Diabetes and Nutrition in the Latino Community

Diabetes and Nutrition in the Latino Community


>>Female: I apologize
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ma’am, you may begin.>>Betsy Rodriguez:
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nutrition education resources. So if you love food, or by any
chance you’re hungry today, I honestly can say that
this is the right webinar for you at this time. So today’s webinar
is brought to you by the National Diabetes
Education Program. It’s from Latinos [inaudible]. My name is Betsy Rodriguez, the
[inaudible] director at CDCNVP, and your host for
this afternoon. Our presenter today is
Lorena Drago [phonetic]. Lorena is a registered
dietician, certified diabetes educator, and Hispanic education
specialist [inaudible] private practice. Ms. Drago also works as a
consultant conducting lectures, stress management workshop
and diabetes patient education for managed care organization,
business and individual. Ms. Drago discussed the role
that nutrition plays in managing and preventing diabetes,
as well as focusing on motivating clients
for behavior change, primarily in the
Latino community. So without further
introductions, I leave you with Ms.
Lorena Drago; Lorena.>>Lorena Drago: Thank you. Thank you; and I will be
happy to share this — the next 45 minutes
with all of you. The objective of this webinar
are to state three goals: [inaudible] nutrition
therapy for diabetes, describe one component of
the nutritional management of diabetes, to describe at least two nutrition
interventions targeting Hispanics or Latinos
with diabetes. I’m going to be using that term
interchangeably throughout the conference; and highlight
the MDEP’s nutrition education materials. [ Silence ] Let me start with
giving you a snapshot of Hispanic demographics. Based on the 2010
US Census survey, we can see that the Hispanic
population has grown almost 56% in the United States. The largest Hispanic groups in the United States still
remain Mexicans with 63%, followed by Puerto
Ricans, almost 10%, and then we have other
Hispanic subgroups. And this is very
important for those of you who are counseling Hispanic
patients to understand that Hispanics come from
many different locations, and their health
attitudes, their culture, as well as their food
preferences will vary from one group to another. The projection for
2020 is that almost — there will be a almost
20% growth in the Hispanic population. When we look at diabetes and the
racial and ethnic differences in the prevalence of
diabetes in these communities, we see that 6% of
non-Hispanic whites — and this is based on
2010, have diabetes. When we look at Hispanics, the age adjusted rates
were 9.3% of all Hispanics. But as I was mentioning
before, there is a difference in the prevalence of diagnosed
diabetes among different Hispanic subgroups. So we look here that if the
highest prevalence will be for Mexican Americans and
also for Puerto Ricans. And the ones that we have
documented the least will be for Cubans. Now, what are the three goals
of medical nutrition therapy in diabetes management? The three goals are to achieve or maintain a blood glucose
level in the normal range and of course or close to that
normal as long as it is safe for the patient to do so. A lipid and lipoprotein
profile that reduces the risk for vascular disease and
then the blood pressure to maintain the levels once
again just like blood glucose to be as close to normal
as is safely possible. And this is taken from the
American Diabetes Association Clinical Practice Guidelines
in 2008, and it has remained so even at the clinical
guidelines of 2012. Now, how effective — when we
talk about food, when we talk about management of
food and diabetes, how effective is medical
nutrition therapy? Well, when we look
at these studies that have been conducted,
there is a report of A1C of roughly a decrease of
1% in type 1’s and one to two percent in type 2’s. And this is just
with meal planning and with meal modification
that is specific for the person with diabetes. And this is excluding
all types of medication. So medical nutrition
therapy it is very effective in managing blood glucose. And it has also been shown
to reduce LDL cholesterol 15 to 25 points, effective
in reducing hypertension, and the improvements of
hypertension becomes apparent in three to six months. So medical nutrition therapy
is an adjunct to medications, exercise and other
lifestyle modifications for the person with diabetes. I am going to share
with you some of the general medical nutrition
therapy recommendations. For 2008 those —
that was a review of all the recommendations
that exist today and every year thereafter,
including 2012, there has been some
modification. So I’m going to be using
both recommendations. The recommendations for the
primary prevention of diabetes; so we know that not only
do we have diagnosed cases of diabetes, but we also have a
