"There's an old phrase that says that we are what we sow, maybe the opposite is also true and we eat what we are. If we want to really make an impact in our Latino community, we need to understand that it takes more than used to provide information, sometimes the how, and to whom that information is the lever is more than important than the word." - Karina Nayeli Soto, RD, Yumlish’s lead Dietitian.
Shireen: Registered Dietitian Karina Soto who is a bilingual Registered Dietitian is joining us today. She has a master's degree in Clinical Nutrition worked for the Department of Health and Human Services at Dallas city, and for the health department over in Mexico. She's also the lead dietician at young English and provides culturally relevant nutrition therapy to our patients. Welcome, Karina.
Karina: Hi, thank you for having me today. I'm so excited.
Shireen: Absolutely. We have all these registered dieticians on our podcast, and we haven't had you on here, and you're part of our business. So it's a good time to bring you on.
Karina: Thank you. Thank you.
Shireen: Alright, so Karina diving right in what led you to work within nutrition and then have this specific focus on the Latino population?
Karina: Well, I was born and raised in Mexico. So I didn't know with being very passionate about natural science. And you know, in high school, I was abiding between study foot chemistry, or medicine. And both of my parents, they are gastronomy, engineers. So my dad told me, Hey, what about nutrition, it seemed like a perfect match for you like a perfect combination. And he gave me all blue cup nutrition that he used in college. And I just fall in love about the idea of being able to cure and impact people's lives through food. So that led me to study my bachelor's in nutrition, my master's degree in Clinical Nutrition. And in Mexico, I had the opportunity to work in the medical nutrition therapy, mainly in grunted, assesses on the nutrition under five years old, pregnant woman in more than 20 rural communities in Mexico. And then I never plan to move to the United States. So when I came here, I realize about the huge need of bilingual registered dieticians and not only dietician, health care providers in general, so six years ago, I know how Eddie's through a struggle with the language, I know how it feels, being in the physicians doctor and wanting to ask questions, and wanted to explain my symptoms in a better way, and not being able to because of the language barrier. And then I realize about the huge disparities in the minority groups in the health disparities. And I found out that only 3% of the registered dietitians are Hispanic. So that really motivated me to become a registered dietitian here in the United States. And you know, it's been like very fulfilling when I see my patients faces just light enough, like, Oh, my God, you speak Spanish. And they ask questions, and because they, they, they feel this trust and these connections with me. And it's very, like, really, really nice and very fulfilling for me.
Shireen: That's lovely. So let's talk about specifically within the Latino community, we talk about high incidences of diabetes. So how prevalent is diabetes in this community?
Karina: So yes, actually, the prevalence of diabetes in Hispanic population is higher than the national average. So actually, the prevalence of are 18 years old is in Hispanic population is 13.2 versus 8%. in white, non Hispanic. And actually, we know that Hispanic is one point times more likely to be diagnosed with diabetes than whites. Also, it's very sad to know that Mexican and Puerto Ricans are about twice as likely to die from diabetes. And actually, the prevalence of obesity and diabetes are higher in Mexican Americans than in Mexico.
Shireen: So that's interesting. So the premise of what you're saying is the prevalence of obesity and diabetes is higher within Mexican Americans, then those in Mexico.
Karina: Yes, and you cool thing because, you know, in Mexico since it's a third world country, and there More like lower income, you're seeing that here in the United States because they, they, they emigrate because of a better quality of life you're paying. Well, they are doing better health wise, but that's not the case.
Shireen: Interesting. So what contributes to this disparity? What… Why is, why does this exist today?
Karina: Well, the answer is not that simple. There's a lot of factors involved in this, problematic. Of course there is genetics. genetically speaking, we are more susceptible to obesity in our higher insulin resistance, but other social cultural factors as lower income, lack of access to high quality, health care, education, also food insecurity, of course, the language barrier, the lack of linguistically and culturally competent healthcare providers for insecurity level of acculturation, and a lack of marketing campaigns, a specific for Latinos. So, there's an old phrase that says that we are what we sow, maybe the opposite is also true and we eat what we are. And because if we want to really make an impact in our Latino community, we need to understand that it takes more than used to provide information, sometimes the how, and to whom that information is the lever is more than important than the word. So understand how our food choices are influenced by culture. And to know more about the misconception in the Latino diet will really help to provide tailor nutrition therapy that could really have an impact on the eating habits in our Latino communities.
