sign in sign up
<<
Home , Bandeja paisa, Brazilian Americans, Chitterlings, Flour tortilla, Lunch

5/16/2018

“All Are Not The Same” Dietary Variations Among Hispanics and Latinos with Diabetes Nilda Benmaor , M.S.,R.D.N., C.D.E.

©Nilda Benmaor, RDN,CDE ‐2017

Learning Objectives After completing this , nutrition professionals should be able to: . Select culturally appropriate for Hispanics and Latinos with diabetes. . Identify the nutrient composition of traditional foods and the impact on post prandial blood levels. . Learn how to individualize a diabetic plan that includes patient’s preferred foods from country of origin. . Apply diabetic dietary guidelines and carbohydrate counting to meal planning. . Assess individual patient’s needs and beliefs in order to improve adherence to dietary recommendations and to achieve optimal glycemic control. CDR Learning Codes: 3000 Nutrition Assessment; 5000 Medical Nutrition Therapy; 5190 Diabetes Mellitus; 2020 Composition of Foods Nutrient Analysis ©Nilda Benmaor, RDN,CDE ‐2017

“It is easier to change a man’s religion than to change his diet.”

Margaret Mead, Cultural Anthropologist

©Nilda Benmaor, RDN,CDE ‐2017

1 5/16/2018

Latin American Culture

Place of Birth : The name of the province, territory or country in which the person was born. Ethnicity Mixed race ancestry: Colonization by , and France. Immigration from , Germany and Eastern Europe, Africa, China and Korea. Language Spanish, Portuguese ( ), French ( and French Guiana). Religion Primary is Roman Catholic. Also Protestant, Jewish, Evangelical, Buddhist, .Hindu

©Nilda Benmaor, RDN,CDE ‐2017

Definitions

Hispanic* Refers to persons of Spanish–Speaking origin or ancestry from Latin , but excludes . * Refers to persons of Latin American origin or ancestry ,including Brazilians, but excludes persons from Spain. What to use? Hispanic refers to language. Latino refers to geography. (Use language as your guide)

Example: are Hispanics AND Latinos are Latinos NOT Hispanics are Hispanics NOT Latinos

*www.Wikipedia.org

©Nilda Benmaor, RDN,CDE ‐2017

Hispanic/Latino Demographics Hispanic Population in U.S. 54 million, 17% of population* Nation’s largest ethnic or race minority

Largest Hispanic Groups in the U.S. ‐2012 Mexicans‐64% Puerto Rican‐9.4% Salvadorans‐3.8% Cubans‐3.7% Dominicans‐3.1% Guatemalans‐2.3% Other Hispanic or Latino origins‐13.7%

2060 Projections 128.8 million,31% of the U.S. population by that date

*U.S. Census Bureau –July 1,2013

©Nilda Benmaor, RDN,CDE ‐2017

2 5/16/2018

Racial and Ethnic Differences in Prevalence of Diagnosed Diabetes

• National Diabetes Statistics Data from the National Diabetes Statistics Report, 2014 (released June 10, 2014)

©Nilda Benmaor, RDN,CDE ‐2017

Targeting Hispanics for Better Diabetes Education The burden of diabetes is even heavier for Hispanics/Latinos due to a number of factors :  Language  Socioeconomic status  Religious faith  Educational attainment and acculturation  Beliefs and perceptions about health care  Legal documentation status  Access to health insurance

©Nilda Benmaor, RDN,CDE ‐2017

Rates of Diagnosed Diabetes Breakdown Among Hispanic Adults

. 8.5% for Central and South Americans . 9.3% for Cubans . 13.9% for Mexican Americans . 14.8% for .