large percentage of individuals that might be in this
pre-diabetes zone, meaning that they are at
risk of developing diabetes. So the studies have shown
that a moderate weight loss — so we are talking about 7%,
sometimes even up to 10% of their body weight,
might impact positively on an individual’s risk
of preventing diabetes. When it comes to
different kinds of diets, whether it’s a low
carbohydrate diet, a low-fat calorie
restricted, a Mediterranean, and even a vegetarian diet, as
long as the calories are kept to sustain the person’s
body weight or achieve the weight loss
have been equally effectively. Of course, adding
physical activity about 150 minutes per week, also increasing dietary fiber 14
grams for every 1,000 calories. And we’re going to go into
that a little bit more so that you can visualize when this recommendation
is made what are we talking about when we are suggesting that individuals consume
14 grams of dietary fiber? The consumption of whole
grains is also very important. At least half of the grains that
are consumed by persons at risk of developing diabetes — and I should say almost
every individual should come from whole grain. And to limit the intake of
sugar-sweetened beverages, and that has been a
epidemic in the nation, is the use of sugar-sweetened
beverages. And what we see is that
there is a 26% greater risk of developing diabetes where individuals
consumed sweetened — sugar-sweetened beverages
consistently. Now, we just talked about
the 14 grams of fiber for every 1,000 calories. So here we have some examples of what foods contain
soluble fiber. So we have one and a half
cup of oats, we have one cup of cooked kidney beans, we
have one cup of okra, an apple, strawberries, and a
cup of cooked broccoli. All these foods contain
soluble fibers. But what I would like you to
do right now, and we can go to poll question number
one, is from those foods which one is highest
in soluble fiber? And if you could please — [ Silence ] Okay. We’re going to
be closing the polls so make your selections. [ Silence ] Okay. The polls are closed now. And I see that 43%
selected kidney beans, and oats was the
second most popular. So let’s go back to the slides. And we’ll see that most
of you were correct. One cup of kidney beans has six
grams of soluble fiber compared to one and a half cups of cooked
oats with three grams of fiber. Nevertheless, all of
these foods are healthy. And when we think about
needing 14 grams of fiber for every 1,000 calories
that we need — so we’re talking about
28 grams of soluble fiber if a person consumes
a 2,000-calorie diet. So it would be easily met
by a combination of fruit, vegetables, as well
as beans and peas. The other recommendation
was to include multigrains, whole grains, et cetera. What I wanted to show here
is it is very difficult to distinguish what is a
whole grain and what is not. In this example we
have two crackers, and most people will probably
select the one on the right, the multigrain cracker
as a whole grain. What happens is what you need to
do as a healthcare professional, as well as the consumer, is to
look at the ingredient list. And you will see that
the first ingredient on both is enriched flour,
which is not multigrain. What multigrain means is that
at least five different grains should be added to a product in
order to be called multigrain. But it doesn’t mean
that the product in itself is a whole
grain product. So here at a glance
when you want to choose whole grain foods, this is what you should be
looking for when you’re looking at the ingredient list. So the word whole should be
— should precede the grain, and we’re talking about whole
wheat, whole corn or rice, brown rice, and then some of
the maybes might be wheat, flour, semolina, et cetera. They might or might
not be whole grain. And definitely when you
see enriched wheat flour, that is not whole grain. So these are now
the recommendations for the management of diabetes. We’ve looked at the
prevention of diabetes with the weight loss,
including whole grain, reduction of calories
to meet that goal. And now we’re looking
at the recommendations for the management of diabetes. Well, the research has shown that about a 5% weight loss
is associated with a decrease of insulin resistance. So, again, the message
should be any kind of weight loss is beneficial
for persons with diabetes. The other recommendation is to
monitor carbohydrate intake, foods with carbohydrates. And we will take a look
at what those foods are. So limit the saturated fats,
less than 7% of total calories, and we’re going to
see an example of how you can take
this recommendation and put it into action. And also to minimize the
intake of trans fats. And trans fats are those foods that contain partially
hydrogenated oil, listed as one of
the ingredients. These are some examples of foods
that are high in saturated fat. It might be certain cuts of
meat, chocolate and ice cream, definitely one of my favorites,
