podcasts

Kalea Wattles:
It’s so helpful to understand all of these moving parts. And one thing that I’ve heard you talk about that’s really impactful is, really any of us could face insecurity at any time because of different circumstances or different shifts in what’s happening in our life. And when we start to think about how there’s so many differences and what food insecurity can look like, we start to see how we might interface with those things at any given point. And that’s helpful as we’re thinking about how we’re approaching patients, regardless of their demographic.

Clancy Harrison:
Hunger is in every zip code, it’s in every scope of practice. I’ve had many dieticians—I’m a registered dietician—so I’ve had many dieticians that will say, “I really don’t work with WIC,” so women, infant and children, “snap,” which is otherwise known as food stamps, “so I don’t really engage with people who are food insecure.” And that couldn’t be further from the truth because anyone… There’s not a zip code that’s immune to food insecurity. And it does really exist in nice neighborhoods behind nice stores and nothing more powerful than something like COVID really put a light, a big spotlight on that in the United States. And hunger is actually now a very top priority for many organizations. So I’m really glad that we’re here talking about this today.

 

Kalea Wattles:
That’s a great point thinking about how maybe if we practice or work or participate in activities in a more affluent neighborhood, we just make assumptions that people are food secure, but you’re right. That’s not necessarily the truth. And as a healthcare provider, I’ve thought about this and I was excited to ask you if you had some advice. Because maybe not everyone has this experience, but I know from my personal experience, it’s hard sometimes to broach that topic and to ask about food security, because maybe that implies that you aren’t sure if that person has enough access to food. Do you have some advice about how we can thoughtfully approach the conversation?

Clancy Harrison:
Sure. First of all, there’s a screening tool. It’s a validated two-question screening tool. And then the questions are very simple and we can certainly hopefully share a link to those, but it’s, did you ever worry if you were going to run out of food by the end of the month? It’s not an invasive question. So the one thing I think is that we’re coming hopefully out of this pandemic. So that’s a great focal point. We see this on the news all the time. It’s impacted so many people. I would just want to ask these questions. And I might… from my experience, people really like to have it on paper versus a verbal conversation during the screening. I do work with pediatricians in the State of Pennsylvania, and this is the research we see coming out of the dyads where we’re actually creating between a food pantry and a pediatrician’s office.

So I think that if we can normalize and make sure that we’re asking everyone at all times, at all visits the question, and it just becomes something… The two questions. So it becomes just a standard practice. So we can say, we’re asking everyone this because of what happened with the pandemic. And we just want to make sure that you’re getting the nutrients to thrive because we understand nutrient security, and that might be even a better word. So we understand that people might not be getting the deep nutrition or the healthy foods that they’re eating, and instead they might be eating prepared pancake mix all the time or the instant noodles. We don’t have to really assume that hunger is starvation or you can’t afford it. And so I think when we can normalize the process, asking everyone at all times, at all visits, it’s not going to seem as if you’re pinpointing anyone out.

And there’s a really great resource with FRAC, Food Research Action Center, and the American Academy of Pediatrics. They have a tool kit, it’s “screen and intervene,” so they have like all of this great information on how do you screen with sensitivity, they even have posters you can hang up. And even if you don’t work with a pediatric population, this free download will clearly give you some great starting points. And it has the screening tool, it has everything in there about coding. And so I think that would be the first place I would start, and just to download that and start reading about it and go right to that screening with sensitivity section.

Kalea Wattles:
Okay, that’s super helpful. Just as we ask screening questions about have you been to the dentist and have you had an eye exam, I think if we just incorporate those questions into our standard practice, that’s going to be super helpful, especially when we think about… You brought up just being in the middle of a global pandemic and anyone who might’ve been walking that line between being food secure and being food insecure, maybe they’ve been pushed to one side of that fence. I know you are very active in your local food pantry, I’d love to hear from you especially in the climate of the COVID pandemic, how has your work with the food pantry changed? How has access changed over the last year or so?

