(Refugee and Diversity Projects) > Health > Anatomy of Suffering
CHEAP UMAMI SOURCES CONTRIBUTE TO POOR HEALTH
In theory, a very poor Montagnard American family could maintain reasonably good health in America if a traditional diet was followed. Such a diet would lack variety (far fewer fruit, vegetable, and wild plant choices than available in Vietnam) and be very boring in the cold months. The reality is that other foods complete this section include American junk food, hotdogs, soda and instant noodles ("Ramen"). The last item must be of special concern because of its extraordinary salt and fat content per package serving, their universal popularity, and in some cases, the consumption of as many as 2-3 packages per day by individuals including children. A box of 30 packages might sit beside a 25-pound bag of rice in a Montagnard kitchen, suggesting that the two are perceived equally. This bottom tier I call Survival Food because items in this group are found in the poorest families' kitchens, but it is also correct to call this "foundation" food for most of the population.
Cheap umami sources Upper left: Ramen or instant noodles. Upper right: Monosodium Glutamate (MSG). Center: Fish sauces and soy sauce. Bottom left: Soup cubes. Bottom right: Salt.
These instant foods are very cheap (30 to a box for about $11) and have been popular for decades both in Asia and in America. Most Asian stores sell them to shoppers in boxes — not as single packages as seen in mainstream American supermarkets.
MSG has had a notorious reputation in Chinese cooking but its alleged negative health effects and use in mainstream American restaurants were subjected to a more balanced review in a NY Times article.
Condiment sauces
Fish sauce is an important part of Vietnamese and Montagnard cooking and even among Western chefs who use it to "round out" a dishes' flavor. Both fish and soy sauce have umami, an essential flavor in all cuisines recently identified by scientists.
A tablespoon unit is used to measure sodium content. A dipping sauce can consist of garlic, sugar, water, chili and fish sauce. In theory, a diner would use a small amount of dipping sauce with her food. But if the family is poor and the meal is almost all rice, then it's likely she will eat much more of it as other umami sources (meat, tomatos, fish, seafood) are too expensive.
Soup and seasoning cubes
A single cube used to make 2 cups of broth is 1760 mg of salt, or 76% of maximum daily recommended intake of salt. Another brand, Bao Long, includes seasoning cubes for preparing various dishes such as bo kho. These, too, have high concentrations of salt per cube (1460 mg). Like Ramen, soup and seasoning cubes are popular and quick ways of adding flavor.
Broadly speaking, instant foods, concentrates, and sauces are convenient and effective ways to add flavor to otherwise traditional, healthy meals. Used correctly, they work.
They are also cheap shortcuts to flavor, which means that poor families that could not afford scarce, expensive meat could still provide their dishes the "full" flavor identified by scientists as umami.
With the increased availability of fresh foods and better ingredients to the Montagnard population, it should not be necessary for them to rely on these "cheats" in the kitchen. As important as it is to point out health risks, solutions might include encouraging people to return to older, healthier, traditional styles of food preparation. But even this might be difficult for the Montagnard American community since items like instant noodles are firmly entrenched as a major food.
What does 2400 mg of salt look like?
The maximum daily recommended intake of salt is 2400 mg. Generally, less than this amount is suggested. The Mayo clinic suggests a range of 1500 - 2400 mg.
A teaspoon of salt holds about 2400 mg of salt.
CHEAP UMAMI SOURCES CONTRIBUTE TO POOR HEALTH
As family fortunes improve, more expensive or healthy foods do not necessarily replace salt-heavy junk food.
Click to enlarge.
THE ABOVE FOOD PYRAMID is a very rough approximation of the diet of Montagnard Americans. At its base is white rice, preferably familiar Asian brands such as Red Elephant or Three Sisters but if the family is especially poor and struggling, a mix of American-grown rice. This food tier includes a good mix of vegetables too numerous to list. These tend to be very inexpensive and can include foraged wild plants such as amaranth or less well-known plant parts such as sweet potato leaves or tomato leaves. Bok choy and Napa (Chinese) cabbage, as well as American cabbage, cost little throughout the year.
