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Exercise and education: Diabetes prevention work helps local Latino children, families

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September 16, 2022

Study headed by ASU professor published in Journal of American Medical Association

Derek Parra’s eating plan was fairly simple. Whatever his mom, Miriam, put on the plate, he would eat — sometimes up to four portions.

In between meals, he would down unhealthy snacks, sodas or juices with a high sugar content.

Parra still can put away the food. He’s 15 years old, after all. But the Valley teenager is making wiser decisions to feed that teenage appetite, drinking water instead of soda – with the occasional Dr. Pepper mixed in – and eating more vegetables and fruit.

Miriam is helping as well, cooking with less oil and encouraging Derek and her other children to get their sugar from fruit instead of candy.

They’ve fallen off the wagon at times, but they’ve also learned what to eat and, just as importantly, how to eat.

“We’re very conscious about what we’re eating,” Miriam said through an interpreter. “That information has stuck with us.”

Those healthier choices — and the education needed to change habits — are exactly what Gabriel Shaibi, a professor in Arizona State University’s Edson College of Nursing and Health Innovation, hoped to accomplish when he launched a program six years ago to help Valley Latino children, ages 12 to 18, who were predisposed to diabetes.

The results of the study, which was boosted in 2021 with a $3.3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, were published this week in the Journal of the American Medical Association.

Among the findings:

  • There was a 10% improvement in glucose tolerance (a measure of how kids process sugar) after 12 months.
  • There was a 37% increase in insulin sensitivity (a measure of how well the body uses insulin) after six months.
  • The kids in the study reported a 10% increase in their weight-related quality of life after 12 months.

“What we learned is that these kids, when you provide them access to preventative services, they can do better,” said Shaibi, the principal investigator on the project.

Shaibi said the impetus for the study was data from the Centers for Disease Control and Prevention that showed Latino children are predisposed for diabetes at a rate between 1.5 and 1.7 times higher than white children.

“We designed a study that says, ‘You know, we appreciate that there’s disparities in the community,'” Shaibi said. “And these disparities are not just about the haves or have-nots but these kids also have a really difficult time accessing traditional health care services.”

The program, which included 117 families from around the Valley, was a collaborative effort between ASU, Valley of the Sun YMCA, St. Vincent de Paul and Phoenix Children’s Hospital, the latter two of which recruited families and helped design the curriculum.

The dual focuses: education and exercise.

“The real key is how do I implement this into my day-to-day life,” said Micah Olson, medical director for the Type 2 diabetes program at Phoenix Children’s Hospital and a co-author and co-investigator on the study. “And that is not easy, especially in the environment that we live in today, where calories come very cheap and it’s hard to move our bodies the way we used to.

“So the hypothesis of the study was: Can we deliver this information in a way that’s culturally focused and delivered by teachers that culturally speak the language and would that be more effective in having kids and families make the kind of changes that we’re asking them to do, compared to what we might do in the halls of a medical clinic?”

Parents and their children made their way to the downtown Phoenix YMCA once a week to do physical exercises, learn how to make better food choices, and both modify and keep track of their behavior. The exercise programs were designed by YMCA trainers, and bilingual health educators and dieticians from St. Vincent’s and Phoenix Children’s Hospital were on hand to help families that didn’t speak English.

“It’s all delivered in the community, by the community, for the community,” Shaibi said. “We think that is pretty unique because it’s not, ‘Hey, come to our clinic at ASU.’ It’s, ‘We’re going to bring the research to the community where it can best be implemented.’”

The families were given assignments, one of which was being handed coupons for Food City and having to find ingredients for a healthy meal at less than $5 per person.

“That becomes their homework,” Shaibi said. “Can you go out, shop for and prepare a healthy meal on that budget? That was eye opening to some of these families.”

The following week, the families would talk about the healthy meal they made and how they were surprised they could do so on such a limited budget.

It’s all delivered in the community, by the community, for the community.

— Gabriel Shaibi, professor, Edson College of Nursing and Health Innovation

“We made it a little bit of a competition as well,” said Elvia Lish, director of the Ivy Center for Family Wellness at St. Vincent de Paul. “We’d tell them, ‘It has to be delicious, but it has to be cost-effective.’ And then whoever hath the lowest cost meals won the prize or the game. They came up with really great examples that highlighted you don’t have to eat really expensive foods in order to be healthy.”

The families were also given healthy recipes they could cook.

“It gave me a sense of nutrition, like certain things that I wasn’t supposed to eat too much of and how to eat a balanced diet,” Miriam Parra said.

