ChangeMAKErs - Dr. Dylan MacKay

Welcome to ChangeMAKErs, a new MAKEManitoba podcast series highlighting research and innovation powered by members of the Faculty of Agricultural and Food Sciences.

In this episode, host and FAFS research facilitator Dr. Chantal Bassett chats with Dr. Dylan MacKay, Assistant Professor, Department of Food and Human Nutritional Sciences. Learn about his journey to the University of Manitoba and his research into nutrition and chronic disease and how it is shaped by living with type 1 diabetes.

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Intro 0:04

The way we grow and produce food is ever changing, shaped by consumers and the climate in which we live and farm, research at all points of our food system is essential for continuously improving foods journey from farm to table . The Manitoba Agriculture and Food Knowledge Exchange explores timely research, innovations and applications that make our food system better than ever. Join us for today's podcast.

Chantal Bassett 0:28

Hello and welcome. This is ChangeMAKErs, a Manitoba Agriculture and Food Knowledge Exchange, otherwise known as MAKE, podcast series with me Chantal Bassett. In each episode, we'll chat with an academic member of the faculty of Agricultural and Food Sciences at the University of Manitoba to find out about the research and innovation they're working on and how this is shaping agriculture and food production in Manitoba and around the world. Now, as the research facilitator for the faculty, I get to work with all our incredible innovators, and I think it's high time for you to get to know them too. Today I'm joined by Dr. Dylan MacKay, assistant professor in the Department of Food and Human Nutritional Sciences. Thanks for joining me, Dylan .

Dylan MacKay 1:07

Well , thanks for having me.

Chantal Bassett 1:07

Dylan, before we get into the details about what you study, can you share your origin story? How did you get to be a professor at the University of Manitoba.

Dylan MacKay 1:17

For that, go back a long time ago when I was 13 years old. I was diagnosed with Type 1 diabetes, and so that's pretty much a straight line to the type of work I do now. So I do a lot of nutrition and human clinical trials and the impact of nutrition on health. You know, when I was 13, I was losing some weight and I was thirsty all the time. I was exercising a lot and I really liked sports. And I was sitting down one day to read a newspaper and I saw a Diabetes Canada ad that said, are you thirsty all the time? You might have diabetes. And I remember putting down the newspaper 'cause I just, I think I just had like probably two or three litres of water at a single sitting and then refill the empty two litre bottle to sip on while I was reading newspaper. And I put it down and I said, "mom, you know, I think I have type one diabetes". My mother was a registered dietician , she definitely influenced why I do the research that I do as well. And she's like, no, definitely not. And so we made an appointment after school the next day. I went there, I walked over from school, they did the testing and I always remember like the face of the person coming back in, being like, "where are your parents"? And then I was like , you know , only my dad's at work, my mom's at home. And they're like, yeah, somebody has to... you have to leave here and go to the hospital. And so I left my family doctor's office went to the Janeway in St . John's, New Foundland, the children's hospital. And I stayed there for a whole week to start on insulin and learn how to survive with type one diabetes. So to extrapolate that, it's kind of intense, you know, with type one diabetes, you're constantly thinking about the impact of food on your health in an almost immediate way. It reinforces it. So I think, because I think about it all the time, I figured I might as well make that my job as well.

Chantal Bassett 3:03

So in terms of like... how did you get into your studies?

Dylan MacKay 3:07

How did I get into my studies? Well, at first I was thinking after, you know, in high school I wanted to do medicine. Maybe, you know, its very common for people with type one to have lots of interactions with healthcare systems . So they think medical field, you know, good experiences or bad experiences with healthcare people. So you wanna do it just like them or better. And so undergraduate, I did an undergraduate in biochemistry. Really thought that was sort of the pre-med program at my home university. I didn't get into medical school the first time I applied and I decided to do a master's degree in biochemistry and nutrition. And then I realized that in that program I fell in love with research and I thought, well, this is even better than treating people. It's creating the evidence for it. And so that was a master's where I looked at the development of type two diabetes in pigs. So in pig models and I grew piglets from three days old until 13 months. It was a really long masters. And I got all kinds of experience in like surgery and glucose response testing, all kinds of biochemical assays. And it was a really fantastic supervisor Dr. Robert Bartolo and Janet Burton at Memorial University. And they're fantastic scientists. I just loved how they lived their life and the work life balance. And somewhere in that master's I said that this is what I want to do. I want to be a professor. And so the next step would be to get a PhD towards the end of my master's . I had to find a place to do my PhD. And someone recommended the University of Manitoba.

