I have always liked the phrase, “We are what we eat”. Having moved to Alice Springs I am, for the first time in my life, largely in control of what I eat; it is quite an odd feeling. No compromise, no surprises and little innovation, although my frugal nature has stretched me to invent broccoli stem salad which is crisp and tasty. What does concern me is what others have to eat in this remote setting and who decides.
As a child, I was passive in what I ate apart from early forays to the rounded Kelvinator with the big chrome clunky handle for a teaspoon of Nestle’s condensed milk from the shower capped can or a slice of raw bacon. I drank mostly milk or water with the addition of cordial later in childhood. We grew fruit and vegetables and I still enjoy a raw carrot with a little tasty earth attached. I then suffered soggy Sunday evening sandwiches at boarding school and frequent food poisoning from my grandmother’s belief in the superior preserving effects of fresh air over the now square latchless Simpson fridge.
But I have a new personal concern which I share with many Aboriginal people here in central Australia. A recent fasting blood sugar was 6.7 mmol/L, a smidgeon short of the ‘diagnostic’ level for diabetes (6.9). Every one of my recent ancestors on my mother’s side of the family have type 2 diabetes – mother Helen and her brother Bruce, their father Bowyer and his sister Molly and their mother (and my great-grandmother) Gig. There must have been some advantage to this common genetic makeup in the past but this clearly pre-dates the establishment of Coles and Woolworths.
What to do? There is a growing proposition as to the power of food, how it affects us, its health giving properties and its unwanted or dangerous contaminants. Messages from health ‘experts’ come and go. I recently learned of evidence that saturated fat in dairy food seems to be health preserving; quite the contrary to the messages of the last 30 years. Similar fat in red meat appears to be less healthy but farmers’ organisations tell us otherwise. Climate scientists warn that domesticated animals produce a lot of methane and consume a massive quantity of water threatening our environment. There is so much information about sugar and fructose and salt and fat that I am totally confused. To find a way forward I generally resort to Michael Pollan’s message, “Each food, not edible food-like substances” and not things manufactured with more than 5 ingredients. A look at the ingredients of ‘milk’ sold in the supermarket will show you it is not easy to live by; milk may consist of milk, unsurprisingly, but the cheaper offerings have a plethora of ingredients. I am at a loss to know how anyone else is processing all this information and particularly if your English is not excellent and your education is limited. What then?
In the aged care homes I have visited in the Top End and visit here in Alice Springs there are a lot of diabetic patients, universally type 2 like my ancestors. This is the slow onset type, usually coming on later in life and the subject of what is described as the world ‘diabetes’ epidemic. As a bizarre consequence of modern life, this condition is becoming apparent in younger and younger people, especially in Aboriginal people in Australia. Lenore Skenazy reported in her speech at the Dangerous Ideas conference in Sydney in 2010 that there were over 700 cases of late onset diabetes in children aged under 10. This maladjustment of insulin production or processing has a variety of causes: genetic causes, like in my family; causes arising during pregnancy; causes in early childhood and the critical effects of diet and exercise throughout life. Working in the Northern Territory I think researchers and doctors totally underestimate the effect of diet, predominantly because it is so difficult to change individual ‘lifestyle’ behaviours as a doctor or dietician. There are also many powerful food and drink companies that need us to buy manufactured food.
My first insight into the profound effects of diet was working in those aged-care homes in the Top End. Aboriginal people would arrive from the bush in a state of frailty or dementia on multiple medications for diabetes. The profound change to the regulation diet at the aged-care home would send many into a confused state due to a very low blood sugar. This is life threatening and brain damaging and never happens to healthy people on no medication, even if they don’t eat for months. As a result, I became accustomed to ceasing people’s diabetic medication on arrival and what I found, most surprisingly, was that I often did not need to reintroduce it. That is to say, when eating an aged-care home diet, most people did not meet the criteria of diabetes requiring treatment. This was shocking to me as most were not exercising, so the entire effect was a change in diet.
In Alice Springs I am also getting to know the Aboriginal people living in aged-care homes. They still appear to be on their medication and many are on Insulin. My first surprise was a patient going into hospital and coming out on a lot less medication for diabetes; apparently she had a hypoglycaemic attack in hospital. But when she got back to the home, her blood sugars went crazy high and we had to reintroduce insulin to regain control of her blood sugars. There was a reluctance from the staff to see this as dietary but it is now clear that her family bring her Coke to drink most days! There are a lot more visitors to the aged-care homes in Alice Springs which may account for the greater need for medication.
