24 I Culturally Sensitive Nutrition—Are You Still Talking about "Whole Grains"? (Aliyah Haq)

• Timespan: 37 minutes & 7seconds
• Transcription Type: Cleaned Verbatim
• Speakers: ( Aliyah Haq & Raj Sundar)

00:00

Raj Sundar:  Hi, I'm Dr. Rush Sundar, a family physician, and a community organizer. You're listening to Healthcare for Humans, the show dedicated to educating you on how to care for culturally diverse communities, so you can be a better healer. This is about everything that you wish you knew, to really care for the person in front of you, not just a body system. Let's learn together. Welcome back to another episode of Healthcare for Humans. As always, I'm your host, Raj Sundar. And today we're diving into culturally sensitive nutrition counseling. I know some of you are listening for the first time. But for those of you who have listened to previous episodes, about caring for different communities, probably noticed that the segment around nutrition shifted. It shifted for something corrective. What you should not eat from your culture so you can be healthier, to something more of a celebration. Tell me about your favorite food. Because food is so much more than just nutrition. You know this, I know this. It's a tapestry woven with culture, memories. And shall I say it, love. It's about those dishes that bring back memories of home, of what your mom cooked. Growing up. The recipes passed down from generation to generation, the joy of sharing and celebrating around a common meal with friends and family. I shifted my conversation, because in clinical medicine, we often miss the mark when it comes to nutrition advice. And I was doing that in this podcast. Those well intentioned but overly simplistic phrases like eat more whole grains, more vegetables. Seems like sound advice that we're all taught that, but don't always resonate with everyone. After all, not everyone grew up knowing whole grains. What does that even mean? And vegetables are so much more than just broccoli and kale. Today, we're fortunate to have a real expert around food joining us.  Aliyah, a seasoned nutrition counselor with decades of experience working with patients now working at a community health center. She approaches her work with grace and intentionality, leading by example on how to respect and honor food and cultural traditions while navigating the challenges of chronic diseases at the same time. Cultural sensitivity and nutrition counseling means recognizing that food is deeply woven into the fabric of people's lives and identities. When we respect and honor these connections, we create a much deeper level of trust and understanding with our patients. When dealing with chronic diseases like diabetes and hypertension, she helps them make positive changes while preserving the essence of their cultural foods. Now, that's what we should all be doing. I learned a lot from her. And I think you will too. Here's Aliyah. Welcome to the show.

03:00

Aliyah Haq: Thank you. It's a pleasure to be here today.

03:03

Raj Sundar: Yeah, of course, I'm so excited to talk to you about nutrition. This topic specifically because we talk about it in a lot of our episodes. And I struggled through it. Because initially when I started this podcast, the idea was to talk about what nutrition to change, what food items to change, but it always came out as this strange feeling of though traditional, culturally appropriate food is unhealthy. And we're trying to get people to eat this like broccoli. Yeah, exactly. Broccoli. Everybody loves broccoli. Right? So we got to be careful about that. So I'm hoping our conversation will cover a lot of things that hopefully you can help us navigate through so we can be better for the future and give our listeners a little more guidance on how to approach this topic. But tell me about yourself before we get started, Aliyah.

03:53

Aliyah Haq: I am a registered dietitian. And I've been in this field for almost 25 years. I also served as the president of nutrition plus, the organization that presents the public health program. At the national level, I was feeling more and more the need for understanding older nutrition and not just diet because people think that immediately as soon as you mentioned that diet, they think it's for weight loss. I try not to use that.I try not to use words like consumption and intake and all that.

04:28

Raj Sundar: So let's start there. What is culturally responsive nutrition mean to you?

04:34

Aliyah Haq: First of all, you have to understand the term shown and nutrition. What's food? What you eat this food, there's no such thing as junk food or healthy or unhealthy food. And food is so personal. You love what you eat every day. And no one has a right to tell you what to eat. What not.

04:51

Raj Sundar: We got to repeat that. No one has the right to tell you what to eat and not to eat. Because I feel like at healthcare, everything's about telling people not to do certain things for your health.

