Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 11: Eating for Good Health (introduction...) Main Foods and Helper Foods (introduction...) Important vitamins and minerals Eating Better for Less Money Harmful Ideas About Eating Poor Nutrition Can Cause Disease (introduction...) Anemia Beriberi Problems from eating too much food or the wrong kind of food Ways to Work toward Better Nutrition (introduction...) Trying a new idea Working toward a balance between people and land

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 11: Eating for Good Health

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A woman needs good food to do her daily work, to prevent illness, and to have safe and healthy births. And yet, around the world, more women suffer from poor nutrition than any other health problem. This can cause exhaustion, weakness, disability, and general poor health.

¨ Many illnesses could be prevented if people had enough good food to eat.

There are many reasons for hunger and not eating well. One main reason is poverty. In many parts of the world, a few people own most of the wealth and the land. They may grow crops like coffee or tobacco instead of food, because they can make more money that way. Or poor people may farm small plots of borrowed land, while the owners take a big share of the harvest.

This poverty is hardest on women. This is because in many families women are fed less than men, no matter how little there is to eat. So the problems of hunger and poor nutrition will never be completely solved until land and other resources are shared fairly, and women are treated equally with men.

Still, there are many things people can do now to eat better at low cost. By eating as well as they can, they will gain strength. And when people are not feeling hungry every day, they are more able to think about their families’ and communities’ needs and to work for change.

Main Foods and Helper Foods

In much of the world, most people eat one main low-cost food with almost every meal. Depending on the region, this may be rice, maize, millet, wheat, cassava, potato, breadfruit, or plantain. This main food usually provides most of the body’s daily food needs.

By itself, however, the main food is not enough to keep a person healthy. Other ‘helper’ foods are needed to provide protein (which helps build the body), vitamins and minerals (which help protect and repair the body), and fats and sugar (which give energy).

The healthiest diets have a variety of foods, including some foods with protein, and fruits and vegetables rich in vitamins and minerals. You need only a small amount of fat and sugar. But if you have problems getting enough food, it is better to eat foods with sugar and fat than to eat too little food.

¨ Good nutrition means eating enough food and the right kind of food for the body to grow, be healthy, and fight off disease.

A woman does not need to eat all the foods listed here to be healthy. She can eat the main foods she is accustomed to, and add as many helper foods as are available in her area.

Helper Foods

Important vitamins and minerals

There are 5 important vitamins and minerals that women need, especially women who are pregnant or breastfeeding. The 5 are: iron, folic acid (folate), calcium, iodine, and vitamin A.

Iron

Iron is needed to make blood healthy and to help prevent weak blood (anemia). A woman needs to get a lot of iron throughout her life, especially during the years she has monthly bleeding and during pregnancy.

These foods have a lot of iron: · meat (especially liver, heart, and kidney) · blood · chicken · eggs · fish · beans · grasshoppers, crickets, termites · peas Figure These foods also have some iron: · cabbage with dark-colored leaves · potatoes · cauliflower · lentils · brussels sprouts · turnips · sunflower, sesame, pumpkin seeds · strawberries · dark green leafy vegetables · pineapples · yams · seaweed · broccoli · dried fruit (especially dates, apricots, and raisins) · black-strap molasses

It is possible to get even more iron if you:

· Cook food in iron pots. If you add tomatoes, lime juice, or lemon juice (which are high in vitamin C) to the food while it is cooking, more iron from the pots will go into the food.

· Add a clean piece of iron - like an iron nail or horseshoe - to the cooking pot. These should be made of pure iron, not a mixture of iron and other metals.

· Put a clean piece of pure iron, like an iron nail, in a little lemon juice for a few hours. Then make lemonade with the juice and drink it.

¨ It is best to eat iron foods along with citrus fruits or tomatoes. These contain vitamin C, which helps your body use more of the iron in the food.

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Folic acid (folate)

The body needs folic acid to make healthy red blood cells. Lack of folic acid can lead to anemia in women and severe problems in newborn babies. So getting enough folic acid is especially important during pregnancy.

