Shireen: Joyce Verejo has 20 years of experience in dietetics. She obtained a bachelor's degree in science nutrition from the University of Puerto Rico, and a dietetic internship from the Veterans Affairs Medical Center in Puerto Rico. She's an outpatient dietitian, and responsible for guiding the education for clients of all ages with diabetes and their family members.

Joyce: Welcome, Joyce. Thank you, thank you for having me.

Shireen: So glad to have you on. So just diving right in what led you to work within nutrition and specifically within diabetes care?

Joyce: Well, I'm where I have a strong family history of diabetes. And I witnessed how my grandfather went through all his complications, because he was not managing his diabetes the way that he was supposed to be doing it. And also, after that, my dad started having issues as well. And I was so concerned in the same time afraid of going through the same process that I decided to choose a career that could help me understand better how diabetes work, and how nutrition can play a huge role, either delaying or preventing this condition. And that's the reason why I became a registered dietician.

Shireen: So why the focus in the Latino community?

Joyce: I'm Latina, and I'm from Puerto Rico, and I work here with a mixed population community. I had seen Americans and Hispanic and Latinos. But I have noticed that Hispanic and Latino people with diabetes don't feel comfortable enough to share their concerns, and their questions with their providers. So the majority of the time I was, I on the link between the translation, and helping that provider understand what's going on. And part of the time I also just by myself, helping them understand what, it's the diabetes, and what's going on. And they feel again, more comfortable reaching out to me and being open. So I noticed that there's a huge gap and necessity for this population here in the United States. for providers to help this population as well, and I decided, Well, I think I, I need the requirements I need, I am Latina, I speak Spanish, I can relate to them to what's going on with their life. I can understand the culture, and I can help and understand and manage diabetes better.

Shireen: Now, you know, when we talk about Latino foods, there's so much diversity across the board, right? Oh, yeah. So within the community, there are variances in culture and diet. Which group Do you largely speak to? And what are some of those variances?

Joyce: Well, I focus more on Caribbean. I'm from Puerto Rico to island in the Caribbean, next to Cuba, Republic, Dominican Republic, Haiti. So that's the population that I target more, but I have noticed also that I receive a lot of message in texts from people from Venezuela, and Mexico. So that doesn't mean that I only work with Caribbean people, I can definitely work with all their Hispanic and Latino ethnicities, and it's okay. It's just knowing where they're coming from, and how I can help them do better with their nutrition in order to manage their diabetes. But like you said, yes, there's a huge it's another, another podcast. We talk about food, and each region has their different preference and all of that. So yeah, it's different.

Shireen: And so we're talking about the region is sort of split up with the Caribbean, Central America, and then you've got South America and even across each of the sections is very, very different.

Joyce: Yes, I agree.

Shireen: Now, what are your thoughts on the bilingual posts, to make information really accessible? What have you learned from that experience of creating that kind of content, that type of content How does it resonate with your audience?

Joyce: Well, I decided to do the bilingual post because I was able to reach more people. There's a lot of Latinos and Hispanic here in the United States, that they can speak English and they understand English, but they prefer to get the information in their primary language that it will be Spanish. That being said, read my post in Spanish, or if I do, like, short story, my story are in Spanish. So um, that resonates more with them. And like I said, before, they feel more connected to me, and they feel more open to share their concerns, and I can help them better. Mmm. It's like a 50, 50%. I will say that I have 50% of my followers that they do better with English post in your head, the other half in Spanish. So I will continue to do it. Because, again, not everybody feel comfortable just reading or talking in English. So yeah, I think it's better for them.

Shireen: And then when you mentioned, you know, speaking to them in that way of that preference in language, how has that aided their journey in managing their, you know, their condition?