• National Diabetes Statistics Data from the National Diabetes Statistics Report, 2014 (released June 10, 2014)

©Nilda Benmaor, RDN,CDE ‐2017

3 5/16/2018

Hispanic Diets Weaknesses  preparation methods tend to add animal fats in the form of , , and creams.  Preference for high fat , such as and organ meats

Strengths  Contains complex carbohydrate staples  Has protein (such as beans)  Great reliance on and mixed dishes

©Nilda Benmaor, RDN,CDE ‐2017

Bilingual Label

©Nilda Benmaor, RDN,CDE ‐2017

Nutrition Facts Labels

Whole Wheat Bread Corn : 2 Serving Size:2 Calories: 110 Calories:100 Total Fat: 1.5 g Total Fat: 1.5g Carbohydrates: 20 g Carbohydrates: 20g Sugar: 2g Sugar:2g Dietary Fiber: 3g Dietary Fiber: 3g Protein: 5 g Protein: 2g Sodium: 230 mg Sodium: 10 mg

©Nilda Benmaor, RDN,CDE‐2018

4 5/16/2018

Nutrient Content of Traditional Foods from Country of Origin

©Nilda Benmaor, RDN,CDE ‐2017

Mexico ‐Traditional Foods

Corn Tortillas : Treated corn kernels called “nixtamal “are pulverized on a tone slab. The (harina) is combined with water to make the dough.

Serving size :1 =Calories 58, Carbs 12g, Protein 1 g, Fat 1 g (Sodium 3 mg)

Flour tortillas: Serving size: 1( 7‐8”) = Calories 144, Carbs 24 g, Protein 4 g, Fat 4g (Sodium 290 mg )

Caldos:Hearty or stews with chicken, beef, or fish. Serving size : 1 cup = Calories 86, Carbs 8g, Protein 6g, Fat 3g

Choose your Food Exchange List for Diabetes ( ADA& AND)

©Nilda Benmaor, RDN,CDE ‐2017

Mexico‐ Traditional Foods

Tacos: Mexican equivalent of . Soft or crispy filled with meats, , beans, and sauces. Serving Size: 1 (beef) =Calories 257, Carbs 23, Protein 13g, Fat 12g

Burritos Large , thin wheat tortilla folded around beans, , meats, and added Serving Size : 1 (5oz)= Calories 302,Carbs 45g, Protein 7g,Fat 10g

Quesadillas (cheese) : Tortillas filed with leftover , vegetables, cheese, and . Serving Size: 1 (5oz) = Calories 370, Carbs 37g, Protein 21g, Fat 15g

Choose your Food Exchange List for Diabetes ( ADA & AND)

©Nilda Benmaor, RDN,CDE ‐2017

5 5/16/2018

Mexico –Traditional Foods

Boiled Beans (out of the pot) Serving size : 1/2 cup= Calories 80‐100, Carbs 15, Protein 21g, Fat 1g

Refried Beans: Fried with Serving size : 1/2 cup = Calories 190, Carbs 15g , Protein 21g , Fat 5g

Chilaquiles: Stale tortillas broken up and softened in a sauce as side Serving size: 1 cup= Calories 205, Carbs 17g , Protein 11 g, Fat 11g

©Nilda Benmaor, RDN,CDE ‐2017

Mexico ‐Traditional Foods : White or yellow softened in lard or sauce then filled with meat, poultry, seafood , cheese or egg mixture then baked. Sauce is made with green or red chilies, vinegar and spices. Serving size : 1 = Calories 280, Carbs 33‐34 g , Protein 24g, Fat 6 g

Chicharrones: Fried TamalesServing size: Made : 9 pc with= Calories masa 70 (harina)‐80, Carbs or 0.5 lefover g, Protein pozzole 7g, Fat (hominy) 4‐6 g that is placed in corn husks or young leaves of avocados. Folded, filled with meat or vegetable mixture, then baked or boiled. After , the husk or leaf is unfolded, and the inside filling is ready to eat . Very popular during the holidays. Serving size: 1 = Calories 280, Carbs 26 g, Protein 15g, Fat 17 g

©Nilda Benmaor, RDN,CDE ‐2017

Mexico ‐ Traditional Foods : Traditional Mexican (also known as “pancita”) made with beef stomach () in broth, with a red chili pepper base, lime, choppe ,onions, and chopped cilantro, as well as crushed oregano, and crushe red chili peppers. Suppose to cure hangovers. Serving size: 1 cup = Calories 130, Carbs 1 g, Protein 21 g, Fat 5g