Going back to my own blood sugar of 6.7 and ‘near diabetes’, there were some other causative factors involved. I had had a nasty wheezy viral infection and been on a steroid inhaler (relatively low dose) for a couple of weeks and I had drunk a fair bit of alcohol the night before. Could that be related. Then I moved to Alice Springs and reduced my manufactured food and drink intake to zero. I exercised a reasonably amount (3 hours per week) and ate as little sugar as I could. My fasting blood sugar returned to almost normal (5.6 mmol/L). It was surprisingly difficult to eat less sugar. My first trips to the supermarket took ages. Trying to find muesli with less than 10% sugar is difficult – and I had to change to nuts for snacks! I stuck with dairy, eggs, some meat, cheese, fruit and vegetables. Heading around the outside of the supermarket and avoiding the aisles.
[I have just been interrupted writing this on an early morning Virgin Australia flight from Darwin to Alice Springs and offered an apple muffin. Almost everyone accepted it and I read the contents: 25.7gm of sugar per 100gm. That is a quarter sugar by weight! I left it in the packet.]
I shop with Aboriginal people and we often chat a little about the specials. I have learned that a small box of Weetbix in a remote community costs up to 4 times what it does in Alice Springs. It has a very low sugar content compared to other cereals which is why it is the only cereal that ants won’t attack. Nuts are expensive even in town and I haven’t seen many people buy them. The trolleys heading out of the Yeperenye Shopping Centre are often stacked high with sweetened carbohydrates and sugary drinks. I notice as I come along behind that the bill for the trolley that towers over me is often less than I pay for a carry bag or two of what I consider healthy. How so? Why is water more than Coke? Who can explain that? Does Coke have cheap water in it?
I was visiting Ntaria to the west of Alice Springs for the day last week. It has a shop. I walked from the clinic to get some lunch. Tourists were lined up in front of me with a middle-aged local stockman sporting a quality USA cowboy hat which accentuates his “just do it” type of attitude. The tourists come to Hermannsburg to look at the wonderful old group of stone buildings from the mission days. They seemed to be looking for some good food. I struggled to find something to eat that wasn’t more closely related to a Mars Bar than a carrot, and that includes the cooked food. I settled for a shrivelled pie and a Farmer’s Union “Feels Good” ice coffee (skimmed milk and no added sugar but lots of other stuff) and headed for the checkout. The stockman was in front of me with his “basics card”, a smallish block of frozen meat, a few loose potatoes and a loaf of bread. He blew his cash limit on the basics card; computer says “No”. A couple of local people appear and one offered him another card but doesn’t know the pin. He accepted and walked across the store to the pay-phone and dropped a few coins in. No answer. The coins came out. He repeated this a few times but got nowhere. More tourists lined up so the staff opened a second check out. I declined to move to the new queue and stand in solidarity behind the stockman. I wondered if I should pay. Then he pulled a yellow bill and some other reds and blues from his pocket. This leads to an animated discussion with the local checkout person in yet another Australian language I haven’t heard before – Western Aranda no doubt. Bills went in and out of the pocket, others were offered. The discussion remained animated but courteous. This was a very serious business. I felt absolutely invisible. When the other queue has emptied the woman on that cash register called me over. I relented reluctantly to avoid appearing voyeuristic.
I heard a great presentation on the ABC Radio National on “Food Governance”. Corrina Hawkes, a sparkly professor from the UK, dazzled me with pop-culture lingo and a commitment to try to get countries and regions to institute food governance to preserve food production and drinking water. I can see how it might apply to a region like Alice Springs that has largely abandoned efforts to grow vegetables and to concentrate on export foods. There are kangaroos for consumption but even these are usually brought in from other cities. I think “food governance” is something I will go for. How would it work?
I was sharing some of these ideas with a senior man here in Alice. He laughed at the condensed milk story. He told me he still sneaks out and buys a tube when he feels the need. Sucks it dry. He roared with laughter as he told me how to make pralines by rolling it in Milo. Loves it. Maybe we should just accept that the joys of life and happiness involve some risk taking and some gastronomic pleasure. I think I will have some home-made pralines if invited. We are what we eat.
Medicine at the Deep End 