   One volunteer was about 6 feet tall and vegetarian.  He ended up weighing 105 pounds when he left Peace Corps.

When I taught Peace Corps Volunteers in Niger.  Every single volunteer for the nutrition program came in claiming they had allergies and intolerances. There was even less to eat there than in the Congo.  At least the Congo had some fruit and meat and fish.  By the time those volunteers left, none of them felt that they had intolerances anymore.  

AND -- I have to say my sinus allergies were worse in the Congo than any other place I lived because of the mold.  Surprisingly they were really bad in Niger as well because of the acacia trees and the dust.  The concrete of New York City and heavy duty exercise have worked better than anything for elimination of sinus allergies.

Even there, some women and men are EXCELLENT chefs.  They have a wonderful touch with food that can turn the simplest ingredients into something so delicious that you savor every bite.  Ever since then I have really appreciated the skills of good chefs and the amazing work that sometimes goes into food preparation.  I think smart chefs that can figure out how to assist those of us who are more culinarily challenged to make simple nutritious meals and present these in an attractive way have a lot more to offer when it comes to healthy eating than some of the "nutritionists" that focus only on classifying foods as "good" or "bad".  

Best regards, 

Susan E. Burger, MHS, PhD, IBCLC

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