Libby Corral, chief operating officer of the YMCA, said the shared experiences of the families brought them together in a way individual diet, exercise and nutrition programs could not.

“They really developed that sense of community,” Corral said. “We had these groups of families and kids that have the same issues and are able to learn from each other and support each other. They built friendships and relationships that outlasted the program itself.”

Shaibi’s hope is that the study has generational benefits for families. The children who exercise and develop healthy eating habits today will be the parents who teach their own children those behaviors tomorrow. To do its part, the YMCA has given all 117 families in the study free six-month memberships.

“We know these types of diseases travel in families,” Shaibi said. “If you are a kid whose parents have diabetes, you’re more likely to get diabetes. But we also know that prevention and behaviors track in families. If your parents were active, you’re more likely to be active and so on.”

Although the study is complete, the work isn’t. Shaibi and his team have received an additional round of funding to continue the research and target entire households over the next five years.

“We’re trying to have a bigger effect,” he said. “It can be mom, dad, cousins, grandparents, whoever’s living in the household.”

Top photo: Participants in the program after a fitness class at the YMCA.

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Healthy Eating

Pad thai dish is made with zucchini spirals instead of noodles

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“Make half your plate vegetables and fruits” is a key message from the US Department of Agriculture’s Dietary Guidelines for Americans, which emphasize the importance of consuming vegetables each day. Why? Because eating vegetables provides plenty of health benefits. Research shows that people who eat more vegetables and fruits as part of an overall healthy diet have a reduced risk of some chronic diseases. Vegetables also provide nutrients vital for health and maintenance of your body.

It can be challenging to include vegetables in your meals while keeping things tasty and fun. Spiralizing vegetables is one way to do both! With a spiralizer, you can create curly veggies that resemble noodles. Though spiralizers can be found at different prices, inexpensive models are available for around $15.

Summer squash and root vegetables are best for spiralizing. With a turn of the crank, you can create colorful additions to your favorite meals. Spiralized veggies can also take the place of pasta in your favorite dishes. Zucchini zoodles are the classic substitution, but you can also experiment with yellow summer squash, carrots, kohlrabi, parsnips, cucumbers or beets. Veggie spirals can give salads, soups and side dishes a fun twist as well.

Spiralizer blades are sharp, so be careful of little fingers in the kitchen. With some supervision, your kids might enjoy turning the crank. Children who help with the cooking are more likely to eat what they prepare.

We used spiralized zucchini in today’s recipe for Pad Thai with Zucchini Noodles. You may notice another ingredient that’s new to you: powdered peanut butter, which is made of roasted peanuts that have been pressed to remove oil and then ground into powder. This cuts some calories by removing fats while still providing the flavor of peanut butter.

Let us know what you think of our spin on pad thai.

Bethany Thayer is a registered dietitian nutritionist with Henry Ford Health. For more recipes and health information, visit henryford.com/blog. For questions about today’s recipe, email HenryFordLiveWell@hfhs.org.

Pad Thai with zucchini noodles

Serves: 4 / Prep time: 30 minutes / Total times: 1 hour

4 cups zucchini noodles (2 medium zucchini)3 tablespoons sesame oil½ cup water½ cup powdered peanut butter3 tablespoons less-sodium soy sauce2 tablespoons dark brown sugar½ teaspoon chili pepper flakes2 cloves of garlic, minced3 green onions with greens, sliced2 limes, quartered1 cup fresh cilantro1 cup bean sprouts¾ cup unsalted peanuts, finely chopped

Wash and trim ends of zucchini. Create zucchini noodles using a spiralizer or vegetable peeler and set aside.

Heat sesame oil in a large skillet over medium heat.

In a small bowl, whisk together water, powdered peanut butter, soy sauce, brown sugar and chili pepper flakes for peanut sauce. Set aside.

To the hot oil, add minced garlic, green onions and zucchini noodles. Stir to coat and cook for 3 minutes. Add peanut butter sauce mixture to skillet, stir, and cook for an additional 3-5 minutes. Remove from heat and divide noodles over four plates.

Garnish each plate with 2 lime wedges, ¼ cup chopped cilantro, ¼ cup bean sprouts and 2-3 tablespoons of chopped peanuts.

Cook’s notes: Choose a zucchini with a straight rather than curved shape for longer noodles. If you want to make this gluten-free be sure to purchase a gluten-free soy sauce.

From Henry Ford LiveWell.

301 calories (62% from fat), 21 grams fat (3 grams sat. fat), 21 grams carbohydrates13 grams protein437mg sodium0mg cholesterol56 mg calcium5.5 grams fiber. Food exchanges: 4 vegetables, 1 protein, 3 fat.