Chantal Bassett 4:38

Okay. So you've been here since your PhD? And what did you study then?

Dylan MacKay 4:43

I studied nutrigene genetics, basically. Uh , you know, I did some , uh, molecular biology work in my master's , some, some early gene expression work and the idea of genetics and, and diet and, you know, the idea of like personalized nutrition was sort of really evolving at that time. Uh, and there was actually a posting for an open position for like a Canada research chair in Nutrigene Genetics at the time, at the University of Manitoba. And that's sort of what attracted me here, that posting wasn't filled yet. So I came to a differences supervisor, but I , I did a project focused on clinical trials in humans. And so that was really, I switched from pigs to humans and extra different challenges. And , uh, I really liked that. So it's continued, you know, interventions in humans to create evidence for, you know , uh, dietary interventions and lifestyle interventions for health is where, where it went from there.

Chantal Bassett 5:31

And once you graduated from your PhD, what was the career path that led you to this?

Dylan MacKay 5:35

Well, since my Master's, I kind of had that dream tenure track, like research , researcher , professor , as a career. So PhD went into a postdoc where it was just more and more focused on different nutritional interventions, different populations in clinical trials, different types of clinical trials. And then continuing to focus on clinical trials as the thing that I do or as what I would get hopefully good at some point, getting better and better at designing and implementing nutritional intervention. And then when I started my independent career , where I got to pick more of the focus, it was a lot around engaging people from different populations. My experiences, living with type one, but if you're gonna create interventions or you're gonna test interventions for populations, having people with lived experience of those or having formed the interventions by people who are delivering them. So the physicians that treat those populations or the clinicians that treat those populations. So it was an engaged clinical trial research and then the diabetes because of my personal connection to it and chronic kidney disease because of the incredible collaborators I met in Manitoba. And the unique potential to do research in chronic kidney disease that exists in Manitoba. Because I think kidney disease is very related to nutrition in many ways and impacted by what someone eats. And also, unfortunately, there's a disproportionately high burden of chronic kidney disease in Manitoba. Those burdens offer the chance to have more significant improvements or opportunities to do research to improve interventions for those populations.

Chantal Bassett 7:13

What motivates you in deciding what to study next?

Dylan MacKay 7:17

That's really the engagement. Sometimes you'll get an idea, today I was teaching a class and someone was presenting on a topic and it just seemed like a fantastic idea and if it fits the potential for human clinical trials in nutrition, then that's sort of what I'm interested in. And then the potential for it to get funded, the potential impact of it. If there are people who represent that population, it could impact , that can help inform the ideas. That's sort of how we pick the ones we focus on. Right now we really have a lot of different projects already going. So the future ones are evolving from those as some are completed. You build new ones or you advance them, but they're really focused on type two diabetes and chronic kidney disease. And a lot of the questions we're asking are informed by people who treat those populations or people who represent those populations.

Chantal Bassett 8:14

So Dylan , can you tell me a bit about your research group and what you're studying today?

