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.