high saturated fat food. And dairy products
made with whole milk and of course the
usual culprits, butter, lard or fat, et cetera. So when we talk about what
is that 7% of our calories when we translate it into
our budget, we are talking about between 12 to 16
grams of fat per day. That should be the
budget for someone that might be consuming
an 1800-calorie diet, which will be perhaps what
the average American would be eating. Weight reduction plans might
be somewhere between 1200 to 1400 calories, and
the fat will be reduced. So here we have some common
foods, American cheese, cheddar, et cetera, and what I
would like to know is — and we can go to poll question
number two, from those foods that are listed, which
food has the highest amount of saturated fats? And you can make
your selections now. [ Silence ] Okay. And make your
selections, polls are closed. So we have at one glass
eight ounces of whole milk as our winner, and an ounce of American cheese
as the runner-up. Let’s go back to the slides. And for those of you that selected American
cheese you are correct. Six grams of saturated
fat for the most part, and of course each
gram might vary a bit; and a glass of whole milk. It’s five grams of
saturated fat. So as you can see very easily,
someone that is consuming one to two glasses of milk —
let’s say ten grams of fat, and has a grilled sandwich
with two or three slices of American cheese, can really
go over their daily budget. So 12 to 16 grams of saturated
fat per day really does not give you a lot of wiggle room. And many times many of our patients are limiting
their egg consumption because of their
cholesterol content — and I’m referring to the yolk, but you see that one egg
including the yolk only has one gram of saturated fat. So when you’re counseling
you have to pay attention to the consumption of other
foods that others might not feel that they need to limit
from their diet and that that might be because of
their high cholesterol levels. A diet that is high in
saturated fat will increase LDL cholesterol. And that’s one of the goals
of diabetes management. So pay attention to
those foods in the diet. Okay. So we talked about
carbohydrates, and people talk about a low carbohydrate
diet, is it better than a low-fat diet, better
than a Mediterranean diet? And the optimal mix of macro-nutrients really
mostly should come from carbs, and again, we talked about
fruits and vegetables, beans, legumes in general,
and whole grain. That’s where most of the carbohydrates
should be coming from. The protein and the fat
well most likely should come from lean and also the
good and the healthy fat. So while saturated fat
might need to be decreased, there are other types of fats that are considered
to be healthy. But above all, the total number
of calories do matter regardless of that macro-nutrient mix. And the number of calories
should be appropriate for a person’s age, height,
weight, physical activity, medication and their
blood glucose levels. So when we look at a meal,
and we deconstruct that meal, we see that the meal that you
have on the left it’s a mix of carbohydrates,
protein and fat. And very seldom did we
consume just one type of food. And I want to focus, even though
our foods come from carbs, protein and fat, I want to
focus on just one component of the nutritional
management of diabetes. And that will be for today’s
lecture, the carbohydrates in diabetes management. And the reason that I want
to focus on carbohydrate is because carbohydrate in foods
is what affects blood glucose levels the most. So that’s the reason why
that will be the choice. So when we are talking
about carbohydrates, I want to use managing
carbohydrates as the primary strategy for
achieving blood glucose control. And the blood glucose
levels it’s a combination of how much carbohydrates a
person with diabetes eats, how much available
insulin they have, and that determines their
blood glucose levels. So what is the minimum daily
carbohydrate recommendations? Is it 100, 130 or 150? When we are talking about going
low carb or having enough carbs to sustain health, what
would that look like? And the answer is 130. That’s the American Diabetes
Association recommendation. Now, what is 130? How many cups of rice
can I eat for 130, how much bread can
one eat with 130? Let me just give you an
idea of what 130 looks like in terms of food. One cup of cooked rice, one cup, will have 45 grams
of carbohydrates. And that’s about a fifth worth. So that means that if a person
has two servings or two cups of cooked rice, that will
use 90 grams of the 130 grams that are budgeted for the day. [ Silence ] I will just summarize some
of the recommendations by the American Diabetes
Association, and I will just reiterate that the fiber intake
is very important. When the fiber is increased
in the diet, that can help to manage hunger, and also
soluble fiber can help to manage cholesterol levels. And very high fiber
