Shireen:  In today’s episode, we discuss nutrition and nutrition literacy in the Chinese community with Amy Yiu, a passionate advocate in this field. We explore unique challenges, cultural factors, and differences between immigrants and native born individuals. We also touch on popular diets, traditional Chinese medicine, common misconceptions, and the impact of social determinants of health. Stay tuned.

 Amy is a nutrition counselor, educator, author, speaker, media dietician, and the founder of Libra Nutrition since 2008. She was recognized as one of the top 10 dieticians by today’s dietician magazine in 2023. She offered 40 diabetes workshops with over 300 people that attended in just the past year at a diabetes clinic in her community. Goodness, Amy, 300 people and offering over 40 workshops. That’s quite a bit. 

Amy Yiu: Yes, that’s quite a bit. And offer in three languages English, Cantonese and Mandarin. 

Shireen: Okay. All right. So, so just, just no, no worries at all there. No big deal at all. 

Amy Yiu: Right. 

Shireen: So Amy diving into the podcast and you, can you tell us a little bit more about your background and just what made you become so passionate about advocating for nutrition, nutrition literacy within the Chinese community?

Amy Yiu: Sure I would love to. I was born and grew up in Hong Kong and moved to Singapore to study food technology before relocating to Vancouver because I am passionate about learning food, nutrition, and wellness. I after graduated from UBC, University of British Columbia, I worked in the hospital for just under two years.

Because I realized that I really more passionately about, you know, promoting public health in the community. So I left my hospital job, I started my private practice and also found Libra Nutrition. So at any time I would recruit a number of university graduates or undergraduate students, or a dietician to join me, to serve the public as well as the community. 

And one of the reason I’m more passionate about advocating the nutrition and nutrition literacy for the Chinese communities is because as a first generation immigrant, I know it could be quite challenging and difficult to navigate the food system in the new country with a very different culture. So that’s why I like to help other people with similar, you know, backgrounds or uh, circumstances to eat healthier and to learn more about the local food system and incorporate the food into their traditional. Chinese diets. 

Shireen: So you have a very strong focus on the Chinese community. Help us understand what are some of the unique challenges that the Chinese community faces in terms of that nutrition and diabetes management?

Amy Yiu: Yeah, over the years I have, you know, counsel so many people and a lot of them are Chinese because the language I speak and they know I understand their culture and eating habits. So I often receive questions about, you know, how they can eat healthier when they adopt some of the, you know, recipes from the western diets and they get confused because, you know, their upbringing are very different.

The culture and the eating habits could be very different. So I see this as a challenging and that’s why over the years I have done many, many in-person workshops or I do a lot of media work, tv, newspaper. I have written over 500 articles for the Chinese newspapers and magazines and also understand what are their challenges, especially for the older immigrants, english as their second languages and they are not familiar with the healthcare system as well. So those are some of the challenge I perceive. 

Shireen: And that is interesting. Can you also just dive a little bit more into some cultural factors that may influence dietary habits specifically within the Chinese community?

Amy Yiu: Yeah, I can share some examples. So one example is the Chinese like to stay together in a big household. I’m in the family, so you will see two or three generations with the grandparents and parents and younger children. They live together and it’s very common for them to share family meals on the dining table.

So we eat with both and then a few dishes to share the best one. The other one is eating out is a very common social activity. So just like in the community I live, you can find all kind of restaurants, Western, Japanese, Korean, Vietnamese, whatever you name it, we have it there. 

And we also celebrate a lot of festival throughout the year, quite a few. So Chinese New Year, mid-autumn festivals, dragon Boat Festival is coming up and we love to use food to celebrate. So quite often those food are high in carbohydrate, sugar, and sodium, but they just taste so good because we eat it as a tradition. So those are some of the challenge in terms of their cultural habits as well as cultural background. 

Shireen: You know, you talked earlier about helping people navigate, especially as they’re exposed to sort of the American culture, the diet, eating habits, all of that. In your work, do you notice any notable differences, again, in nutrition, literacy, dietary habits between those that may be immigrants and those that are perhaps native born individuals?