Dylan MacKay 8:18

We call the research group the M&M Lab. It's myself and Dr. Rebecca Mollard, who's based at Seven Oaks Hospital. We do basically nutrition and chronic disease research, strong focus on chronic kidney disease, type two diabetes and obesity. And then I have some projects with rheumatologists at the Health Sciences Center, Dr. Hani El-Gabalawy and Dr. Liam O'Neill looking at the prevention of rheumatoid arthritis. But the core element of our research is human clinical trials. We do a lot of acute glucose response trials, so new food products and new formulations that are looking to reduce the glycemic impact of foods. We do sort of glycemic response testing. And Dr. Mollard is just a world expert in that. And I've learned and been able to work with her to do those trials. So right now we have one looking at wild rice versus brown rice versus blends of wild rice and brown rice versus white rice. You know, no one's really looked at the glycemic impact of wild rice before in these types of trials. So it's very unique to have a food that has historically been consumed in North America for millennia, but no one's really done the comparisons to see how much better these products might be in terms of glycemic response. So it's personal interest for me and I think it's really valuable to have that information. Classically it's an indigenous crop that's looking to be developed to expand, how it's grown and the economics. But also to investigate the health impacts. And that's sort of where my research comes in, the health impacts of potential foods. And then another one that I'm really interested in is sort of the delivery of groceries as part of the intervention. So through work with my colleague Dr. Naveed Tangri , who's a nephrologist and a fantastic clinician researcher, there is a condition called Metabolic Acidosis that occurs in chronic kidney disease where the kidneys fail or have reduced function. They have trouble maintaining the acid base balance in the blood. So normal healthy kidneys, people don't really need to worry about the acid base balance of their diet. The buffer systems take care of that. But as the kidneys begin to fail, some people get more acidic or they sometimes have more base, depending on their diet because the kidneys regulate that balance. But the acidic blood and body is really bad because it impacts a ton of systems in your body. And so it needs to be treated and if not treated it's associated with really fast acceleration of kidney failure and bad outcomes... increased mortality. So right now it's treated with sodium bicarbonate tablets, basically taking baking soda tablets. It's like creating a volcano, but essentially large sodium bicarbonate tablets multiple times a day, three or four grams of it. It's not a great intervention in terms of lots of people don't continue with it because it's painful and uncomfortable, there's a huge pill burden to it. And the idea is that they're trying to reduce the dietary acids in the stomach with this sodium bicarbonate research out of Texas. And some other places have suggested that you can modify the acid load or the acid-based balance of the diet. And that's where most of the acid load that the kidneys have to deal with comes from. And turns out that fruits and vegetables are actually sources of dietary bicarbonates. And so, you can design interventions that provide bicarbonate, but not in the tablets, just through the diet. And so we have a trial that's looking to compare feasibility trial here in Winnipeg and in Halifax and in Nova Scotia. Where we're recruiting individuals with Metabolic Acidosis. They're gonna get groceries delivered fruits and vegetables delivered to their house on a weekly basis as the treatment for their metabolic acidosis. And comparing that to the tablets in a randomized controlled trial, the idea there being that if you provide it through food, it might be more tolerable, less side effects, more chance of continuing with the intervention. And we know that fruits and vegetables have all kinds of other beneficial health effects... benefits to potentially blood sugar, blood pressure, those kinds of things. And then it's the provision of food without barriers and for free , rather than a drug has potentially economic and social benefits. So that's what's really interesting me is those kind of interventions where you give people food as the intervention. And so Metabolic Acidosis and chronic kidney disease, I think is the best population we could think of to show that that model works. But then I think scaling that or thinking of other ways to do that for other chronic disease populations is really what I wanna do for the rest of my career. And then the translation of that, if we show it's as effective as a medication, how do we develop systems? You know, working with the fruit and vegetable growers and the delivery systems and logistics and grocery stores on creating programs where you don't get a subscription, you get...sorry, you don't get a prescription. You get some type of like subscription for food delivery on a weekly basis for your condition. And if you think about some of the drugs that get approved for chronic kidney disease or any disease these days where they can come in with like treatment that cost $20,000 a year, and they're still getting approved for some cases in the healthcare system we all pay for. Then that $20,000 a year that makes the cost of weekly fruit and vegetable delivery more affordable. Some people will immediately balk at the idea and say, oh that's not possible. You can't do that. And I think the pandemic has shown that we can deliver foods regularly. Grocery stores have set up the infrastructure to deliver groceries. Things like those meal delivery services or the companies that almost prepped meals get delivered at your house. You could do all your meals that way. You could never grocery shop outside of your house again. And that same thing could be used for healthcare interventions. And creating the evidence for which populations to do those types of interventions and designing those interventions is really what I'm interested in.

Chantal Bassett 14:02

Now that's truly fascinating in terms of not just about a message and whenever I talk nutrition with somebody, it's well known that let's say wild rice is healthy, fruits and vegetables are healthy, but that's just the message. It's the putting it into action is often the challenge. So by designing an intervention that is meant to reduce barriers. And that's what you're hoping to see an increase in uptake. I am also hearing that it's not just about prevention, it's about actually using nutrition as a treatment.

Dylan MacKay 14:39

In this case. Yes. And I think there are specific cases where that would cross into the treatment because the problem there is too high an acid load in a diet, and we can treat it with a drug or we can change the acid load in the diet. And I think there are circumstances in certain chronic diseases where that works. And like in diabetes and chronic kidney disease, I think those are the chronic issues and potentially arthritis, that's where some of those potentials exist. But in other cases, I think it would be prevention as well. The amount of cost that you can put in prevention is obviously the farther you get away from the expensive endpoints and the less we can invest in them. But there's a balance along that line where I think those interventions have space. And that's where I want to do my research or our research. And, and I think it's really interesting because when we think of evidence for nutrition, it's really messy and everybody eats and everybody thinks they're an expert in it. And we tend to use a lot of nutritional epidemiology, like observational research to develop our guidelines. But then those guidelines and recommendations even in the healthcare system are often "go eat these things". And in many cases, especially if you think of the burdens of chronic disease and the way socioeconomic status intersects with risk and geography intersects with the risk for these conditions, we know that to a lot of the people just telling them to do it, you might as well tell 'em to go fly away as well. So that is an ineffective intervention. And so when you test those ineffective interventions where you tell people to change their diet and they can't because they don't have the autonomy or ability or access or sovereignty to do those changes, we just end up with messy noisy data. And then we risk people thinking... nutrition system, I can't make a sense of this. One trial's this way, another trial's that way. You end up with a healthcare system that may say, I tell all my people to change their diet and they never do, and they come back in 3 months and I put 'em on this drug. And it starts to work in a way, if you're testing an intervention that you know, people don't have the ability to do, you've tried nothing and you're all out of ideas, come up with interventions where we try to reduce the barriers. You deliver the foods directly to the house. If that doesn't work, maybe you can deliver foods ready to eat directly to the house, investigate why the interventions are not being taken up or successful, and then make those better. If we fundamentally believe the mechanism works. And that's what I like to get up every morning and think about it .