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7 Delicious Dishes That Taste Better In Their Native Country        

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Travel usually means marveling at spectacular sceneries. Five years ago, we noticed how much better food tastes in his home country. That is understandable because outside, the exact ingredients may not be readily available, or the recipes have been modified to cater to local tastes.

So, for those who truly love good food — we don’t have to be gourmets or the next Anthony Bourdain — we have to travel to taste the real thing.

Hainanese chicken rice

Photo credit: Chacol / Shutterstock.com

1. Hainanese Chicken Rice

Singapore And Malaysia

This is one of my all-time favorite dishes. I discovered it in Singapore at the Hyatt Regency Hotel (now Grand Hyatt Singapore) in the early 1990s, when I was still traveling the world for corporate work. Reports are that the hotel chefs have perfected the recipe over the past 30 years and the Singapore branch is where they now have the best Hainanese Chicken Rice in the world.

Originating from Hainan in southern China, immigrants brought the dish with them wherever they eventually settled. So, it is also widely available for just a song in hawkers’ centers. It has become Singapore’s unofficial national dish and Malaysia has adopted it as a culinary staple.

It’s healthy and full of flavor, especially when served with sliced ​​cucumbers and steamed bok choy. I make a poor man’s version, remaining true to three key secrets: poaching the chicken slowly at low temperature, cooking the rice with the poaching broth, and using the poaching broth as the base for the three sauces (garlicky, sweetened soy, and spicy ).

Pro Tip: The KL International Airport 2 has a branch of the well-known Malaysian chain, “The Chicken Rice Shop,” that is built around the dish. Don’t miss it on a layover!

Seafood paella, a popular Spain dish

Seafood paella

Photo credit: Carol Colborn

2. Spanish Paella Con Chorizo

Spain

During a week in the Andalusian region of Spain, we took day trips to the historic Alhambra and Generalife in Granada and the Plaza de Espana, the Alcazar, and the Catedral in Seville. We were based in Malaga right on the Costa del Sol, relishing the beach, sun, and building fancy sandcastles for hours.

Every waterfront restaurant was peddling its version of the world-famous Spanish Paella. My husband fell in love with the dish, so I had to learn how to make it! The secret ingredients are:

  1. Spanish chorizo ​​sausage
  2. Expensive authentic saffron
  3. Special short grain rice

They were cooking them in plain view and I saw that the chorizo ​​slices were first fried to release their savory oil whereas garlic, onions, tomatoes, bell pepper, and rice were sauteed. Adding broth and covering finishes the steaming of the rice. Lastly, chicken or seafood previously fried with chorizo ​​oil decorate the top.

I have found a special kiosk to buy good Spanish chorizos in Phoenix. I use either cheaper imitation saffron or substitute with turmeric and source the rice (paella, arborio, or sushi) from the grocery store. Bless my husband. Even if what I make is just passable, he loves it.

Pro Tip: Never use another type of chorizo, especially not the Mexican version. Mexican cuisine is very different from Spanish.

Prekmurje gibanica, a Slovenian dessert

Prekmurje gibanica

Photo credit: Carol Colborn

3. Desserts With Just A Hint Of Sweetness

Slovenia

We hosted two friends in the US that we met on the Philippines’ island of Palawan. In turn, they hosted us in Slovenia. We stayed at the Airbnb property of our girlfriend’s family located at the foot of the castle in the Old Town of the capital Ljubljana. The National Slovenian Cuisine Restaurant was a tenant on the ground floor, so she hosted a dinner of Slovenian sausages paired with special buckeye wheat dumplings.

What we loved best was the prekmurje gibanica, a layered pastry filled with poppy seeds, cottage cheese, walnuts, apples, and cream. It had just a hint of sweetness. This dessert experience was repeated in beautiful Lake Bled where our other friend had a waterfront condo unit he lent us. He also led us to where tourists flock to sample kremna rezina, the famous Bled cream cake.

The secret to Slovenian cuisine is that very little sugar or salt is added. They depend on the natural sweetness or salinity of the ingredients. Every Slovenian house has a small garden where they plant their favorite vegetables and fruits. Water comes from crystalline sources, aplenty in the green country.

Pro Tip: Usually, dishes have no names at authentic restaurants. Instead, menus list all the ingredients used in a dish.