¨ Avoid cooking food for a long time. This destroys folic acid and other vitamins.

Good sources of folic acid are: · dark green leafy vegetables · whole grains · mushrooms · liver · meats · fish · nuts · peas and beans · eggs Figure

Calcium

Everyone needs calcium to make their bones and teeth strong. In addition, girls and women need extra calcium:

· during childhood. Calcium helps a girl’s hips grow wide enough to give birth safely when she is fully grown.

· during pregnancy. A pregnant woman needs enough calcium to help the baby’s bones grow, and to keep her own bones and teeth strong.

· during breastfeeding. Calcium is necessary for making breast milk.

· during mid-life and old age. Calcium is needed to prevent weak bones (osteoporosis).

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These foods are rich in calcium: · milk, curd, yogurt · cheese · ground sesame · bone meal · green leafy vegetables · almonds · beans, especially soy · shellfish · lime (carbon ash) Figure

To increase the amount of calcium you get from food:

· Soak bones or egg shells in vinegar or lemon juice for a few hours, and then use the liquid in soup or other food.

· Add a little lemon juice, vinegar, or tomato when cooking bones for soup.

· Grind up egg shells into a powder and mix with food.

· Soak maize (corn) in lime (carbon ash).

Sunshine will help you use calcium better. Try to be in the sun at least 15 minutes every day. Remember that it is not enough to just be outdoors. The sun’s rays must touch the skin.

Iodine

Iodine in the diet helps prevent a swelling on the throat called goiter and other problems. If a woman does not get enough iodine during pregnancy, her child may be mentally slow. Goiter and mental slowness are most common in areas where there is little natural iodine in the soil, water, or food.

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The easiest way to get enough iodine is to use iodized salt instead of regular salt. Or you can eat some of these foods (either fresh or dried): · shellfish (like shrimp) · fish · seaweed · cassava · cabbage Figure

¨ The easiest way to get enough iodine is to use iodized salt instead of regular salt.

If iodized salt or these foods are hard to get, or if there is goiter or mental slowness in your area, check with the local ministry of health to see if they can give iodized oil by mouth or by injection. If not, you can make an iodine solution at home with polyvidone iodine (an antiseptic that is often available at a local pharmacy). It contains 6 ml of iodine per drop. To make an iodine solution to drink:

1. Pour 4 glasses of clean drinking water into a jug or jar. Store iodine at room temperature and in dark containers to protect it from light. Figure 2. Add 1 drop of polyvidone iodine. In areas where there is little natural iodine, everyone over 7 years old should drink 1 glass of this iodine solution every week of her or his life. This is especially important for pregnant women and children.

Vitamin A

Vitamin A prevents night blindness and helps fight off some infections. Many pregnant women have problems with night blindness, which probably means that their diet lacked vitamin A before they got pregnant. The problem shows up when pregnancy places extra demands on the body.

Dark yellow and green leafy vegetables, and some orange fruits, are rich in vitamin A.

Lack of vitamin A also causes blindness in children. By eating foods rich in vitamin A during pregnancy, a woman can increase the amount of vitamin A her baby will get in breast milk.

Eating Better for Less Money

When money is limited, it is important to use it wisely. Here are some suggestions for getting more vitamins, minerals, and proteins at low cost:

1. Protein foods. Beans, peas, lentils, and other similar foods (called legumes) are a good, cheap source of protein. If allowed to sprout before cooking and eating, they have more vitamins. Eggs are one of the cheapest sources of animal protein. Liver, heart, kidney, blood, and fish are often cheaper than other meats and are just as nutritious.

2. Grains. Rice, wheat, and other grains are more nutritious if their outer skins are not removed during milling.

3. Fruits and vegetables. The sooner you eat fruits and vegetables after harvesting, the more nutrition they have. When you store them, put them in a cool, dark place to preserve vitamins. Cook vegetables in as small an amount of water as possible, because vitamins from the vegetables go into the water during cooking. Then use the water in soups or drink it.