Chantal Bassett 17:04

But in terms of... does your intervention include beyond delivery recipes or consultations with dieticians? There's a difference between getting the food and letting it go to waste or utilizing it.

Dylan MacKay 17:16

It's both of those things, that education in that time with a dietician, we know there's value for those things. But if the person leaves and they can't access the ingredients in foods or food preparation or time to do it, it's not gonna work. And if we just give them food and no information, in the interventions that we have educational material that outlines the intervention or helps facilitate the intervention. At least for the food delivery trials that we're doing right now, we have education 1 or 2 hours with a dietician every time we change, explaining how to do the intervention, how to weigh out the food, how to dose, or eat the right amounts and determine what to eat and different ways to prepare the foods. In those interventions, we're delivering fruits and vegetables that are not necessarily ready to eat. So we want them to be incorporated into diet, but education around that and support around that is critical. So it's not the same of just delivering food. And it's also not the same of just telling people to change. It's gotta be both.

Chantal Bassett 18:11

So in terms of... what do you predict could be lessons learned from this trial beyond somebody with a... if I'm not in that population of metabolic acidosis, what could I still learn from the research that you're doing?

Dylan MacKay 18:23

I think we're learning so much about the logistics of setting up those kinds of interventions. The results are obviously gonna be applicable to that population. But I think if we can show our next step for this trial, we're looking for funding. This current trial's funded by CIHR and it's in 2 sites, but we're looking for a trial that's, you know, 10 or 20 times as big where we have sites lined up coast to coast. Like from Cape Breton to Victoria, 15 different hospitals where we would do a large randomized controlled trial for this intervention and show that it works all across Canada. This type of model can work for other chronic disease conditions. And that there are likely price points and economies of scale where we can give people food, part of the healthcare system with wraparound support, where it's integrated with your primary care and dietetic support, you know, videos and education to make the intervention more effective or more likely to help. And I think that as a model it hasn't really been demonstrated well, especially with very high quality RCT evidence. I would love to be able to set that so that people could look eventually at this program of research and say, well, maybe we should try this in a different condition. Or maybe someone's done this before, can we take that delivery model and apply it to other conditions?

Chantal Bassett 19:46

So Dylan , you've referred to an RCT , like a Randomized Control Trial. Can you tell me, like, I've heard that it's considered the gold standard. What is it and how does it impact or does it impact policy?

Dylan MacKay 19:57

Yeah , so Randomized Control Trials are often considered the gold standard in showing causality. You test an intervention or a drug or a diet, and you're looking at outcomes of interest. So let's say for type 2 diabetes, you want to reduce the people's high blood sugar. So you take an outcome like HBA-1-C, it's a measure of glycemic variability. Over time you randomize some people to get the intervention and some people to not get the intervention or another intervention or continue hopefully on what's normally happening in that population, the standard of care, because you want to be introducing better and improve on what's already there for the most part. And randomization simply means that when people come into the trial they have a percentage chance of getting one or the other. And that's not always the same percentage chance, but we know that at the end, a certain amount of individuals will be allocated to one or and other interventions. And then we know we can compare them afterwards to determine which ones are better or similar depending on what the trial is looking at. So Randomized Controlled Trials, it's got randomization, it has a control and it's an intervention where you're testing something as opposed to observation. Where in nutrition, of course, it's very difficult, the observational research to figure out what people are eating, we have to ask them. Whereas in a nutritional trial, for the most part, we'd be trying to give them some of the things and then hoping they eat it. In terms of the level of evidence, the Randomized Control Trial is very near the top. The only thing that's higher than it is sort of systematic reviews and meta-analysis of Randomized Control Trial. Very important because systematic reviews, random meta-analysis of non-randomized control trials don't create better evidence than Randomized Control Trials. Yeah, the top of the evidence pyramid is RCTs and then on top of it, meta-analysis or combined multiple RCTs together.

