Transcription

An RD’s Guide to CulturalHumility & Heritage DietsSara Baer-Sinnott

About Oldways A food and nutrition nonprofit Vision: A healthier, happier life through cultural food traditions. Mission: Inspire people to embrace the healthy and sustainablejoys of the old ways of eating To fulfill our mission, we create and share healthy “how-to”resources & recipes and organize educational programs andevents. We believe food is heritage’s great gift

MediterraneanDiet Pyramid

Asian HeritageDiet Pyramid

Latin AmericanHeritage DietPyramid

Ve g e t a r i a n &Ve g a n D i e tPyramid

African HeritageDiet Pyramid

A Taste of Latin American Heritage Curriculum Lesson 1: Herbs & Spices Lesson 2: Tubers Lesson 3: Whole Grains Lesson 4: Fruits & Vegetables Lesson 5: Pulses Lesson 6: Nuts & Seeds

Honoring cultural differences At Oldways, the foundation of our work for the last 30 years canbe summed up in the words of Michael Pollan, “The more we honor cultural differences in eating, the healthierwe will be.”

Honoring cultural differences We encourage you to join us in amplifying the culinary legacy andoften-unsung cultural ownership of healthy eating for people ofall cultures. We all still have a lot of work to do, but we know that the morewe honor and respect the contributions of African Heritage, AsianHeritage, Latin American Heritage, among other cultures, thehealthier, safer and happier our world will be.

Cultural humility and clients Those who practice culturalhumility work to increase theirself-awareness of their ownbiases and perceptions andengage in a life-long selfreflection process about how toput these aside and learn fromclients

Cultural competence and clients Honor and recognize andunderstand history, cultures,languages and traditions. Value individual's differentcapacities and abilities. Respect differences in families'home lives.

Constance Brown-Riggs, MSED, RD, CDE,CDN Identify the primary healthdisparities faced by Black people inthe US and their causes Highlight some of the characteristicfoods and food traditions fromacross the African diaspora Tips for RDs working to help reducehealth inequities in Black patientsusing cultural humility and culturallyrelevant programming

Karen Lau, MS, RDN, LDN, CDE Identify the primary healthdisparities faced by Asian Americansand their causes. Describe the characteristic foods andfood traditions that are commonacross Asia. Tips for RDs working with AsianAmerican patient populations / howto integrate culturally relevantcomponents into dietaryinterventions.

Sylvia Meléndez Klinger, DBA, MS, RDN, LDN,CPT Identify the primary health disparitiesfaced by the Latin American communityand their causes. Describe the characteristic foods andfood traditions that are common acrossLatin America. Tips for RDs working with the LatinAmerican community / how to integrateculturally relevant components intodietary interventions & reduce healthinequities.

An RDs Guide toAfrican Heritage

Constance Brown-RiggsMSEd, RD, CDE, CDNAward winning author of “The Diabetes Guideto Enjoying Foods of the World”and “The African American Guide to LivingWell With Diabetes”Past Chair, Diabetes Dietetic Practice Group,Academy of Nutrition and Dietetics

Disclosures Consultant to OldwaysPT Honoraria from OldwaysPT No conflict of interest existsfor this program

TODAY’S OBJECTIVES Discuss African American healthdisparities observed in the US. Highlight some of thecharacteristic foods and foodtraditions from across theAfrican diaspora. Provide tips for RDs to reframenutrition education usingcultural humility and culturallyrelevant programming.

Young African Americans Are Living with DiseasesMore Common at Older Ageshttps://www.cdc.gov/vitalsigns/aahealth/info

Diseases Starting Early Lead to Earlier raphic.html#graphic

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Comorbidities and COVID-19Death RateCardiovascular Disease10.5%DiabetesRespiratory Disease7.3%6.3%High Blood Pressure6.0%Cancer5.6JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648

Cultural HumilityRequires HistoricalAwareness

Who are African Americans? Black racial groups of Africa In US for generations Recent immigrants– Africa, Caribbean, WestIndies Southeast and mid-Atlantic– Louisiana, Mississippi,Alabama, Georgia, SouthCarolina and Maryland

11Health Beliefs Mistrust Tuskegee 1997 eight survivors Low priority AIDS, crime,education Susceptibility Low income Spirituality Fatalistic view

Is SOUL FOOD PUTTING THE “DIE” IN DIET?HARVESTINGAND CLEANINGPASTEURIZATIONPACKAGINGPresentations arePresentations arePresentations arecommunication tools that cancommunication tools that cancommunication tools that canbe used as lectures.be used as lectures.be used as lectures.():-4;3810.2MJA

TRADITIONAL AA SOUTHERN DIETHARVESTINGAND CLEANINGPASTEURIZATIONPACKAGINGPresentations arePresentations arePresentations arecommunication tools that cancommunication tools that cancommunication tools that canbe used as lectures.be used as lectures.be used as lectures.