The tough outside leaves or tops from vegetables like carrots or cauliflower contain many vitamins and can be used to make healthy soups. For instance, cassava (manioc) leaves contain 7 times as much protein and more vitamins than the root.

Many wild fruits and berries are rich in vitamin C and natural sugars, and can provide extra vitamins and energy.

4. Milk and milk products. These should be kept in a cool, dark place. They are rich in body-building proteins and in calcium.

5. Avoid spending money on packaged foods or vitamins. If parents took the money they often use for sweets or sodas (fizzy drinks) and spent it on nutritious foods, their children would be healthier for the same amount of money.

Since most people can get the vitamins they need from food, it is better to spend money on nutritious foods than on pills or injections. If you must take vitamins, take pills. They work as well as injections and cost less.

You can buy more nutritious food than packaged food for the same amount of money.

Harmful Ideas About Eating

In many parts of the world, certain traditions and beliefs about women and food are more harmful than helpful. For example:

It is not true that girls need less food than boys. Some people believe that boys need more food. But these people are wrong! Women work just as hard as men in most communities, if not harder, and need to be as healthy. Girls who are healthy and well-fed during childhood grow up into healthy women, and have fewer problems at school and at work.

It is not true that women should avoid foods during pregnancy and breastfeeding. In some communities, people believe that a woman should avoid certain foods - like beans, eggs, chicken, milk products, meat, fish, fruits, or vegetables - at different times in her life. These times may include her monthly bleeding, pregnancy, immediately after childbirth, while breastfeeding, or during menopause. But a woman needs all these foods, especially during pregnancy and while breastfeeding. Avoiding them can cause weakness, illness, and even death.

It is not true that a woman should feed her family first. A woman is sometimes taught to feed her family before herself. She eats only what is left and often does not get as much food as the rest of the family. This is never healthy. And when a woman is pregnant, or has just had a baby, it can be very dangerous.

If a family does not help a woman eat well, we encourage her to do what she must to get enough food. She may need to eat while cooking, or hide food and eat it when her husband is out of the house.

It is not true that a sick person needs less food than a healthy person. Good food not only prevents disease but also helps a sick person fight disease and become well again. As a general rule, the same foods that are good for people when they are healthy are good for them when they are sick.

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Poor Nutrition Can Cause Disease

Because girls and women often get less food - and less nutritious food - than they need, they are more likely to get sick. Here are some common illnesses caused by poor nutrition.

Anemia

A person with anemia has weak blood. This happens when red blood cells are lost or destroyed faster than the body can replace them. Because women lose blood during their monthly bleeding, anemia is often found in women who are between puberty and menopause. About half of the world’s pregnant women are anemic, because they need to make extra blood for the growing baby.

Anemia is a serious illness. It makes a woman more likely to get other kinds of diseases, and affects her ability to work and learn. Anemic women are more likely to bleed heavily or even die during childbirth.

Signs:

· pale inner eyelids, tongue, and nails
· weakness and feeling very tired
· dizziness, especially when getting up from a sitting or lying position
· fainting (loss of consciousness)
· shortness of breath
· fast heartbeat

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Causes of anemia:

The most common cause of anemia is not eating enough food rich in iron, since iron is needed to make red blood cells. Other causes are:

· malaria, which destroys red blood cells

· any kind of blood loss, such as:

- heavy monthly bleeding (an intra-uterine device, or IUD, can make bleeding heavier)
- childbirth
- bloody diarrhea (dysentery) from parasites and worms
- bleeding stomach ulcers
- a wound that bleeds a lot

¨ For more information about malaria, parasites, and worms, see Where There Is No Doctor or another general medical book.

Treatment and prevention:

· If malaria, parasites, or worms are causing your anemia, treat these diseases first.

· Eat foods rich in iron, along with foods rich in vitamins A and C, which help the body absorb iron. Citrus fruits and tomatoes are rich in vitamin C. Dark yellow and dark green leafy vegetables are rich in vitamin A. If a woman cannot eat enough foods rich in iron, she may need to take iron pills.

