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Dinehtah Diabetes Quarterly Spring 2016 News on Diabetes Prevention and Wellness Across the Navajo Area Food for Life: Reconnecting with the Three Sisters ▼ Community Role Models: An Educator Gets Educated By Margilene Barney, Navajo Nation Special Diabetes Project nutritionist I Planted by children, the Navajo Nation Special Diabetes Program community garden behind the Kayenta Senior Center, being tended by staff member Nathaniel Brown. (Three Sisters graphic courtesy of Elayne Sears for www.MotherEarthNews.com.) he Three Sisters style of planting utilizes the three main agricultural crops Native Americans are known for growing: winter squash, maize (corn), and climbing beans, containing complex carbohydrates, essential fatty acids and all eight essential amino acids, allowing most Native American tribes to thrive on a plant-based diet. Traditional plantbased foods are full of nutrition and many have healing properties. Animal-based foods were used when available through hunting. Diabetes, obesity, and health problems commonly seen even in young people and children today, were rare in centuries past, and healthy foods can make them rare once again. In April 2009 the Navajo Nation Special Diabetes Project (NNSDP) and the Washington, D.C.-based Physicians Committee for Responsible Medicine (PCRM) started a collaboration when Dr. Neal Barnard, PCRM President, met with NNSDP nutritionists in Window Rock and introduced the concepts and benefits of a plant-based diet. As it turns out, the Three Sisters plant-based traditional foods are a great OLD approach to health. In September 2010 the reintroduction of plantbased food choices for Navajo began with the Food for Life Classes for NNSDP staff, presented by Dr. Barnard. Barnard is author of the book Dr. Neal Barnard's Program for Reversing Diabetes. The Food for Life Program came from research conducted by Dr. Barnard, and has been cited by the American Diabetes Association’s annual Clinical Practice Guidelines for the past six years. Caroline Trapp, DNP, CDE, ANP-BC, FAANP, Director of Diabetes Education and Care at PCRM, presented the plantbased diet, with a food demonstration by Chef Walter Whitewater, who has trained under several renowned chefs. He’s now at Red Mesa Catering in Santa Fe, and cooks with Dr. Caroline Trapp traditional Native Americans foods. He shared that he started cooking when he wanted to provide more healthy food for his grandmother. In the Food for Life classes the NNSDP staff learned that food has the power to heal our bodies. However, some foods have the power to hurt. Many traditional foods have healing properties; these were the foods focused on, with a modern approach to eating the foods that people ate and enjoyed many years ago – foods that protected people from diabetes and other diseases now common, like heart disease and cancer. Dr. Trapp stated, “Food is our focus because in fact, this new approach has been shown to help many people, those with diabetes or at risk for diabetes, to get healthy, lose weight, and feel great.” In October 2010 the NNSDP, in partnership with PCRM, hosted an eight-week course on a plantbased, meatless diet, Food for Life – Cooking to Live in the Beauty Way, an exciting new approach to preventing and treating diabetes. The weekly, two-hour Food for Life classes offered lectures, videos, discussions, and demonstrations of plant-based cooking. Instructors were Edbert Little and Chef Whitewater. Barnard and Trapp kicked off the classes in October and returned for the final session in December. The Chef’s Cooking Class was filled with nutritional instruction. Attendees participated in cooking demonstrations and enjoyed tasting the foods prepared. The topics during the course included: A Reason for Hope for People With Diabetes by Dr. Barnard; New Recipes Using the Three Sisters; Healthy Recipes With Commodities; Grocery Store Tour and Healthy-in-a-Hurry Recipes; Grains – the Staff of Life; Health From Head to Toe; Stocking Up: Canning/Freezing/Drying/Sprouting; Holidays and Feast Days; Living in Beauty: Staying Healthy/ Feeding Your Family/Sharing Knowledge. Three Sisters, continued on page 2. ▼ T Chef Walter Whitewater of Santa Fe serves traditional dishes using corn, squash and beans to NNSDP staff during a "Food for Life" class. Role Model, continued on page 2. ▼ ▼ n 2008 I was introduced to the Physicians Committee’s Food for Life curriculum. I attended the