The Great MigrationEarly 20th CenturyMovement from rural South tolarge cities in the North and Westchanged eating habits of Africanmigrants.

Shifts From Traditional Eating toIndustrialized Meal PatternsHealth Outcomes: Metabolic syndrome and obesity increases inBotswana New rates of hypertension in West Africa Urbanization linked to poor dietary quality andgreater risk for chronic diseaseSouth African Medical Journal , May 2009, Vol. 99, No. 5.

Presentation OutlinePoints of Discussion

TWO WEEK FOOD EXCHANGESAA fed African-style diet55g high-fiber16% fatRural Africans fed Western style diet12g low-fiber52% fat“African Americans experienced a reduction in inflammation oftheir colons, improved markers for cancer, and an increase in thediversity of their healthy gut bacteria. On the other hand, ruralAfricans who ate a Western-style diet produced more bile acid—a risk factor for colon cancer—and experienced a decrease in thediversity of healthy gut bacteria.”

Helping AAReclaim TheirCultural HeritageTips for Healthcare Providers

‘WHITE PEOPLE FOOD’CREATING AN UNATTAINABLEPICTURE OF HEALTH

0Interaction Institute for Social Change Artist: Angus Maguire.

Nutrition must go beyond aone-size-fits-all approach.According to the DHHS, “practicingcultural competence to honor diversitymeans understanding the core needsof your target audience and designingservices and materials to meet thoseneeds strategically.”Oldwayspt.org

– DIY– AADE’s DiversityCOI– AND’s EthnicDPGs Cultural FoodPractices book

Food Choices Taste Predilections ush puppies Ham hocksHogshead cheeseStamp and goBammyAckeeCallaloFestival

Culturally Competent Counseling TipsUsing Cultural HumilityRecognize barriers– Physical: lactose Intolerance is prevalent in AfricanAmericans– Culturally shaped food practices, family influences, andhardships– Your patients’ daily experiences: income levels, foodaccess in their neighborhoods, SNAP benefits,transportation, kitchen equipment – what do they need?

Culturally Competent Counseling TipsUsing Cultural HumilityRecognize strengths– Understand & utilize the healthy roots ofAfrican American cuisines– Find the positives, even when unhealthyhabits abound– Establish trust and interest – show genuineconcern– Use education materials depicting AfricanAmericans, rather than other ethnic groups

Culturally Competent Counseling TipsUsing Cultural HumilityRecognize strengths– Use inclusive “we” language rather thanisolating “you” terms– Know where to locate farmer’s markets andthe best produce around town – equippatients with an African Heritage Grocery List– Send patients to an Oldways Taste of AfricanHeritage cooking class nearby (and if one isnot available, consider teaching oneyourself!)

Adopting a westernized dietincreases susceptibility tohealth problems.In SummaryCultural humility requireshistorical awarenessReframing nutritioneducation programing canplay a key role in bridgingthe health-equity gap inAfrican Americans

Our SalesGallons sold annuallyPresentations are communication toolsthat can be used as lectures.FOLLOW CONSTANCEInstagram: @eatingsoulfullyFacebook: facebook.com/LivingWellWithDiabetesTwitter: twitter.com/EatingsoulfullyWebsite: www.constancebrownriggs.com28

An RD’s Guide to CulturalHumility & Heritage Diets- Asian HeritageKa Hei Karen Lau, MS, RDN, LDN, CDCESJoslin Diabetes CenterAffiliated with Harvard Medical SchoolBoston, MA

Objectives Identify the primary health disparities faced by Asian Americansand their causes. Describe the characteristic foods and food traditions that arecommon across Asia. Tips for RDs working with Asian American patient populations /how to integrate culturally relevant components into dietaryinterventions.

Who Are Asian Americans?– A Diverse GroupPEW Research t-asian-origin-groups-in-the-u-s/

Low Mean BMI & Lowest Obesity Rate29.3% 29.1%24.0% 20.6% 61.1%Adapted from JAMA. 2019;322(24):2389-239869.4% 44.9% 68.9% 38.3% BMI 25

Highest Diabetes Rate at All Weight CategoriesBMI 18.5-24.9King et al. Diabetes Care May 2012BMI 25-29.9BMI 30

Highest Undiagnosed Rate of Diabetes & rcentage (%)59%75%17.430.0Prediabetes - aware (%)15.120.010.0Prediabetes - unaware (%)Diagnosed (%)8.313.32.6Undiagnosed (%)11.522%4.729%3.018%9.411.313.7AllAsian, nonHispanicBlack, nal Diabetes Statistics Report, 2020. CDCWhite, nonHispanic

Ethnic Disparities in Diabetic ComplicationsKarter AJ, et al. JAMA. 2002;287(19):2519-2527.

