In Miami, patients manage diabetes with the power of food

Every couple of months, Annie Neals attends a diabetes cooking class at her neighborhood health clinic, where doctors and nurses and nutritionist and culinary instructor promise to help her manage the disease with the power of food.

She brings her family’s history to the table: Neals’ grandmother had diabetes. So did her two older brothers. Because he did not lose weight or adjust his diet, one brother lost both legs to the disease — one amputated above the knee, the other below. So Neals intently takes in the quarterly cooking demonstration at the Jefferson Reaves Sr. Health Center, with the knowledge of the generational toll taken on her family.

She makes mental note of the healthier spices and herbs that can be used to substitute for the rich goodness of her traditionally African-American diet. “I come to these classes because I learned how food contributes to my diabetes,’’ said Neals, 47, of Overtown, who was diagnosed in 2010 and began attending the classes that year. “I am changing my habits, learning how to cook and re-cook using the most real and natural foods I can get.’’

As the health world grapples with ways to control the nation’s seventh leading cause of death — and the trigger behind of a slew of other related chronic issues — the kitchen has moved to the frontlines of diabetes and pre-diabetes management. The idea of re-learning how to cook traditional foods and discovering new foods is a growing approach to attack what experts call a public health crisis, particularly within ethnic communities. In that way, the cooking classes are at the intersection of modern healthcare and cultural identity, especially important in South Florida where ethnicity is often defined by food.

“Diabetes as a whole is a significant health problem. We have 26 million people with diabetes and another 79 million who are pre-diabetic, and together that is about a third of the nation’s population,’’ said Ann Albright, director of the Centers for Disease Control and Prevention’s Division of Diabetes Translation. “In high-risk ethnic groups [which include African Americans and Hispanics], the proportion is higher. Those groups are hit particularly hard. There is no question they are shouldering a bigger burden of the disease.”

In Miami-Dade County, 9.3 percent of the adult population has diabetes, according to 2010 Florida Department of Health data. But at the Jackson Health System-run clinic on Northwest Fifth Avenue, which serves Overtown, Allapattah and Little Haiti, about 24 percent, or approximately 1,500 residents are living with diabetes.

The morning cooking demonstrations, led by “kitchen counselor” Lori Hollander, are designed to introduce healthy alternatives, broaden cooking methods and temper culturally familiar food recipes that are typically high in fat and salt. The classes began about two years ago and attendance ranges from eight to 20 people.

“The purpose is to acquaint the people with a different way of preparing foods using ingredients they have access to,” said John G. Ryan, who co-directs the United Health Foundation Center of Excellence at Jefferson Reaves, where the diabetes care program is based. “We want to introduce them to the nuances and to new foods.”

Participants set the agenda for the class, choosing the foods they would like to use — often a staple item that reminds them of home. Hollander makes recipe selections that are vetted to make sure they meet diabetic dietary standards. In past sessions, they have learned how to stir-fry collard greens with turkey bacon; make fish tacos with tilapia and whole wheat tortillas and mix a Creole dry marinade made without salt. Along the way, the students have been exposed to new foods, too: spaghetti squash, red lentils and seaweed.

“It’s critical that we acknowledge that food is so much more than fuel for our bodies. Culturally speaking, it’s used in celebrating, showing inclusion, hospitality. It is a reason for people to gather and exchange and talk,” said Albright. “So while diabetes is a metabolic disease and you have to pay attention to food, we also want to find ways to accommodate people’s taste, culture, even preferences, which is critical in increasing their likelihood to make lifestyle changes. The idea is not to tell people they can’t have something ever, it’s about developing the skill of moderation and making other relatively modest changes in choices and preparation. It’s about making sure the foods we eat are not calorie dense and nutritionally vacant.”

In a room at the primary care clinic, the long table is full today with foods and spices. There’s a big bowl of greens, packages of ground turkey; lemons, canisters of sea salt and apple cider vinegar. Before the 90-minute session is over, students will have prepared a meal and added three more diabetes-friendly recipes to their portfolio. The menu consists of turkey burgers flavored with arugula and apple chunks; a kale and grain salad and, for dessert, lemon zest ricotta pudding.

After learning about the nutritional value and benefits of some foods (ginger and broccoli are good for digestion and detoxifying the blood), students gather around the table. Every person is assigned a task: mixing, grilling, stirring, shaving, tossing. It will become a communal meal prepared by strangers bound by diabetes.

Every ingredient, or a reasonable substitute, is available in the neighborhoods where the participants live — the local supermarket or, in some cases, the convenience store. That’s why when the original salad recipe called for pine nuts, Hollander substituted it for easy-to-find shaved almonds.

Ryan, an assistant professor in the family medicine and community health department at the University of Miami’s Miller School of Medicine, said patients in the diabetes program are facing daunting social and financial barriers that can influence lifestyle choices. Some don’t know how to make affordable changes to their diets. Some feel powerless to make changes. Some are hampered by the physical pain of living with other chronic diseases.

But he believes a holistic approach and self-management education goes a long way toward healthy living. And, in the best case scenario, empowered patients take the message back to family and friends in the community in a more personal and powerful way than any doctor ever could.

The clinic offers a four-week Diabetes Self-Management course, launched about six years ago, to learn the basics of the disease, which can lead to heart ailments, kidney failure, blindness and limb amputation. Those that complete the course can attend the Peer Education monthly workshop, available in English and Spanish, where participants can share stories and “best practices.” The next phase is the cooking class.

The programming is funded through a United Health Foundation gift, provided through the UM’s Department of Family Medicine and Community Health. Overall, the annual $1 million gift is aimed at making healthcare more accessible and addressing serious health issues, including diabetes and related risk factors.

This class is not just about preparing tasty meals, but also about making good decisions — to bypass the cheap, processed frozen meals aisle in the supermarket, to whizz past the fast-food drive-thrus.

“It’s nice to be in a class where everybody you are all dealing with is facing the same kinds of issues,’’ said Jorge Tacoronte, who has lost about 35 pounds since joining the program two years ago. “It makes you feel like you are not alone.”

Diagnosed in the early 1990s, he said he has worked to revamp his eating habits now that he has wider choices.

“I used to eat a lot of rice and beans, yucca, fried bananas. Now I am replacing the white rice with brown rice and I learned how to cook collards without the bacon. I can now stir fry it with olive oil and add lemon for flavor,’’ said Tacoronte, who lives in Little Havana. “We are learning ways to cook food and to make it taste good.’’

Neals has a sweet tooth.

She’s had it all her life, and still gets giddy at the sight of Oreos. But after learning how to use ricotta cheese to make a dessert in the class, she is cutting back on the cookies, a few here and there instead of mindlessly munching through a box. She sums up the takeaway value of the cooking demonstration: “More than anything, the class helps me to do right.’’

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