05:01

Aliyah Haq: Yeah, no, that doesn't work. That doesn't work. It's something very personal. If you tell someone not to eat that immediately, there's this barrier curtain between you and that person, and they're not going to listen to you. So it has to be a conversation, more of an understanding of what is going on with there life, and why are they here with you, so I never start telling them what to do. I just asked them how I can help you. I'm trying to understand what you do and what you eat. So I never used the term, don't eat this, don't eat that, unless they asked me specifically.

05:37

Raj Sundar: Talking about how food is so much more than nutrition of the sides of breaking down food, and so nutrients and micronutrients. And it has so much more meaning in people's lives. And I think that's the history of how somebody cultures have sustained themselves for EODS over different food practices. And we need to acknowledge that there are traditions to not only the consumption of food, milk producing, growing it, preparing it, and their social cultural practice along with all of it. So when you say don't eat that thing, you're actually taking away a lot more than that specific food items sometimes, right?

06:15

Aliyah Haq: Yeah, yeah. Yeah. It's very personal beauty for many reasons, to live for cultural reasons, medical reasons why you either can't eat certain foods, whether you can eat things by mouth, your ability to eat solo.

06:32

Raj Sundar: Second question. How do people determine what they're going to eat? Because I think sometimes in healthcare, food is a moral decision. Like you choose the right food or the wrong food. And you're a bad person if you're eating the wrong food all the time, right? There's this moral concept to it. But I think people's decision around food is complex. So how do people choose what to eat?

06:56

Aliyah Haq: I think it's culture which dominates the whole decision to eat or not eat certain things. You grew up around a certain culture, eating certain things, and you attach religious reasons cultural beliefs and practices and like. for example, in certain cultures, there's this ying and yang approach hot and cold foods. And sometimes the accessibility of food, where you live, what you grow, you have this personal attachment potential. That is the regular bread that you get in America, or the flat bread that's made in India at different times, or Denis injera adds another bread or that is pita or that is tortillas. So, there are different foods that different cultural reasons. And those cultural reasons have religious influences on top of them. And then festivals, or cultural beliefs like fasting. In the Orthodox Ethiopian culture, you cannot eat for 55 days starting February 22 to April, you cannot eat any animal products, including milk and eggs or in the Ramadan, which is coming very soon in the month of March 22 to April 22. For a while, and they can't eat or drink anything by mouth for the whole day, this Ramadan. Thus, we have to be sensitive. Number one, many people don't know that if they are sick, they are supposed to fast. So there's no question about fasting so I cannot eat and medicine. But then again, you can't sit here and teach religion to anyone. Right? Your best advice is you want to talk to a religious scholar. And even though I know 100%, you're still I can't say that circumcised. You could talk to your mom, or our modern religious scholar who knows more about fasting.

08:39

Raj Sundar: Yeah, there's a humble way to approach and I think other part of food is you said it's about culture, about food availability schedules, goals. I don't want to undervalue taste preferences. Because I think when we talk about food, sometimes we make it so functional, that we don't taste and it's okay for wanting food that tastes good.

09:02

Aliyah Haq: Its because I remember one patient telling me that people asked me to eat brown oatmeal and I hate it. You have to take into consideration ones likes and dislikes. And then of course, food allergies, food intolerance, sensitivity, availability, access, access, not just in terms of but that they have money to buy or a transportation is a big problem with many people with elderly but people who live on farms, or far from sources. So there are many things and that's why usually even a dietitian or anyone who talks about food, meets with the patient. It takes one full hour because you have to learn so much before you can give your advice.

09:44

Raj Sundar: Yeah, we'll talk about this because I feel like clinicians or people casually give food advice and two minutes, which is probably an appropriate so we talked about what food means to people, all the components of how people decide what to eat. My next question that I had was what is healthy mean? And how do you navigate that topic?