Chantal Bassett 21:48

And I would imagine that in nutrition, having randomization could be a challenge. It's kind of difficult to... in a pill form you could have a placebo and an identical looking form if I'm either consuming vegetables or not. Isn't that evident to everyone involved or how do you control for that?

Dylan MacKay 22:04

Yeah, that's where I would say that doing trials in nutrition is harder than other trial areas where you can do better things. Like blinding is often an important thing. So people don't necessarily know which allocation they're getting. So if you were doing a surgical, the person may be unconscious, they don't know which surgery they got, or the people who evaluate the outcomes afterwards may not know which drug you're getting. And it could be a placebo, more of a challenge in nutrition. So then that makes what I do extra challenging. And I think it's because the concept of doing the original Randomized Control Trial or an original clinical trial is sometimes thought to also have been a nutrition intervention. It was looking at scurvy and it was James Lind a long time ago, a medic in the Navy trying to treat scurvy and they had treatments and one of them was salt water . One of them was nutmeg, one of them was oranges, one of them was apple cider. And they allocated, although not necessarily randomly, 2 sailors each who had scurvy to those conditions. The 2 sailors that got the oranges and the lime, I think it was the citrus fruit, did really well. The apple cider wasn't too bad either because it was the vitamin C in both of those things, except they didn't know what vitamin C was at the time. Salt water did not work out. The sulfuric acid wasn't great. And the nutmeg didn't really do anything. So they quickly saw that vitamin C and then all the ships would carry citrus fruits. So that one, not necessarily a challenge, but if you think about how ethical it was for those controls, you need to have ethical controls and interventions and the idea before you do a trial that you have equipoise , which is that you don't already know which ones better, are really important ethical standards in RCTs that have evolved since that original trial. And that makes nutrition very challenging because you can't not eat and everybody needs to eat. And when you change a diet, you're not just adding something. If you add something, then you're diluting all the other components in terms of their makeup of the diet, or you're replacing something you can't add without taking away. Because as I said, everybody needs to eat. And so that does make trials and nutrition extra challenging. Sometimes I envy the individuals who are doing the pharmaceuticals. Because you can just have a placebo tablet, as I mentioned before. Why the RCTs? Because they're sort of the gold standard for causality when people are... we only have so much money in healthcare and budgets for those types of things or coverage for health insurance. When people are trying to make the tough decisions about what to spend money on, Randomized Controlled Trial evidence is the highest quality. And that's when you know, decision makers, even in Manitoba Health or around the world, people who write guidelines that direct or guide care for conditions, they're looking for Randomized Controlled Trials. So if you want to change how people are treated or if you want to change how a condition is treated you really need the Randomized Controlled Trial evidence. And that's one of the issues is getting that quality evidence in nutrition is challenging, as you mentioned, getting to that level where clinicians that are treating diseases will pay attention to the evidence and trust it when they can see from the pharmaceutical side, we know that this one's better. We see the number needed to treat or the reduction in mortality or the change in outcomes very closely. We know it's because of this drug versus another in nutrition. It is challenging to do that. It's where it means there's lots of things for me to work on for the rest of my career.

Chantal Bassett 25:32

In terms of... you kind of touched into the economics of it before. We need the Randomized Control Trials or the clinical trials to inform future decisions. Do your... the trials, that you're involved in look at an economic analysis or is it something that you might look into the future so that because I could see that that would be important information for policy makers or program developers.

