Ethnic intimidation: Reducing diabetes risk factors

SACRAMENTO, Calif. - Maria Medina's life is littered with the destruction of diabetes.

Her neighbor had a foot amputated because of the disease. Her mother went blind from it. Her sister died of it.

Damage that pervasive is a common experience in the Mexican-American community, which has some of the highest rates in a surge of diabetes nationwide. The disease can provoke heart attacks, high blood pressure, kidney failure and blindness, and is the seventh-leading cause of death nationwide.

But when Medina, a 43-year-old mother of three, was diagnosed with diabetes five years ago, she decided not to let the disease exact such a heavy toll from her. The Rancho Cordova, Calif., mom began, bit by bit, turning around one of the big risk factors for Mexican-Americans: her diet.

She got coaching from a nutritionist and took free cooking classes with Kaiser doctors and at her younger daughter's school, Cordova Villa Elementary. The sessions taught her healthy substitutions - like whole-wheat for white bread, and oil for lard - and cooking methods that use less fat than the traditional preparations she brought with her from Mexico City more than 20 years ago

At various points, Medina's family resisted. But she pressed on, and now her kids and husband abide by the low-fat, soda-free, veggie-rich regime she has created. She hasn't needed to take her diabetes medication, Glipizide, in four months.

"I want to live a long time," she said last week in her kitchen, speaking in Spanish as she prepared a dinner of baked tilapia fillets with nopal (cactus) salad. "I want to know my grandchildren."

Medina exemplifies the kind of transformation possible for people in heavily affected groups, who are up against genetic and cultural forces that propel them toward diabetes. Yet she also shows what determined effort and investment it takes - by both the individual person and the community around her - to turn the tide.

Diabetes rates have been rising for decades in the U.S. The Centers for Disease Control and Prevention report that more than 11 percent of adults - or about one in nine - in this country have the diagnosis. The vast majority of those cases are Type II diabetes, in which the body loses its ability to produce and use insulin, the hormone that controls blood-sugar levels.

As with many chronic conditions, it strikes more ethnic minorities, more poor people, and more people who lack a high school diploma, compared with whites and those who are better off.

Although blacks are diagnosed at slightly higher rates than Latinos overall - 12.6 percent versus 11.8 percent - the rates vary when you look more closely at Latinos' country of origin.

Mexican Americans, who make up the majority of U.S. Latinos and the vast majority in California, have one of the highest rates. Nearly 14 percent of Mexican American adults have diagnosed diabetes.

Doctors and public health experts blame both genes and the social environment for those extra-high numbers. The predisposition for diabetes runs in families, and Latinos seem to be vulnerable, said Catherine Vigran, a Kaiser Permanente pediatrician who sees Medina's children and taught some of their mom's cooking classes.

Food factors in. The high-carbohydrate diet common in Mexico tends to get worse when immigrants arrive in this country, explained Gustavo Rosales, a Guatemala native and physician who runs Rosales Medical Clinic in Sacramento, Calif.'s Fruitridge neighborhood. And rich diets and obesity are risk factors for diabetes.

"Sometimes in the change from Mexico to the U.S., people tend to take the worst, not the best, of the American diet. They tend to go for sodas and sweets," Rosales said.

Add in some unhealthy aspects of American lifestyle - the reliance on automobiles, the ready availability of cheap and fattening fast food, and the necessity in many families for both parents to work long hours - and doctors say you've got a toxic combination for promoting obesity and disease.

In Mexico City, Medina said, she walked daily to get milk, tortillas and bread. "There, for everything we needed, I walked. Here, the store is far away. When I have errands, I go by car."

In Medina's household, the change in diet started as a tough sell. Her husband complained that she wasn't buying the foods he liked.

"It was really hard for us at the beginning, because the flavor was like nothing for us," said Medina's older daughter, Janet, who is 17 and attends Cordova High School.

With coaching in her cooking classes, Medina learned to make her family's favorite dishes in a healthier way. Instead of bathing the tortillas in oil for her son Daniel's choice meal of chicken enchiladas, she softens them by toasting them in a dry skillet.

Janet loves chilaquiles, a traditional dish of crunchy tortilla strips simmered in salsa. Medina explained, "In Mexico, you crisp the chips in oil, and at [the elementary] school they taught me you can crisp them in the oven and they're healthier."

To make such turnarounds feasible for many more families, public health advocates say, it will take more than individual crusades like Medina's.

After all, Medina had some advantages - free nutrition classes in her native language and a husband who earns enough as a landscaper that she can devote herself full time to the home - that other low-income and immigrant families may not.

"You're not going to solve this problem in the doctor's consulting room," said Vigran, the Rancho Cordova pediatrician. "These are big social problems and they're going to require big social answers."

To Rosales's eye, the name of the game is "education, education, education." People need information on healthy food - not only what it is, but how to cook it and weave it into their diets - from someone who speaks their native language and understands the culinary culture they come from.

And for Medina, obstacles remain. She still drives most places. She still has to withstand her kids' clamoring for pizza and greasy buffets, and maintain a healthy menu on one salary for a family of five.

All three of her children are still "overweight," she said, because at school they can eat whatever they want.

At home that afternoon, Daniel, who is 12, wanted a snack before dinner. There were no tortilla chips or pastries in sight - Medina had seen to that. Daniel reached into a basket on the kitchen table, heaped full of fresh produce, and chose a banana.