Immigrant Eyes

Three years ago, I came to the United States (U.S.) from Bangladesh with new hopes and dreams. Being a public health professional, I was expecting to see a healthy environment. Many fast-food chain restaurants are famous globally, but my first experience trying this food was here in the U.S. I tried fried chicken at Popeyes, and was surprised by how salty it was. It was too salty for me and I would not want to eat it again. I wondered why no one else seemed to complain about the saltiness of the fried chicken. Perhaps, I was the only one who had a problem with the high salt content of Popeyes. Next, I tried a tuna footlong at Subway, this was unique because I was able to select what I wanted on my sandwich. But the tuna was also full of salt!

Before moving to the U.S. I was a nutritionist in Bangladesh. I understood that high salt intake could increase the risk for certain conditions, such as cardiovascular disease. After trying all this salty food, I became curious about the prevalence of chronic diseases in the U.S. and decided to look up more information online. From the CDC website, I found that the prevalence of cardiovascular diseases is quite high here in the states, which surprised me. I expected that a developed country that has the best doctors, health insurance, and the best research and funding in medical fields would have lower rates of non-communicable diseases. My journey in the U.S. has come with lots of discovery and many new experiences.

After coming to New York, I started my first job in the U.S. as an optical assistant at a doctor’s office and I checked patients' eligibility to get the services and performed basic eye exams. I was open to learning and meeting new people. One of the first things I noticed was that my co-workers were accustomed to eating breakfast they ordered from restaurants. A typical breakfast consisted of a sandwich, hash browns, and hot chocolate. This is different from what I was used to, as I preferred to eat breakfast from home. Sometimes, I packed my breakfast if I woke up late and I had to rush to the office. One day, I was eating oats with some fruits. Some of my co-workers asked how I ate oats. They were nice and said it is hard for them to eat oats as a meal for breakfast. I took it positively because I know that food habits are controlled by many factors, including culture, tradition, and purchasing capacity, and this showed that my coworkers were curious.

To my surprise, some of the doctors in my office also purchased food from restaurants for breakfast and lunch. I soon realized that people preferred to purchase prepared foods because they had little time to prepare the foods and cleaning up after eating and buying food meant that they did not have to carry food from home. Though fast foods are unhealthy and can increase the risk for diet-related diseases, health was not the priority. In my country, healthcare professionals are more conscious about their health, and they usually avoid unhealthy behaviors. We expect that the person who advises others about health will follow the healthy lifestyle they are suggesting.

I became interested in knowing more about healthy food options. I went to a supermarket and was happy to see a variety of fruits and vegetables. But I was surprised to see that the prices of vegetables were sky-high, and red meat seemed cheaper than vegetables. Healthy foods are not affordable!. This is tough especially in an area like New York where rent is high and people do not have much money to spare. People are bound to limit their food expenditure. When I looked for ready-to-eat healthy foods, I found some salads, but the starting price was $8 USD. This is when I realized that it is not easy to have healthy foods for people who have no time to cook. It is easier to turn to fast foods that are cheaper and already prepared.

Coming to the U.S. came with many new experiences for me. As a Muslim, I do not drink alcohol. I never even saw a bottle of wine until an office Thanksgiving potluck party. As my co-workers were complementing the Bangladeshi and Indian foods I brought, I noticed that one of the doctors brought soda and alcoholic beverages to share. I knew it was normal for parties in the U.S. to serve alcohol, but this was a first for me. I liked the culture at my workplace because they did not ask questions and they respected my decision to abstain from drinking by offering me soda instead of wine.

I still remember the first day of the COVID-19 lockdowns in 2020. I went to the nearest supermarket to buy some necessary food items and essential household goods. While I was shopping I noticed that while I was busy thinking about getting enough fruits, vegetables, and legumes, other people were busy buying alcoholic beverages. It concerned me that people seemed to prioritize alcohol over the foods they would need to eat three times a day during a pandemic. I thought it was more responsible for me to save money for the future, rather than to purchase unnecessary things because there was so much uncertainty in the world at that time.

Another new experience was learning that women could be fired from work after returning from maternity leave. A co-worker had shared a story with me about a woman who had been forced by her manager to work the day before she had delivered her baby. The new mother came back after two months, but the manager did not allow her to work. As I had worked on different nutrition projects encouraging exclusive breastfeeding while living in Bangladesh, I knew that maternity leave is very important for a mother and baby’s life. This incident hurt me and left me questioning how the threat of being fired can impact the life of both the mother and the baby. If a mother has to return to work soon after her baby is born, for fear of losing her income, how will she ensure that her baby is exclusively breastfed? Moreover, she might fail to purchase enough food for her family and she might choose to eat unhealthy and cheap ultra-processed foods which can be harmful to health.