diet could even help to manage blood glucose levels. Some — the diet should
be a combination of fruits and vegetables and
whole grains, legumes and low-fat milk
and dairy products. We also talked about the
amount of carbohydrates and how quickly those 130
grams might go in one day when a person counts
carbohydrates. Another recommendation is
the use of glycemic index and load as an advantage. And I’m not going to go into
the definition or examples, but I will just say that the
glycemic index it’s really how quickly the blood glucose level
rises, depending on the type of carbohydrates
that is consumed. And foods that have
sugar can be substituted for other carbohydrates foods;
even though they might not be as nutritious, but
they can be used. Now, let me just give you a
couple foods, some of the foods that may contain carbohydrates,
and some of them may not. So let’s go to poll
question number three. And there are six foods. What I want you to
do is select the food that does not contain
carbohydrates. [ Silence ] Okay. Let’s close the polls. Okay. So the first
answer, chicken cutlets, the most popular one,
followed by spinach, and sugar-free cookies. Let’s go back to the slides. And I just want to show the
foods that are now in red, those are the foods
that have carbohydrates. Chicken cutlets was
the correct answer; unless the chicken cutlets
is breaded or it has flour. But just the chicken
cutlets that is not a food that contains carbohydrates. Spinach might be a
surprise for some of you since it is a starchy and
very nutritious vegetable. Most non-starchy vegetables
do have carbohydrates, however the amount
is very little. I would say that when
I compare one cup of cooked rice having 45
grams of carbohydrates, if I had one cup of cooked
spinach the amount would be 10 grams of carbohydrates. However, because there is so
little amount of carbohydrates in most vegetables and people do
not consume a lot of vegetables in one meal, that many meal
recommendations advise not even to count these vegetables
at a source of carbohydrates unless they’re
eating very large quantities. And I just want to remind you that sugar-free foods
might be sugar-free but they are not
necessarily carbohydrate free. Even though the sugar might not
be an ingredient in that cookie or cake, there is flour, and
there might be fruit added to it or milk, and all
those three foods that I just mentioned
they have carbohydrates. And that’s very important to
talk to people with diabetes about because they might assume
that once a product says, sugar-free, it is equivalent
to carbohydrate-free. Now I’m moving to some nutrition
interventions targeting Latinos with diabetes. I’m going to talk about
traditional foods, newly acquired from tradition,
nutritional counseling based on the food groups, and I’m
going to share with you some of the tools that I have used
in practice that I have deemed to be culturally
appropriate teaching tools. The first item will be the food
differences by Hispanic groups. As I was mentioning before,
just as the prevalence of diabetes is different
among certain Hispanic groups, so is the countries of
origin and the food prices. So our Mexican patients
with diabetes came from different parts of Mexico. Depending on where they
come from, their food habits and preference foods
will be different. Individuals that live in the
Caribbean parts of Mexico, let’s say in the Yucatan
Peninsula, will have access to different kinds of foods
such as fish, compared to people that are coming from the
Northern part of Mexico, especially the central part in which goat might
be a preferred meat. Corn and beans, though, are two of the staple carbohydrate
sources. They use seafood, poultry and
pork depending on what part of Mexico they come from. And it is ubiquitous to use
chili throughout Mexico. Some places might prefer
to have corn tortillas, and some other places might
prefer to have flour tortillas. When we look at the countries
from Central America, I am just going to focus
here on the staples. As we saw in Mexico, corn
and beans are the staples. Those are two sources
of carbohydrates. Now, rice, beans and corn are
staples in Central America. Pork, chicken and beef are also
used as the sources of protein. And it is seasoned also
with tomatoes and onions, and chilies are not used as
prevalently as in Mexico. When we look at South
America, it’s a vast territory, so it will be very difficult to just summarize all
the different foods in South America. And once again, the coastal
regions will have a very different food traditions
and food cultures as the inland part
of the countries. Going back again to the
staples that are traditional in South America, potatoes,
corn and rice are staples. Now, the Caribbean from Puerto
Rico, Dominican Republic and Cuba; rice and beans are
staples but now I’m going to add something else, which
are starchy root vegetables, which are also predominant
in the diet. So things such as cassava,
