Katherine L. Tucker, Ph.D. is Professor of Nutrition at the University of Massachusetts Lowell. Her research focuses on dietary intake and risk of chronic disease, with an emphasis on health disparities. She is the PI of the Boston Puerto Rican Health Study, a cohort study, to examine the roles of diet, in relation to chronic conditions, including heart disease, cognitive decline, and bone health.

 Shireen [0:32]: In today’s episode, we are pleased to welcome Dr. Katherine Tucker to our podcast as we delve into her exploration of region ethnicity specific nutrition and health disparities. Join us as we explore Dr. Tucker’s insights into the diverse patterns of nutrition across different populations. Stay tuned.  Dr. Catherine Tucker is professor of nutrition at the University of Massachusetts Lowell. Her research focuses on dietary intake and risk of chronic disease with an emphasis on health disparities. She’s the PI of the Boston Puerto Rican health study, a cohort study to examine the rules of diet in relation to chronic conditions, including heart disease, cognitive decline, and bone health. Welcome, Dr. Tucker. Thank you. It’s a pleasure having you on. So Dr. Tucker, I want to actually start from the basics right. Just getting to know you a little bit more. Can you tell us a little bit about your journey in the field of nutrition and your interests specifically on health disparities?

Dr. Tucker [1:37]: Yes, thank you so much for asking. I’ve always been interested in diet and health, and food and ever since I was in high school, actually, and I majored in nutrition in college. And during that time, I had a project with Professor that went to low income areas of Hartford, Connecticut, where I worked with a variety of different ethnic groups and people and learn more about their cultures and diet. And so then I went to grad school, and majored in nutrition for my doctorate. And from there, I did my work in Panama, and worked with low income population there, and really saw how important nutrition is to health, both in those very low income settings and also in everywhere. In this country, right now, we have this epidemic of obesity and diabetes, but it hits some groups harder than others. And so when I was looking at who were the groups that really were suffering the most in the northeastern region of the United States, I realized there was absolutely no information about Puerto Ricans. And yet they’re a very large percentage of our population. We have the Framingham Heart Study, we have a lot of studies on the general population, but in some on Mexican Americans, but there was really nothing on Puerto Ricans. So that’s why I focused on them. 

Shireen [3:03]: I do want to get into that a little bit. But before I do, I do want to start out with understanding what is the definition of health disparities? I feel like that term gets thrown around a lot. What does it truly mean? And how do Health Disparities Impact our daily life?

Dr. Tucker [3:20]: Well, health disparities are very prevalent in this country. And I’m not sure if there’s a specific definition, but basically, there’s a greater prevalence of certain diseases or certain health conditions in some groups than others. A lot of it is due to income, health access, but some is stuck due just to behaviors, health behaviors, and diet is a big part of that. And so for example, in the Puerto Rican population, when we first documented the health disparities, we did a study of statewide in Massachusetts, of Puerto Rican adults and comparison group of non Hispanic individuals who were the same age and living in the same neighborhoods, we found that the Puerto Ricans had twice the diabetes as the other groups, and they had more hypertension, more physical disability, and more cognitive decline. Since then, we’ve also measured their bone there’s there had never been a large study of bone mineral density in Latinos before. And it was thought that because African Americans tend to have denser bones than white Americans, that Latinos were somewhere in between, but we found that the bone density of the Puerto Ricans was actually much worse than expected. So those are the health disparities, they have more chronic disease and the purpose of our study is to understand why is it health care? Is it diet? Is it lack of access to medication In food insecurity, availability of good food, lack of exercise or other things, we also have a genetic component to see if that has any interaction. And we find that it does. It’s not that there’s these clear genetic differences. But there are some things called polymorphisms, that are more common in some populations, particularly if they have a history of deprivation. And they don’t tend to be a problem. Unless you don’t have a good diet, you may have a polymorphism, that means that you need more of a certain vitamin than other people. Or you may have a polymorphism that says, You pack on the fat because in the past three, four generations back, you only survived if you kept every calorie on now that works against people because it keeps the calories on and we have this epidemic of obesity. Does that explain it?