Flautas (chicken): Tortillas tightly rolled around the filling and fried until crispy Serving size: 1 = Calories 180, Carbs 7g, Protein 18g, Fat 9g

Tortas : with French bread with beans, cheese or beef Serving size: 1 = Calories 475, Carbs 63g, Protein 17g, Fat 18g

Choose your Food Exchange List for Diabetes ( ADA & AND)

©Nilda Benmaor, RDN,CDE ‐2017

6 5/16/2018

Mexico‐ Traditional Foods

Pozole (green) :“hominy” soup or with pork, chili peppers, salsa, cabbage, and lime. Serving size: 1 cup= Calories 220, Carbs 17g, Protein 22g, Fat 7g

Nopales : cactus also known as prickly pears are one of the favorite vegetables. Contains fiber and pectin, which may decrease carbohydrate absorption. Serving size: 1 cup= Calories 16, Carbs 3g,Protein 1g,Fat 0 g Sweets Pan Dulces : Variety of sweet and savory breads Serving Size: 1 ( small round) = Calories 147, Carbs 16g, Protein 1g, Fat 9g

©Nilda Benmaor, RDN,CDE ‐2017

Mexico‐ Traditional Foods : Masa corn flour, , and sugar Serving size: 1 cup= Calories 209, Carbs 40g, Protein 4g, Fat 3.8g AGUAS FRESCAS : White long with cinnamon, sugar, and water Serving size: 1 cup= Calories 98, Carbs 25g , Protein 0.2g, Fat 0.5g

Tamarind or soda: Is a with sour taste that is sweetened with sugar or honey .Also sold as a natural flavor soda . Serving size: 1 cup= Calories 116, Carbs 29g,Protein 0g,Fat 0g

©Nilda Benmaor, RDN,CDE ‐2017

Nutrient Content of Traditional Foods from Country of Origin EL SALVADOR

©Nilda Benmaor, RDN,CDE ‐2017

7 5/16/2018

El Salvador –Traditional Foods

Pupusas : Thick corn tortillas stuffed with cheese, meat, squash and/or other fillings; Served with pickled cabbage Serving size: 2 = Calories 600, Carbs 43g ,Protein 12g, Fat 16g

Sopa de Pata :a hearty soup made from cow’s feet, tripe, yucca, sweet corn and green beans. Serving Size: 1 cup = Calories 241, Carbs 8, Protein 18g, Fat 15 g

Yuca Frita: Fried yucca, often served with chicharron Serving size : 5 pc = Calories 170, Carbs 22g, Protein 1g , Fat 9g

Choose your Food Exchange List for Diabetes ( ADA & AND)

©Nilda Benmaor, RDN,CDE ‐2017

El Salvador‐ Traditional Foods

Loroco: a small green unopened flower bud used as an herb for flavoring in Central America. Loroco tastes "green" with overtones of nuts. Taste like a cross between mild broccoli and squash. Loroco con queso** with cheese as a filling in Serving Size: 1 (28g)= Calories 12, Carbs 2g, Protein 1g, Fat 0g

Pacalla: A pacaya vegetable is the flower of tepejilote palm or date palm. It is a common ingredient in Guatemalan and Salvadorian , which is where the palm is primarily grown. The flower is then coated in a beaten batter of egg whites, flour, chili powder, , and fried in oil.

Fried Pacalla Serving Size : ½ = Calories 5 , Carbs 1 , Protein 1 , Fat 0g ( not fried)

©Nilda Benmaor, RDN,CDE ‐2017

Nutrient Content of Traditional Foods from Country of Origin

CARIBBEAN ISLANDERS

©Nilda Benmaor, RDN,CDE ‐2017

8 5/16/2018

Cuba –Traditional Foods

Moros y Cristianos*: Black beans mixed with rice and fried onions, peppers, garlic, and sugar. Serving Size: 1 cup = Calories 470, Carbs 66g , Protein 15g, Fat 14g

