Arming patients in the battle against diabetes

Margarita Mendoza is a foot soldier in King County's battle against diabetes. Her weapon of choice one day last week: pollo en cilantro.

Mendoza, King County public-health-worker-turned-visiting chef, arrived at a mobile-home park in Kent toting $9 worth of groceries. She was there to see Jesus Valdovinos, a Mexican immigrant who has been diabetic for 13 years.

On Mendoza's menu this time is a familiar dish from Valdovinos' native Jalisco — chicken in cilantro. But Mendoza was going to teach him how to make it with little fat, reduced carbohydrates — and not a granule of salt.

Mendoza's foray into culinary coaching is an occasional but vital part of her public-health work. Diabetes rates among the region's minority groups, like those all over the country, are soaring. But combating it has been tough because of cultural divides. Language gaps, varied eating habits and even differing attitudes about exercise have caused many public-health efforts to be lost in translation.

"People say, 'I heard that rice is bad, so I eat only noodles now,' " said Abbie Zahler, a diabetes educator with International Community Health Services, a Seattle nonprofit medical and dental center that serves Asians and Pacific Islanders. "That's not really fixing the problem."

An alarming increase

Adult diabetes rates in King County have more than doubled in a decade, climbing from 2.8 percent in 1996 to 5.8 percent, or 84,000 adults, last year. Pacific Islanders and blacks suffer the highest rates. But Asian Americans, Hispanics and Native Americans also are significantly more likely to have diabetes than whites.

Equally alarming to public-health officials is a rise among children and adolescents of type 2 diabetes, which used to be called "adult-onset" diabetes. It is a problem that was practically unknown a decade ago.

In type 2 diabetes, the body's ability to produce or use insulin to convert blood sugar into energy has gone awry.

Some people are genetically susceptible to the disease. Asians, for instance, tend to develop the disease at a lower body weight than a white person of the same height. But being overweight greatly increases the risk of triggering the disease in anyone.

Fortunately, much of the damage of diabetes can be undone through changes in lifestyle, researchers say. In fact, losing weight and eating right can often be more effective than the most common diabetes drug, according to a 2002 clinical trial funded by the Centers for Disease Control and Prevention in Atlanta.

Customizing messages

But willpower alone is probably not enough to fight diabetes, said Dr. James Krieger, chief epidemiologist for Public Health — Seattle & King County. So minority residents would be much less likely to develop diabetes with "culturally tailored" education about the disease's triggers.

"If people are given a chance to make healthy choices, they will do so," Krieger said.

Customizing messages for different cultures can be as simple as suggesting to Asian Americans that brown rice would be a healthier alternative to white rice than whole-wheat bread, which they traditionally do not eat. Or recommending exercise through salsa dancing or tai chi.

Or the effort can be as hands-on as sending health workers moonlighting as chefs to minority neighborhoods, most of whom are referred from community clinics.

Changing habits

At the Valdovinos home in Kent, Mendoza started by showing Valdovinos how to chop the cilantro.

Valdovinos, a 63-year-old stay-at-home husband, is 5 foot 6, and used to weigh 180 pounds, which made him borderline obese. He has lost 15 pounds over the last few years, but he's still a bit overweight. He and his 49-year-old wife, Rosa, eat exclusively Mexican food at home, but enjoy going out for Chinese or American food.

On a folded-up piece of paper in his wallet, Valdovinos carefully records his daily blood-sugar levels. His glucose level on this particular morning was above his normal, at 160.

Mendoza said Valdovinos is one of her better clients. He works hard to keep his disease in check. She had visited him twice before, but this was her first turn at his stove.

Next, Rosa Valdovinos cubed the chicken thighs, so that Mendoza could slide them into a skillet lightly coated with olive oil. She added the cilantro and some chopped onions, then tossed in some diced tomatoes from the Valdovinos' own backyard. Finally, Mendoza squeezed two orange halves over the skillet and added a dash of cayenne pepper from the family's cupboard.

Twenty minutes of simmering later, Mendoza prompted her patient to take a taste. Valdovinos scooped the stewlike concoction onto a small plate, then raised a fork to his mouth with the deliberation of a man biting into the unknown.

He nodded, as if in approval. But then he snatched up a salt shaker and added several quick dashes to his plate.

Mendoza smiled. She's patient.

"It's hard to change habits."

Kyung Song: 206-464-2423 or ksong@seattletimes.com