10:05

Aliyah Haq: Yeah, to me, it's what makes you feel good, is my simple explanation. What makes you feel good? What causes less problems? If I hear about a patient saying hyperacidity, or reflux problem, then I say, Okay, this is a four digit help you reduce that feeling. So how you feel when you eat something, and I'm always telling people, when you look at the food, you should be happy, you should feel like eating them. And I tell them, please don't do this, because earlier, they asked you to do it. But because you would like to do it for yourself. Because if they constantly do it, because I am telling them to do it, then they are welcome at times, I'm not gonna listen to you, I will do whatever I want. Because you want control, right? You want control over things, Whether it's food or feelings of depression, it's about the loss of control, right? People just can't control their feelings. Do you like it? Do you feel like eating this food? And I go with that kind of approach.

11:04

Raj Sundar: It's so simple, but beautiful. Because I think whether intentionally or unintentionally, we tell people not to trust their intuition. I think the point that I'm getting there is just reflecting on my own experiences and talking to others, is what makes you feel good is not just the immediate taste of the food. But how do you feel afterwards? Like, physically, it's how do you feel the next week physically? Do you feel like you can do the things you want and move as you want? And overall, just feel well, not just limited to that one second of tasting it?

11:40

Aliyah Haq: Yeah, that’s very true. And sometimes they come in and tells me and not just you, I have nothing against doctors. But sometimes, they come and tells me that my doctor told me not to eat this and that. What do you think And I say, “Yeah, of course. Maybe that’s the reason she sent you to me and because maybe there wasn’t enough time to explain the whole thing to you, and you don’t have that much time. So I guess, basically, they said, eat whole foods, eat whole grains and more fruits and vegetables.  

12:06

Raj Sundar: It's a good transition on how are we doing wrong. Let's focus on this one set, dso you just said. I think a lot of people default to this, Hey, you have diabetes, you have heart disease, you have hypertension, high blood pressure, whatever, you should eat more whole foods, more fruits and vegetables. That's it. Tell me why that doesn't work?

12:28

Aliyah Haq: First of all, how many of you even know, the meaning of whole foods, or whole grains, right? And how many people you think, can eat fruits and vegetables only and live? Right? There are so many other foods they eat and alive. Maybe they like to eat a doughnut sometimes maybe they hate orange, or they hate leafy vegetables? You don't know anything about that. So if you just tell them to eat whole grains, and you know, it's okay to eat white bread sometimes.

12:56

Raj Sundar: Yeah. So I think there's a lack of understanding what those words even mean. And you don't understand the situation to see if that's practical, or meets all the needs of the patients. The other thing that I often see is using my plate, you've seen that diagram. And I think that also falls short. Because it tends to say that each food item is different. And that's how you meet your needs.

13:19

Aliyah Haq: Yeah, so that's why again, like I said, depends on the culture, and I go by what they eat, like in some cultures, they have a big plate, and everyone is like that. So I usually talk about portions, I just showed them with my fist saying, if you have this much rice, try to get double the amount of vegetables. So then when they even form a single plate, they know how much vegetable to bring on their side. So yes, just going by the MyPlate idea doesn't work. I asked them, do it in a bowl or plate, post upon how you know, eat your food. And then I go by that. And now with the telehealth and all that I'm having to just ask them and playing to them what they're eating. And they tell me balls sometimes and tablespoons. So the whole concept is I tell them sometimes. So from what you're telling me looks like you can eat a little bit more of a specific vegetable that they normally eat, and just ask them, How would adding one more tablespoon to that. And when you get used to it, add another tablespoon. So it's really important to go by the way they eat food and how they're standing yields.

14:27

Raj Sundar: That were one a small adjustment. So just a tablespoon bar and see if you'd like that A to like look in front of you and see the size of your hand and then you try to double it for this other. So using simple ways to communicate topics and making small changes can go a long way. The third is I think you're good about this. Let's just be cognizant when you're telling people to change something that you're not unintentionally telling them to change their tradition. What's been passed down through generations as part of their culture and whole being careful about that.

14:59

Aliyah Haq: Yeah. But I do tell them that now they're here, especially in America, right? And sometimes I say, I've learned from different cultures, and eating this other food is also a good way. Have you heard about it? As they say, oh, yeah, I want to hear what. So some of them are not used to eating, for example, injera, which is made from Jeff, a very healthy grains, which has iron protein, everything. So I tell that in there, they said, Oh, yeah, I heard from my friend or something. And I said, you want to try. So I'm always trying to add an additional level of something for them to try. And some are very receptive to that.