Picadillo**: Beef hash seasoned with olives, raisins, tomatoes and peppers Serving Size: 1 cup= Calories 140g, Carbs 17g , Protein 4g, Fat 5g

Ropa Vieja***: Spicy beef strips, with peppers and onions Serving Size: 1 cup= Calories 230, Carbs 10g, Protein 20g,Fat 13g

©Nilda Benmaor, RDN,CDE ‐2017

Puerto Rico –Traditional Foods

Arroz con Gandules: Is a combination of rice, pigeon peas, and pork cooked in the same pot with sofrito Serving Size: ¼ cup= Calories 175, Carbs 29‐45 g‐Fat 4 g

Tostones/Mofongo (mashed): Fried chunks of plantain Serving Size: 1 medium = Calories 92, Carbs 14g, Protein 0.5g, Fat 4.5g

Sofrito: Made from fresh tomatoes, peppers, onions, garlic, and cilantro; used as a base in soups, stews, chicken, and meats Serving Size: 1 TBSP= Calories 35, Carbs 1g ,Protein 1g, Fat 3g

©Nilda Benmaor, RDN,CDE ‐2017

Caribbean Islanders‐ Traditional Foods

MOJO In Cuban cooking, mojo applies to any sauce that is made with garlic, olive oil, and a traditionally bitter orange juice. It is commonly used to flavor the cassava tuber and to marinate roast pork.

Serving Size : 2 TBSP = Calories 25, Carbs 5g, Protein 0g, Fat 1‐5g

In , mojo is an herb sauce of finely chopped coriander or parsley with salt, plenty of crushed garlic, and olive oil. Black pepper, butter, grated onion, vinegar, and any citrus fruit can also be added. It is commonly used on the island as a marinade for chicken roast, and as a dip for and fried cassava. It can also be mashed with mofongo.

©Nilda Benmaor, RDN,CDE ‐2017

9 5/16/2018

Nutrient Content of Traditional Foods from Country of Origin

©Nilda Benmaor, RDN,CDE ‐2017

Colombia‐ Traditional Foods

Arepas: Cornmeal , grilled, baked, or fried with cheese filling. Serving Size:1 = Calories 165, Carbs 33g, Protein 4g, Fat 1g

Bandeja : Traditional dish from Paisa region. Consists of white rice, red beans, ground beef, plantain, , morcilla, chicharon, , avocado, and a fried egg. Serving Size: 2 cups= Calories 920, Carbs 87g, Protein 65g ,Fat 32g

Ajiaco Pollo: Soup or stew with corn, potatoes, vegetables and chicken. Serving size: 1 bowl= Calories 397, Carbs 39g, Protein23, Fat 1‐5g

©Nilda Benmaor, RDN,CDE ‐2017

Brazil‐Traditional Foods Picanha Steak

Serving size (3.5oz) Calories 284,Carbs 0g,Protein 28 g, Fat 18.5 g

Feijoda Completa**: Black beans, smoked meat, sausage, and rice Serving Size : ½ cup =Calories 349, Carbs 18 g, Protein 31 g, Fat 15 g

AcarajéAblack‐eyed pea fried in palm oil, usually stuffed with shrimp and vinaigrette. (Also called Brazilian )

Serving Size: 3 oz = Calories 289, Carbs 19g, Protein 8g, Fat 20g

©Nilda Benmaor, RDN,CDE ‐2017

10 5/16/2018

Argentina‐Traditional Foods

Parrillada: A meal of a variety of meats that are grilled or barbecued. This version uses four types: skirt steak, , and chitterlings for a big enough to serve a crowd. Serving Size: 5 oz= Calories 340‐400 , Carbs 2‐3g, Protein 35g, Fat 21g

Chimichurri: A green sauce used for grilled meat, originally from . It is made of finely‐chopped parsley, minced garlic, vegetable oil, oregano, and white vinegar.