Shireen [5:55]: It does. And you know, so and I do want to get into the study a little bit more. But I do want to take a step back to something that you mentioned earlier, which is around this focus on this particular population. And you mentioned not a lot of research had been done on it. What is it about the way research approaches this population that may not take into account their unique needs or genetic? Like you were talking about genetic makeup? What is it about the way this population is studied that leads to some of that? 

Dr. Tucker [6:26]: Well, it just literally hasn’t been studied at all, especially, there have been a few studies on children in the past and mothers and children because that’s a very high risk group. But in terms of aging, and chronic disease, they just haven’t been included. That’s another aspect of health disparities that we’re trying to overcome. My work is epidemiologic observation. But there are also clinical trials. And those clinical trials help to inform drug, they help inform therapies, and they’ve mostly been done on a middle class, non Hispanic white population. So there just hasn’t been a lot of inclusion of the diverse groups that make up this country. Because of that the National Institutes of Health really only in the past 20 years or so has been focusing on working on that gap to improve those differences. The other group that has a lot of health disparities is African Americans in the South. And for that reason they started the Jackson Heart Study, which is parallel to the Framingham Heart Study in Massachusetts, but including African Americans and I work with that group is well, they tend to have slightly different health disparities, they have more hypertension, and a very different dietary pattern higher and fat meat, for example, than the Puerto Ricans do. But Puerto Ricans tend to have more diabetes, the African Americans in the South tend to have more hypertension, both are related to diet,

Shireen [8:02]: which actually takes me to my next question. And in that, how crucial Do you see nutrition as you mentioned some other factors as well, but what is the role that nutrition in particular plays?

Dr. Tucker [8:13]: Well, experts have looked at this and really think that for chronic disease, 60% or more, could be prevented with nutrition. And so it’s probably nutrition and physical exercise, and not smoking, are the three behavioral risk factors that could really make a difference in prevention, and then treatment or control of some of these chronic diseases, hypertension, diabetes, heart disease, even cancer, there’s a role for the protective effects of vitamins and minerals in preventing cancer, although it’s less direct and less clear, than the more metabolic chronic diseases.

Shireen [8:58]: You mentioned three particular ones, right? So you mentioned nutrition, physical activity, and then smoking cessation, based on the region and ethnicity specific research that you’re doing in the Puerto Rican population, be it you know, all the way in Boston to Mississippi, what do you see as common sort of general environmental impact that is on chronic conditions? And what factors really create gaps and differences across these populations?

Dr. Tucker [9:28]: Yes, one thing is what they call food deserts, or food swamps. So a lot of people with lower incomes, in particular in ethnic neighborhoods where they prefer to live. There just isn’t access to good quality, fairly priced supermarkets. So for example, in the Puerto Rican population, they buy an awful lot of their food from small corner stores, which ironically, even though they may have less money in those neighborhoods, the stores have to charge more, because they don’t have the scale. And it may be a long distance to get to a large supermarket. So that is one thing. The other is that there tends to be a lot of fast food. And it tends to feel at least relatively cheap, you can get a meal it’s filling for relatively fewer dollars. So they call those food swamps where you really don’t have good supermarkets with fresh produce and good quality seafood or things like that. But you have fast food and you can eat for $5. And so that combination, that environmental combination is really bad for nutrition. And it’s a hard thing to change because it’s so ingrained in our neighborhoods.

Shireen [10:49]: And how do you balance it when you’re looking at nutrition because you’ve got the cultural foods, then you’ve got the fast foods and what you’re surrounded by in the environment that we live in? How do you then define nutrition and foods, when there can be such a diversity in the intake of those types of foods? 

