diabetes in the african american population€¦ · –african americans with diabetes develop...

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Diabetes in the African American PopulationImproving Outcomes with Traditional Diets

and Integrative Nutrition

Presented by Constance Brown-Riggs, MSEd, RD, CDE, CDN

Diabetes Care and Education DPG Diversity Liaison

CBR Nutrition Enterprises

Disclosures

Expert Advisory CommitteeOldways Preservative Trust

ConsultantOldways Preservative Trust

Today’s Discussion

• Diabetes Prevalence, Trends and Risk

• Identify African Americans

• Food Choices, Taste and Preferences

• CAM in African Americans

• Culturally Appropriate Strategies to Motivate

Behavior Change CBR Nutrition Enterprises

Diverse Populations

National Diabetes Statistics Report – 2017

• African Americans – 13.4%

• Hispanics – 11.9%

• Asian Americans – 10.3%

• Caucasians – 7.3%

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Compared to the general population, African Americans are disproportionately affected by several major chronic diseases in incidence, aggressiveness, and mortality:

Obesity• Over half of African American, aged 20+, are obese. (37.9% for

Men)

• African American women have the highest rates of obesity compared to other ethnic groups in U.S.

• 4:5 African American women are overweight or obese

African American Health

CDC 2014. Summary Health Statistics for U.S. Adults: 2012 CBR Nutrition Enterprises

• African Americans get diabetes more often.– African Americans are almost twice as likely

than whites to have diabetes. – About 1 in 7 (13.4%) African American adults has

diabetes. – Over the last 35 years, the number of people with

diabetes has doubled.

CDC 2014. Summary Health Statistics for U.S. Adults: 2012

African American Health - Diabetes


• Diabetes affects African Americans differently. – Diabetes is the #1 cause of kidney failure. It causes almost

half of all cases in the United States.– African Americans with diabetes develop kidney failure more

often than whites. – Diabetes causes heart disease and other problems in African

American more often than whites.

• Many African Americans don't know they have diabetes. – About 1 in 3 African Americans with diabetes do not

know they have the disease. www.kidneyfund.org

African American Health -Diabetes


• High Blood Pressure is the #2 cause of kidney failure. It causes about 1 out of 4 cases in the United States. High blood pressure is a serious problem for African Americans:

• African Americans get high blood pressure more often. – Almost half (over 42%) of African American adults have

high blood pressure.• High blood pressure affects African Americans differently.

– African Americans are six times as likely to get kidney failure from their high blood pressure than whites.

African American HealthHigh Blood Pressure

www.kidneyfund.org

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Who are African Americans?

• Black racial groups of Africa

• In US for generations

• Recent immigrants

– Africa, Caribbean, West Indies

• Southeast and mid-Atlantic

– Louisiana, Mississippi, Alabama, Georgia, South Carolina and Maryland


Almost 1 in 5 African Americans is uninsured.If diabetes, high blood pressure, and kidney disease are caught early, they can usually be managed. However, almost 1 in 5 African Americans are not insured. As a result, their health care choices may be limited.

Health Disparities – Why?



• Mistrust– Tuskegee

• 1997 eight survivors• Low priority

– AIDS, crime, education

• Susceptibility– Low income

• Spirituality– Fatalistic view


• Shifts from traditional to modern eating patterns include an increase in: – Sodium– Unhealthy Types of Fats– Sugar– Processed Foods– Animal-based Foods

– Fast Food

• As well as a more sedentary lifestyle.


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• Avoid making assumptions based on ethnic identification– Avoid Stereotypes– Not all African American pts incorporate ethnic

foods• Understand the use of CAM

What Health Professionals Can Do?


CAM Use in African Americans

:United States,2002–2012 National health statistics reports;no 79.

Arthritis Care Res (Hoboken). 2014 Feb; 66(2): 180–189.Res Social Adm Pharm. 2010 Sep; 6(3): 196–208.

• NCCIH – 2007 estimates 25.5%– 2012 estimates 19.3%

• Most Prevalent Modalities– Prayer– Herbals– Relaxation


How African Americans deal with illness

“Doctor told me I havediabetes but I’m notclaiming it”

CAM Use in African Americans


Ask Questions About Cultural Beliefs & Practices

– It is important to assess these areas even when the educator and patient share a cultural or ethnic identity.

– What type of home remedies do you use when you’re sick?

– Which foods do you eat to be healthy?

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�I have yet to hear of a traditional diet — from any culture, anywhere in the world — that is not substantially healthier than the �standard American diet.� The more we honor cultural differences in eating, the healthier we will be.� Michael Pollan

Heritage Diets


Traditional Diet Characteristics

• High in complex carbohydrates• Rich in fiber & whole foods • Abundance of fruits and vegetables• Moderate in healthy fats and oils• Herbs and spices, lower in sodium• Low to very moderate animal protein

consumption, mainly fish & seafood in flavor!