eight-week class and I heard about eating a plant-based or vegan diet – avoiding foods that come from animals. In the beginning, I really didn't understand what the class was about. At that time I was not at all serious about changing my diet. For example, every chance my colleagues and I got together to eat, they would ask, "Where shall we eat?" I would always suggest the flea market for mutton stew Margilene Barney, with fry bread. I was October 2015 thinking about all the vegetables in the stew, and not that they were swimming in grease from the mutton. “That would be vegan,” I thought! I did try vegan for a little while, or so I thought. But I was still eating a lot of low fat cheese, cow's milk, ice cream and egg whites. Surprise, I was way off! Whatever kind of diet I thought I was on, I could not resist the fried foods and fatty mutton meat that I grew up with. I also ate plenty of the inexpensive processed, fast foods that were available. I honestly thought a diet is not a diet without meat, cheese or milk products. I'm a nutritionist and I know about the "Choose My Plate" diet, and I just couldn't see a diet without meat. During the time I thought I was on a vegan diet I did lose some pounds, and I was very happy and proud that I lost some weight. But, I gained back all of those pounds and more! In November 2013 I was diagnosed with diabetes. I didn’t want to believe it – “Me, diabetes? It can’t be, I’m a nutritionist,” I kept saying to myself. Because of this, I was ashamed. I did not want to believe it. I was in denial. As I say this, I remember enjoying greasy fried bread with delicious fatty mutton stew, fried liver and onions with buttered biscuits, blood sausage, mutton ribs, BBQ spare ribs and all the fast food. One day, all of a sudden I didn't feel well. I kept telling the health care professional that my body is aching, I felt very tired and I slept every chance I got. I wasn't happy anymore. I felt this way for over a year. When the healthcare providers ran blood work on me I was diagnosed with high cholesterol, high blood pressure, and diverticulitis. They prescribed pills of all sizes. I remembered thinking that all of the cosmetics that used to be in my hand bag were now replaced with medications. A caring co-worker asked me if I knew what I was teaching about when I was teaching about fiber foods. I really thought about it. What was happening to my body with all the high cholesterol, low fiber food I was eating? In October 2015 I put my own foot down, no ifs or buts about it. I attended the Native Food for Life meal demonstrations at the 2015 Navajo In the fall 2015, NNSDP nutritionists with Yolanda Ellis Bileen developed the powerful Diné Power Plate brochure full of nutritional information, recipes and a shopping list, encouraging use of Native foods. At the October Navajo Nation 2015 Research Conference, and again in December at the New Mexico Diabetes Advisory Council, NNSDP nutritionists presented the Food for Life Curriculum and the Diné Power Plate brochure to health educators, informing the participants how to use plant-based food to live healthier, explaining that the real problem foods are animal products and refined foods. In November 2015, just 14 days after Vice President Nez spoke with nutritionist Margilene Barney at the NN Research Conference, Navajo Yolanda Nation President Russell Begaye Ellis Bileen issued a proclamation encouraging the Diné people to eat more plant-based meals to prevent diabetes based on the PCRM’s Food for Life In Indian Country message. Work continues with the NNSDP and PCRM efforts to reduce the burden of type 2 diabetes among the Navajo. Dr. Trapp met with the Gallup Indian Medical Center Diabetes Program Staff, Dietitians, Nutritionist, and the NNSDP staff in April 2016. The Food for Life Curriculum is being updated to follow the U.S. Centers for Disease Control's Diabetes Prevention Program (DPP) model which incorporates information that is meaningful to Native Americans. The forthcoming Food for Life curriculum and Diné Power Plate will then be available for use by everyone. NSDP and GIMC SDPI Diabetes Programs plan to use these tools as an integral part of their programs in 2017. Role Model continued from page 1. ▼ ▼ Three Sisters, continued from page 1. Dinehtah Diabetes Quarterly, Spring 2016 ▼ Page 2 Nation Research Conference presented by the Navajo Nation Special Diabetes Program (NNSDP), taught by Dr. Caroline Trapp and Chef Amber Poupore of the