Dylan MacKay 25:56

Yeah, so the trial we're looking at now with the grocery delivery for metabolic acidosis has health economic modelling components. That's really important because to translate it, when we were putting in these grants, a lot of the review comes back... no one's gonna cover that. It's gonna be too expensive giving people free fruits and vegetables. And it's such a shift where we have to convince the reviewers to think about it. Because as I mentioned before, we cover all kinds of very expensive things. You know, as a person with type one diabetes, I pay thousands of dollars a year in different medical supplies and things. And many of that is covered through the provincial government because it saves money in terms of outcomes. But making people think of that from a food stand point, we just think of it differently. "We can't give people free food" or maybe it's even political. I think we can, we could, and I think there are many places where we should and still save money. And it's interesting this idea that maybe there is an idea where we should give people free food. We should give people free housing. We should give people free money. All these things because we can develop evidence that it saves us money and it improves everyone's outcome in society. And I guess I'm convincing people that the food provision is something they should think about. And that showing it, not just showing the evidence that it improves, but showing that it's cost effective is really important in the translation of the research that I do. So we do work with health economists to do the modelling of this type of stuff and then thinking about how you can develop the infrastructure and the logistics to have these systems where you could deliver foods through the healthcare system or related to healthcare system for some of these trials, I work with grocery stores because they have logistics and delivery set-up. So we have a trial right now that's looking at potassium in fruits and vegetables in chronic kidney disease. And we're working with food fair, the local grocery store in Winnipeg. And they're delivering the foods to the people in Winnipeg on a weekly basis for our larger trial. We work with Save on Foods and they're delivering the foods in Winnipeg not in Halifax. Save On isn't in the east coast. We don't have a grocery partner there. So it's harder. We have a colleague who has to do the packet together. But it's gonna be the same types of things. It's gonna be like bags of apples, carrots, not fancy fruits and vegetables. These are just staple fruits and vegetables that we're delivering to the people because they have high bicarbonate and we think that'll be as effective or better than the medication they're taking. The health economics is critical for the translation because if we go back to say the province of Manitoba afterwards and say, "listen, this is what you should do for metabolic acidosis and chronic kidney disease". It improves all the outcomes. They're gonna say, how much does it cost? And we have to show them that it's cost effective or better than what they're currently paying for or cheaper. More affordable at the same level and that's something we think about in, in the long term . I , I don't really wanna do research and interventions where it'll never worked because I have had experience doing previously throughout my career doing some research that I think never had a chance to translate. Sometimes in nutrition and in trials we end up with research that's more advertising than real health translation. And there's reasons why. But you know, you'll have food industry groups or food companies that fund research and it's highlighting their products. But I don't see that translation these days. I really wanna pick the ones where we can, hopefully show the cost effectiveness and then work to see that if it's shown to be effective, it makes it into the lives of the people who have those conditions and hopefully improves those lives.

Chantal Bassett 29:30

And I can imagine, eating is often a social activity, so benefiting one often can benefit others. So in terms of what do you think of the role of nutrition? How do we get a consumer, an individual to shift what they're consuming and how could that benefit not only themselves?

Dylan MacKay 29:50

Well, in one of our trials... in those two trials that we have fruit and vegetable deliveries, the group in Texas that did the first one of the interventions to show what might work when they were just giving enough food for the one person in the household to eat, it wasn't working. And so they were sending fruits and vegetables , but just enough for the dose that that person needed for the day , and it wasn't working. And so they did some interviews and of course the people were sharing it, so they were diluting their dose and so they upped it so that everybody in a household could get as much as they wanted, that one person to get. And that's when it started working. So when those interventions were delivering foods to like a household and will deliver 4 times as much if there's 4 people in the household, to avoid that dilution, I think that it may seem like it's more expensive, but if it doesn't work until you do that... it's important. And then that potential benefit to improve the entire household through the intervention is interesting. We haven't thought about how to measure that, but how the idea of providing fruits and vegetables to an entire family because someone in the family has a chronic disease and then the trickle down effect that grandchildren or the children get more fruits and vegetables. It's really fascinating to me. And then exposing members of that family to more fruits and vegetables and different ways of preparing it, the lifelong effects of that is fascinating too. So how do we change the behavior as well? I don't think it's an advertising or a knowledge thing, sincerely. I think in nutrition there's probably lots of misinformation, but I think the biggest thing is a shift in how much do people have the ability to personally change their diets and their circumstances. As I mentioned before, I used to do nutri genetics and this idea that like personalized nutrition and the biggest change throughout my career is kind of a zooming away from that. Like DNA single cell , like changes in individual responses. I've kind of abandoned a lot of that. Because I don't think it matters as much as like, if you want someone to change their diet, you can't tell them to change their diet. You have to work together to change the entire environment, the entire family's food environment, the entire neighborhood's food environment by doing things like, either delivering that or having more health education and nutrition education earlier in schools, school lunch programs that provide meals and expose children to a variety of foods that are healthy earlier. That's how, 'cause you develop your taste. We may not like the foods, we like the taste of, we actually like the taste of the foods that we have is one of the ideas that may be driving why preferences exist and stuff. So that's what I think that we need to, you need to think of ways that we can intervene on large populations of individuals because personalizing I think sometimes is a distraction from the fact that we do know that larger interventions are more costly as a whole, but telling someone to do things personally, they often don't have the ability to. Does that make sense?

Chantal Bassett 32:40

And in terms of timeliness , Manitoba is set to introduce and I actually don't know the full scope of it.