Vegetable tempura

Vegetable tempura

Photo credit: Piyato / Shutterstock.com

4. Vegetable tempura

Japan

My husband and I are in our 70s and we have committed to eating as healthy as possible; vegetables are now center stage for us. It is generally believed that Japanese cuisine is one of the reasons for long lives in Japan. Thus, we try to make Japanese dishes at home; it’s also a good way to remember about our trips there.

One of my favorites is tempura. I always order it at Japanese restaurants because it has this light and soft breading that’s very difficult to replicate. The dish usually consists of seafood, meat, and vegetables that have been coated and deep-fried to perfection.

It was introduced by the Portuguese who had settled in Nagasaki and their fritter-cooking technique of the 16th century took root. The name comes from the Latin phrase quatuor anni tempora, historically the Ember Days, when no meat is supposed to be consumed. Tempura must have originated as a vegetable dish. That’s how I choose to make it — with sweet potato, carrots, broccoli, eggplant, and onions.

Pro Tip: I can now make my humble version at home, almost like the way they make it in Japan because this tempura batter mix is ​​available on Amazon. Use the air fryer for a healthier version!

Belgian waffles

Belgian waffles

Photo credit: Carol Colborn

5. The Belgian Waffle

Brussels, Belgium

We were hugely impressed by the absolute grandeur of the Grand Place and the Atomium in Brussels, Belgium. What struck us most was how food is celebrated on every corner with Belgian culinary specialties. Two of them, beer and chocolates, can be easily packaged to reach our homes in their original distinct flavors.

You have to try the Belgian waffle in Belgium. I am a waffles (instead of pancakes) girl because of its texture. Our waffle maker at home makes the ordinary kind, but much thinner. So, we were determined to have a Belgian waffle a day while we were there. At first, we had a tough time deciding which waffle place to enter and which ones to order. However, we soon learned to choose the least sinful.

The waffle itself is a treasure, made with a yeasted batter that makes it extra light and fluffy yet crisp on the outside. Baking powder and/or baking soda have been used of late but it’s better the original way. They are made in a special larger iron with a deeper grid pattern and finished with crunchy sugar. Choose to load up with healthy toppings.

Pro Tip: If you are in Belgium, don’t forget to sample moules-frites or fried mussels. I don’t normally eat mussels, but I love this dish!

Cornish pasties

Cornish pasties

Photo credit: Carol Colborn

6. Cornish pasties

England

When we are in England, my husband usually looks for Cornish pasties. I soon learned how different they are from meat pies. This British pastry was associated with the mining industry and Cornwall. It is made by placing an uncooked filling — of beef, potato, and the buttery vegetable swede (yellow turnip or rutabaga), seasoned with salt and pepper — on one half of a flat pastry circle, folding the pastry in half, and crimping the curved edge to form a seal before baking.

There are variations in Australia, the US, and elsewhere. But, all pasties are different from the meat pies from other cuisines and cultures like the Spanish empanadas, pierogies of Eastern Europe, Indian samosas, etc. They are much larger and have more veggies.

Pro Tip: The West Cornwall Pasty Company is the UK’s largest pasty maker and is number 51 of the UK’s top 100 companies. Their pasties are available in UK groceries and cafes.

South Melbourne Market

South Melbourne Market

Photo credit: Benjamin Crone / Shutterstock.com

7. DimSim

Melbourne,Australia

My daughter’s first home was just a ten-minute walk to the South Melbourne Market. I was there at least once a week for food items like Hot Jam donuts. I also loved the famous Australian dim sim, a snack that dates back to 1928. Like dim sum, it’s a kind of dumpling.

Popularized by a Chinese immigrant in Melbourne, it consists of minced meat, cabbage, and seasoning encased in a rectangular wrapper. It’s much larger than the traditional dim sum, but also served deep fried or steamed and dipped in soy sauce. I have not seen them outside Melbourne so for this one, you definitely have to go there!

Pro Tip: The South Melbourne Market is the birthplace of the even larger circular version, commonly known as the “South Melbourne Dim Sim.”

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What Is the Definition of a Chronic Disease?

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Whether it’s heart disease, cancer, stroke or diabetes, 6 in 10 adults have a chronic disease. Even more alarming, 4 in 10 people have two or more.

With chronic diseases affecting more and more people each year, it’s important to be aware of what causes these health conditions and the steps you can take to reduce your risk of developing them.

What Does It Mean to Have a Chronic Disease?

A chronic disease is a condition that lasts for an extended period of time and requires ongoing medical treatment. Typically, these illnesses have no cure, however, many are treatable and manageable through tools like integrative and functional medicine, dr Casey Kelley, MD, ABoIMFounder and Medical Director at Case Integrative Health, explains.