Heterogeneity among AsiansVolgman et al. Circulation. 2018; 138:e1-e34

Diverse in Food CultureOne of the commonalities: eseIndian

VERY Diverse in Food CultureRiceBreadDessertsChinaSouthernChinaJapanese riceJapanIndiaNorthernChinaJasmine riceChinaBasmati riceIndiaIndia

Similar Traditional Asian DietAsian %15%16%FiberN/A15 g/ 1000 kcal15 g / dayCarbohydratesMisra et al. British Journal of Nutrition. 2009;101: 465-473Campbell et al. Toxicology Sciences. 1999; 52 (Supplement): 87 – 94Ford et al. AJCN. 2013; 97(4): sing fiber intake/

What is today’s eating pattern like for Asians?1) Similar to Traditional Asian Diet2) Similar to Typical Western Diet3) Somewhere between Traditional Asian Diet & Typical Western DietTraditional Asian Diet 70% Carbohydrates 15% Protein 15% Fat 15 g Fiber/1000 caloriesTypical Western Diet 50% Carbohydrates16% Protein34% Fat6 g Fiber/1000 calories

Current Eating PatternTypical Western Diet& Modernized Asian Diet 50% Carbohydrates16% Protein34% Fat6 g Fiber/1000 caloriesZhang R et al. Nutrients. 2015;4661-4688Fiber: 5 g/ 1000 kcal

2019 ADA Nutrition Consensus Report “Evidence suggests that there is not an ideal percentage of calories fromcarbohydrate, protein, and fat for all people with or at risk for diabetes;therefore, macronutrient distribution should be based on individualizedassessment of current eating patterns, preferences, and metabolic goals.” “A variety of eating patterns (combinations of different foods or foodgroups) are acceptable for the management of diabetes.” “Until the evidence surrounding comparative benefits of different eatingpatterns in specific individuals strengthens, health care providers shouldfocus on the key factors that are common among the patterns: Emphasize nonstarchy vegetables. Minimize added sugars and refined grains. Choose whole foods over highly processed foods to the extent possible. One of the goals: “To address individual nutrition needs based on personaland cultural preferences, health literacy and numeracy, access to healthfulfood choices, willingness and ability to make behavioral changes, as well asbarriers to change”Evert et al. Diabetes Care. 2019; 42:731-754

The Multiple Components of Cultural cationMaritalStatus

Practical Tips in Counseling– Gathering Information Lifestyle Eating habit Food preferences Social history Born in the USA? When immigrating to USA? Support system Do family, friends or coworkers know about their diabetes? Living with their family? How often do they have meals with their grandchildren? Financial situation Work schedule Cooking methods

Practical Tips in Counseling– Providing Recommendations Eating mindfully Making vegetables the star Use meat as garnish Introduce legumes and different types of whole intact grains Gradually switch out processed grains Plate method / bowl method / hand methodOldwayspt.org

Special Considerations Religious & cultural festivals Buddhists: e.g. First and fifteenth of lunar month Hindu: e.g. Diwali Various East/South-East Asians: Lunar New Year, Moon Festival Life period Chinese: confinement during the first month after pregnancy Special food (varies in regions; high caloric) Cannot leave home Traditional Medicine Using without knowing - medicinal dishes or foods Balancing of forces

Keeping the Food Culture HealthfullyTraditional Asian Diet 70% Carbohydrates 15% Protein 15% Fat 15 g Fiber/1000 caloriesHsu WC et al. PLoS One. 2014Typical Western Diet& Modernized Asian Diet 50% Carbohydrates16% Protein34% Fat6 g Fiber/1000 calories

To Learn Moreoldwayspt.orgPDF available onlineaadi.joslin.orgnutritioncaremanual.org/

An RD’s Guide to CulturalHumility & Heritage DietsSylvia E. Klinger, DBA, MS, RDN

Disclosures Presentation with Oldways Member, Grains Food Foundation Scientific Advisory Board Member, Bayer Crop Science LEAD Network Consultant to the Soyfoods Council Consultant to the Glutamate Association

Hispanic Food Communications Inc.

My family Hispanic Food Communications Inc.