Amy Yiu: That’s a very good question. For example, some of the resources we use here in Canada, one example is the new Health Canada guide. You can see the use of plates to tell people, you know, eat half a plates of vegetables and quarter protein, high food in a protein, and then quarter in grains, whole grains, right?

So visually that doesn’t quite make sense to some of them because we don’t eat with the plates. So automatically they try to, you know, figure out how they can put their food in a plate so that they believe it is healthier for them. And because Vancouver is so multicultural and you can buy a lot of food from importer from Asia, so a lot of them tend to, you know, buy those foods they’re family with and didn’t really have the opportunity to learn.

That’s why one of my work in the past, I work as a supermarket tour leader. So I actually brought, you know, groups of people to the supermarket and bring them to learn about, you know, other food choices from aisles to aisles, like the yogurt. So there’s a huge section of yogurts and, you know, dairy, it’s not a really common staples in our home country for, because some of the people, they have lactose intolerance, so they’re just not common and the prices are a lot more expensive back home as well. So this is just some of the examples I can think of when it comes to, you know, the cultural difference or the nutrition difference in different cultural group. 

Shireen: Yeah. Another, uh, potential barrier that I may assume maybe around language? How does a barrier like language perhaps impact health literacy? And again, nutrition literacy within the community, within the Chinese community? 

Amy Yiu: For language, it’s less a difference between, you know, the, uh, older generation, first generation immigrants, or those who are born here. Those who are born here, of course you don’t have the barrier, but for older first generation immigrants, If they come here, some of them have to learn English, you know, in their fifties and sixties. So you can imagine this, imagine it’s quite, quite challenging to, to do this.

 And then they have to translate some of the English term to Chinese term before they can understand fully. And there’s a lot of technology we use when it comes to, you know, going to see a doctor and then they’re telling you all this, you know, diagnosis and medication in the English term and you are fortunate sometimes you can speak with, uh, you know, someone to understand your language and cultures, but that’s not always the case. 

Shireen: I find that interesting. I think one of the other things that comes to mind is what we hear normally is questions around fad diets, things like, it’s keto right for me, whichever it may be, a low carb diet, keto, whatever. How do you see the prevalence of these popular sort of fad diets taking over communities and really, and really sort of navigating them through making food choices for themselves? How do these trends get incorporated? Do they get incorporated and then how do you navigate them through that? 

Amy Yiu: Yeah, there’s so many bad diets as well as misinformation on the internet. Like if you ask how many people got their nutrition information or health related information from the internet, especially the past few years. So it’s very hard for them to, you know, distinguish which one is true, which one are not. And of course they hear this piece and pieces and try to incorporate.

So what I do is trying to use their language, easy to understand, plain language, to explain the pros and cons of different diets. The key is to understand what you need because everybody is different. You have different kind of, you know, chronic health issues or lifestyles because diet is really a choice of lifestyle. The one that suits you is the one that you can use it for a long time. You can get on it for a long time without any side side effects to your chronic health issue. 

One example is for, if you have diabetes. If you go on a keto diet, you cut out a lot of the carbohydrates, whether that’s complex carbohydrates or simple carbohydrates, then you tip the scale, your cholesterol become high because they, they thought they can eat like deep fried chickens and fatty meat only, uh, in addition to whatever they, they eat. So, that could be quite challenging. 

A lot of time when I do media work, you know, the listener call into the radio station and ask, you know, what do you think about keto diet? What do you think about intermittent fasting? So we got a lot of those question and that’s why I have written a lot of articles and interview to explain how you could, you know, get the benefit of some of them. You don’t have to follow them. A hundred percent. 

Shireen: Which also takes me to another question. I know, so I come from the South Asian community and within that community there’s a lot of emphasis on, uh, herbal medicines. And I know the Chinese culture also looks to that how, again, how do you address traditional Chinese medicine and overall Eastern medicine in relation to nutrition and diabetes management. And how do you really incorporate or do you incorporate these practices into your own work? 