Dr. Tucker [11:06]: Well we measure it, we use something called a food frequency questionnaire where we ask how often per day or per week or per month you eat hamburgers, or how often do you eat fruit or specific vegetables. And what we find is that there is a range, of course, and that range of intake and quality of the diet, which we measure with dietary patterns, is clearly associated with risk of diabetes with control of diabetes with hypertension. And right now we’re working now that we’ve been following these individuals for almost 15 years, we’re looking at cognitive decline and finding a strong association there as well. The major thing is lack of fruits and vegetables, and lack of variety, and diversity of foods with too much refined carbohydrate, and that all the white rice and the white bread and the sugar, sweetened drinks, and desserts and cakes. Those are the things that are contributing to the diabetes, and they tend to be the things that are the least expensive. That’s the difficulty is that good quality fruits and vegetables and seafood for omega three fatty acids, olive oil, extra virgin olive oil, nuts are the things that can really make a difference. And reducing this risk, we find nuts a very powerful olive oil is very powerful from the Mediterranean diet studies. But those things are expensive. And somehow it’s a matter of not only nutrition education, but food assistance and other things more availability, more policies to help low income people get the good quality food.

Shireen [12:56]: So it’s not only about access to foods, but it’s access to nutrient dense foods. 

Dr. Tucker [13:03]: Correct, correct. We also in addition to looking at the diet through the food frequency, we measure blood levels of nutrients. And we find that there are deficiencies in specific nutrients and those nutrients that they’re deficient in, or that some people are deficient in, in greater proportion, are things like vitamin B six and magnesium, potassium, and carotenoids. So those are the nutrients that are helping in energy metabolism or processing the food that you eat, and keeping things healthy rather than having it all deposited is fat. And when we measure those in the blood, we find very strong associations between low vitamin B six for example, and metabolic syndrome, low vitamin B six and cognitive decline. And interestingly, depression depressive symptoms, feeling depressed. Vitamin B six helps to make neurotransmitters in the brain. Vitamin D also is important in relation to depression and cognitive function. And that’s partly because the stress of everyday life we don’t think about it this way. But stress puts a toll on your body. And that actually means that you need more nutrients to protect against that stress, oxidative stress, it damages your bloodstream and your blood vessels and pressure, that stress you know, that pushes and makes high blood pressure. All those things that can damage your body and your organs and yourself. If it’s out of balance with the nutrients you need is that much worse. And it actually can lead to early aging and DNA damage and we see that as well. So I can’t overemphasize how important good quality Any food is fruits and vegetables in particular dietary fiber to feed the microbiome. We’re learning more about the gut microbiome and forming health and even brain health, the gut microbiome gets overrun with bad bacteria when your diet is so high in those refined carbs. And that’s a major problem for a lot people is those refined carbs rather than whole grains, nuts, legumes, the Puerto Rican population, it’s part of their cultural diet, legumes, and we were curious why they weren’t getting the basics and the magnesium that those are such a good source of, and one thing that we realized is that, at some point in time, legumes were expensive, and they started diluting them. So when we see the recipes, now, it’s a lot of white rice with bean, liquid, and a few beans rather than it should be about as many beans as there is rice. But it’s just so disproportionate right now that they’re not getting the nutrients from the beans they need and insufficient amounts, but they’re getting way too much from the white rice. And so that’s a simple thing that can be changed without a lot of costs, that can make a big difference. 

Shireen [16:18]: I see. So there’s consumption but not sufficient consumption.. Interesting. And are there any other specific nutrients that are of concern here?

Dr. Tucker [16:29]: Correct, correct. Yes, another one that we’re seeing deficiency and when we measure it in the blood, only because of the diet is vitamin B 12. And vitamin B 12 is critical. And keeping your homocysteine down, I know that something a lot of people may not have heard of, but it’s an amino acid that’s elevated in your blood and causes damage to your heart and to your brain. And that requires folic acid, vitamin B six and vitamin B 12, we’re finding high levels of vitamin B 12 deficiency, not only because of insufficient food, because it does come in protein. But because of drug interactions, that’s another thing. Using a lot of acids, which tends to be it’s all related, a lot of people are using it acids, because their gut microbiome is not healthy. And they’re feeling their system with regurgitation, because they don’t have enough fiber in their diet. Then they’re taking the lead acids, the Add acids actually block your stomach acid which you need in order to separate nutrients from food and absorb it. So b 12, in particular, is a big molecule that needs to be separated from the protein. When you’re on these acid blockers. It’s not absorbed and we see deficiency. We saw it in 16% of the Puerto Ricans that we measured in Massachusetts. And so it’s very important, it’s kind of silently doing damage to your body over the long term. And if it gets severely deficient, it causes peripheral neuropathy and deterioration. So it’s a very important nutrient. Because of this problem of absorption, it’s recommended that older people actually take a supplement that contains that or get it from fortified breakfast cereals, where it’s added, it’s so it’s not, it doesn’t need to be separated from the protein. The other major major thing is magnesium also associated with depression, and cognitive decline. And we just measured that in the blood and found a lot of people are deficient. Again, this is partly because of the magnesium losses and food over time, it’s less in the soils now, but also because of the foods that are not being consumed the nuts, the seeds, the vegetables, and then legumes. But that low magnesium is also getting worse. Once you have diabetes. It’s like a vicious circle, we’re finding that people taking the diabetes medication have even lower magnesium to serious degrees. So that’s another nutrient that may be it’s definitely needed from better quality foods, but may also be needed is supplements if you’re taking diabetes medication,

