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diabetes challenge

By Patrick Neustatter, MD

You may not immediately see a connection between a challenging afternoon at the Moss Clinic, and "Yumfest." But I'll give you a clue - the connection is to do with food.

The afternoon at Moss was challenging because I was overwhelmed with patients with diabetes. To make it harder, many were Latino and didn't speak English.

One lady had a hemoglobin A1c (a measure of the average blood sugar over the preceding 90 days) of 11.7 and it shouldn't be more than 5.7. She didn't seem to have a very good grasp of her illness and it seemed impossible to get a good feel for what she was eating - diet being all important in diabetes.

Then I wanted to find out if she was having any heart/vascular complications. Asking about chest pain got us in to some long story about walking with her family in Loriella Park - but there are quite a lot of patients that the time pressured doctor wants to shake them by the lapels, and tell them "get to the point!"

I at least had Erica, one of our wonderful bilingual nurses, translating for me - rather than an interpreter over the phone which really is the ultimate in "the telephone game."

Diet is Everything Diabetes can be controlled, reversed, or prevented with the right diet. The trouble is that, as Dr. Nimali Fernando, otherwise known as "Dr Yum" the founder of the Doctor Yum Project who I wrote about for Front Porch in 2018, knows, the standard American diet is not so good. That predominance of refined carbohydrates with salty, fatty, sugary foods.

This is a significant cause of the frightening increase of diabetes - which worldwide has increased about four-fold between 1980 and 2014 (in the US, Latino's have the second highest rate at 12.8 percent versus 7.6 percent for nonHispanic whites).

Obesity, which leads to diabetes is also growing. In kids 12 - 19 prevalence has increased from 6.1 percent in the early 1970's to 20.6 percent in 2013-14 (and here Latino kids have the highest rate). and I sometimes wonder if we're not all going to die of diabetes before global warming gets us.

The explanation for the prevalence of obesity and diabetes in Hispanics seems to be that they fall foul of the awful diet of their new host country.

"When I ask Latino patients when their weight started becoming a problem, they often say 'When I came to this country,'" says Silvana Blanco, RD, a bariatric dietitian at a Weight Loss Surgery Program.

Other factors are because they don't understand the language, are often more sedentary than where they came from, are living in conditions where it's hard to cook for themselves, and often don't have health insurance - though not being able to see the doctor may not impact their diet so much as "despite the importance of diet quality, most clinicians and other members of the healthcare team do not currently assess or counsel patients about their food and beverage intake" scolds an article in Circulation.

To The Rescue To save us The Dr. Yum Project is here. It teaches healthy eating and gives cooking lessons for kids and their parents

The "Yumfest," where we drank some great Highmark beer, tasted Bowmans bourbon, ate Phat Yummy quesadillas and gourmet burgers from Fire Escape (maybe not quite what would be approved by Dr Yum) played cornhole, raced tricycles (wife Paula leaving me in the dust), and bobbed to the music of Hard to Tell, was a fundraiser for this wonderful project - to which Paula and I were invited by Els Van Wingerden and Andy Craig of the Fredericksburg Food Coop.

So the rather clumsy message behind my linking my hard day at the Moss Clinic with the "Yumfest" is that diet is so important. The consequence of bad diet is the patients we see at the clinic with diabetes - of many ethnicities.

The solution is to learn, our kids especially, to eat right.

Patrick Neustatter, MD is the Medical Director of the Moss Free Clinic

The NIH has warned "childhood obesity is one of the most serious public health challenges of the 21st centaury"