· Avoid drinking black tea or coffee, or eating bran (the outer layer of grains) with meals. These can prevent the body from absorbing iron from food.

· Drink clean water to prevent infection from parasites.

· Use a latrine for passing stool, so that worm eggs will not spread to food and water sources. If hookworms are common in your area, try to wear shoes.

· Space births at least 2 years apart. This will give your body a chance to store some iron between pregnancies.

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Beriberi

Beriberi is a disease caused by lack of thiamine (one of the B vitamins), which helps the body turn food into energy. Like anemia, beriberi is most often seen in women from puberty to menopause, and in their children.

Beriberi occurs most often when the main food is a grain whose outer skin has been removed (for example, polished rice) or a starchy root, like cassava.

Signs:

· not wanting to eat
· severe weakness, especially in the legs
· the body becomes very swollen or the heart stops working

Treatment and prevention:

Eat foods rich in thiamine, like meat, poultry, fish, liver, whole grain cereals, legumes (peas, beans, clover), milk, and eggs. If this is difficult, a person may need thiamine pills.

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Problems from eating too much food or the wrong kind of food

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If a woman weighs too much or eats too much fat, she is more likely to have high blood pressure, heart disease, a stroke, gallstones, diabetes, and some cancers. Being overweight can also cause arthritis in the legs and feet.

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People who weigh too much should lose weight by exercising more, and by replacing fatty and sweet foods in their diet with fruits and vegetables. Here are some suggestions for cutting down the amount of fat in the diet:

· When cooking, try to use as little butter, ghee, lard, or oil as possible. Or cook with broth or water instead.

· Remove fat from meat before cooking. Do not eat the skin of chicken or turkey.

· Avoid processed snack foods that are high in fat, like chips and crackers.

Diabetes

People with diabetes have too much sugar in their blood. This disease is usually more serious if it starts when a person is young (juvenile diabetes). But it is most common in people over age 40 who are overweight.

Early signs:

· always thirsty
· urinates often and a lot
· always tired
· always hungry
· weight loss
· frequent vaginal infections

¨ Diabetes is more likely to develop during pregnancy than at other times. If you are pregnant and are always thirsty or are losing weight, see a health worker who can test your urine for sugar.

Later, more serious signs:

· itchy skin
· periods of blurry eyesight
· some loss of feeling in the hands or feet
· sores on the feet that do not heal
· loss of consciousness (in extreme cases)

All these signs may be caused by other diseases. To find out whether you have diabetes, you can test your urine yourself. Use special paper strips, like Uristix, that change color when dipped in urine that has sugar in it. If the strips are not available, see a health worker to get a simple urine test for sugar.

Treatment:

If you have diabetes and are less than 40 years old, you should be treated by a health worker whenever possible. If you are over 40, you may be able to control diabetes by watching your diet:

· Eat smaller meals more often. This helps keep the same amount of sugar in the blood.

· Avoid eating a lot of sweet foods.

· If you are overweight, try to lose weight.

· Avoid foods high in fat (for example, butter, ghee, lard, and oils), unless you have trouble getting enough food to eat.

If possible, you should also see a health worker regularly to make sure your illness is not getting worse.

¨ There may be plants in your area that are helpful for diabetes. Check with a health worker.

To prevent infection and injury to the skin, clean your teeth after eating, keep your skin clean, and always wear shoes to prevent foot injuries. Check your feet and hands once a day to see if you have any sores. If you have a sore and there are any signs of infection (redness, swelling, or heat), see a health worker.

Check your feet once a day to see if you have any sores or signs of infection.

Whenever possible, rest with your feet up. This is especially important if your feet get darker in color and become numb. These signs mean that the blood flow to and from your feet is poor.

Other health problems that can be caused or made worse by poor nutrition: · high blood pressure · weak bones · constipation · stomach ulcers, acid indigestion, and heartburn For more information on stomach ulcers, indigestion, and heartburn, see Where There Is No Doctor or another general medical book.