Clancy Harrison:
Yeah, sure. So we’re a small food pantry, actually we’re a large food pantry in a small town. But we’re a small food pantry if you compare us to big cities. And we went from our distribution on average, 150 people to over 2,000 people in one day. So the amount of food that we would go through in a month is completely gone within two to three hours. And it’s a drive-through operation now. So I think that’s also been very helpful for people, but we see a lot of people who… What was interesting, they waited until six or nine months into the pandemic, before they ever came to us. And that was after they used up their savings. And so now they’re coming and they’re like, “We’re at a time of desperation. We really need help, we thought we could get through this, we used all of our savings and…” They just unleash all of this—I don’t know if you want to call it guilt, but they wanted to validate why they were there. And that’s part of that shame and that stigma we really need to work on getting rid of.

But that’s what we see; people who have really lost their businesses that struggled, and now they’re here, hopefully we’re helping them, but we want people to know that this is a resource for people that we wanted to support them from the beginning. So they really didn’t have to use their savings and wait until they are in a worse situation to come. And I also want to share with anyone listening, what was interesting in pre-COVID era, we would set up these fresh produce stands, and many times people would come through and just start crying. And I would say, “Why are you crying? What’s going on? Can we help you? Are you okay? Did someone say something?” And they’re like, “We can finally follow our doctor’s advice because you’re giving us produce.” Super powerful.

So were they having that conversation with their healthcare provider? Probably not. People don’t want to raise their hand and say, “You know what? I can’t afford the broccoli for my diabetes,” but when they come to our food pantry and they see that they’re like, “Oh, there’s a solution. I have it in front of me.” And that can go back to even also asking those questions, am I asking you to eat food that maybe you can’t find at a grocery store? It’s not asking if you can afford it, it’s asking if you can find it.

And we have to remember that finding food and affording food, they are two different things and food insecurity is not just based on income. It could be if you’re living in a food desert or you have only access to a dollar store, or are you going to a full service operational store. And even if you’re working with an elderly population, we want to keep in mind that maybe that elderly person might not have… They might be still living at home, but not have the mental capacity to cook the food, to make the food. They might be able to afford it, but they might not be eating appropriate foods. Maybe some that have even expired, that also is food insecurity. So I think that’s just one other point I want to make here that it doesn’t always have to be income-related. And I think when we start asking these questions and screening, and looking at how things have changed within our food pantry and the people that we’re working with, I really feel that that was an eye-opening thing that I learned in my process.

Kalea Wattles:
That’s great. I think it’s so important that we focus on this, just asking the question piece. And one thing I’ve thought about with the functional medicine model in general is that that’s part of our philosophy, that therapeutic partnership and telling of the patient’s story, that’s so critically important just to the whole functional medicine approach. And I think that that helps to foster some of that trust and partnership as we ask those questions. I’m wondering from you, how do you feel like the functional medicine approach or mode can really help to address the link between food access and just overall health and wellbeing?

Clancy Harrison:
I think it goes back to what you were saying, are we really asking those right questions? Are we screening? But are we going even deeper and asking about; where’s the favorite place for you to shop? Do you have cooking equipment? So instead of assuming that people might not have cooking equipment, you can say, “Do you have any problems with stuff in your kitchen, equipment in your kitchen?” I know me, a can opener, I’ve had so many can openers that were horrible. So, if we can even put ourselves in a situation and have that empathy or that compassion, I have these problems too, you’re going to start uncovering some information. If you even ask, “What is your favorite way to cook?” And they say a microwave, then now maybe you should ask more questions about a microwave, because that might be their only way of cooking.

So when we can start really uncovering the barriers to food access from… For many times as a healthcare professional, as a dietician, I just made a lot of assumptions. When I would prescribe broccoli for diabetes management, I was assuming they could get into a car drive to a grocery store, they had access to the grocery store, that grocery store actually had really great food, and then they could buy the food. And then I made assumptions that when they got at home, they had a cutting board, they had a really good knife, they had a can opener, they had a pot, they had a stove that was working. And all of those assumptions went into that recommendation without me ever even thinking about it. So I think we have to really take a step back and say, “Okay, I need to really seek to understand what’s the starting point of this patient. What’s really success for them?”