15:34:

Raj Sundar: So we seldom them do that, because we look at somebody's traditional culture. And then we try to compare it to, I'll say, quote, unquote, American food, whatever that is, and you did something interesting there, which I don't think many people do is like talking about other cultures food, actually, have you tried injera? Or have you tried? Do you have another example? I'm curious.

15:54

Aliyah Haq: Pizza pocket, for example. So have you seen the pita bread, it's made from whole wheat also. And then you can fill it up with these things. And they find it so interesting, especially kids, and you can make a pizza pocket and eat. And they find it so fascinating and interesting. That I've had many people of different cultures tried.

16:13

Raj Sundar: The other thing I think we do wrong is we don't ask enough questions. So sometimes people have beliefs about relationship between food and health. Like high blood or low blood. So when you say high blood pressure, you might actually be talking about something else for them. So they think they need to change this food. Have you encountered that?

16:37

Aliyah Haq: Yeah, that's a very good point that you brought in that the understanding of chronic disease basically is very different in different cultures. As you can see, I tell them blood pressure, and what's high in low blood, cholesterol, what's high and low, and I tell them that all of us have it. But sometimes it's a little more than what we need, or little less than what we need. And then blood sugar, that pressure, blood, and cholesterol level. So I let things that you don't, it takes some time for me to explain this to them that these are things that you don't see. But obviously, a doctor has seen them by testing your blood. So it's good pay attention to it. And many of the foods that you eat, are already good foods, and then I asked them, maybe cutting down on this a little bit will help you. So then they are receptive, you should appreciate what they eat in their culture. So basically making friends that test before you even tell them about what's happening in your body and how they can help.

17:34

Raj Sundar: I don't think we know how to trust people to be experts with their bodies. And that phrase itself is a little complicated, because I think we think of ourselves as experts. Any clinician, because we go to school, we studied so much we have all this knowledge. So this idea of the patient, being an expert or something is hard to reconcile with this problem that we're trying to solve together. Right? You came here because you're sick, and you want to know how to be healthy. And I'm telling you, this is what you should do. How do you make sure you incorporate the idea that patients or people have expertise to their own bodies and their lives?

18:10

Aliyah Haq: Very good question. I have also tried my best to make it easy for them. Like for example, when they come to me with high blood sugars, right? Very common these days, diabetes and high blood sugars, I tell them that " Look, remember, you are in control of your body, you can control it yourself, no one is going to control it for you. You can do a lot of good things for yourself. I'm just here to give you some advice on whatever I know. But yeah, I'm gonna learn more from you first.". So that helps them. I think that gives them some kind of confidence in themselves. And then they take care of it. If I tell them that I'm controlling all what you're doing, it's not good, since that's what I'm saying. I spend 75% of my time just listening to them. Because people have to say so much about themselves, especially when we talk about food is so personal. And they're here with me. They think it makes them after some time comfortable. And they tell me everything about what to do the whole day. And it's so interesting. And it tells me a lot about how difficult it is for people to manage their own life, especially when they're sick. So it's not just medicine, and so many other things are going on in their life. And beginning to see a lot of kids going on this ketogenic diet, and they restrict themselves to so few things. And then when they come to me, they are almost at the verge of developing eating disorders because they say, my brother wants me to go out with them. He doesn't understand what I eat. So it's a matter of relationships going bad there.

19:44

Raj Sundar: I unintentionally sometimes start eating disorders, because we blame and shame people and don't follow up because maybe their diabetes is a little bit under control. They lost some weight, but maybe they have developed an eating disorder, very unhealthy. But we say oh the number look a little better. So you must be doing okay.

20:02

Aliyah Haq: Yeah and exactly. Just recently, we were talking in a group about a patient whose numbers look good. But then when he came to me, I asked him if he was like to any headaches and anxiety and feeling of hunger, all symptoms of hyperglycemia. He said, Yes. I said, How many times in a week, three or four times a day. That Oh, then I immediately doctor's provider, I said, maybe he needs to cut down on his because he stopped eating. Because the minute they hear about high blood sugars, they stop eating. And just the fact that someone tells them, You can't eat this, you can't eat that, that gives them so much anxiety. That they develop on other progress because of anxiety. And I see pregnant women, immediately weight loss because they think that if I eat the blood sugar will go up, they forget about the baby developing in there.

