NICBC student Thanit (Pao) Vinitchagoon shares one of the most heartwarming stories for him when he was working as a clinical dietitian at a hospital in Bangkok, Thailand.
Many patients came to the chemotherapy unit to see me when I was working as a clinical dietitian in Bangkok. One of my patients was a 69-year-old woman, Mali (which literally means Jasmine), who survived stage III breast cancer. I first met Mali in 2013 when her oncologist referred her to see me. She is among the few patients with whom I remain in contact since I left the hospital in 2015. Now, six years later, I had a chance to interview her for my writing class, and it ended up being a beautiful story I need to share here.
Mali grew up in an old-town area of Bangkok. Her grandparents were immigrants from China who opened a noodle stall using some space in and in front of their house to lay foldable desks and chairs for customers. This typical “restaurant” is familiar during that time for a layperson to sit down, eat quickly, then move on. Her typical breakfast was a pork congee with X-shaped fried flours called “Pa Tong Go,” along with a glass of freshly brewed soy milk with millets and tapioca pellets. This breakfast was an everyday staple, as the stall was very near her home.
She didn’t attend the school after grade six, so only a little part of her life was in school. Her lunch during her adolescence to young adulthood was a variety of dishes sold at the stall, ranging from typical noodle soup to a more sophisticated Chinese duck and fried pork belly with rice. The big meal for her was dinner, which always contained enough food for her entire family of eight to enjoy. Examples included rice, a bowl of soup, a plate of stir-fried vegetables, and a fluffy omelet. Meat-based dishes like pork meat, pork belly, chicken, or fish would be served at most twice a week, and fruit was inconsistent depending on the availability. Though her family was not wealthy, Mali’s parents always made sure that there were enough foods, and each meal had at least one animal-based dish with a lot of grease or fat, and a wide array of Chinese herbs and spices. These dishes are considered “good” for affluent Chinese families. Vegetables were considered poor people’s food, so most of the time, they were simply there to add volume to the meal, served stir-fried or as a hotchpotch.
Compared to current dietary guidelines and recommendations for Thai, her “good foods” guidelines seemed to give higher emphasis on fats and animal-based products and less emphasis on fruits and vegetables. However, she didn’t consume an excessive amount of meat due to financial status and she ate both greasy and non-greasy dishes together in a meal. Combined with the fact that she intensively helped her family work, her physical activity level was above average, which enabled her to stay in shape throughout her adulthood. However, she started to become more overweight as time passed, probably due to the change in the environment, and also because of decreased metabolism due to aging.
Her story became more interesting when she was diagnosed with breast cancer six years ago. At that time, she met me and learned about nutrition strategies to prevent malnutrition during cancer treatment. I introduced her to the concept of healthy eating when she finished her chemotherapy course. She took it so seriously until she became too strict with her diet because she thought that cancer was a consequence of her past diet. I discovered this in the follow-up visit, where she told me that she was not enjoying the foods. Her weight decreased, most likely due to malnutrition.
The idea of blaming historical food consumption as cancer-triggering seemed to be a popular misconception in cancer patients. Many had an intense fear of eating to the point that they lost weight as rapid as someone with Anorexia Nervosa. Losing weight in overweight/obese patients may currently be socially acceptable, but not in the scenario of receiving active cancer treatment. It may further increase the risk of malnutrition, which is already likely to have occurred due to side-effects from treatments. I recommended modifying her comforting dishes to make them healthier, rather than changing her entire eating pattern. Mali took some time to realize that the point was not to be too strict with eating “healthy foods,” but instead finding a balance between comfort and health. She is currently enjoying developing healthier comforting recipes for people in the cancer support group.
After witnessing Mali’s story unfold, I believe that many people in the past were able to live a balanced life with regards to eating and physical activity. However, changes in the current environment may cause diseases in those who struggled to find a new balance. I learned from Mali that former lifestyle and culture combined with more recent knowledge in nutrition and health might be the most sustainable way to live for many older people in this rapidly changing generation.
Thanit (Pao) Vinitchagoon is a U.S.-based Registered Dietitian who worked in a hospital in Bangkok, Thailand prior to joining the Friedman School as a Ph.D. student in Nutrition Interventions, Communications, and Behavior Change. His interest is in eating disorder prevention and the “non-diet” approach to nutrition and health. He enjoys eating out occasionally in different places since experimenting with new foods (for him) is very fun!