If they’re eating those instant noodles, maybe we start with the instant noodles and start adding more nutrition to those instant noodles, that is if… And you find out that the dollar stores is the most convenient place, because it’s down the street and they’re lacking transportation, well then how do you eat a healthy at a dollar store? If you don’t have access to those higher-end grocery stores that I know I used to promote, I call myself a recovering food elitist for crying out loud when I get on stage. So I put myself right out there saying, “I was the first to do this.” And I learned from the food pantry in so many cases, by putting myself into a situation where I normally wouldn’t have been in that, I learned that I was wrong. And I learned that I had a lot of projections of my own food philosophy out into the world as a healthcare provider. And I made a lot of assumptions.

So one of the things that I really learned is that, unless we truly understand barriers and we have these, sometimes difficult conversations, we’re never going to be the solution. We will always be even contributing to that problem of food access for them because we’re not helping them get the resources that they need.

Kalea Wattles:
I’ve heard you say before, and I think you just highlighted this with what you just spoke to is, as a dietician and as an educator, you wanted people to understand what you were saying, the advice that you were giving. And then I heard this sound bite from you of, you have to understand in order to be understood. And that’s just, wow!

Clancy Harrison:
And that’s not… I just want… I didn’t make that up. That’s from the book, from Seven Highly Effective people. There’s a whole chapter on it. And when I read that chapter and I was like, “That’s it! That is what we need to do.” We need to understand people before we ever even want to try to be understood. There’s just walls. Some might be like, “Yeah, okay, broccoli, I’ll go home and eat the broccoli.” And then they leave. They’re like, “I just need to feed my kid. They want me to eat broccoli. I just want food. I just need nutrient rich food, but how do I get that?” And I think it’s just a really important way to look at that process that we have in these conversations that we have with our patients.

Kalea Wattles:
Absolutely. And I keep attributing these quotes to you. So in my mind, you came up with all of this, but I’ve heard you say, “I might be the expert in food and nutrition, but I’m not an expert in your life,” the client or the patient, they’re the expert in their life. And so we have to look at our nutrition recommendations in the context of everything that’s happening. And to a certain extent, I feel like functional medicine practitioners are uniquely suited to do that work because of what we’ve talked about, that we’re willing to go to those hard places and have those hard conversations. But oftentimes our therapeutic, our treatment plan does take kind of a food first approach. And I think we can get into a little bit of a tough spot if we’re making all of these food first recommendations and then we’re not exploring that contextual piece.

And going back to the screening questions, from my perspective, I think just as in medicine we’re taught, don’t order labs that you don’t know what to do with if you get an abnormal. It’s like, don’t open the conversation if then you don’t know what to do with the results. And so sometimes I think we’re not asking about food security because we don’t know what to do if someone says, “Actually, I’m not able to access the foods that I need.” Do you have some advice for any healthcare practitioners that might be listening and, “Oh, actually, if you do find your patient is struggling, here’s some resources or some path forward.”

Clancy Harrison:
Sure. I think first, you’re right. Like, if we screen for food insecurity and someone says, “Yes,” where are the ethical implications if we can’t help them? Right now, we know something, but what do we do with that? And again, if we go back to that “screen and intervene” toolkit, they have a great—from FRAC, Food Research Action Center—they have a great list of resources on food assistance programs. One thing I work really hard with my dietician, my dietetic colleagues and other healthcare professionals, I work with pediatricians and nurses is, how do we start prescribing food assistance programs? We’re taught so many times to advocate for the programs, to do our action alerts as dieticians. But I asked people to go a little bit further. We don’t have to work in those food assistance programs to be a part of them.

Any healthcare professional can have the application to a school lunch program on their desk or in their file. And if this person screens positive and they have children, you’re going to save them about $6 a day in food if they have access to free lunch and breakfast. And that’s on average. I’m kind of making that number up based off of the Feeding America average meal, which is about $3.09. So I mean, that money can add up, that money could be the budget that they need for their disease management. And it’s really a simple application. And then you can help them fill it out. So you’re putting tools in their toolbox. They leave, you could say, “Who do you feel most comfortable with at the school? Do you have a relationship with the teacher, the principal, the guidance counselor, the lunch lady?” Whoever it is, you can give that application.