Physicians Committee for Responsible Medicine. Since that conference I’ve helped to spread the word about the Dine Power Plate that NNSDP nutritionists adopted from the Food for Life curriculum. I am a very strong believer in the healing power that the Power Plate foods have to help prevent diabetes, heart disease and even cancer. Every time I presented on the Three Sisters from the Diné Power Plate/Food for Life, I was uncomfortable with my teaching. Why? Because I was not living this way of eating, so I thought about it; I thought it would be more meaningful to experiment firsthand so I may teach others to live a healthier life. By doing so now, “I’m living the talk.” As I started my journey to eating with corn, beans, and squash – The Three Sisters – I noticed the positive changes my body went through and I can actually give positive examples. I am now comfortable to teach about The Three Sisters, and other “Healing Food” for a healthier journey of life here on Mother Earth. And, . . . I feel great! Examples of What Margilene Eats • Breakfast: Cold/hot cereal (blue corn mush, oatmeal, Malt-O-Meal, rice) with dried fruits, nuts/ seeds, agave, herbs/cinnamon, and soy milk. Potatoes (with skin) and vegetables. Wheat/ blue-corn pancakes with fruits/vegetables. • Lunch: Meatless Navajo taco, water, an occassional diet Pepsi treat. Spaghetti with vegetable sauce accompanied with raw mixed vegetables and hot natural Indian tea. • Dinner: Spinach taco, homemade chili beans, and green salad. Fruit/soy-milk smoothie. • Snacks: Parched corn, piñons/mixed nuts/ seeds, dry roasted edamame, homemade chili on tortilla/tortilla chips/rice or wheat crackers. Dried/fresh fruit/vegetables. • Beverages: Water, flavored water, flavored iced tea, natural Indian hot tea (wild tea). Email Caroline Trapp at: [email protected] ▼ Margilene Barney participates in a cooking class at the Native Food for Life Diabetes Prevention Leadership Academy in Santa Fe, on February 4, 2016 Margilene by the Numbers “Then” (October 2015) • Weight: 168 pounds • Blood sugar: 278 When I took that first step out of bed, or after a long drive, my body and feet used to hurt. I’d be a hunchback until I could straighten up. I had trouble breathing just walking a short distance. “Now” (June 2016) • Weight: 157 pounds • Blood sugar: 127 No more aches & pains! I move better, breathe better, and feel better. ▼▼▼▼▼ Explore foods that can make a difference in the Diné Power Plate at the top of this page. Dinehtah Diabetes Quarterly, Spring 2016 ▼ NAVAJO AREA SWEET SUCCESS Chinle New Moms Wellness Group – Inia Nizhoni Page 3 Quarterly Nutrition Feature A Bountiful Basket E very second Wednesday of the month from 9:00 a.m. to 11:00 a.m., a team of perinatal professionals – Alison Starling, Certified Nurse Midwife; Cecelia DelaVallee, MD, Chinle Chief of OBGYN; and Lisa Jim, RN, Nurse Specialist High Risk OB/GYN; are available to meet the needs of the postpartum mom. All new moms with gestational diabetes, pre-diabetes or diabetes are invited to bring their babies and family to take part in a shared medical appointment for postpartum check-ups, 75 gram glucose and A1C tests, lactation and nutrition consultation, as well as physical therapy, Native medicine, and any other support for the new mom and baby that may be needed. After being seen by the team, the moms and families convene to a conference room group setting. Introductions are made, healthy foods are demonstrated and shared, and lifestyle changes are introduced. The staff members share ideas and encourage everyone, mothers and their families, to speak up and participate during a lifestyle change discussion. The New Mom’s Wellness Group is a way for women and their healthcare providers to assemble in an informal setting, share stories, support one another, and achieve short and long-term health goals related to lifestyle together. This innovative, shared medical group geared for fun, focusing around wellness, and achieving sustained lifestyle change, started in May 2016 with seven people participating. In the future, the plan is to: increase and measure the rates of post-partum check-ups, the rates of 75 gram and A1C tests, the number of women who follow up with their primary care provider, and to increase the lactation support new moms need. The group is planning to walk together when the weather allows. Up to half of gestational diabetes patients will develop type 2 diabetes. We hope this prenatal discussion group