Additionally, many patients suffering from a chronic disease find that it severely impacts their day-to-day, even impeding their mobility or preventing them from working. It’s important to remember that many chronic diseases are what we refer to as “invisible illnesses,” Dr. Kelly adds. That is, they are not immediately apparent externally but continue to impact the patient’s daily life. Remember that someone’s appearance does not always accurately represent their internal health.

dr William Soliman, PhD, BCMAS, founder and CEO of the Accreditation Council for Medical Affairs, explains that having a chronic disease usually means that it’s a progressive disease that gets worse over time. Individuals with chronic disease have the disease for at least one or more years.

Related: What You Need to Know About Living With Chronic Pain—Plus, Steps for Managing Symptoms

Causes of Chronic Diseases

There are many different chronic diseases, each with its own respective cause.

Affecting roughly 21 million Americans, one common chronic disease is type 2 diabetes, where your body doesn’t properly use insulin (also known as insulin resistance). This leads to blood sugar building up in the blood stream, damaging parts of your body, Dr. Kelley states. Those with type 2 diabetes are often at a greater risk of stroke, kidney disease and blindness without proper management. You can reduce your risk of developing type 2 diabetes by maintaining a healthy weight, leading an active lifestyle and eating a balanced and low-carb diet.

While rarer than type 2 diabetes, Crohn’s disease is a chronic disease affecting over 700,000 Americans. Crohn’s is a type of inflammatory bowel disease that causes inflammation in your digestive tract, leading to abdominal pain, fatigue and malnutrition. There is no known cause of Crohn’s disease, although genetics and environment both likely play a factor, Dr. Kelly explains. Unfortunately, there is no cure for Crohn’s disease, and symptoms can be debilitating and even life-limiting. However, many patients find that with the proper treatment they can achieve at least temporary remission, and improve their quality of life.

Finally, one under-thought of chronic disease is depression. Unfortunately, when we think of chronic disease, we often neglect to remember that it includes mental illness as well. Major depressive disorder is a mood disorder causing persistent feelings of sadness and apathy, and it affects over 17 million Americans.

Depression has many causes, from genetics and faulty brain chemistry to adverse life events. While depression may occur just once, most patients typically find that it recurs periodically throughout life, Dr. Kelley states. Unfortunately, there is no “cure” for depression. However, individuals can usually manage the condition with the proper medication and therapeutic team.

(scroll to keep reading)

Related: 50 Chronic Pain Quotes For When You Need Motivation, Empathy, and Understanding

The most common cause of chronic disease is lifestyle, Dr. Soliman, explains. For example, sedentary individuals are more likely to develop chronic heart disease than those that exercise. The other major factors are environmental and genetic. Individuals with a strong family history of certain types of cancer, for example, colon cancer, may be more prone to developing colon cancer earlier than other patients.

How to Reduce Your Risk of Developing a Chronic Disease

Chronic disease is a huge category, and while some can be prevented, some are simply due to the genetic lottery, infection or something else. However, you can take steps in your daily life to maximize your health and minimize your likelihood of developing some of these conditions.

Stop drinking and smoking

First, do the most obvious: Quit smoking, and ensure that you aren’t drinking too much alcohol. Both smoking and alcohol consumption are linked to various cancers, high blood pressure, and heart disease, Dr. Kelly explains.

Eat a healthy, well-balanced diet

Do what you can to consume a nutritious diet and make sure that you’re incorporating movement into your life, Dr. Kelley states. Both of these will help you maintain a healthy weight and prevent chronic diseases such as heart disease and type 2 diabetes.

Get enough sleep

Another step you can take is to establish a healthy sleep schedule. Insufficient sleep can lead to a host of chronic conditions, such as type 2 diabetes, as well as depression, says Dr. Kelly.

Engage in physical activity

Regular exercise and movement play a very important role in reducing the risk of developing chronic illness.

You don’t have to be a gym member to do this—simple things like regular walks after dinner or a nightly yoga routine can greatly reduce your risks, Dr. Kelly explains.

Find healthy coping mechanisms for stress

Stress management is crucial when it comes to protecting yourself from illness.

Mental health is just as important as physical health, so make sure to invest in self-care, and seek treatment if you are struggling, Dr. Kelley states. While there is no 100% prevention method for chronic disease, mitigating risk behaviors and incorporating healthy alternatives will help you decrease your risk over time.

Next up: Can Lifestyle Changes Actually Reverse—Not Just Prevent or Treat—Chronic Diseases?

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