They will get it to the right person. And the great news about school lunch programs and breakfast… I’m a product of the eighties, so I remember people having tickets, you knew who was paid and who was free. That’s not the case anymore. No one knows, so that stigma is removed. But think of that as an example, for all the other programs, SNAP, so otherwise known as food stamps, women, infant, and children, even meals on wheels for your elderly population. I think the more we can learn about these programs and say, “Hey, you know what? Let me prescribe these. Here’s the link. Here’s the list of resources that you need to get together to apply for SNAP,” have them ready, “Go to this link, do it at home.” If you have an intern or a medical student that works for you, maybe that’s a great opportunity for them to get involved with a patient and start helping people get signed up for food assistance programs.

So it doesn’t really have to be that difficult. There’s a couple people in your community that you can partner with. So that would be your WIC dietician. And the reason I say that, even if you don’t work in pediatrics, they have a robust referral system. So they already know the grassroots effort in your area. They know where those local resources are, state and national. So become friends with that dietician  and say, “Look, I’m going to refer to you, but do you mind sharing that resource?” And then you’re going to have a checklist of all the programs in your area. Also your local Feeding America Food Bank, they have a person that’s a liaison that sets up their member agencies.

So they will know, again, the grassroots efforts. You could probably go on that website and get a list of all the programs. We have something so cool down the street. It’s called Dinner for Kids, where this organization, every night during the week, drives meals, warm meals to kids in our neighborhoods. So you wouldn’t know about that unless you reached out to your local food bank and then you could be the one prescribing and promoting those as a resource.

Kalea Wattles:
Those are some really great suggestions because I feel so many of us have those resources available in our community and may not even know. And you just reminded me, I actually had a chance to contact the dietician that works at our local food pantry to converse with her about some access in our local community. And she shared with me that she actually develops recipe books that utilize a lot of the ingredients that commonly come through the food pantry; beans and dried goods. And it was so nice to have that to offer folks who might say, “Okay, now I have access to these foods, but I’m not sure what to do with them.” To have those really practical takeaways, super helpful.

Clancy Harrison:
Very helpful. And it’s not really that difficult. We don’t know what we don’t know, and it can seem a little intimidating. So I might make it sound easy, but it really is. It’s just having a list of resources that you… Even summer, summer’s coming up, summer meals. You could literally have a list of summer meal sites where kids, anyone under the age of 18 can go and get a free meal during the week at lunchtime. So again, just having that, those resources that you can give to people would be very helpful.

Kalea Wattles:
This is… just came up that I thought maybe would be good for us to discuss and get your take on. When I contacted my local food pantry, the dietician actually told me, people are spending a lot of money on non-food items like diapers, and that’s taking away from their food budget. And what she has found was that it was actually easier to do things like diaper drives rather than food drives, because food might be more perishable, people don’t hang on to it where people might have a closet full of diapers that their kid grew out of, it’s just sitting around. And that sometimes if we can provide those kinds of staple items, that actually frees up some space in the budget. Is that something you’ve come across?

Clancy Harrison:
Totally. I don’t even want to do food drives because we always get expired… I don’t want to sound rude, but sometimes people feel that a food drive is an invitation to clean out your food pantry. And then we get expired foods and we ended up throwing them away. And so one of the things that I know people make daily dilemmas every day, they decide, “Am I going to wash my clothes in laundry detergent, or can I spend this 10, $15 on bread, cereal, and milk? So am I going to pay for gas or am I going to buy food?” And these are… It goes from diapers, like you said and–we’re in Pennsylvania—to heat in the winter.

So having… I always say that I’m in the diaper business, anytime I can get my hands on diapers and we do these food drives, but they’re not food drives. We do do drives that have themes. So maybe it could be like, if it’s a dentist month, so we might do toothbrush and toothpaste. Maybe the next one might be soap and shampoo or diapers or baby drive, and really try to get those other resources because we know if we can close a gap somewhere else for freeing up money that they can use towards food. So thank you for asking that, it’s really important.