In one of my classes, I asked a professor about mandatory maternity leave in the U.S. and was shocked by the answer. The duration of maternity leave is 12 weeks, and it is not guaranteed that employers will pay throughout this period. It was distressing to hear that the U.S, a developed country, does not have strict maternity leave rules while many developing countries have paid maternity leave. When a mother has guaranteed maternity leave, it is easier to take care of the baby and ensure breastfeeding.

While the U.S. was behind many developing countries with regards to federal maternity leave requirements, they were ahead in other ways. In my country, tap water is not safe to drink. To purify the tap water we would have to boil it for 30 minutes to kill any bacteria or viruses, before drinking. In developing countries, many children become malnourished due to water-borne diseases and repetitive infection. Safe drinking water, hand washing, and hygiene are very important to prevent diarrhea, jaundice, and typhoid. It was a new experience for me to drink water directly from the tap here in New York and I was impressed.

Overall, I had different expectations from a developed country. I thought people would be more conscious of maintaining a healthy lifestyle, however, there are still many public health problems here in the U.S that are made worse by social injustice and health disparities. I am respectful of others' cultures and food habits. But I would like to request to be more conscious of dietary practices and healthy cooking styles to avoid diet-related chronic diseases. We can enjoy a party without alcohol and we can start from this St. Patrick's day.

"The Intersection of Public Health and Food Technology"

“If we are telling parents that breast is best, but most of them are going to use formula at some point, why aren’t we just trying to make breast milk?” - Laura Katz on why she founded Helaina.

Breast milk is considered to be the most appropriate food source for all infants because of the benefits it provides to both the infant and the breastfeeding person. . Breast milk provides all of the nutrients that are necessary for the physical and mental development of the babies. Human milk contains approximately 0.8% to 0.9% protein, 3% to 5% fat, 6.9% to 7.2% carbohydrates, and 0.2% ash (minerals). These bioactive components include immune proteins that support the infant's immune system helping them to fight disease, and decreasing their risk for infant mortality. Some studies suggest that breastfeeding may be associated with a lower risk of developing diet-related diet-related non-communicable diseases, such as type 2 diabetes. The WHO and CDC both recommend exclusively breastfeeding infants for the first six months of life and continue feeding with breast milk alongside complementary feeding until one year of age and up to two years of age.

Unfortunately, there are many various barriers to feeding with breastmilk. Some researchers, like Professor Laura Katz, have decided to search for a solution to make human breast milk more accessible to parents and infants, by providing parents with a better option to the formulas that are currently available on the market. Back on November 22, 2021, our team had the opportunity to sit with Laura on our Instagram live to learn more about her work. Laura Katz is an expert food scientist and alumni of NYU’s Graduate Program in Food Studies. She is also a professor of Food Science and Technology here at NYU! As a self-described “Milk Magician” she founded Helaina, a research and development company dedicated to improving the health and development of infants by making a first of its kind nature-equivalent human breast milk alternative. Her team works to replicate the unique components, such as immune proteins, found in breast milk using microbial fermentation; these proteins could provide infants with immunological benefits similar to those they would normally get from human breast milk. Helaina is giving parents a better option for their children that offers the closest nutritional benefits to breast milk compared to other products currently on the market. At the beginning of our discussion, Laura shared how she became interested in working in the food technology sector and how she came up with the idea for Helaina.

She stated that from a young age, she was obsessed with food and loved science. Then she graduated, and she wanted to broaden her understanding of food outside of the sciences because culture and behavior are so important in developing food products from a scientific perspective. This perspective allowed her to think further in terms of what it means to people and that turned into a lot of different jobs where I really started to fall in love with developing food products.

She decided to create Helaina because she saw a need for (or a gap in the current market of meat and dairy alternatives)…nobody cares what we are feeding our babies and pushing that into the future which really motivated Helaina. Helaina was making so many products and seeing where we're putting our dollars and seeing where we're putting in the effort but that wasn't happening for babies but what that really means is their parents because it's the mother who has to use their body to provide milk. It is not possible for everyone.

Finding an alternative to breast milk for infants is important because… almost all parents in the US rely on infant formula at some point due to medical issues, breast cancer or some diseases. It might prevent them from using their breastfeeds because the baby might not latch in the hospital during the first few days. Additionally, 25% of mothers go back to work within two weeks in the US. Two weeks maternity leave is not enough to recover from giving birth and they have to go back to work. Some mothers can try to pump breast milk, but it is cumbersome due to office work and a safe place to pump milk. I think the reason why somebody would reach for infant formula is really personal and there's so many reasons. Breast milk is the best option but that doesn't mean that we shouldn't innovate on the alternative to support parents with this idea.

Helaina is different from options that are currently on the market because…current formulas don't contain human proteins. Helaina is the first company ever to include human proteins into food. Moreover, we are really the first people to humanize formulas whereas current infant formulas depend on corn syrup, maltodextrin soy and that is the antithesis of what Helania is trying to do.