Latinas View aHomemade Mealas the GoldStandardHispanics are 23% morelikely than the total USpopulation to becategorized as a “CookingEnthusiast” Functional: Larger families Emotional: Cooking is an actof love, a conduit for gatheringaround the table and enjoyingfamilySource: Mintel Hispanic Food Communications Inc.Source: Ahzul. 2016.5

ImprovingConsumption ofhealthy foods:Involve theFamily in FoodDecisionsINSIGHT: Market to the family, not just mom.91%of Hispanic groceryshoppers will ask theirfamily members “whatthey want” as part oftheir planning (vs. 77% ofthe general population)39%80% of Hispanicshopping trips conductedwith family and friendsof Hispanic shoppers saythey “love” groceryshopping44%of Hispanic groceryshoppers say they’ll buya brand because “thekids asked for it” (vs.16% of the generalpopulation)Source: Mintel20

Typical Latino Diet Traditionally, Latino diet is filled with whole grain corn,vegetables, fruits, beans, rice, herbs and spices has combined witha strong emphasis on family life, to support good health As Latin Americans adopt a more typically Americanized diet andlifestyle, however, they are at higher risk for many chronicdiseases

Hispanics and Health Worry about their health onbehalf of family A life-threatening illness canaffect their ability to providefor their family Focus on wellness andprevention Hispanic Food Communications Inc.

Thinking about Food and Diet Food Love Bonds the family Mom interested in trying to cookhealthier Cooking from scratch Source of pride and self-expression Hispanic Food Communications Inc.

Lifestyle Characteristics Perception of weight Acceptance of large portions Lack of nutrition education Celebrations – food at the center Longer time spent in U.S. generally more western foods added totheir diet Hispanic Food Communications Inc.

Characteristics of the Hispanic Diet Influenced by country of origin Traditional Hispanic diet revolves around: Grains Beans Fresh fruits and vegetablesHeise, D. USDA, ARS. www.nal.usda.gov/outreach/HFood.html Hispanic Food Communications Inc.

Focus on Hero Foods Hispanic “hero” foods are: Highly nutritious Variety more power Often lower in fat and calories Includes: Grains Beans/legumes Fruits Vegetables Nuts and Seeds Hispanic Food Communications Inc.

Hispanic Hero Foods - Fruits Sample Hero Fruits Avocado Barbados Cherry (Acerola) Guava Mango Orange Papaya Passion Fruit Sapodilla Hispanic Food Communications Inc.

Hispanic Hero Foods - Vegetables Sample Hero Vegetables Chayote Chiles Jicama Pumpkin (Calabaza) Sweet Peppers Sweet Potato (Camote) Tomatillo Yuca (Cassava) Hispanic Food Communications Inc.

Hispanic Hero Foods – Grains, Seeds, Nuts Sample Hero Grains, Seeds& Nuts Corn Quinoa Pumpkin Seeds (Pepitas) Sunflower Seeds Sesame Seeds Almonds Hispanic Food Communications Inc.

Hispanic Hero Foods – Beans/Legumes Sample Hero Beans Black eyed Peas Black Beans Chickpeas Kidney Beans Lima Beans Gandules Soybeans Hispanic Food Communications Inc.

Flavoring con Sabor Herbs and species such ascumin and smoked paprika Add more onions, garlic,cilantro, chiles, etc. Flavor desserts with morecinnamon, vanilla, ginger, citrusjuices or zest and coconut

Food Differences by HispanicSubgroup Differences in heat, spiciness andsweetness Sofrito – used to flavor many dishes Spanish: tomatoes and is sweet Puerto Rican: cilantro and is robust Cuban: parsley, tomatoes and is mild Heat or spiciness Cooks from the Caribbean (e.g., Cuba, PuertoRico and Dominican Republic) tend not touse chilies in their cooking (maybe only as acondiment) Hispanic Food Communications Inc.Heise, D. USDA, ARSwww.nal.usda.gov/outreach/HFood.html

Latin Sauces and Spices Hispanic Food Communications Inc.

Flavoring Food Hispanic Food Communications Inc.

How to Increase Fruits and Vegetables

How to Increase Fruits and Vegetables

My Plate Guide to Portion Control

Portion Control and Food Combinations Hispanic Food Communications Inc.

Methods of Preparation Hispanic Food Communications Inc.

A Guide to Healthy Eating Hispanic Food Communications Inc.

Summary Hispanic women still owns the kitchen Spend more money on food purchases Interest in healthy food purchases and homecooking. Diets generally healthier, but need variety andmoderate portions A significant number of favorite foods are nutrientdense and can be flavored with little calories, saltor sugar.

ClosingThoughtsRegardless of age and country oforigin, the majority of Hispanics areretaining their unique identity andpreserving their culture.– Hispanic Food Communications Inc.28

GraciasFor more icnutrition.com630.930.7963Twiter/IG: @sklingerrdFacebook: Sylvia Klinger Hispanic Food Communications Inc.

A Taste of Latin AmericanHeritage

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