Kalea Wattles:
I appreciate hearing that, that just got my wheels turning of some ideas that we could do. Another thing that I wanted to ask you about is about milk. To be honest, I’ve heard you talk about milk as such a great nutrient-dense source of good quality nutrition for people. And it made me realize, using the term of food elitist that you brought up earlier, so many of us have the privilege to say, “Well, I’m not going to eat dairy. Dairy’s inflammatory. I’m going to avoid dairy.” But really at the bottom of it, this can be a really great source of nutrition. And so I feel like this is something that I want to be particularly aware of in our functional medicine community, where we have the tendency to make food rules. And I think sometimes dairy can be one of these really polarizing topics. So I’d love to hear from your perspective, how emphasizing dairy can actually be really helpful.

Clancy Harrison:
I can tell you from a food pantry perspective, milk is the most requested item. We see that in research, we see that with Feeding America, we see that with National Dairy Council. And the average person who’s food insecure gets one gallon per year. So when we talk about milk being… There’s four nutrients of public concern. That’s calcium. potassium, vitamin D, and fiber. A glass of milk provides three of those: calcium, potassium, and vitamin D. There’s also 13 total nutrients that dairy is allowed to say. So we have eight grams of protein. If we can get that… And we know that anyone’s at high risk of low bone density, especially children. So if we can get children enrolled in these school programs, they get access to this milk. We’re giving them the nutrients, super important.

From a personal standpoint, I don’t know what I would do if I didn’t have access to milk. My son does not eat a lot of protein, I think it’s a texture thing. That’s what I used to write a book about: textures and eating, infant feeding, childhood feeding. And he will not, he does not like to chew meat, milk is really the only way I could get a high nutrient quality protein. We know we can eat a lot of plant-based foods and there’s nothing wrong—plant-based for me is also when we can put a little bit of animal meat with the plant, we can put the milk with the plant. We can still have a plant-based… a lot of plants. There’s nothing wrong with that, just a little bit. We’re not talking about a ton of milk. We’re not talking about a ton of meat either.

So it can all fit in a well-balanced diet, but from a mom who worries if my son, even a dietician, I worry if my son’s going to get the protein, but guess what? I know he’ll drink that milk. Full disclosure, everyone here listening needs to know that I’m an ambassador for National Dairy. So I represent cows, dairy cows, and I get paid to speak. They’re usually a sponsor of me. They’re not sponsoring me to speak now or at your event, but I wouldn’t be an ambassador unless I really believed in the whole dairy consumption, especially from a nutrient density standpoint, in that it fits in a well-balanced diet.

Kalea Wattles:
Well, one of the things I appreciate about your work is that you’re a realist. It’s like we have all these food ideals, but our lived experience is also a thing. And we have to really meet people where they’re at, which is that’s our whole foundation in the functional medicine world. And so I think that that’s really helpful. Just before we wrap up one thing I’ve really loved hearing you talk about from the food pantry is that you encourage volunteers and everyone working to enjoy the food also, and that builds this whole community and removes some of the shame of accessing, because everybody’s accessing it. And it’s kind of this community and we’re all sharing these resources together. And I think that’s a really powerful mental model.

Clancy Harrison:
So it really hit me. We used to do pop-up produce stands pre-COVID. And we would go to organizations where we knew we can meet people right where they were instead of asking them to go to a food pantry. So we set up in front of a career fair. People are looking for a job. And I remember one day this lady came in and she was so mad. And I learned really fast from these pop-up produce stands is that the people who get the most mad about the free produce are the people who need it the most, but they don’t want to be seen as someone who needs it.

So they’re like, “What do you want from this? What do you mean it’s for free? You have to be selling something. You need something.” And then I would get to the point where like, “No, no, it’s free. We just want—we’re a community, we share food. In fact, I’m going to pack up my food. Do you want to pack up yours? And I can help you carry it out?” And I would have a bag, they would have a bag, and we get to the parking lot in this one instance, and the lady started crying. She said, we have five people in our house, we have no food. I’m here trying to find a job. I was too embarrassed to even want to take it in front of other people because I didn’t want people to think that I needed it. And it was like, “Oh my gosh.” So then at the food pantry, I was like, “We’re all—this produce is either going to go in the dumpster if we don’t all eat it, or it’s going to go bad in the walk in. So guess what, we’re going to all start taking produce home.”