Dylan MacKay 32:47

No, I dunno the full scope of it either.

Chantal Bassett 32:48

Okay, new school food programming. Just kind of how would that relate back? Hypothesizing here, we don't know what goes on behind the scenes of how a program changed and this is a major program change. How could research have influenced that?

Dylan MacKay 33:07

Well, I'm hoping that they're talking to people who are from this faculty in this process. And I have a friend of mine who is in the new government. And I was fascinated by that promise for the school lunch program, because that just checks a lot of the policy things that I think would be great. Like efficiency to scale, time cost for doing lunches, equity and access to foods. Just fascinated by it. But with every promise, it's all about the implementation, right? You can have a great idea and if you implement it horribly, it's a terrible idea, and I'm waiting to see the details. The funding amount seems a little low for universal, but now they're talking about universal access and I would love to be involved. I don't know who's on those committees and how they're there . I really hope they have some of the fantastic researchers have looked at those kind of food provisions and food security and food access to inform it. Because I think that those are things that could be incredible economic drivers. I know our premier likes to talk about like the economy pulling the cart for the health and stuff like that. I think providing universal lunch and breakfast programs are an economic benefit to it. If I think, every day I get up and I spend time packing my kids' lunch and they don't have the selection, there's the potential for so much waste. Then there's also the potential for so much inequity, what I can put into my kid's lunch versus others. And then if you think about that... that's hours for every single parent all across the province that could be centralized and done better and more efficiently. And with economies of scale and healthier, we are overseen by diet dieticians, highlight crops that are grown in Manitoba that are healthy. The potential for it to be done properly is incredible. But I wanna see if under deliver , then it never gets continued. It is my biggest question mark. I'm excited to see how that'll come out. One of the research areas that actually touches on that is some of the feedback we got about our delivery interventions was, can people with disability have the capacity to change their diets? Or how much work is this putting on their caregivers? It's really important things that I like to think about in this intervention that creates food. How much food work is that saving homes? We don't have good tools to measure food work. And so a colleague of mine at Dalhousie University , Dr. Leah Cahill, who's from the University of Manitoba originally, she and I and others have been working on a questionnaire that measures food work. And the idea is that, if we don't measure it well, we can't value it. Well, the amount of work that goes into planning, obtaining ingredients, putting those ingredients together and then cleaning up after food is often undervalued. And then if you think about the EDI , the gendered, those are often gendered gendered roles around food work. And then we think about what we value, who does those, and whether we value that in something like a food lunch program, making sure that we put that in the equation, that it's freeing up those individuals hours and that their time freed up is evaluated, is a fascinating concept for these kinds of things. And so we're gonna publish in the next couple of months, the manuscript that's been developing that questionnaire. And then I want to use that questionnaire in all our trials and then in cohorts. To see, because household work is real work and food work is real work, and we pay people to do it outside the house. But we, we sometimes forget that that work is real value inside the house. And if we create policies that lessen that burden for everyone in a province, what does that turn into from an economic benefit?

Chantal Bassett 36:35

Fascinating work, Dylan . In terms of... obviously I'm reflecting on my own home and the amount of time and the investment that I choose to make for my own family in terms of their nutrition, because there are so many faster options that are available... readily available. I could be offering fast food or other junk, but there are true barriers to having a healthy lifestyle, a good nutritional balance. And so I could see how it's all about removing the barriers. It's not just about a message.

Dylan MacKay 37:11

Yeah. So that's the idea . That's why that promise in the election really like made me pay attention to politics at the provincial level this year. Because I thought that's one of those things where if every kid is in school, we hope every kid's in school, and that's the place where we could intervene and remove all those barriers for healthy food. So breakfast and not just universal access, but universal breakfast and lunch programs have that potential, in my mind. In my view, the way nutritional interventions could impact health at least for a period of time of the year. They're in school for more than the time that they're out of school. But then the trickle down effects of that exposing to other foods. Maybe you integrate in some schools the making of those foods into the classroom. Like home economics and those skills... how to grocery shop and how to grocery shop for the food that you're gonna get. The importance of preparation and storage. And as you mentioned with ultra processed foods or junk foods and things like that. There's maybe food work and time savings, potentially. There's also health consequences of those and the balance of those. That's another aspect of my research where the food work around... is it complete ? It's a completely... it's like a side project, but I'm super excited about it. Then how could it be used to evaluate policies like that. That's the big one I wanna know. How are they evaluating this new program? Who's doing it? What researchers are they in our faculty? What are they gonna do? And how are they gonna do it? Because I would love to be involved in that. That's just a fascinating last stage. Or like, you know, when it has the impact that to impact my kids, to impact my life, to impact all of the children in Manitoba. That's a really cool opportunity.