Amy Yiu: Well, I grew up in a Chinese family, very traditional family. I still remember my mom used to boil bone broth in the past few years. bone broth become so popular, right? I said, oh, I have been drinking bone broth since the age of three or four years old.

And we go to traditional Chinese medicine doctors as well. So I myself believe in it, and I have business. A lot of the patients that come to me, they, you know, receive the benefits by going to, you know, acupuncture or traditional Chinese medicine herbs. So as a dietician, what I do is I explain, you know, what are those herbs are, by learning from, actually from a registered traditional Chinese medicine doctor.

We work together very closely because I want to understand what is their rationale, how they treat people, what are the, you know, recommendation they give to their patients?. So if they tell people this list of food are good for you, and then I will try to understand if they might or might not have all the nutrients they need from the Western medicine kind of angle.

And also trying to figure out if there are any herbs or medication interaction. That’s the key. Because of my advantage, I understand very well. I know where to find the reliable sources. I use a lot of databases. I have a team that I can access to. We have pharmacists and doctors and specialists in our team. So I provide sort of comprehensive care to those people who choose to go to traditional Chinese medicine or alternative medicine as their part of their treatment. 

Shireen: And I like your approach. And what you’re saying is, it’s not to say that it’s all or none. It is you first learn about it and then from there you help the person navigate how that can be useful to them, how it can add value to them. But it, and of course then also navigating to say like, It isn’t a substitute for what other things are supposed to do as well, and then, right, 

Amy Yiu: That’s right, that’s right. 

Shireen: Then how, how do you navigate when, as you’re working with individuals? Because individuals, oh, medicine that, you know, they, they hook me in there, it doesn’t work. Or this other alternative that I have will work better because it worked for a certain family member. And again, I just base this on what I see in the South Asian culture time and again. Do you come across anything like this? And again, how do you help people navigate that? 

Amy Yiu: All the times. Well, first I thank them for telling me what they are using because it, it takes courage, right? Sometimes what they believe, they don’t know how the healthcare professional will perceive. So, and also listen, really listen carefully and effectively understand why they do that. There must be a reason, right? So maybe they have some side effects they get from. The Western medication or they cannot really afford because drugs could be expensive.

One example was, I can share with, story with you is one of my client with diabetes went on Ozempic and he lost a lot of weight and he has no energy. And so that’s why he come to me and he’s also trying to seek other help from the traditional Chinese medicine to see if he can get off or reduce the dose of the Ozempic so then he can gain his life back because he’s working part-time, he has no energy to go out and do the things he used to love. So that’s some of the challenge, I hear from my patient. 

Shireen: My next question to you is more centered around some misconceptions that if you could share with us, are there any misconceptions or myths about nutrition, diabetes management within the Chinese community that you commonly see? And again, how do you address them within your practice? 

Amy Yiu: Often when I ask people, you know how you feel when you were told you have diabetes or heart disease or other chronic health issue, the first thing they ask is, do I have to give up my favorite traditional food? Rice, noodles, breads and buns, and then can they still have it or enjoy it because it’s difficult to cook or eat with your family if you are on a very restricted diet.

 Again, another story. One of my clients went to a weight loss clinic and you know, she was told, you cannot have noodles anymore because what a, what the healthcare professional done was to Google. So that kind of noodle, oh, that’s a lot of carbohydrate and you’re not supposed to eat it, but apparently it is okay to eat pizza. So, so you got really confused and was struggling with it. So some of them, as you know, they felt that they have to be going on a diabetic diet, which is very different from what they, their family eats. So those are some of the myth. 

Shireen: And you know, I think you pointed out to something that is so intrinsic within the way, um, health healthcare operates, which is the immediate, no, you cannot do X. Right? For the most part, it tends to be those types of foods that there’s perhaps not as much familiarity with, which is what a health professional may say no, you cannot eat that, just because there again, there’s that familiarity that’s lacking. How do you help with some of this conflicting information right? To where that health professional is telling him, no, you cannot eat noodles, but yeah, pizza, you can have it occasionally, which I find so intriguing. And then with what you are saying, which is to say it is, okay, this is what the path looks like, but how does one as a patient, really try to navigate sort of that conflict in trying to, in which I, which I think is just terrible, where we have to put a person in a position to pick between their culture and their health. 