taro, yams are also part of the traditional meals. And when counseling persons that
are coming from the Caribbean, it is very important to be
aware that these are sources of starch and carbohydrates. I wanted to mention the
globalization of food. And that is because
many times we assume that when a person comes from
any Latin American country or region, that they’re only
eating their traditional foods. And it’s not the case anymore. This is a McDonald’s
in Bogota, Colombia. So many of the younger persons from a particular country might
already be exposed to some of the same foods that
we are exposed here. This is a Kentucky Fried
Chicken in Oaxaca, Mexico. And here we have the places
where Dunkin’ Donuts has stores. So we are not — we
should not assume that just because someone’s coming
from Mexico, from Colombia, and they’re coming
from another region that they might not already
be mixing traditional with nontraditional foods. And here we have McDonalds that
is already ethnically correct, with a selection of McPinto, which is a combination
of rice and beans. So not only do we become,
quote, unquote, Americanized, but even a chain like McDonald’s
becomes also, should I say, Guatemalized, and it
even has fried plantains. I am briefly going to go over what the main
points of the slides. And as you can see on
the left-hand side, you have all the
different food groups. The column in the center it
says, ‘What you need to know, meaning as the person that is
teaching diabetes education, that is bringing nutrition
messages, to groups and individuals of persons
with diabetes or pre-diabetes. And in the right-hand
column is what your clients or your patients
need to know and do. So if you’re not familiar
with Hispanics in general, what you need to know
in these category is that Hispanics consume more
beef than non-Hispanic Whites. And what you need to share is
to encourage the leaner cuts of the different foods. Where rice and beans
is prevalent, rice is much more prevalent
on the plate [inaudible], so it should be switched around. Fruit is also added to shape
and it’s eaten and preserved in juice, et cetera, and
many times it is important to differentiate real
juice from juice drinks. I also want to highlight
that many times when we talk about healthy oils, such
as olive oil or canola oil, that we need to emphasize
to our patients that oils even though they — some of them might
be very healthy, they still have calories. And that’s every
important for them to know. They might think, ‘Well,
I’m just having olive oil. I’m cooking with olive oil,
therefore I can use as much as I want because it’s healthy.’ Very important to look
at nutrition labels, especially when they
are using certain foods, such as corn flour to cook with. Choose healthier fats. And again, I want to stress
this that portions matter even if the foods are healthy. Somebody might be drinking an
oat beverage or eating oatmeal because they have heard
that it’s healthy. But one cup is — I mean,
it might be healthy, but not three and four cups. And vegetables, encourage
the use of vegetables in stews and soups, et cetera. I am going to share
with you a program that I spearheaded
that I developed. And it was — it’s a supermarket
tour for Latinos with diabetes, and how to make this
program culturally competent. In this particular program,
I walked with a group of 10 to 12 individuals with diabetes, and some of them had
pre-diabetes, to teach them about meal planning, reading
food labels, et cetera. It is very important
that instead of just providing information that the program was
culturally appropriate. When we started in the produce
section, many of the handouts and food lists include
starchy foods such as squashes and sweet potatoes, et cetera. So this might be a common list of certain foods
that are included. However, translating this into Spanish might not be
culturally appropriate. This is a picture of
the actual supermarket where I was conducting the
tour, and as you can see, the starchy vegetables that
are here include things such as cassava, it
also includes taro, different kinds of yam. So when I had to
culturally adapt the list, I included things such as
the pumpkin, as the cassava, plantains, yams and the taro. It is important to include in
your handouts, even if they’re in Spanish, not just the foods that are commonly traditionally
listed, but the foods that the group consumes. And in here instead of
just listing the breads and the different types of
breads, as you can see here, there is one aisle with
tortillas, another aisle with tortillas, another
aisle with tortillas, and more carbohydrates in
the form of corn flours to make different products. And of course from
the floor all the way to the ceiling, rice and beans. So it is very important
to once again — and I am going to
reiterate this, that when you’re creating
a program for Latinos, it’s not just about translating
the existing food list, but to incorporate those foods
that are traditionally sound in the Hispanic groups