Shireen: And when you talk about, you know, sort of working with them and meeting them where they are, right, so look at the influence of culture, and how that impacts their food. And I love the saying that you use that if we are what we eat, we eat what we are that that is so powerful. But then if we are, if we are meeting them sort of where they are, right. And then if we sort of peel back the layers, we can see that Latino cuisines are high on carbs, right. So you've got Mexican foods that include 30 as rice, potatoes, beans, you got Caribbean foods that have you good plantain again, and rice. Sometimes these carbs are consumed within the same meal itself. Yes, there's also a concern for sugary drinks, right. So what is your approach then in providing nutrition therapy to them, meeting them where they are, and yet sort of being conscious of where you want them to go?
Karina: Okay, it's a gift. That's correct. And I think it's very important for registered dietitians and health care providers to understand that those items like tortillas, beans, rice, potatoes, are meats in the same place. So for example, I will say some typical Mexican dish could be beans with rice, some potatoes with chili saw, and three to 530. Yes, on the side. So right there is use around like 200 grams of carbohydrates in just one meal. So for example, the American dietary guidelines recommend for all day, around 250 grams of carbohydrates. Yes. So this is all your carbohydrate requirements. ryedale. So I believe, so just tell our Latino community, do not eat or tea yes or not eat rice is definitely not the answer. So because we know that restrictive diets does not work in the long term. And also research has found that there is an association between a greater level of acculturation and a higher rates of diabetes. So we understand that cooperation by the process, which an individual adopt the norms, the volumes, and the practices are the new host society. So we will have better outcomes if we teach our Latino patients how to do modifications on their traditional diet, rather than have them adopt an American diet. So for this, we need, really take time in explaining portion control how to pair these foods, for example, we know, we know that if we pair carbs with fiber, we're going to slow the part a spike of glucose. So we can recommend way to prepare vegetables in combination that makes sense for them. And, for example, there are some surgeries that I like to use in mnP. One of them is, for example, that change system. So I explained my patients, for example, eating 130 Yeah, it's very nutritional, similar to eat 1/3 of rice, or one is more potatoes. So for example, I can tell my patients all for the lunch, you have four servings of carbs. And they can do different combinations, they will either sell it, or I can eat for 30 years, or 230 years and two thirds of cup of rice. So that is more like, easy for them. And they can take more pleasure out of that. And another Israeli delight, I like to use is just to provide different dishes and different combinations with this vegetables. And I would like to mention that I believe my plate is a great tool to use. But it's important to point out that the way that might play was the sign here in the United State, ellipse, a lot of gaps of misinformation for Latino communities. Because in my play, we include, for example, starchy vegetables, and beyonds in the same section of grades. So for example, they might play that we use in Mexico, we use those separations. So it's just very important to, for the registered dieticians to take into account those kinds of things.
Shireen: I see. And so even, even my plate, as you know, as sort of this, this solution that is implemented throughout the United States, even that has its gaps, right, that also has sort of a lot to be left for because it's sort of taking like this one size fits all approach. And it doesn't speak to cultured foods, it doesn't speak to other ethnicities and their eating habits. So that's, that's interesting. Now there's a, there's a strong emphasis in the Latino population on herbal self care remedies. How do you go about addressing that? What do you do?
Karina: So yes, I found a really interesting study research, according to the Journal of American Board of Family Medicine, that say that 80.3 of Hispanic patients report using herbs and natural remedies. So I think this is huge. And sometimes even if, if the physician or the nurse asked if they are using some natural remedies, there are they are not going to report. So I believe this is some information that we have to take into account. And another thing is to know that, for example, many I witnessed this, and in my experience, it's very common to use T's and then to treat some colleague and gastrointestinal issues mainly in infants. And you know, this could have some interactions. And also we notice they don't have any nutritional value or any calories and this could lead to some kind of malnutrition undernutrition and implants. So for instance, I believe it's mentioned to have this information in mind. Also, in Latino communities, it's very common to use liquids that is just the Mexican word for as moody. So sometimes this kind of liquid dose and different mix of vegetables. Latino community has a misconception that has like some pure properties on diabeetus. And we use this Herbes and natural remedies as substitution. Sometimes for me They send like Metformin and insulin because there is like a lot of misconception and needs around the use of insolence. So I believe this very important, even if they don't report to us, helps us to provide this information that there is not herbs or natural remedy that calls, substitute the medical treatment of diabetic.