Joyce: Well, it, they feel that they feel that when they read my posts in Spanish, or they listen to my story in Spanish, they can relate better. And they, they feel, again, more confident, because somehow they, they understand that I can, I can relate to their story, I can know what's going on with their culture, with their eating habits, with the preference in food, and at the same time, helping them manage the diabetes. So they somehow they, they appreciate more. My, I will say not my effort, but my, the opportunity that I'm given them to have that sort of an outlet to get that information from a reliable leader eyeballs, reliable source, and not getting that information from Google search or Dr. Google, like I say. So that's something that also resonates with them.

Shireen: Now, what is it to include traditional Latin foods into meals and into even your nutrition therapy that you provide? What kinds of foods are you focused on? What kind of ingredients do you recommend or swaps that you recommend? For such foods?

Joyce: This is a good question. And I, I'm glad that you bring this question because there's so many misconception about the nutrition when, on regarding diabetes medicine management. Back in the days, I will say maybe 2025 years ago, there were so many restrictions. For people with diabetes, they cannot eat bread, they cannot eat rice, they cannot eat potato, they cannot eat corn. And all of those are staple foods in our Latin community. So you saying to a Puerto Rican or to Dominican Republic person, you cannot eat rice? It's like, Okay, what do I eat then? What, why, what, what you want me to eat? How do I feel when I'm not eating the food that I like to eat? So that being said, there's no food, it's off limits. And this may be shocking, because there's a lot of influencers and a lot of venues that say, says otherwise, that you have to get rid of the carbs, that the carbs are bad that you cannot manage diabetes, if you have, if you eat rice, bread and so on. So again, no food is off limits. It's just the serving size, how much you're eating and how to care, the food that you are eating. So if you have a plate like it's just white rice You for sure your blood sugar will spike quickly. But if you pair that white rice with maybe half a cup of beans, and a piece of chicken, the fiber in the beans, the protein in the chicken will make your sugar spikes slowly that, that's what we are looking for. So again, it's just having the knowledge of how to pair your food in order to make sure that that blood sugar doesn't spike quickly. And don't show us a high sugar level or alpha low sugar level. Does that make sense?

Shireen: It does. And so what do you say in terms of quantity of these ingredients or even making healthy swaps?

Joyce: Yes, so for instance, um, instead of white rice, you can do brown rice has more fiber, will help you make sure that your blood sugar doesn't spike too quickly. That doesn't mean that you cannot eat white rice you can but it's better for your diabetes, manage, management to switch or choose more often food that has more fiber content like white rice for Mexicans. Although I know they do a lot for 30 years, but the ones living in here, we usually go to the grocery store and buy the flour tortillas, the flour tortillas are more refined and your blood sugar will spike more quickly. So instead of choosing flour, tortilla, just choose corn tortilla. Okay, the core has more fiber, and again your blood sugar will spike not as quick as with the flour to cheat you. Also Latinos and this is some regard Puerto Rico and the Caribbean they we we eat a lot of starchy vegetables like potatoes don't come along got their names in Spanish that I don't remember sorry about that the name in English. So do come Malanga that type of starchy vegetable, it's a good option. Instead of making fried potatoes, you can either bake them or do mashed potatoes. Or if you have the means you can buy a airfryer. And that's a good option to do your food that has more, that is cooking oil to do it using that type of device to get rid of that extra fat. So for instance, in Puerto Rico we eat a lot of stoners is plenty reimprinting. And it's literally fried in like four inches of oil. Oh, you can't imagine, you can have that, you can have the same benefits, not the same benefits, let's say the same flavor and feel at home, if you choose to do this with the airfryer instead of the prime. So stuff like that. It's what we are trying to teach our population grilling, it's a good option. You can grill, you can bake stew, you can cook on your chicken like in the type of stew instead of deep frying and get the benefits of the meat about, without the extra saturated fat that we know doesn't make good to people with diabetes.

Shireen: What are some of the widely held misconceptions or points of misinformation when it comes to nutrition?