Health Studies on The African Diaspora

Blood Pressure Rises, as Traditional Diets Turn Western

A Loyola University study measured blood pressure and sodiumLevels in 2,704 people from Nigeria, Jamaica, and the UnitedStates. They found that both factors were lowest in Nigeria,Where there is little added sodium in foods, mid-range inJamaica, and highest in the U.S. Researchers concluded thatthe standard American diet, containing foods higher in sodium,is associated with a higher risk of abnormal blood pressure thantraditional diets.

Journal of Human Hypertension, 2011 May 19 [Epub ahead of print] CBR Nutrition Enterprises

Rural Ghanaians Eat More Roots,Tubers, PlantainsThan Ghanaians Living in Europe

Researchers analyzed the diets of 4,543 Ghanaians living in urban Ghana,rural Ghana, and Europe (Amsterdam, Berlin, and London). Ghanaians livingIn Europe had more obesity and diet related disease than those living inGhana. Researchers found those living In rural Ghana tended to eat moreroots, tubers, plantains, and fermented corn products; those living in urbanGhana tended to eat more rice, pasta, meat, and fish; and those living inEurope tended to eat more sweets, dairy, potatoes, chicken, whole grains,oils and margarine.


Food and Nutrition Research. 2017 Jul 6;61(1):1341809

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Prickly Pear Cactus (Nopal, Jamaican Tuna Plant)

Researchers evaluated the effect of nopal on the postprandial

response of glucose, insulin, GIP, GLP-1, and antioxidant

activity In patients with type 2 diabetes after consumption of a

high carbohydrate breakfast (HCB) or high-soy protein

breakfast (HSPB). The inclusion of nopal in the HCB group

had antihyperglycemic and antihyperinsulinemic effects, and

in the HSPB group, it prevented postprandial blood glucose

peaks.


November 2014, Journal of the Academy of Nutrition and Dietetics CBR Nutrition Enterprises

The Sankofa Symbol

The African word and symbol Sankofa translates as “to go back and take.”

This bird, arching its neck to take an egg from its back, symbolizes taking from the past what is good and bringing it into the present in order to make positive progress through knowledge.


Commonalities in Food Traditions Throughout the African Diaspora

• Healthy staple starches as a primary food: Squashes, pumpkins, tubers, root vegetables, and yams in certain places

• Vegetables in abundance (especially leafy greens), typically with these starches and stews

• Fruits plentiful, often eaten as or within desserts


Commonalities in Food Traditions Throughout the African Diaspora

• Rice & bean dishes common; nuts and seeds featured, as was seafood in fishing communities

• Meat, poultry and wild game eaten modestly and often as flavorings

• Herbs, teas and fermented drinks enjoyed moderately as a regular part of the diet

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South America 1. Vegetable & Rice Soup2. Black Beans & Rice with Hearts of

Palm Salad3. Moqueca De Peixe with

Watercress Salad

Africa1. Peanut Soup

2. Jollof Rice & Black Eyed Peas

3. Chicken Yassa

American South1. Shrimp Gumbo

2. Hoppin’ John, Braised Collard

Greens and Cabbage Slaw

3. Pecan-Crusted Baked Catfish,

Baked Sweet Potato and Okra &

Corn Mix-Up

The Caribbean1. Hearty Pumpkin Soup & Spinners

2. Red Beans & Rice in Light Coconut

Milk with Sautéed Spinach

3. Grilled Red Snapper & Mango

with Cilantro Lime Vinaigrette &

Green Beans

African Heritage Plates

Oldwayspt.org CBR Nutrition Enterprises

Traditional Diets

• Traditional diets have the power – both nutritionally and motivationally – to dramatically change the food quality and health climate of America.

• The traditional eating patterns of Africa and the African diaspora have shown to have protective properties against major chronic diseases ; as nutrition-shifts occur throughout the world—departing from traditional diets and conforming to the standard American diet—degenerative diseases arise.


• Recognize barriers– Culturally determined food practices

• Develop culturally relevant educational materials– Food– People

What Health Professionals Can Do? Culturally Competent Nutrition Education

Resources

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• DIY• AADE’s Diversity

COI • Academy’s

Ethnic DPGs– Cultural Food

Practices book


• 11 Popular Ethnic Cuisines (Moroccan, Peruvian, Cuban)

• Healthful Pleasures• Special Occasions• Carbohydrate Counts

for Popular Foods

Eatrightstore.org

An Effective Tool for Better Health

A way for health professionals to easily incorporate more culturally competent strategies into their dietary recommendations for African American patients.

A way to respect and celebrate the different cultures and regions of African Heritage

Minority Health ResourcesResource URLOffice of Minority Health www.cdc.gov/omh

National Medical Association

www.nmanet.org

National Hispanic Medical Association

www.nhmamd.org

Diversity RX/Cross Cultural Health Care Network

www.diversityrx.org

EthnoMed• Ethnic medicine

information

www.ethnomed.org

Oldways Preservative Trust www.oldwayspt.org

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Ethnomed.org


Questions and Answers

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