is a positive force in taking care of, and contributing to, diabetes prevention for at-risk Chinle moms. New USDA Dietary Guidelines for Americans 2015 - 2020 In a Nutshell More Plants, Less Meat! I f you enjoy typical American fare but want to make sure you're eating right, the U.S. Department of Agriculture (USDA) Guidelines provide information and recommendations on a number of healthy eating patterns – how much of different food groups and certain items within each group to consume. If you want to try a Mediterranean eating pattern that has been linked to promoting longevity and healthy brains, the Guidelines map it out. If you want to shift from meat to vegetables, fruits, nuts/seeds and whole grains, a balanced vegetarian eating pattern, you can, as research shows this also promotes health and longevity. Sustainability & Support O n May 9 and 10, 2016 the Second Indian Country Breastfeeding Conference was held in Albuquerque, New Mexico, funded by the Kellogg Foundation, and organized by American Indian & Alaska Native Communities and Hospitals Advancing Maternity Practices (AI/AN CHAMPS). The two-day conference for healthcare professionals and the community covered topics relevant to American Indian and Alaska Native breastfeeding: sustainability of the Baby-Friendly Hospital Initiative and breastfeeding programs, breastfeeding and clinician support, historical trauma and breastfeeding, mothering through trauma, breastfeeding and illicit drug use, food sovereignty, reforming breastfeeding education, and creating breastfeedingfriendly communities. CHAMPS and Baby-Friendly USA Executive Director Trish MacEnroe, BS, CDN, CLC, personally congratulated the 16 Indian hospitals (both Indian Health Service and tribal) who have in the past few years become Baby-Friendly! Special congratulations to the 16 Baby Friendly facilities, six in Navajo Area: Chinle Comprehensive Health Care Facility, Chinle, AZ; Crownpoint Health Care Facility, Crownpoint, NM; Gallup Indian Medical Center, Gallup, NM; Northern Navajo Medical Center, Shiprock, NM; Tsehootsooi Medical Center, Fort Defiance, AZ; and Tuba City Regional Health Care Corp., Tuba City, AZ; and to our neighbors: Hopi Health Care, Polacca, AZ; and Zuni Comprehensive Health Center, Zuni, NM. Also, congratulations to Amanda Singer, CLC, our new AI/AN CHAMPS Consultant, and Chair of the Navajo Nation Breastfeeding Coalition (NNBC). If you have questions about the AI/AN CHAMPS activities contact Amanda Singer at [email protected], or the AI/AN CHAMPS Team at: [email protected]. Key Recommendations Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. A healthy eating pattern includes: • A variety of vegetables from all of the sub groups – dark green, red and orange, legumes (beans and peas), starchy, and other • Fruits, especially whole fruits • Grains, at least half of which are whole grains • Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages • A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products • Oils A healthy eating pattern limits: • Saturated fats and trans fats, added sugars, and sodium Other Key Recommendations Specified limits can help individuals achieve healthy eating patterns within calorie limits: • Consume less than 10 percent of calories per day from added sugars • Consume less than 10 percent of calories per day from saturated fats • Consume less than 2,300 milligrams (mg) per day of sodium Healthy Youth Teen’s Perseverance Leads to Success – Jenson Yazzie’s Story Food for Life in Indian Country by Jenson Yazzie I weighed 288 pounds! I noticed that my joints hurt, it was hard for me to get around, and I sweated very easily. It was a chore just to get up and go clean around the house or go outside to get wood. Socializing with people was harder. I more or less just didn’t care what people thought of me physically. People didn’t care about how I felt emotionally. Nobody wanted to socialize with me. It worried me that I wasn’t healthy but I thought it was just normal to be overweight – everybody else gets chubby. My dad sat us down as a family and said that we are going to change our lives. I thought, “like what are you talking about? I can’t change my life over food. I love food. Food is my best friend.” He was just smiling and “I’m like I’m serious – I’m not Jenson before going to stop eating meat; are you crazy? That’s my protein.” He smiled and said, No, I’m pretty sure you are going to get better protein, healthier protein.” He asked, “Do