20:58

Raj Sundar: And I try to be really careful about children, because I think we do a lot of harm there. Because we start this idea of good and bad food and blaming their bodies when it's sometimes hard for them to control what they look like. And especially with different cultures, I think people worry less, they're proud. They're their kid is chubby, and like eating well. So be careful about navigating around this topic. But I'm curious on how do you make sure that you instill good habits of listening to your body and helping children trust their bodies and their eating? And like, how do you talk about that, because we talk about childhood obesity so much. I feel like sometimes we're causing harm the way, we're approaching it, weighing them all the time and all that stuff, too.

21:43

Aliyah Haq: Yeah, I think pediatric nutrition Chatlin is the most difficult. In my experience because you're talking to people, the patient, the child, and the parent who seek out the child. So sometimes the child that listen to you understand, but the parent is not letting them. Many times what happens especially, they have come from a different culture, to like to America or to the Western countries, they are used to the Western foods. And the parents are really feeling bad that the child is not eating there. And if it's a teenager is even harder. So usually what I do is I do listen to them. And then I do try my best to tell the child to go to the library, I do that a lot and tell them to learn more about what your mom is talking about your heritage, the foods that are good in your culture, and how about bringing that recipe to the mom. And that has worked in many cases, that parent is happy that the child is learning about the culture. And at the same time, I feel bad that the child is not respecting the parents culture, I give them some homework, I listen to them and talk to them about what they should be doing. And I tell them that I wonder if he has a little bit of homework, can you go home? Or can you go to the library and find a book on your culture and read about it and bring some recipes to your home. So that has helped in the past. And they've continued to use that strategy, depending on what the situation is like. And then the other thing is that and this is very hard. You mentioned obesity. Sometimes parents bring the child in and say, he or she is fat. And I don't know what to do about that. You want to cry very hard, and then tell them that your son or daughter is beautiful. I tried to make the child feel good. And that you're not fat. So you're horrible. No, I try not. And then if the child is not, then I tried to slow it. And that's not a good way to talk to the child never say that. If they're very little kids, I tell them please don't talk to this child about being fat or the thing just introduce foods that you eat and that they're not introducing the right kind of foods and delta. This may be good for the child's health, it will keep him or her strong you can play better and concentrate more on the studies.

24:12

Raj Sundar: Is there any barriers or roadblocks that the parents tried to raise children here and navigating different cultural diets?

24:22

Aliyah Haq: Yeah, I think it's hard for the parent as well as the child and many different things that are going on in their lives. For example, one of the primary care providers send us obese kids to me and the mom she met me in the hallway. She said why do I have to come and see you my kids are fat and healthy. Culture that she was coming from, they're being chubby, a slightly fat or the sign of health and nourishment. So was I or anyone here telling them that the child is overweight, so not healthy? To her, they were fat and healthy. Then she explained the whole thing to me. So I said, okay, yeah, seek me out for lunch right at one o'clock. Let's talk about that. And she's like, it's already healthy. Then I learned that she was feeding nine cups of milk to her child. So I said, Okay, let's talk about money today. So why do you think that was important? And then during the conversation, she told me that in the refugee camp, all they had was milk. So she was feeding milk. She was doing the right thing to the child, at least was getting some nourishment. So you have to understand the reason behind why someone is doing something. Can be something as simple as that milk was a thing that was available or sometimes not available. So whenever it was available, she was just feeding milk.

25:43

Raj Sundar: Yeah, come out and other episodes, sometimes the experience of being in refugee camps or types of scarcity? Yeah. Makes it so now you're in such a period with the abundance of so much food, it seems confusing to restrict yourself when you don't have to, because you've suffered in that way. And I think your body physically remembers that suffering.

26:06

Aliyah Haq: It happens on him and to this. The child was born in the times of scarcity tends to be obese. Later as the child was programmed that manual efficient environment and then not that this thing's available then.