that you’re working with so that they actually
know what to do. This is, again, another
picture of — and many of you might
not know of what this is, but it’s called cremes, which
is the sour cream equivalent, which is widely used
in Central America. So we have avocado. We needed to include that. So a list of traditional fats for the American population
may include mayo, cream cheese, sour cream, salad
dressing and oils. But then what happens
is look at this picture. Again, this is pork skin. So there is this giant
display of pork skin. Now, if a person with diabetes
that consumes pork skin, how are they going to be
able to manage the pork skin and still manage their diabetes? So the — my fat list included
cremes, included pork rind, and included avocadoes, again,
to make it culturally acceptable to an individual so that they
know how to fit that pork rind in their — in their meal plan. These are some carbohydrate
teaching tools for Latinos and other populations that I
work with at the supermarket. And many of them
were not literate in Spanish or in English. So what I did was at the end of the supermarket I just
created a visual tool. And my goal was for them
to identify the foods that had carbohydrates. So it was a mixture of
just pictures that I copied and pasted from Google, and — but it includes things such
as cassava, as plantains, and different — and
of course tortillas that are ubiquitous
in the person’s diet. And then I wanted to
show them the foods that did not have
any carbohydrates, so that they could relate to that concept during our
first visit to the supermarket. And again I included
things such as chicharrone, which means pork back fat. And I also included the cremes,
which are the jar that you see at the right-hand side,
right above the avocado. The other part of the — at the end of our presentation
I wanted to make it real. We go to these carbohydrates,
protein and foods and we eat food. So what I did was I
showed them a meal that had many different
types of carbohydrate. And most of the patients
came from El Salvador, so I wanted to create a
visual that brought the foods that they are familiar with,
the foods that they like to eat. And as you can see here,
we have fufusa [phonetic], which is made out of corn. We have cassava,
fried plantains. We have pork, we had an
empanada, which is a patty. And we have two different
kinds of tamal, one made out of chicken, and
the other one out of corn. So what I did was
I asked them first, ‘Which of these foods
have carbohydrates?’ And I had them just point at the
food or just call it out loud. And then I told them how
much carbohydrate was in all the foods that
they have selected. And I asked them, ‘Well, if
you have a 50-gram budget for this meal, you
clearly have gone over. So what would you do to
bring it to a 50-gram budget, or you can change it to 75.’ And then I had the
individual say, ‘Well, I guess I’m not going to have
the pupusa,’ or, ‘I’m not going to have the tamal,’ or,
‘I’m going to eliminate.’ So this way they
were able to think about what they would
do at home. It was not just about
the numbers, but it was about meal
planning with real foods. We also looked at
before and after. This is the plate method. And we said, ‘Well, you still
can eat your rice and beans, but instead of having two scoops
or two cups, maybe have one and then increase the
amount of vegetables.’ We also looked about adding
more vegetable into a meal like arroz con pollo, less
vegetables, more vegetables. We looked about food
preparation, and we looked about plantains,
deep-fried or oven-fried. And how do we teach
portion control, we looked at the spoon method,
how many spoons can I have of this food in order
to be balanced? And you see comparisons that
people were familiar with. One ounce of cheese
doesn’t mean much. However, when I told them
that one ounce of cheese looks like a tile of domino,
especially Puerto Ricans that love to play dominos,
at least here in New York, they knew exactly what
one ounce looked like. So you see, not just the
light bulb and other things, but things that are
meaningful to the culture. So what questions
should you ask? This is really my little point
questions that I have used and that is, ‘Tell me
about the top 20 foods that you buy in your house. If I went to your house
right now, what would be in your pantry, what
would be in your kitchen?’ I asked them, ‘What would a
Mexican, Colombian, Venezuelan, what would be in
your shopping cart, and some of the other
questions that are — that are listed there. So the take-home message is, Hispanics comprise the largest
minority in the United States. They’re a very diverse group. The good preferences vary
widely amongst the different Hispanic regions. So you’d better ask, ‘What are
your top 20 favorite foods?’ Medical nutrition therapy,
the three goals are to manage blood glucose levels, minimize cardiovascular
disease and hypertension. The energy balance should be