Shireen: Interesting, and you said, just to clarify, you said that number is 80%. So 80% of Latinos are reporting using herbs according to this, according to the study.
Karina: Yeah. And sometimes, as I say, they're not going to report because they don't, they feel like the physician is not going to understand sometimes, they don't know the name of the herbs in English. So even if the position as a view using this herb, they sometimes don't understand.
Shireen: And the dangerous part about that is they almost substitute the herbs, instead of having the Metformin, the insulin, they try to switch that out with an end that can be dangerous.
Karina: Of course, of course. For example, there's like a big one misconception about that insulin when actually is the lack of glucose control in the long term that is going to lead to retinopathy, you know? So, yeah, unfortunately, that is the reality. So I believe that it's really important to have this information on hand for local communities.
Shireen: So the misconception is that insulin causes blindness, whereas it is, how further along the diabetes gets that, you know, that can cause that Oh, oh, man. What are some, I want to switch gears here and ask you, what are some grocery shopping habits that you observe in your Latino patients? And what changes do you recommend they make?
Karina: Yes, so this is very interesting, because Latino food purchases are influenced by the family, which up together, we love to go to the grocery market with our husband and with our kids, is just an activity that we do. And also we chop more active. Okay, so I believe in this area, there's a lot of niche opportunity. First, because food leveling, education, nutrition, education, info lavalin is going to be key in the Latino community. And also to understand that in order to be successful in the nutrition treatment in the Latino community, we need to enroll the family, we need to take into account the family, the husband, Lolita, so make them to understand the importance of the health journey, the importance and the role of nutrition in the in the therapy of certain chronic diseases. So I guess this is a really important also, according to the ci package fact, more than 60% of the Latino community prefer to purchase organic food. So this is huge, because we can because this is, there is this perception about organic food of being more natural, or has the word calories, or has a greater nutrition density. So we just need to provide information about that, that just because it's organic, that doesn't mean it has less calories. But also this could be like a great opportunity for us because we enjoy cooking demonstration. Because we used to cook from scratch. We are open more to try new recipes. So this, is this is great because we can use these techniques with Latino communities. And it were any works because we love to cook and we love to go to the grocery market and chop. And also, for example, Hispanic children are more likely to influence food purchases, decisions, mainly in the cereals, and the snack areas. And we know that some of these foods like cereals in its snacks could be high in sugar content. And that's very important to again provide nutritional About leveling because sometimes some of these products are market to be like healthy, and sometimes they are not. And also sugary drinks, it's at huge issue we know like the consumption of sugary drinks are higher sometimes in lower income family or in Mexican Americans. And this is not surprising because Mexico has the greatest consumption per capita of soft drinks in the world. Oh, yes. So it's in. There's also this misconception or me that for example is for drinks or some juices, because are like the market by natural or healthy. So yes, between our children and mainly to a yours like a sport drinks and your cells I highly use. So again, nutrition education in those topics is going to be key to really make an impact in the healing habits in our Latino communities.
Shireen: And my big takeaway here, that number surprised me, that 60% of Latinos buy organic foods that is very interesting. All right, so with that, Kareena, we are toward the end of the episode. And my favorite question at the end is, how can our listeners connect with you learn more about your work?
Karina: Yes, of course, you can find me in my social media, as you're that Mexican, that dietitian. So you can find me also too, as I have a YouTube in Spanish YouTube channel in Spanish. And you can find me also as your Mexican dietitian,
Shireen: Lovely. And also follow, follow Korean as well on all of our young English pages. And we're going to link everything up on this show notes. So that if you are trying to try to reach out, learn more or have questions about your own health, you can certainly do that. Again, it'll all be linked in the show notes. So with that crina this I wish this episode could be like two hours long. It was great talking to you. In fact, we went over time, but you were giving all of these pieces of wisdom that I found were so useful and so relatable to so I really appreciate your time. Thank you so very much for joining us today.
Karina: Thank you so much. I love being part of Yumlish.
Shireen: Thank you.