Amy Yiu: Yeah, that’s a very good question. Um, I think what they do sometime is to, they go back to their home country to try to get information how to manage certain diseases because the language, this language they use, the food they eat.

However, if they do that, sometimes they might be different. You know, if the healthcare system are very different, they might not understand how like Canadian work here, some of the medication may be different. So then they get more confused because there’s more difference between the two countries or, the healthcare system.

So what I do is I tell them, you know, what they can eat more instead of what they cannot eat. You know, once they open their mind, they know that, you know, that’s what I eat. How about you adding this one and adding that one? So a lot of the handouts I created myself, I’m very cultural specific. I make the 10 hours available in Chinese as well as I use common food, they will know. 

And I also include, if you go out for dim sum, I dunno if you’re familiar with dim sum. Dim sum is something you enjoy, sweet, savory, dedicated, you know, items that you enjoy with tea. So when I tell them you, when you go for dim sum, that’s what, that’s kind of food you can eat and you can order a plate of, you know, the green leafly vegetables to enjoy with your family. So if you go with your family, the portion size automatically are smaller. 

So again, it’s not all or none, it’s how much you eat it. What is the portion size and what you do after eat? Enjoying a bake some lunch. We go for a walk together, and we have a lot of beautiful parks and natures here. You know, environment.

Shireen: And I like that attitude again, to where it is. It’s not all or none. Enjoy what you need to enjoy, especially within the context of a culture that is so, that has this, not individualistic, but more of that collective way of eating and sharing experiences. You talked about going out and having dim sum. From food to even doing activities together. Can you next speak to the impact of social determinants of health and it, I feel like it’s a word that gets thrown around, especially when it comes to communities of color, but help us understand more along the lines of health literacy and again, access to healthcare and even language barriers that we referred to earlier on nutrition and diabetes management. Again, as it impacts the Chinese community. 

Amy Yiu: Yeah, those are very compact factors and depend on who you work with. In my work, I work with a lot of seniors, older immigrants, and they have lower socioeconomic status. They might not have access to a car. So those are some of the challenge I help them navigate.

For example, if they don’t have the resources, choose those, find a dietician of their own culture or understanding food to work with, then I tell them what are the free resources they can use? We have free hotline, uh, BC Health Link. And they provide over 150 languages. So I tell them, you can call them and they can speak your language.

So then those are the resources that they can tap into. So I’m more creative that way. And also try to find, like for example, the diabetes classes I teach in the community center are being sponsored by the health center. And so they don’t have to come out with their pocket money to go for those classes.

And if we have a virtual workshop, I send it to a lot of nonprofit organization. So that’s some of the way to help them. Because there a lot of challenge, a lot of time they have to go to see the doctors with their adult children as a translator or interpreter. So those are some of the challenge, you know, getting to the, to the doctor’s office, understanding the diagnosis, the treatment. Those are not easy, especially when English is not your first language. 

Shireen: And with that, Amy, we are toward the end of the episode. At this point, I would love for our listeners to know how they can stay in touch. Just learn more about your work. 

Amy Yiu: Go to my website, uh, Libra Nutrition. You can download a three day free meal plan for people with diabetes and pre-diabetes. It has a lot of Asian inspired recipes and Western recipes. So again, it’s LibraNutrition.com. You can find me on social media, Facebook, Instagram. I also have a LinkedIn account under my name. 

Shireen: Lovely. And with that, thank you so very much for your time. Amy. To our listeners, thanks so much for tuning into this episode of our podcast.

We want you to head over to social media. You know the drill at this point. Head over to our social media, find this podcast post, and tell us what are some common misconceptions about nutrition in your culture. So again, head over to social media, head over to Facebook, Instagram, find this podcast post, comment below to tell us what are some common misconceptions about nutrition in your culture. We’ll take the conversation there. Amy, thank you so much again for your time. 

Amy Yiu: You’re very welcome.