Ways to Work toward Better Nutrition

There are many different ways to approach the problem of poor nutrition, because many different things help cause the problem. You and your community must consider the possible actions you might take and decide which are most likely to work.

Here are a few examples of ways to improve nutrition. These suggestions can help you grow more food or different kinds of food, or store it better so the food does not spoil. Some of these examples bring quick results. Others work over a longer time.

Some ways people can improve their nutrition Family gardens Community gardens Rotation of crops Every other planting season, plant a crop that returns strength to the soil - like beans, peas, lentils, alfalfa, peanuts, or some other plant with seeds in pods (legumes or pulses). Figure Try to grow a variety of foods. That way, even if one crop fails there will still be something to eat. Irrigation Contour ditches prevent the soil from washing away. Food cooperatives The community can buy large amounts of food at lower prices. Fish breeding Natural fertilizers Better food storage

Trying a new idea

Not all the suggestions in this chapter are likely to work in your area. Perhaps some will work if they are changed for your particular community and the resources at hand. Often you can only know whether something will work or not by trying it - that is, by experiment.

When you try out a new idea, always start small. If you start small and the experiment fails, or something has to be done differently, you will not lose much. If it works, people will see that it works and can begin to use it in a bigger way.

Here is an example of experimenting with a new idea:

You learn that a certain kind of bean, such as soya, is an excellent body-building food. But will it grow in your area? And if it grows, will people eat it?

Start by planting a small patch - or 2 or 3 small patches under different kinds of conditions (for example, with different kinds of soil or using different amounts of water). If the beans do well, try cooking them in various ways, and see if people will eat them. If so, try planting more beans using the conditions in which they grew best.

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You can also try out even more conditions (for example, adding fertilizer or using different kinds of seed) in more small patches to see if you can get an even better crop. To understand what helps and what does not, try to change only one condition at a time and keep the rest the same.

¨ Do not be discouraged if an experiment does not work. Perhaps you can try again with certain changes. You can learn as much from your failures as from your successes.

Here is an example of adding animal fertilizer (manure) to see if it helps beans grow. This person planted several small bean patches side-by-side, under the same conditions of water and sunlight, and using the same seed. Before planting, each patch of soil was mixed with a different amount of manure, something like this: Figure This experiment shows that a certain amount of manure helps, but that too much can harm the plants. This is only an example. Your experiments may give different results. Try for yourself!

Other ideas to experiment with · To increase the amount of food a piece of land will produce, try planting different kinds of crops together. For example, plants that grow along the ground can be mixed with plants that grow tall. Fruit trees can be planted above both. Or plants that take a shorter time to grow can be mixed with those that take a longer time. Then the first crop can be harvested before the second crop gets too large. · If you must plant cash crops (non-food crops that you sell), try planting food crops together with the cash crops. For example, plant nut or fruit trees to shade coffee. Or plant cassava with cotton. · Try to find nutritious plants that grow well in local conditions, so that you will need less water and fertilizer for good results. By planting breadfruit and cacao together, this family can earn some money and grow more food for themselves - with the same amount of land.

Working toward a balance between people and land

Most food comes from the land. Land that is used well can produce more food. But even the best used piece of land can only feed a certain number of people. And today, many of the people who farm do not have enough land to meet their needs or to stay healthy.

For this reason, some people argue that ‘the small family lives better’. For many poor families, however, having many children is an economic necessity. Because of the work they do to help the family, children of poor families often produce more than they cost by the time they are 10 or 12 years old. Having a lot of children also makes it more likely the parents will have someone to give the help and care they need in old age.

So lack of social and economic security creates the need for parents to have many children. Therefore, the answer to gaining a balance between people and land does not come from telling poor people to have smaller families. It comes from sharing the land more fairly, paying fair wages, and taking other steps to overcome poverty. Only then can people afford small families. Then we can hope to achieve a lasting balance between people and land.