Chantal Bassett 38:54

Well, Dylan , I feel like I could talk to you all day. I feel we should wrap it up. You know what we... you've given us, you've given us some nuggets in terms of who you are, what you're passionate about, and a bit about your origin story. But why don't you tell us something about that's outside of your professional life. What, what is something we might be surprised to hear from you?

Dylan MacKay 39:17

Okay. I guess we hit on a lot of those things. You might've noticed that I'm really interested in politics and policies, but that kind of links to my work as well. Or maybe I've made my work linked to that. And food is a big part of my life. Type one diabetes. I'm obsessed with food. I think about food all the time. People would say maybe I'm a food snob. I really like very nice food. I love all kinds of food. I like food from all over the world. I have a potluck coming up for my research group. And because there's so many people from all around the world that are gonna be making food from that they grew up with. I can't wait for that. But if I haven't hit on it yet, I love sports. I grew up playing hockey and soccer and I still try. I wish I could still play it all the time. But, family and life and all those other things run into times for that. And I guess I did mention that , I'm German, a German citizen. My mother's German and she never gave up her citizenship. And so I've gone to Germany almost every year, and learned German and half my family is there. And I think that exposure to different... it's very similar, but a different food culture has informed a lot of my work again. I'm trying to think . Maybe I worked too much or maybe I've designed my work to highlight all the things that I like to do anyway. Yeah. It's a little bit like that taste preference, right? Maybe I do the work that I do because of my life rather than the reverse. Yeah, it's a lot of food. That's the focus. And outside of work, I have my family and that's really, I will say the overall balances. And, maybe the... my bosses might not, I work to live, not live to work, despite the way it sounds. I just think there's a lot of blend between the two in my life.

Chantal Bassett 40:57

So, Dylan , from my understanding, you're cross appointed. So 50% with the faculty of agricultural and food sciences and 50% with the Department of Internal Medicine in the Rady Faculty of Health.

Dylan MacKay 41:09

So my position is in food and human nutritional sciences, but it's also 50% in internal medicine. So in the Rady Faculty of Health Sciences, the way it happened is was I was in community health sciences in my previous position and I had been successful with some recent national grants. And I was looking for a tenure track position and I was shortlisted at some other universities. The way, unfortunately, the academic system is that, sometimes institutions don't value who they have as much as the other ones wanna steal from them . And so I had 2 job opportunities on either coast of Canada and I went to my associate Dean and just asked about the potential to stay. I really like my research and I love living in Winnipeg. I love the research environment here. The people I work with, my kids are here, my friends, everything. I've been here for a long time. I considered myself at Winnipeg. And I said, you know, is there a chance you can make a position for me here that's tenure track? Because I wanted that job security. The associate dean said, you know, we'd love to, and you've been doing great research, but it's just not in the cards to create a new position, so I responded to the email and I said, well, you know, that's too bad. Just be aware the Rady faculty is gonna lose 2 faculty 'cause my wife's gonna go move with me. She's an instructor in nursing. And then the next day the associate dean called me on my cell phone, I've never spoken to them in person before. And they're like, can we make something work out? And I think that's important to think about. Research is great, but creating the nurses and the clinicians that run the faculty, that's really important part of this university. And so in a roundabout way, I guess they talked to nursing and nursing and said , under no circumstances could we lose instructors right now . You need to create a position for her husband. They went around and they asked, you know, faculty, agriculture and food science, "do you guys have the ability to make a position?" And they said no, maybe half. But the way it worked out is now I have 1/2 from Rady , 1/2 from faculty agriculture and food science. I couldn't be happier. I really love the blend there because all of my research colleagues that are clinicians are pretty much in internal medicine. The rheumatologists, the endocrinologists, the nephrologists, all the people who treat the chronic disease conditions. And then they come to me when they wanna do nutrition trials. And that's just fascinating. I love to do that. So it's a job that was made for me because my wife was really valuable to the university.

Chantal Bassett 43:28

That's awesome. So this has been Dr. Chantal Bassett, joined by Dr. Dylan MacKay, assistant professor in the departments of Food and Human Nutritional Sciences and internal Medicine at the University of Manitoba. And that's it for today's episode of Changemakers, the Faculty of Agricultural and Food Sciences Research and Innovation podcast. Join me in future episodes to hear about other fascinating research being led by agricultural and AgriFood innovators at the University of Manitoba.