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Diabetes and Cultural Differences
Dear Diabetes Health,
My parents moved to Los Angeles from Manila 35 years ago, when I was 10 years old. I just married a beautiful man from Mexico who came to LA last year. He has type 2 diabetes, but he doesn't take care of it. He likes to eat big servings of rice, beans, and tortillas with almost everything. The doctor told him that it isn't good for him, but he says that his mother cooked this way and that it's what he wants.
I don't think he understands much about diabetes. He doesn't talk about it and says that it's not a big problem, that things will be all right. But I worry about him and want him to take care of himself. I am 20 pounds overweight, and I want to eat healthier, too. How can I help him?
Congratulations on your marriage! You are experiencing problems common in culturally mixed marriages. When couples like different foods or have different expectations about food, diabetes management can be more difficult. Having different beliefs about diabetes is also an issue.
The first thing to understand is that cultural preferences in food are not bad. Groups that have high rates of diabetes often believe that their traditional foods are the problem. In fact, traditional foods are usually healthier than modern American diets. The problem is matching the old ways of eating with the new environment. Large amounts of fat and starches were quite healthy when people were laboring for hours in the fields because they provided needed energy. However, they're not a good match for television watching and desk jobs.
You and your husband's doctor may have misunderstood each other. Beans are usually considered healthy for diabetes. Rice is OK also, in small amounts. What's not good for your husband are the "big servings" you mention. He probably doesn't have enough insulin to handle such large doses of starch.
According to an article in Clinical Diabetes, published by the American Diabetes Association, a "typical Mexican breakfast" might include ¾ cup of refried beans. They suggest reducing that to 1/3 cup of boiled beans and adding a small banana to make up the difference. I'm not a fan of the ADA's diet recommendations, but the point is that beans are OK.
But changing from refried to boiled beans would probably not please your husband. The rice issue could also bring up cultural differences. Brown rice is clearly healthier than white rice. It's still a carb and should be limited, but studies show that brown rice doesn't raise blood sugars nearly as much as white rice A study in the Archives of Internal Medicine found that "[refining brown rice into white rice] causes loss of fiber, vitamins, magnesium, and other [minerals and proteins], many of which may be protective against diabetes."
Here's where healthy eating may differ from your mother-in-law's cooking. She probably didn't use brown rice, and your husband might not be excited about trying it. If you want him to eat less rice and/or eat brown instead of white rice, how can you approach him about it? How can you talk with him about exercising and taking diabetes more seriously in general?
You will need to use good communication skills to make this conversation work. You have to let your husband know how you feel. For example, you might say,"I love you, and I don't want to lose you. I would feel so much safer if your diabetes were in better control. But so much rice and so many tortillas aren't good for diabetes. Could we eat less of them?" When you tie your concerns to your actual feelings, he won't feel like he is being nagged.
Of course, you have to use your own words (in your own language). You could even be more specific about the issues you want to address. For example, you might say, "Honey, I've been reading that brown rice is healthier than white rice for diabetes, and I'd like to try it. It would make me feel like we're doing something for ourselves."
When it comes to changing behaviors to manage diabetes, it's almost always better to have someone do the change with you. So if you want your husband to do more walking or more exercise, offer to do it with him. Find out what kind of movement he likes, and say you want to do it together. Perhaps dancing is an exercise option that would bring the two of you closer while improving his glucose control. Or perhaps he can find a friend to exercise with.
If your husband doesn't take diabetes seriously, it may be that he hasn't really been educated about diabetes. Do you go to doctor appointments with him and ask questions? Have the two of you spoken with a diabetes educator, knowledgeable nurse, or diabetes counselor who understands your husband's culture and speaks his language? In the LA area, you should be able to find one. Ask your doctor or search the American Association of Diabetes Educators list.
You also might want to find a cookbook that helps you with diabetes-healthy meal plans. The National Diabetes Education Program puts out a bilingual cookbook called Tasty Recipes for People with Diabetes (Ricas Ricetas para personas con diabetes), which you can see here.
You don't have to deal with this issue alone. Probably a dozen people on your own block are dealing with similar issues. Perhaps you can find someone to talk to about diabetes at your clinic, at your church, or in your neighborhood. There may even be lay diabetes counselors there.
When people are from different cultures, it can be harder to agree on food and on attitudes toward medical care, exercise, and many other issues. The key is to communicate openly and share your feelings without attacking or criticizing. Let us know how it goes.
David Spero, RN, writes regularly about relationships, sex, and diabetes at Diabetes Health and Diabetes Self-Management. He is the author of The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, and Diabetes: Sugar-coated Crisis - Who Gets It, Who Profits, and How to Stop It. Visit his web site and read his blog.
Aisha Kassahoun is trained in marriage and family therapy. Aisha and David present sex and intimacy programs for people with diabetes, those with multiple sclerosis, and health professionals. You can learn about these programs at their web site.
Categories: American Diabetes Association, Bilingual Cookbook, Diabetes, Diabetes, Diabetes Education, Diabetes Management, Diets, Exercise, Exercise, Food, Insulin, Losing weight, Overweight, Type 2 Issues, Walking
2 comments - Aug 29, 2011
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