Breast milk is complex and composed of different kinds of components which help to build babies' immunity, improve gut health, brain development, and many other functions. As a scientific community, we have not yet been able to identify each of the things found in breast milk that have specific functions. However, we have been able to identify a unique set of proteins found in breast milk. Helaina’s goal is to recreate all of the unique proteins, but they are only able to make one at a time. They are able to use fermentation technology to recreate the proteins. To do this her team of food scientists and engineers take yeast and teach them how, or program them, to manufacture breast milk proteins.

We have a whole team of yeast engineers. We provide nutrition to yeast, and they multiply in large volumes, and they produce proteins. We make our proteins in giant fermenters, and we collect them and purify them.

At step two, we take the protein, and the immunology team looks at all of these functions in our protein. We can recreate protein in our lab and bring them to a consumer product. Parents who turned to formula will know what we're providing to them.

There are probably hundreds of proteins in breast milk but four or five comprises 90 percent of the proteins. So we are making one at a time and we are starting to scale up the production. Now our focus is to see what happened in the lab in scaling up the production of protein one with the manufacturer.

Helaina really wants to change what nutrition means to people right now. We think to include immunity in addition to nutrition, calories, vitamins, and minerals.

To hear more from our discussion with Laura Katz, watch the IGTV post on our Instagram page and recorded live.

Sources

Jeness R. The composition of human milk. Semin Perinatol. 1979;3(3):225-239.

Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013;60(1):49-74. doi:10.1016/j.pcl.2012.10.002

Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr. 2015;104(467):30-37. doi:10.1111/apa.13133

CDC. Breastfeeding faqs. Centers for Disease Control and Prevention. Published August 10, 2021. https://www.cdc.gov/breastfeeding/faq/index.htm

Event Recap: The Intersections of Food Law and Public Health

Nutrition Without Border’s latest event, “The Intersections of Food Law and Public Health,” took place on Zoom on Thursday, October 28th at 7pm. Our guest speaker was Julia McCarthy, Senior Program Officer at the New York Health Foundation.

Julia and our members discussed the importance of WIC (the Special Supplemental Nutrition Assistance Program for Women, Infants and Children) and SNAP (Supplemental Nutrition Assistance Program) for population health, targeted marketing tactics and legal loopholes used by food and beverage companies, and her food policy career path.

She highlighted the importance of SNAP in addressing hunger and non-communicable diseases including diabetes, hypertension, and heart diseases. SNAP aims to reduce food insecurity among low-income people and ensure farmers’ financial success 一 often goals that are at odds with each other if we want folks to have access to healthy food. Because most food that is subsidized by the government and grown in large, affordable quantities (e.g. wheat, corn) is used to produce unhealthy products, those products often dominate in SNAP participants’ food environments. Julia shed some light on the ongoing conversation of whether or not SNAP participants should have limitations on what they can purchase with their benefit dollars. Some argue items like soda or chips should be disallowed, but in areas of food apartheid and food insecurity, those items are often the only affordable choice. Limiting purchases may also exclude cultural foods and reinforce a white-washed version of “health,” and decrease individuals’ sense of autonomy.

While SNAP targets hunger, WIC is targeting mother and child nutrition. Therefore, only certain items approved by nutrition professionals can be purchased with WIC benefits. WIC used to use vouchers that could be used to purchase specific items. These vouchers protected users against rising grocery costs, but are cumbersome and difficult to navigate 一 especially for those who are not fluent in English.

Unlike SNAP, WIC has been proven to improve the overall diet quality of mothers and infants. WIC’s prescribed foods like vegetables and fruits that support dietary diversity. Beneficiaries cannot use the benefits to purchase ultra-processed foods or sugar-sweetened beverages.

Several barriers to enrollment in these programs exist in New York: undocumented folks are excluded and many legal immigrants fear political retaliation for participating. People experiencing homelessness, without cooking supplies or access to refrigeration are not able to take advantage of the program. And finally, the income threshold is such that if beneficiaries make slightly more money 一 think a $0.50 raise or being granted full-time hours 一 they experience an even greater hardship than before because they disqualify from benefits. Being “time poor” in general is a barrier to healthy eating: people who work hourly or have inconsistent schedules may not be able to manage meal plans, shopping, budgeting, and cooking. Fresh food delivery was discussed as a potential option to deliver healthy foods in areas with poor access, but short shelf life, and the necessity of a family member at home to receive the package are some inevitable challenges.

Julia also expressed the negative impact of food and beverage company marketing specifically to marginalized communities (who are at greater risk of nutrition-related diseases due to racism, low socioeconomic status, and high levels of allostatic stress) and children. She discussed with our members the idea of “corporate personhood”, and how the First Amendment is being used to allow food companies to continue aggressively marketing their products. We provided members with the link to a webinar and a two-pager from the UConn Rudd Center for Food Policy and Health, if they are interested in learning more about targeted marketing.

Lastly, Julia reminded members that food policy and food law career paths are not limited to law students. She says that strong writing and public speaking skills, and analytical ability, serve her well in the field. Our members loved speaking to and learning from Julia, and we look forward to our next event!