And we want our clients to see that as well. Our guests, we call people at our food pantry our guests. And I remember the volunteers really pushed back on that for a long time. But then when they finally started taking it and we had something like rutabaga, guess what happened? The guests and the volunteers were like, “What are you going to do with the rutabagas?” So then it just created this community where the dialogue changed. And now we have a lot of our people who do come into our food pantry now as volunteers, they do take for themselves and they also go out and deliver food to their neighbors who they know need it too. So it was an interesting start to the process, but I think it was one of the best decisions I ever made.

Kalea Wattles:
Well, I just think that’s a beautiful picture of everybody sharing resources, sharing food, building community in that way. As we come to the end of our episode, I want to wrap up by hearing, what do you see as the path forward when it comes to addressing health disparities like food insecurity? I know that’s a super loaded question, but just as healthcare professionals, I think it’s somewhat of our duty to be thinking about these things especially in the COVID era. And I’d love to end with some takeaways about what’s the next step? What can we do to move forward?

Clancy Harrison:
I think from a personal standpoint, your next step, anyone’s next step would be to really reflect on what your definition of visualization of hunger is. Really understand that and try to learn more about that. And also I’m going to challenge you to think back to a time in your life where maybe you might’ve experienced food insecurity. For many years I said, I’ve never experienced food insecurity, but I’d also just told you on this call that I ate noodles at college. I’ve had many people, professionals, healthcare professionals, professors who teach nutrition, say, I didn’t realize I was food insecure in college. I thought I just had heavy groceries because I ate canned goods.” Now these are people teaching nutrition didn’t even know it. And then, have these dialogues within your own house.

I’ve had many people after they hear me speak on stage they’ll call, I get the email, “I went home and I didn’t realize my spouse grew up on food stamps.” So if we’re not having these conversations in our own house, with our own partner, or our own children… You know my stepfather is a doctor, and when he was in medical school, he was on food stamps. He just told me that. He’s been my stepfather for 35 years. But I didn’t know that. And he knew this was my profession. So we need to really start… How do we start having those dialogues? And then from a professional standpoint, your own industry… I’m going to challenge, what are you teaching your students when they go through school? What are we teaching? Are we talking about food insecurity? Are we adapting food or hunger awareness, nutrient insecurity in every single class?

So from a counseling standpoint, it could be put in from… It’s always put in a charity box or community outreach, public health, but it’s not. And one of the things that we do at our food pantry is we’re a site where I’m a preceptor for dietetic interns. And it’s really important for me to really work with those students and train them. So when they go on to their profession, they understand it does not matter where you work, your scope of industry, your scope of practice, you are going to be working with people who are at least questioning if they’re going to have enough money for food. And that stress alone has been shown to increase 10 chronic diseases. So that impacts your work, it impacts your bottom line. So I guess that’s my… If I really think about what the path is, we need to think about how we’re educating future health care professionals. And is that curriculum where it needs to be in the program so that they understand and are they getting the experience that they need so they can make better decisions?

We’re all here to learn. And so that’s what I truly believe is the path forward is education, not from a personal standpoint, but then from a larger infrastructure.

Kalea Wattles:
Well, as a healthcare professional, I really appreciate the work you’re doing to surface those conversations and to surface the resources and the tools that are available for us all to offer support. I think you’ve given us such practical advice today, and I am excited for anyone who’s listening. I think we all feel more empowered to have those conversations and then to know what we can do with the answers that we receive. So I so appreciate your time. Thank you very much for being with us today.

Clancy Harrison:
Thank you for having me.

Kalea Wattles:
To join the conversation on this topic. pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org.

Show Notes

• Food Research & Action Center (FRAC) resources
  • FRAC Screen and Intervene website: https://frac.org/screen-intervene
  • FRAC Screen and Intervene toolkit: https://frac.org/wp-content/uploads/FRAC_AAP_Toolkit_2021.pdf
  • FRAC validated two-question screen (Hunger Vital Sign) for food insecurity: https://frac.org/wp-content/uploads/hunger-vital-sign-graphic-oct-2019.jpg
• Feeding America network of food banks https://www.feedingamerica.org/