Serving Size 2 Tbsps.=Calories 80, Carbs 2g, Protein 0g, Fat 8 g

Mate: Infusion drink made with the leaves and twigs of the Yerba Mate plant, which are dried and steeped in hot water to ©Nilda Benmaor, RDN,CDE ‐2017 make herbal . Like black tea, it contains caffeine and without sugar it has no calories

Popular In

Platos Fuertes (Main dishes on ADA list) Rice with chicken, peppers, peas and carrots

Serving Size : 1 cup= Calories 250, Carbs 40 ‐50g, Protein 9‐12g, Fat 5‐10g

SOPA DE ARROZ: Long grain rice cooked with onions, tomatoes and chicken stock. Serving Size : ½ cup = Calories 184, Carbs 26g, Protein 2g, Fat 7g

Choose your Food Exchange List for Diabetes ( ADA & AND)

©Nilda Benmaor, RDN,CDE ‐2017

Popular in Latin America Types of paella include: Valencian paella (Spanish: paella valenciana), paella , seafood paella (Spanish: paella de marisco). Valencian paella consists of white rice, green beans, meat (chicken and rabbit), white beans, snails, and seasoning such as saffron and rosemary. Serving Size: 1 cup= Calories 379, Carbs 40g, Protein 22g, Fat 13g

PLATANO MADURO FRITOS ( FRIED PLANTAIN) Serving size : 1 (100 g) sliced = Calories 252,Carbs 36g, Protein 1g, Fat 13 g

©Nilda Benmaor, RDN,CDE ‐2017

11 5/16/2018

Popular in Latin America EMPANADAS They are made by folding dough or bread with stuffing consisting of a variety of meats, cheese, vegetables (potatoes, corn, spinach)or ,then fried or baked .

Brazil Argentina

Serving Size: 1 Calories :235 Carbs: 20g Protein: 8g Fat: 10‐18 g Puerto Rico

©Nilda Benmaor, RDN,CDE ‐2017

Popular in Latin America Thinly sliced top round beef dipped in egg and bread crumbs, and fried in oil on each side. They also can be cooked in the oven and topped with tomato sauce and mozzarella cheese called “Napolitana”. Very common to be a filling in a sandwich . Serving Size : 3 ounces = Calories 250, Carbs 16g, Protein 24g, Fat 10g

TORTILLA ESPAÑOLA (Spanish) Consisting of an omelet made with eggs and , vegetables ,onion and red peppers fried in oil. Serving Size : 1 slice = Calories 180‐230 , Carbs 5‐10g, Protein 11‐12g, Fat 14g

©Nilda Benmaor, RDN,CDE ‐2017

Popular in Latin America

FLAN Baked custard, sometimes served with caramel sauce. Serving Size: 5 ½ ounces = Calories 290 , Carbs 41g , Protein 5g , Fat 12g

DULCE DE LECHE A thick, creamy caramel sauce traditionally made with milk and sugar. It is very easy to make at home with a can of sweetened condensed milk. Serving Size : 2 Tbsp. =Calories 120, Carbs 20g, Protein 3g, Fat 3g

©Nilda Benmaor, RDN,CDE ‐2017

12 5/16/2018

Mealtimes in Latin America

Mexico‐ Centro America Desayuno (Morning): 7:00 ‐10:00 am ( or milk shake) Almuerzo (): 10:00 am (beans, tortillas, cheese, eggs) Comida (): 1:30 ‐ 4:00 pm (biggest meal) Cena (Dinner): 8:00‐ 9:00 pm (lighter meal)

Argentina‐ Brazil Desayuno: (Breakfast):7:00 ‐8:00 am (coffee, , jam) Almuerzo (Lunch): 1:30 ‐2:00pm (“Spanish” tortilla, and fruit) (): 5:00 pm ( tea, mate, pastries) Cena (Dinner): 9:00‐10:00pm (Largest meal of the day)

All other countries closely follow U.S. mealtime schedules.

©Nilda Benmaor, RDN,CDE ‐2017

Eating Customs

Culture influences each person’s choices about what to eat, when to eat, how and with whom.