In theory, a very poor Montagnard American family could maintain reasonably good health in America if a traditional diet was followed. Such a diet would lack variety (far fewer fruit, vegetable, and wild plant choices than available in Vietnam) and be very boring in the cold months. The reality is that other foods complete this section include American junk food, hotdogs, soda and instant noodles ("Ramen"). The last item must be of special concern because of its extraordinary salt and fat content per package serving, their universal popularity, and in some cases, the consumption of as many as 2-3 packages per day by individuals including children. A box of 30 packages might sit beside a 25-pound bag of rice in a Montagnard kitchen, suggesting that the two are perceived equally. This bottom tier I call Survival Food because items in this group are found in the poorest families' kitchens, but it is also correct to call this "foundation" food for most of the population.
In the next tier labeled More Food Choices are vegetable favorites that cost more and I've listed a few examples. Meat is more plentiful. In the top tier, More Expensive Choices, I include foods that are rare treats for struggling families and more regularly consumed in better off ones.
The point of this food pyramid is to emphasize that as family fortunes improve more expensive or healthy foods do not necessarily replace salt-heavy junk food and instant noodles at the base of the pyramid. Improved income and stability don't automatically lead to improved health; often they simply permit more food choices—some of which have the effect of piling on more salt, sugar and fat into the diet.
THE PROBLEM OF DIET AND HEALTH in the Montagnard American community can't be solved without looking at and addressing the bigger problems it faces. Health education, for example, is based on the availability of and access to information by Montagnards. The number of interpreters, translators and media delivery systems (information delivered by newspaper, Web, radio, TV, etc) developed over 25 years amounts to almost zero. Intimate knowledge of their kitchen practices by Americans is low. Local agencies offer no solutions and few insights because they are ill-equipped to deal with cultural problems. They know individual families and success stories but they don't track trends. The inability of any agency to generate a definitive population number accurately reflects local American inadequacies and shortcomings. For these and other reasons it is fair to say that the American response to improving the health of the Montagnard community has been shallow and ineffective. At this point, a single grant, a special task force and list of low-hurdle benchmarks won't work. The Montagnards themselves are caught in a special kind of trap because of the heavily salted foods that make up the foundation of their diet. Over the years and decades the cheapness of these foods and the community's social and linguistic isolation combine to produce a special kind of poverty that defies a single fix.
SO WHERE TO START?
First, let's reject single fixes. Second, progress will be linked to a multi-layered approach that will take years. Third, change has to come from within the Montagnard community with Montagnard community members in the lead. Fourth, Americans should recognize that in matters of health every community member has a stake. Montagnard current and former health professionals and mothers have an abiding interest but they're regularly overlooked in favor of the usual political and religious leaders. American agencies can do a lot by accepting the first premise, organizing themselves to support a long term effort by investing in technology and media tools to facilitate education and information and training more interpreters and translators. When Americans see individuals in the community interested in change, they must be ready to assist. My work with the lay health team suggests real change agents will probably come from within the community, from the very food experts who prepare meals everyday in Montagnard households.
________________________________________________________What about growing food?This has been proposed many times over, often by well-intentioned Americans who themselves might be familiar with suburban gardening but unacquainted with the reality of refugee living circumstances. Refugees who live in apartments might have a small container garden, that is, a few plants in buckets. Occasionally an apartment landlord will allow for more, but that's rare. Seed, supplies and dirt are cheap for the American weekend gardener but often impossible for poverty-level refugees. Communal gardens located at some distance from refugee residences pose transportation, community maintenance and security problems. Families that live in rentals with backyards will usually grow something. Some are very intensively cultivated and yields are substantial. While North Carolina has a long growing season that still leaves families in the winter and early spring without garden vegetables. These are not arguments against urban agriculture but rather an example of the technical problems that must be squarely addressed if it's proposed as a long term health solution.Whenever Montagnard Americans, themselves former farmers and agricultural experts, can grow their own food they usually do. But unless high salt consumption is also reduced, serious physical health problems will continue. Growing food is sometimes proposed as if it were a single solution. It can only succeed if it is combined with several interlocking lifestyle changes and education (that is, a multi-layered approach).________________________________________________________
Sad but true
Call it junk food. A list of World Instant Noodles Association members.