good quality wholesome food in the appropriate quantity. And use culturally
appropriate teaching tools. And we looked at carbohydrates
as one tool to manage diabetes, not the only one, but
one that we use today. I also want to very
quickly share with you some of my favorite resources,
because they are colorful and they are beautiful. They’re in English and
they’re in Spanish. And these are tailored
specifically for people with diabetes. And the latest edition contains
new and revised recipes, things like a Spanish
omelet, beef stew, red Caribbean snapper,
et cetera. So these delicious recipes could
be yours through this tribute and to have in your clinic
in your place of business; because people want
to share them. Then these are recipe
cards that you can share, that you can keep, that
you can keep handy, and that you can
even give as a gift for simple activities
that you can have. So this is set one. This is set two. And I would say that
you also have — there’s something
else, you have posters. You have posters that you
can use in your waiting area, that you can utilize if
you’re having a health fair, if you’re putting anything up. I think they’re colorful
and look at those mouth-watering
pictures. And last but not least,
these are sample ads. So if you’re communicating,
you’re sending newsletters, if you are — anything
that is printed, you can just utilize them,
use them and print them. So I am going to now
very quickly turn over the presentation to Betsy
Rodriguez, and she’s going to explain how you can order
these colorful and delicious and practical materials.>>Betsy Rodriguez:
Thank you, Lorena. For more information
or to order materials, please call our number, 1-800 — 1-888-693-6337, or you can
visit our website [inaudible]. You can also send me an
email at [email protected] This is one. Don’t forget to complete
your evaluation, please. We invite you to use the
resources on our website at www.yourdiabetesinfo.org. Here you will find information
for people with diabetes, at least for diabetes,
healthcare professionals, business, school and
community organizations. When you put — when you are
in our website under the second on diabetes topics, you
can select there, recipes, and you will find all the
information from [inaudible]. It’s more than 40 slides. All of them are together,
all of these resources that Lorena just
showed to you all. Thank you for participating
in this webinar. The National Diabetes Education
Program is a partnership of the Central Disease
Control and Prevention and the National Institute
of Health and with more than 200 public and
private partners. Our goal is to [inaudible]
of course by diabetes. And now let’s move very
quick to the Q&A section. Lorena, so I’m giving
you the mike so you can answer
questions right now.>>Lorena Drago: Okay.>>Female: Thank you. At this time if you would
like to ask a question over the phone, please
touch star one at this time. Once again, to ask a question
over the phone, press star one. One moment. [ Silence ]>>Female: The first question
we have comes from Amy, and your line is open.>>Amy: Hello. Early on you mentioned about limiting sugar-sweetened
beverages. I was just wanting to
point out that it seems like many sodas are
actually sweetened with high-fructose corn
syrup, and I was wondering if you wanted to talk about
the effects of that as well, and is that something that we
should also let clients know they should be limiting?>>Lorena Drago: Yes. Thank you, Amy, for
your question. The issue, of course is of high-fructose corn syrup
having a different effect than just regular sugar is
— has been highly publicized and it’s controversial. I don’t know enough
about the subject of high-fructose
corn syrup for me to feel comfortable
speaking about it. However, what I do know is
that increasing the consumption of beverages that increases the
amount of calorie consumption and also replaces other healthy
foods is not a positive way to manage diabetes or even just
for a healthy person overall. So I really want
to be very careful because our society really wants
to look for just one bad guy. So if we eliminate high-fructose
corn syrup, then it is okay if we utilize other
sources of added sugars. And whether there might be some
documentation, some evidence that it might be harmful
then I also do not want to give the message
that once a soda or a beverage doesn’t
have high-fructose that then it can be
consumed [inaudible]. So I would say refrain
from using it, whether it’s high
fructose or not.>>Amy: Thank you.>>Female: And once
again, if you would like to ask a question,
please press star one. [ Silence ]>>Female: The next question
we have comes from Florence. Your line’s open.>>Florence: [Speaks Spanish].>>Female: [Speaks Spanish]. I’m going to repeat the
question for those of you that did not understand. She wanted to ask the
question in Spanish. She wanted to know if there
was a Spanish speaking educator in Arkansas. The American Association of Diabetes Educators has a