Communal Table Tortillas or Bread vs. Fork or Spoon

Image :http://www.nationalgeographic.com/foodfeatures/communal‐ table/images/gallery1/images_1536/gallery2_1536.jpg

©Nilda Benmaor, RDN,CDE ‐2017

Same Name Different Nutrient Content

Mexican Tortilla Carbs= 24g Protein= 4 g Fat=4g Mexican Corn Tortilla Carbs= 12g/s Protein=1 g/s Fat= 1g/s

Spanish Tortilla Carbs= 5‐7g/s Protein= 11‐12g /s Fat= 14 g/s

©Nilda Benmaor, RDN,CDE ‐2017

13 5/16/2018

Same Name Different Nutrient Content Mexico: Rice (1 cup) TortaMexico: “Sandwich” (1) Sopa Carbs: 30g Carbs: 63g Protein: 2g Protein:17g Fat: 7‐8g Fat :18g

Central and South America South America: “” 1 slice Chicken; Vegetable soup (1 cup) Carbs: 42g, Protein: 4g, Fat: 10g Carbs: 8g, Protein: 6g, Fat: 3 g

©Nilda Benmaor, RDN,CDE ‐2017

AMERICAN DIABETES ASSOCIATION STANDARDS OF MEDICAL CARE IN DIABETES ‐2018 GOALS OF MEDICAL NUTRITION THERAPY  To promote and support healthful patterns, emphasizing a variety of nutrient‐dense foods in appropriate portion sizes, in order to improve overall health and specifically to :

 Achieve and maintain body weight goals  Attain individualized glycemic ,blood pressure and lipid goals  Delay or prevent complications of diabetes

 To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy ,access to healthful foods, willingness and ability to make behavioral changes, and barriers to change.

**Diabetes Care , Volume 39, Supplement 1, January 2016: S23

©Nilda Benmaor, RDN,CDE ‐2017

Diabetes Dietary Guidelines  Monitoring carbohydrate intake and blood glucose response to dietary carbohydrates are key for improving post prandial glucose control .

 Individualized meal planning, practical approach to follow a day‐to‐day plan.

 Takes into account individual preferences, culture, religious beliefs, tradition, and metabolic goals.

 Replace refined carbohydrates and added with whole grain, , vegetables, and fruits.

 Individuals with fixed daily insulin schedule, meal planning should emphasize a relatively fixed carbohydrate consumption pattern.

Diabetes Care. The Journal of clinical and applied research and Education, vol. 39, Supl. 1,January 2016

©Nilda Benmaor, RDN,CDE ‐2017

14 5/16/2018

Diabetes Meal Planning Guidelines

Meal Plans are Balanced  They include breakfast, lunch, dinner, and 1 to 2 .  Each one‐day plan includes about 8 servings of fruits and vegetables.  Fruits and vegetables are included at almost every meal and snack.

Moderate Carbohydrate Intake  Carbohydrate intake is spread throughout the day.  Most have 45‐60 grams of carbohydrates.  Most snacks have 15‐30 grams of carbohydrates.

300 mg of cholesterol per day. >25 grams of dietary fiber per day 2,300 mg of sodium or less per day

www.diabetes.org/about‐our‐meal‐plans.

©Nilda Benmaor, RDN,CDE ‐2017

“My Plate Diabetes” vs. Latin American Plate

The Plate Method

©Nilda Benmaor, RDN,CDE ‐2017

Challenges and Barriers to Dietary Adherence

 Diabetes Educators need to be aware of the cultural traditions and customs among all cultural and ethnic groups and to recognize socio‐economic challenges that may exist.

 There is no one “ diabetic diet and no one type of eating pattern that “ works” for all.

©Nilda Benmaor, RDN,CDE ‐2017

15 5/16/2018

Factors that Affect Blood Glucose After Meals  Food Ripeness: the riper the food, the more quickly it can raise blood glucose.

 Raw vs. cooked food: the more it is cooked, the more likely it is to raise blood glucose.

 Food Variety: for example long grain or short grain rice, white or red potatoes, etc.

 Amount of fat in the meal: Increase in fat causes food to take longer to be absorbed, which may result in high blood glucose several hours later.

 Types of foods: consumed at meal or snack time.

 Blood glucose: at the time of eating.

©Nilda Benmaor, RDN,CDE ‐2017

What is Carbohydrate Counting?