Instant noodles aren't just consumed by college kids and Asians. Check out the Wikipedia entry.
One company’s instant noodle product line.
Related
A Montagnard-centric approach to diet and health was the inspiration for an educational chart, Am I Fat?
A Montagnard recipe and ingredients example, How to prepare Banh Canh
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SODIUM SOURCES IN THE MONTAGNARD AMERICAN DIET
Educational materials I developed for free blood pressure clinics held at Central Highlands Montagnard Church.
Ramen or instant noodles
Salt content is extremely high. 2007 mg of sodium equals 84% of maximum daily recommended intake of salt, a staggering number. The other example, 1480 mg, is 62%. The habit of adding vegetables to the mix while it cooks in the microwave doesn't reduce their high salt content. Children munch on unheated noodles out of the bag (each package has 24-29% daily fat).These instant foods are very cheap (30 to a box for about $11) and have been popular for decades both in Asia and in America. Most Asian stores sell them to shoppers in boxes — not as single packages as seen in mainstream American supermarkets.
Monosodium Glutamate (MSG)
Like other products here, MSG is cheap and an excellent flavor-enhancer. It's relatively low in sodium but used a lot. One family of six said they use about a bag of MSG a month. This equals about 300 mg of salt on average per family member coming from MSG alone. Another said a bag would last about three months in their household. When it is combined with other Survival Foods, it results in staggeringly large consumptions of salt per individual per day.MSG has had a notorious reputation in Chinese cooking but its alleged negative health effects and use in mainstream American restaurants were subjected to a more balanced review in a NY Times article.
Two fish sauces, left, and soy sauce, right.
Condiment sauces
Fish sauce is an important part of Vietnamese and Montagnard cooking and even among Western chefs who use it to "round out" a dishes' flavor. Both fish and soy sauce have umami, an essential flavor in all cuisines recently identified by scientists.
A tablespoon unit is used to measure sodium content. A dipping sauce can consist of garlic, sugar, water, chili and fish sauce. In theory, a diner would use a small amount of dipping sauce with her food. But if the family is poor and the meal is almost all rice, then it's likely she will eat much more of it as other umami sources (meat, tomatos, fish, seafood) are too expensive.
A single cube used to make 2 cups of broth is 1760 mg of salt, or 76% of maximum daily recommended intake of salt. Another brand, Bao Long, includes seasoning cubes for preparing various dishes such as bo kho. These, too, have high concentrations of salt per cube (1460 mg). Like Ramen, soup and seasoning cubes are popular and quick ways of adding flavor.
Broadly speaking, instant foods, concentrates, and sauces are convenient and effective ways to add flavor to otherwise traditional, healthy meals. Used correctly, they work.
They are also cheap shortcuts to flavor, which means that poor families that could not afford scarce, expensive meat could still provide their dishes the "full" flavor identified by scientists as umami.
With the increased availability of fresh foods and better ingredients to the Montagnard population, it should not be necessary for them to rely on these "cheats" in the kitchen. As important as it is to point out health risks, solutions might include encouraging people to return to older, healthier, traditional styles of food preparation. But even this might be difficult for the Montagnard American community since items like instant noodles are firmly entrenched as a major food.
The maximum daily recommended intake of salt is 2400 mg. Generally, less than this amount is suggested. The Mayo clinic suggests a range of 1500 - 2400 mg.
A teaspoon of salt holds about 2400 mg of salt.