Joyce: Misconception, this, this is a huge one because can interfere with what your prohealth care team it's trying to address. But Debbie leave or the misconception that the person with diabetes may have can be a barrier between the physician and the patient. So we need to be critical about that. But one of them will be that if they don't feel sick, they don't visit the physician in diabetes. And I can say this because like I said, My dad has diabetes. You, some days you don't you don't show symptoms at all. But inside your body fighting a battle that eventually will let you have complications. And not because you're not seeing signs or symptoms, that means that you are doing fine. So making sure that you have your annual checkups and follow up with your physician. I think it's, it's a most, not rely on, okay, I don't feel bad, I don't feel like I'm sick. So there's no need to me to visit a physician, don't wait until you have a problem, be proactive. Because the only way you can manage diabetes and avoid complications is being proactive. If you wait on, okay, you see your signs and symptoms, it could be too late. It could be too late. A second misconception is that they want to manage diabetes, with natural remedies. As Latinos, we have a lot of our grandparents, great, great, great grandparents, they believe in maybe cinnamon, special herb teas, you name it, it's a lot. But using that type of natural remedy will not help manage diabetes. Diabetes is a chronic condition that the majority of the people need either oral medication or insulin. And both of them are okay. And there will they may be a miss you the person with diabetes can be afraid can be I'm not into starting medication. But if they don't do so they will see complications in the future. So relying on natural remedies will not help them either avoid diabetes or cure diabetes, because unfortunately, diabetes doesn't have any cure. So we need to deal with this. It's there and we need to deal with this. I will say that's the second misconception. And the third misconception it's that they don't want to do medications. That is, it's related to using natural remedies. So medications, so such as insulin, they’re super afraid of insulin. And insulin has so many benefits for people with type two diabetes, and can help them make your blood sugar be arranged in rage and be better. So I think that's the, the misconception I actually make a post about insulin, because it's, it's a lot. I see a lot of people say no, I don't want to do insulin. And for instance, I know that we're running short in time. But just a quick story. I saw this patient last week, 44 years old, type two diabetes for 14 years. And he came to the hospital because he wasn't talking well. And he had a stroke. He's a one C was 16%. So that's double what we're looking for, we're looking for 7% or less. And it was time for him to get on insulin, but he refused for the last five years insulin and having blood sugars constantly Hi, hi, hi, hi, can trigger eventually, strokes in other chronic or debilitating conditions like a stroke like he had. So that's a huge misconception that insulin is bad that insulin it's it's it's got some work that insulin will give you we'll do me wrong in that instead of do me better.

Shireen: Definitely, it's also a combination, right? You look at the medication side of it, which is so important, but you can't, you can't also continue to eating in a healthy in an unhealthy way either sort of like that balance between getting your medication staying on top of that. And then also looking at your diet very closely.

Joyce: And physical activity, which role so I think that's the perfect combination. Like you said, medications, your nutrition, physical activity, and yeah, you can definitely do better.

Shireen: Sounds good. Well, with that Joyce, we're toward the end of the episode. So the end of the episode, I like to ask the guest to see how folks here listening can connect. So how can people connect with you? How can they learn more about your work? 

Joyce: Well, my Instagram handle is Latin dot diabetes dot nutrition. They can search for my account that way. And I also have a YouTube channel. That YouTube channel is just Spanish videos about type two diabetes. And it's also called the same lateen nutrition not left in diabetes nutrition. So yeah, they and they can reach me out, they can send me the ends. And I'm glad to always answer all of them. They, if they have questions, I can make posts about their questions and all of that. So I'm very open to help my community and help them manage this condition because it's not the end of the life is not the end of the world. If they can definitely manage this. They just need the right information and the right support. And I'm here for them.

Shireen:  

Well, thank you so much for your time. Joyce, I know it is I really admire your work because there are only so few that talk about the sort of that cultural relevance when it comes to nutrition and how important of a factor it is to be able to manage health outcomes. So I really admire your work and thank you so much for your time.

Joyce  

Thank you for having me. I really appreciate this.

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