“A method of teaching people how to eat consistent amounts of carbohydrates at meals and snacks at similar times each day, with the end goal of achieving glycemic control and other diabetes and metabolic nutrition goals.”

Hope S . Warshaw , and Karen Bolderman , Practical Carbohydrate Counting : A How‐To Teach Guide for Health Professionals, American Diabetes Association 2008

©Nilda Benmaor, RDN,CDE ‐2017

Rational for Carbohydrate Counting  Carbohydrates have the greatest impact on blood glucose levels, since they are broken down into glucose during digestion.

 It is important to control the intake of carbohydrates by eating the same amount of carbohydrates, along with some protein and fat at each meal.

 Offers flexibility in food choices.

 It is used for pattern management to determine medication doses.

 Helps understand that healthy foods that contain carbohydrates should not be significantly limit or avoided as a means to achieve glycemic control.

 Helps understand how much carbohydrates to eat per meal or snack.

©Nilda Benmaor, RDN,CDE ‐2017

16 5/16/2018

Menus Comparisons Incorporating Hispanic Foods Typical Breakfast “Almuerzo / Desayuno” ( Breakfast)

Food Amount CHO ( grams) Food Amount CHO (grams) Oatmeal cooked 1 cup 30 Tortillas corn 2 20 Raisins ½ oz. 11 Eggs 2 0 Bread 1 slice 15 Beans ½ cup 15 Milk 8 oz. 12 Milk 8 oz. 12 Total 68 Total 47

Tortilla ( ) 1 large 30 1 regular 30 Cream cheese 1 Tbsp. 0 Beans ½ cup 15 Low sugar jelly 1 Tbsp. 6 Cheese 1 oz 0 Milk 8 oz. 12 Milk 8 oz. 12 Total 78 Total 57

©Nilda Benmaor, RDN,CDE ‐2017

Counseling Tips  Diabetes educators should work with the best that Hispanic culture offers.

 Promote consumption of traditional foods ,such as corn beans, nopales etc.

 Encourage small frequent meals instead of two large meals.

 Avoid confrontation and criticism, if a client feels intimidates he/she may become passive and not ask questions.  Nodding affirmatively does not necessarily mean agreement. Silence may indicate that a client lacks understanding and is too embarrassed to ask for clarification or disagree.

 Recommend economically available and acceptable foods ie :Target, Wallmart vs. Whole Foods, Sprout, Trader Joes.

 Sensitive health issues should be discussed through a professional interpreter, not using family members to translate.

©Nilda Benmaor, RDN,CDE ‐2017

Case Study #1

A 56 year old 5 ‐2”, 190 # Spanish speaking woman from Mexico, with Type II DM with an Hemoglobin A1C of 11.9, was referred for Medical Nutrition Therapy .Patient reported FBS=140‐150s and 2 hour post prandial between 250‐260 mg/dl. She is taking Metformin (500mg) 1 tablet BID ( with breakfast and before bedtime) also injecting Lantus 20 units/ HS .Also stated that now she eating healthier adding more fruits and oatmeal and only one large meal a day. Recommended 1500 calories/d ( 40‐45 g carbohydrates/meal) Diet Recall Morning (8:00 am)( #1) Afternoon 2‐3 pm (#2) Evening 7:00pm ( #3) 1 cup coffee 2 eggs fried 1 cup 2 tsp sugar 1 cup 4 oz. milk “Licuado” ( shake) 2 corn tortillas Carbohydrates: 40 ‐45g ½ c oatmeal raw ½ cup sopa (rice) 1 banana 8 oz atole ¼ c berries 1 medium banana 1tbsphoney Carbohydrates 130‐135g 12 oz milk Carbohydrates: 100‐140 g