directory that can be utilized to identify and also to
locate different educators and the languages
that they speak in different parts
of the country.>>Lorena Drago: Yes. In the ADA website — ADA
website there’s a map. It says, ‘Find an educator.’ You go to their website
you will be able to access what are the
health educators in your area in what is the language
they speak.>>Florence: Okay. Well, thank you very much.>>Lorena Drago:
[Speaks Spanish].>>Florence: [Speaks Spanish].>>Lorena Drago: Si.>>Florence: Okay.>>Lorena Drago: Well,
thank you very much, okay?>>Female: And once again that’s
to ask a question star one. The next question
comes from Patricia. Your line’s open.>>Patricia: Yes, thank you. Is the PowerPoint that you use in this presentation
available to the audience?>>Female: [Inaudible].>>Patricia: Hello.>>Lorena Drago: Yes. The presentation is —
it’s going to be archived. Actually, the whole webinar
is going to be archived, and the presentation will
be archived as the PDF. So that means that
people will not be able to make any observations
to the presentation, because our speaker
— if this is about proprietary
information of the speaker.>>Patricia: Okay. So how will we be
able to access that?>>Lorena Drago: As soon as we finish this email
I’ll be sending an email to all the webinar participants,
sending the evaluation form, and sending some other
information including how to access the archive webinar.>>Patricia: Thank you.>>Female: The next question
we have comes from Lisa. Your line’s open. [ Silence ]>>Lisa: I got my
question answered. Thank you.>>Female: Thank you. The next question
then comes from Jean. Your line’s open.>>Jean: Hello?>>Lorena Drago: Hello?>>Jean: Yes. This is Beverly Atlanta. I’m calling from Indianapolis. And I’m all — I see a
lot of Hispanic patients, and they always have a
question about eating carrots. I know there are some vegetables
that are starch vegetables that I haven’t met
[inaudible] about carrots. I just tell them I don’t
know about carrots. How is that as far as
eating a starch vegetable. Is that true or not?>>Lorena Drago: It’s —
that’s a very good question. Thank you for asking it. Yes. I think overall patients
feel that they stay away from carrots and also beets because they feel
they’re high in sugar. And I just want to say
that they are not included as a starchy vegetable. They are included as a
non-starchy vegetable, which means that half a cup of
cooked carrots and half a cup of cooked beets on average would
have approximately five grams of carbohydrates. So sweetness should
not be the measure for the amount of carbohydrates. Things that are not sweet like a
slice of bread or a cup of rice, will have much more
carbohydrates than carrots and beets. So you should encourage your
patients to consume carrots and beets as one of their
vegetables of choice. But I think that giving them
those numbers can really help them. And just to let them know that
don’t guide themselves just by how sweet a food might be, because that does not determine
the amount of carbohydrate.>>Jean: Okay, thank you. [ Silence ]>>Female: Showing
no further questions. [ Silence ]>>Betsy Rodriguez: Okay. So being no further
questions, I thank all of you for your participation.>>Female: Apologize. We did have someone come in.>>Betsy Rodriguez: Okay.>>Rita Diskenzy: Rita
Diskenzy [phonetic]. Could you — could you
repeat the instructions for the evaluations? How do fill out the evaluations?>>Betsy Rodriguez: Rita,
I will be sending an email with the evaluation
form and you can…>>Rita Diskenzy: Oh, okay.>>Betsy Rodriguez: …talk
to me by — to my email.>>Rita Diskenzy:
Oh, okay, I’m sorry. I thought I [inaudible]
into the system. Thank you.>>Betsy Rodriguez: And also
you can go to the system as we speak right now to
the three-page outcome. You download — you
click on that icon, and then from there you can
download the evaluation.>>Rita Diskenzy: Oh, okay. But anyway, it was an
excellent presentation. Thank you.>>Betsy Rodriguez: Thank you. It is in the three-page
icon call handouts, but on the upper right
portion of your screen. Select the file by checking the
box, press download and browse to the location on
your computer. Then select the destination
folder and click okay. Or you can wait until I
sent those to all of you.>>Rita Diskenzy:
Okay, thank you.>>Female: No further questions.>>Betsy Rodriguez: Well,
thank you very much. Muchas gracias for
being on our webinar. I’m hoping that this
webinar was informative, and you learned what to deal — how to deal with the Latino
population and diabetes. I want to thank Lorena Drago
for being our speaker for today. And I want for all of you to
give her this round of applause. So thank you very much,
Lorena, and thanks to everybody.>>Lorena Drago: Thank you.>>Female: Thank you
for your participation. You may disconnect at this time.

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