26:22

Raj Sundar: Yeah, exactly. Okay. Next is indigenous communities. I hear from indigenous communities about food sovereignty a lot. I don't know if you've thought about this, because with the native Hawaiian community, we've done an episode on that. As well as some of the native communities here, the conversations also about how we've demolished their food pathways, right? So then a lot of the communities became dependent on a government subsidies. Which were not that healthy. And now we say they're unhealthy and blame them for them healthy. So this cycle of blaming people and communities, I think leads to more distrust. And we're still telling them at the end of the day, they come to see me and I tell, Hey, eat whole foods and fruits and vegetables. I don't know how you think about that, I think about the food sovereignty idea with indigenous communities.

27:11

Aliyah Haq: So usually, before I see a patient, I read about a little bit of history about their food habits, that they're coming from, what have they been eating. And that helps me a lot in beginning the conversation. And I never tell them to whole wheat and vegetable, right? But I asked them what their food habits and the conversation has to be very friendly around for. And there as a learner, not as an educator, I think I immediately put myself in the role of a learner. And that helps a lot. I learned so much about what they eat, or they used to eat. And then I slowly talk about access. Now, if they have access to those foods, and I encourage them to start eating, I tell them, You know what, these foods from your culture are excellent, because I've seen people hesitate a little bit when they tell about their food because they think that I might change that when I encourage them to eat what they used to eat. Immediately they open up and tell me more simple example I give because it happened recently is of injera that someone was hesitating to tell me said it's a kind of cultural bread. So I said, Can you tell me the name of it? Because I like to learn more about different types of breads. She said in general. And I said, Yeah, Jeff, you said, oh, you know about that. So I said, Yeah, it's a great pass this and that. And I guess you'll eat it. But what are Shiro said, Oh, my God, you know everything about our food. So she got so excited. It was an odd conversation. And then she started telling me all about the other foods they were eating until she opened up and started telling me the actual legs. And then at another time, we had a Punjabi lady. And again, she said, we put some logistical that eat it. I said, is it like, potatoes and cauliflower? Is that? Yes. He said, I said he's gonna tell with that. He said, Yeah, and for example, I missed affricates they make a lot of different things. I said, in the thick of my mouth. She said, Oh, you know what, when you don't act as if you know everything, but you can grant them so then they open up and tell you more about that they feel comfort in talking to you. So a lot of my counseling sessions are concentrated on making a friendship, and developing that rapport because otherwise I'm not going to know. I don't want them to tell me things that please. I want them to be honest.

29:35

Raj Sundar: Yeah. Because there's a power dynamic because they do want to please you because they're putting their lives in your hands, right?

29:39

Aliyah Haq: Right. And yeah, it's about that if I tell them Did you tell your doctor about it? They said no, because they're scared of you guys. If they think that you will get mad at them if you don't use it.

29:51

Raj Sundar: But I like that so hoping to become a friend. And I think the second point you made that's really important for Folks, it's about being curious enough and learning enough about each culture. So you have somewhere to start. Because people approach every relationship feeling like, Can I really share this with this person? Do they know anything about my culture? And if they trust that you at least know a little bit, and then you can ask the right questions that can open up space for more conversation, which I've found with this podcast, that's what we try to do. helps a lot like you saying, injera, you're like, oh, this person knows a little bit so I can actually share and they won't just stare at me blankly and then talk about Mediterranean.

30:37

Aliyah Haq: They're not. Few things happen. One they think that you know a little bit amd after this they think that you have interest in it. That's why you know it.

30:46

Raj Sundar: Okay. Wrapping up. So I got a few more questions. What do you think about the Mediterranean diet? We talked about that a lot in medical circles about how it has a lot of evidence. But I find that it's a tradition, rather than a small adjustment. So somebody comes in with a new diagnosis of diabetes, and then we tell them to, Hey, eat the Mediterranean diet.

31:10

Aliyah Haq: If you learn about the Mediterranean diet, it's nothing but a general. I add different things that we think are good, and it comes to be totally customized to the patients'. You can just say eat vegetarian diet, you just have to customize it that that needs is all that needs health and attorney, nutrition.