you know what vegan is? Vegan (a plant based food plan) is when you have no meat products.” I was shocked – none of my meat, my milk, my dairy, my cheese, my eggs? What really made me change was my weight. I weighed almost 300 pounds. The first 21 days of going vegan were the hardest for me in my life. I thought about giving up. I thought I’ll just go back and get a burger, quick food. But we didn’t. You are what you eat, and that is what really changed me. I lost about 80 pounds. I lost that weight quickly enough to make me to feel good about myself. Jenson today, I noticed my knee doesn’t hurt. I can run five miles, I can hike. I don’t get heartburn 5-1/2 years vegan. any more, and my complexion is better. I personally l think being vegan is a spiritual thing of being healthy, being one with your food. Mother Earth grew that plant so I can enjoy it. Our Mother Earth – that’s where healthy food comes from. Jenson’s dad, Eddie Yazzie said, “Jenson is an inspiration to everyone. He is so positive about life, he looks so happy and is so happy now, everybody sees it and everybody feels it. He wasn’t like that before, but he is that now. One day you see your kid walk in and he has a smile on his face you haven’t seen in years. He is holding a pair of pants and says, ‘I have had these pants for three years and now I can fit into them.’ That was the gift that I gave back to Jenson. When you give that gift to your child it is the best feeling a parent can ever feel.” Read more about the tools Jenson used on the top of page 2 – The Dine Power Plate. And see a video at http://www.pcrm.org/health/diets/pplate/navajo-nations-power-plate. Drinking alcohol in excess can cause nutritional deficiencies and addiction. If alcohol is consumed at all, it should be consumed in moderation, and only by adults of legal drinking age. Americans of all ages – children, adolescents, adults, and older adults – should meet the Physical Activity Guidelines for Americans to help promote health and reduce the risk of chronic disease. Americans should aim to achieve and maintain a healthy body weight. The relationship between diet and physical activity contributes to calorie balance and managing body weight. From New Dietary Guidelines For Americans 2015-2020, 8th edition, 12/2015, and Physical Activity Guidelines for Americans. – Diane Hodge, MBA, RD, CSR, CDE, CLC, HPDP-Public Health Nutritionist, Gallup Indian Medical Center Three Sisters planting method is depicted on the 2009 US Sacagawea Native American dollar coin. ▼ Page 4 Dinehtah Diabetes Quarterly, Spring 2016 ADVANCES Food Nutrition Facts Label Gets a Makeover O n May 20, 2016 First Lady Michelle Obama and the U.S. Food and Drug Administration (FDA) announced a major step in making sure consumers have updated nutritional information for most packaged foods sold in the United States. The Nutrition Facts label on the back of food packages – that many of us check to see how many calories and how much fat, protein, and fiber are in the foods we eat – is getting a new look the first time in 20 years. “This is going to make a real difference in providing families across the country the information they need to make healthy choices,” Obama said. Nutrition advocates cheered the new rule which had faced some fierce opposition from the food industry. Most food manufacturers will be required to use the new label by July 26, 2018. Smaller manufacturers will have an additional year to comply. How Sweet It Is A new line will tell people how much sugar has been added to a processed food. We will know how much sugar in yogurt is natural milk sugar and how much has been added to sweeten it. Right now, the average American eats about 115 grams (23 teaspoons) of added sugar a day. The new recommended daily value for added sugar will be 50 grams – less than half that amount (about 10 teaspoons). Food manufacturers and the sugar industry fought hard to keep added sugars off the food label, saying that people won’t understand the changes. The Sugar Association has said there’s no scientific basis for distinguishing between added sugars and those that are naturally in foods. They also say there’s no evidence that labeling these sugars will help people improve the quality of their diets. However, it is difficult to meet nutrient needs and stay within calorie limits if you consume more than 10 percent of your total daily calories from added sugars. This is consistent with the scientific evidence supporting the USDA 