Shireen [19:18]: You know, based on your longitudinal research. So far, what have you learned about the interactions of some of the other factors? You talked about stress? I’d like to learn more about social support even, I think you’ve touched on genetic predisposition. Really again, in relation to overall health. 

Dr. Tucker [19:36]: Yes, we do look at stress, and we look at social support. I did mention that also, my colleague is the PI of a parallel study in Puerto Rico. And they’ve had tremendous stress there. In addition to just poverty and neighborhood conditions and economic stress. They’ve had natural disasters, hurricanes that have been devastating minor earthquakes that have still been affecting them. And what she’s finding is that the social support is the factor that makes the difference with that stress and poor diet, it takes a toll on the body. But what the social support does, one helps to reduce the stress. And two is very important for continuing to eat well, sharing food, encouraging each other to eat well, on the island, they have more access to fruits and vegetables, through family members who actually grow them and share them. That is one of the things we find in Boston and the Puerto Ricans is that they, a lot of them report being lonely and isolated and not having access to fresh food.

Shireen [20:52]: I’m going to try to squeeze in one more question here.., where do you see potential improvements for the food environment in the areas you’ve been studying? both culturally and then also, to some extent, politically, and what you mentioned within social determinants?

Dr. Tucker [21:07]: Sure, Sure. Well, there are a lot of people working on Social Determinants and the policy to improve access to fresh foods in the corner stores, for example, and to kind of push the junk food back and, and emphasize fruits and vegetables. There are some states that have experimented with taxation on soft drinks, which are major, major problems, so much contribution of sugar to the diet, and nutrition education, you know, making people aware that these chronic diseases, which affects their lives, so much, can be improved. With a good diet. And with increasing fruits and vegetables. There are a lot of resources online now for people, but you have to be careful. So I recommend looking at things like the National Institutes of Health, which has nutrient pages that you can find and read about the USDA now has a lot of materials in Spanish around my plate, that give ideas for recipes, or finding good ways to use food and to have a better healthy diet, which makes such a difference for your health overall.

Shireen [22:19]: I mean, that is truly music to my ears. Because as you know, that’s at the heart of the work that we do at Yumlish, as well as really building that nutrition, literacy and that education in the community. I do have one more question for you, which is to say we are toward the end of the episode. How can our listeners connect with you, Dr. Tucker, and just learn more about the work that you’re doing? 

Dr. Tucker [22:40]: Well, people do email me and I’m happy to receive questions. My email is just catherine.tucker@uml.edu. And I frequently do point people to other resources, and would be happy to do that.

Shireen [22:56]: Lovely. Thank you so much, Dr. Tucker, for your time and to our listeners. Thank you for tuning in to another episode, right here on the Yumlish podcast with us. At this time you knew exactly what time it is, there is a question that we have for you that you will head over to social media to answer and the question is, What are common health disparities that you see in the areas that you live? Again, what are some common health disparities that you see in the areas that you live in? Head over to Facebook to Instagram, find this podcast post comment below to tell us again, what are some of those health disparities that you see in the areas within which you live, and with that, Dr. Tucker, thank you so very much again.

Dr. Tucker [23:33]: Thank you. Always a pleasure.

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