31:31

Raj Sundar: Okay, I'm gonna ask a hard question. Not everybody sees a nutritionist. They only see me as a doctor or the another clinician for a few minutes. What is one thing that we can do? Ask that's actually helpful? Is there something else we should be doing to not make things worse, or actually make them distressful? Or not come back to us? What is the better way for us to talk about or ask if we have just a few minutes to start the conversation about food?

That's a hard question.

32:01

Aliyah Haq: That’s a hard question.

32:04

Raj Sundar: I told you, it’s gonna be hard.

32:06

Aliyah Haq: It shocked me. it's really hard to know everything about a person decent. Yeah, representative of doctors. I'll go back to your question. I told them that, when you asked him to voice Yes, it's very important for you as a primary care provider, to have that trust in us. If you will trust us and say that, I'm just using my name that AliyH can help you. If you want information, and then they will come to me with a recommendation from you that I can help. So that's one thing about making a referral, not just go as your dietitian, but then adjust that you put into action makes a huge difference. then believe me, dietitians go through a lot of training. So they know a lot, they can help the patient. So having said that, if you as a doctor want to tell them? While short, I would say the first thing is that, what would you like to know about? I ask them that question, then they may have a lot of things that they are afraid about, like for example, one patient said, I love my coffee with cream and sugar. So you will hear things like that. There'll be one or two things the last few. And that will open up the conversation and say, purely you can haveyour coffee, but how much sugar they're putting a little bit of spice, because that's not going to change the whole treasure. And from there, you can see it's not just sugar in your cup, but it was also the pinch then have no fiber, for example. Why 10 to three minutes, three minutes a big actually, I remember when I was a student, I was going to the doctor home. Yeah. And he bought learned about each other intriguing. They didn't tell us how extensive it was about motivational interviewing. In three minutes, I knew a lot about him. Obviously I did a good job. And then they stopped us and said, What do you know? And I told them about his stupid life. And when he got his education and what he was doing, oh, how many kids yeah. And he knew a lot about me the same plan. So yeah, ask what would you like to know about food as a doctor what might guide you? And they will have a question for you. They always have questions that they want to ask primary care providers and usually the reason they don't ask you is you can say things you don't have. And then because it is so rash.

34:37

Raj Sundar: That is an excellent point, though. I do think people of all backgrounds, but specifically immigrant refugee, asylum base, know a doctor they know well, and they want to know this other person they can trust to the doctor, clinician, whoever says you can trust them. That goes a long way. Not because it's hard to build relations. trips and know who to trust because a lot of people haven't been supportive, helpful, curious, interested, you know, they've led a lot of people that aren't that helpful. Yeah. So they just want to know, because it's hard to try and make time for all of this stuff.

35:13

Aliyah Haq: Yeah. It's very hard as a student at once I've saved up the sidewalk. And this pipeline, very drastic, but it's also very challenging. Because this woman wasn't eating. And this student dance, I don't have receptors to me challenging situation. I know why is silent, then she wasn't eating. So I talked for some time. And then an idea came to my mind. I said, If I check your tray every time there's an issue when you eat. So after that time that I had spent with her she said, he trusted me. I think she said, sure with you make sure that they don't poison me. I said, I promise you, I can look at each tree before it's sent to you. And I checked with a nurse later on, she was eating. So I know I didn't sound worse, like dietary problem, but at least you were eating. And I wasn't there to solve that problem, right? I'm sure some of that trust is that we do the same here. The same thing about increasing the breastfeeding rates. You tell the doctors, let's tell them and if they have a problem to come to us that you trust us advice, and it makes a huge difference.

36:24

Raj Sundar: Thanks you so much. This has been a pleasure and very informative conversation about food.

36:29

Aliyah Haq: Thank you.

36:30

Raj Sundar: Thanks again everyone for joining me on another episode of Healthcare for Humans. If you liked this episode, as always, may I ask you to  please share it with one other person, so they can also hear it. I'll see you next time.

36;45

Speaker 3: This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participants past, current or future employers unless explicitly expressed so. Always seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land that makes a regular commitment to Real Rental Duwamish.

The transcript ends here.