©Nilda Benmaor, RDN,CDE ‐2017

17 5/16/2018

Case Study #2 A 49 year old Cuban male, 5‐11”, 250 # with Type II DM, was referred to see an RDN to evaluate and treat. He stated taking oral medications and insulin before bedtime and FBS > 200s. Provider is adjusting insulin and medication with little improvement on glucose levels. Patient stated that he was given a diet sheet in Spanish that stated not to eat cookies, cakes, candy, and tortillas. Patient was confused and told PCP that he was not eating any of those foods, however his blood sugars were still very high in the morning. Recommended 1800‐2000 Calories/d ( carbohydrates = 45g‐60g/meal)

Breakfast Dinner ( Cena ) at 8:00 pm 1 c coffee Moros y Cristianos 1 cup ( Carbs 66g) 2 tbsp. creamer (Carbs 5g) de Carne 1 cup ( Carbs 17g) Dinner roll 2 small ( Carbs 26g) Lunch Platano maduro frito 1 med ( Carbs 24g) 1 c ropa vieja (Carbs 10g) 1 c rice (Carbs 30g) Before Bedtime Snack ( Bocadillo) at 10:30 pm 1 c salad Flan 5 oz ( Carbs 41g) 2 tbsp. salad dressing 1 Tbsp ( Carbs 20g) 1 papaya (Carbs 25g) 8 oz. juice (Carbs 30g) Total Carbohydrates :290‐300 g

©Nilda Benmaor, RDN,CDE ‐2017

Summary  Diabetes management requires individualized, patient‐centered, and culturally appropriate strategies.

 Integrate, language, religion, literacy skills, and traditional foods from country of origin to improve blood sugar levels.

 Educate patients that controlling after meals blood sugar levels takes time and effort.

 Adapt expectations of patients to keep accurate records of their blood sugars, food, and physical activity, based on their literacy skills and education levels.

 A Registered Dietitian can provide in‐depth personalized nutrition education to help diabetics develop a personal action plan.

©Nilda Benmaor, RDN,CDE ‐2017

Questions

©Nilda Benmaor, RDN,CDE ‐2017

18 5/16/2018

©Nilda Benmaor, RDN,CDE ‐2017

References ‐U.S. Census Bureau(Census Briefs,2010: “The Hispanic Population in the : Population Characteristics. Washington DC : U.S. Government Printing Office . ‐Goya Foods and Recipes www.goya.com/english/recipes/categories/main‐dishes. ‐American Diabetes Association( www.diabetes.org) and Academy of Nutrition and Dietetics (www.eatright.org);2014 “Seleccione Sus Alimentos , Listas De Alimentos Para La Diabetes”. Exchange List . – ‐The Calorie King ; Calorie, Fat and Carbohydrate Counter 2014. www.calorieking.com ‐My Fitness Pal ;Calorie Counter, Diet and Exercise www.myfitnesspal.com ‐Calorie Counter ;Count your Calories for a Healthier Lifestyle. www.caloriecount.com ‐Fat Secret ;All things Food and Diet .www.fatsecret.com ‐The Journal of Nutrition ; “The Role of Acculturation in Nutrition, Lifestyle and Incidence of Type 2 Diabetes among Lations” ,(2007). vo.137,no 4, pg860‐870. ‐ The Journal of Clinical and Applied Research and Education ,Diabetes Care ; American Diabetes Association Standards of Medical Care in Diabetes 2016, , Volume 39 , Supplement 1. www.diabetes.org/diabetescare. ‐ U. S. Department of Health and Human Services ,The National Diabetes Education Program (NDEP) ;“Ten Ways Hispanics and Latinos Can Prevent Type2 Diabetes ,2015. www.niddk,nih.gov/health‐informatin/hispanic‐latino. ‐Clinical Diabetes Journal: Food , Culture and Diabetes in the U.S.2004,Vol.22,No 4. ‐The Journal of Nutrition ; The role of Acculturation in Nutrition Lifestyle, and Incidence of Type II Diabetes among Latinos. 2007;Vol137, No 4. ‐Kittler ,P. G. and Sucher,K.P.:2004. Food and Culture Fourth Edition, Stanford, CT; Wadsworth ‐Goody,C.M.,Drago , L. :Cultural Food Practices/Diabetes Care and Education Dietetic Practice Group, 2010

©Nilda Benmaor, RDN,CDE ‐2017

19