November 11, 2012

A diet of white rice, few veggies and sweetened drinks puts Hispanics at greater risk of diabetes

When Arleen Barreiros was diagnosed with Type 2 diabetes at age 27, the news didn’t come as a total shock. She was overweight and had trouble making the lifestyle choices necessary to drop the pounds. Plus, her grandmother, mother and father already had diabetes.

When Arleen Barreiros was diagnosed with Type 2 diabetes at age 27, the news didn’t come as a total shock. She was overweight and had trouble making the lifestyle choices necessary to drop the pounds. Plus, her grandmother, mother and father already had diabetes.

But the diagnosis forced her to make immediate changes. As a daughter of Cuban immigrants, that may have been the most difficult challenge.

“I really had to explore foods that I wasn’t used to growing up,” said Barreiros, who is now 35. “Vegetables? We didn’t have vegetables. I had to go away from the traditional Cuban food because it’s full of grease, and everything is fried and heavy carbs. It’s hard to balance that, and balance your blood sugar.”

It’s a sentiment echoed widely in Miami, where more than half the population is Hispanic. Experts say that traditional cuisines from Caribbean, Central and South American countries are often loaded with simple carbohydrates that have a high glycemic index. The sugars in these foods, like white rice and white bread, break down quickly in the body and cause sudden spikes in the blood system’s glucose levels.

That kind of diet coupled with a more sedentary lifestyle in the United States and easy access to packaged foods and soft drinks make for an unhealthy combination for millions of Hispanic immigrants and their children. According to a 2010 national study by the Centers for Disease Control and Prevention, adult Hispanics are 1.7 times more likely than non-Hispanic whites to have diabetes.

“You take somebody who grew up in Cuba, Colombia or Peru. When they were there they didn’t have diabetes,” said Dr. Joseph Gutman, an endocrinologist at Mount Sinai Medical Center. “They moved here and started having the fast foods, and the colas, adding a burden that their bodies cannot handle. Yes, the white rice is terrible, but that just means you can’t have it in the quantities you used to have. You’re adding insult to injury.”

Gutman and others who treat diabetic patients and those at risk for getting the disease say one of their first steps is convincing all patients — Hispanics and non-Hispanics alike — to eliminate sweet beverages, like sodas and juices, which have a high glycemic index, from their diets.

“I’ve had several patients who drink four to five colas a day and the only thing we’ve done is get them to switch beverages,” said Dr. Ted Feldman, medical director of both the Center for Prevention and Wellness at Baptist Health South Florida and the South Miami Heart Center at South Miami Hospital. “By cutting it off, they immediately lose weight.”

For many of her Hispanic patients, registered dietician Rocio Garcia said it’s especially difficult to understand why they should limit their fruit juice intake.

“They think because it comes from a fruit it’s healthy,” said Garcia, who counsels organ transplant patients at Jackson Memorial Hospital. “With the juices, you’re not getting all the fiber from the fruit. If you drink six ounces of orange juice, it’s as if you were eating three oranges at once, but without all the benefits.”

Fibers are important because the body takes longer to break them down. As a result, the fruit’s natural sugars are absorbed more slowly into the blood system and the pancreas doesn’t have to go into overdrive to produce insulin to dispose of it right away.

“It’s as if you left one window open in your house and had a hurricane, and the water came in and damaged everything,” said Gutman. “But if your kids came into the house, wet from the pool, you wouldn’t have to work so hard to clean it out.”

As for meals, the American Diabetes Association recommends drawing an imaginary line on your plate, dividing it in two, and then dividing one of the halves again so that you have three sections. The largest section of the plate should be devoted to non-starchy vegetables. Then, one quarter can go to starches, such as multi-grained breads. Finally, lean meats, eggs or dairy products can fill the last quarter.

Alejandra Cordovez, a registered dietician at the University of Miami’s Diabetes Research Institute, said the greatest challenge with Hispanic patients is increasing the non-starchy vegetable consumption.

“The Hispanic diet has high portions of refined carbohydrates with low fiber, like white rice, buñelos, Cuban bread, arepas,” she said. “People ask me if they can have rice. Yes, but you cannot have three cups of rice, two cups of beans, yucca, malanga and platanitos and some meat.” What worries is Cordovez is that many Hispanic parents children are not introducing their children to vegetables. Some of her patients are obese 9-year-olds.

“I’m trying to get them to eat a serving of veggies but the parents tell me, ‘Oh, I try to make him eat vegetables but he won’t.’ Then I ask the parent: ‘Do you eat the vegetables?’” she said.

Too often, she said, the answer is no.

After her diagnosis, Barreiros began to experiment with vegetables in the kitchen — and actually enjoyed some of them. In fact, she’s even introduced her parents and grandmother to some of these new foods.

“They never even knew what zucchini and squash was until I made some chili with those vegetables,” Barreiros recalled, laughing. “They’re like, ‘What’s this green and yellow thing?’ I had to show them. They’d seen them in the store but never tried them.”

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