2015-2020 Dietary Guidelines for Americans. Added sugar displaces needed nutrients, and contributes to overeating. Other Key Changes • Two important elements in making informed food choices, “calories” and “servings,” will be larger and bolder. • Serving sizes will be updated to more closely reflect the amount of a food people actually eat. A serving of soda will go from 8 to 12 ounces, a serving of ice cream to two-thirds of a cup instead of one-half cup. • “Calories from Fat” will be removed because research shows the type of fat is more important than the amount. “Total Fat,” “Saturated Fat,” and “Trans Fat” will continue to be required on the label. • Package size affects what people eat. For package sizes that are between one and two servings, such as a 20-ounce soda or a 15-ounce can of soup, the calories and other nutrients will be required to be labeled as one serving because people typically consume the entire package in one sitting. • Food products that could be consumed in one sitting or multiple sittings will have a dual column labels with “per serving” and “per package” calorie and nutrition information. People will be more able to easily understand how many calories and nutrients they are getting if they eat the entire box of 3ounce packages of potato chips. National Navajo Code Talkers Day Annually on August 14th The Navajo Code Talkers, United States Marine Corps., served in some of the fiercest battles of World War II in the Pacific. For their bravery and service, in 1982 President Ronald Reagan set aside a day to honor them declaring August 14 to be National Code Talkers Day. The “new” label (shown on the right) lists 12g total sugar and 10g added sugar. This is to give an example of how much sugar naturally occurs in the food, and how much of the sugar has been added and the % Daily Value. • The FDA is also making minor changes to the Supplement Facts label found on dietary supplements to make it consistent with the Nutrition Facts label. Daily Values to Reflect Most Recent Science • The daily value for fiber has been increased from 25 grams to 28 grams, for example. • New vitamins and minerals – vitamin D and potassium – two nutrients that Americans tend not to get enough of, will now be on food labels. • An abbreviated footnote is included to better explain the % Daily Value. The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories per day is used for general nutrition advice. SOURCES: Medscape Nurses – Data from a Food and Drug Administration news release also citing the Center for Science in the Public Interest, and The Sugar Association. The Food and Drug Administration (FDA), an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency is also responsible for the safety and security of our nation’s food supply. ▼ Online: www.IHI.org/ProfessionalCourses Delphine McThomas (505) 368-7425 [email protected] 8:00 a.m. - 4:30 p.m. Comprehensive Diabetes Care Workshop San Juan College, Farmington, NM Delphine McThomas (505) 368-7425 Bernadine Russell (928) 729-8469 September 8-9, 2016 Basic Diabetes Workshop San Juan College, Farmington, NM Delphine McThomas (505) 368-7425 Miranda Williams (928) 674-7806 NACA Spring into Summer 2016 Hiking Series - Old Caves Crater Trail, Flagstaff, AZ NACA Family Health & Wellness Center www.nacainc.org (928) 773-2445 NACA Spring into Summer 2016 Hiking Series - Schultz Creek Trail, Flagstaff, AZ NACA Family Health & Wellness Center www.nacainc.org (928) 773-2445 July 14-15. 2016 8:00 a.m. - 4:30 p.m. July 16, 2016 6:30 p.m. MST August 6, 2016 7:00 a.m. MST ▼ IHI Open School 2016 Online Training (Open to all) ▼ May 2016 April 30, 2017 Editor Mona Patterson, BSN, RN, CBC 928/587-6859 Layout & Design Editor Ron Goulet, Peak Publishing, Inc. Flagstaff, Arizona [email protected] ▼ Save the Date! Dinehtah Diabetes Quarterly Upcoming Diabetes Events in the Navajo Area. Dinehtah Diabetes Quarterly Coordinator Krista Haven, RN, PHN, CDE [email protected] 928-674-7736 Your contributions are important to the success of this newsletter! Deadline for submissions is at least three weeks prior to the beginning of each new quarter. Quarters begin on January 1, April 1, July 1, and October 1. Distribution is approximately the 15th of each of these months. Release forms are available if you’d like to submit photographs or use patient names in submitted articles. Send ideas, photographs, and contributions for publication to Mona Patterson. Reach any of us at: [email protected] ▼