Another Filipino couple came in for guidance on health. She had no insurance but wanted to continue taking the medicines her doc in North Carolina started 2 months ago for blood pressure, cholesterol and sugar. She was on 3 expensive new meds for BP, one standard statin for cholesterol and cheap med most likely for type 2 (late onset diabetes). No old blood tests to show me, unsure about her numbers, just about finished with meds and unsure which med was for which problem but she seemed to have an allegiance to the doc she met. So I had to work backwards and elicit has much history as possible (with my primitive knowledge of Tagalog-the major dialect in the PI) She didnt have any immediate risks for heart attack or early death at the age of 72. Parents were in their 90s at time of death and most of the 10 siblings alive. She was thin, ate typical Filipino dishes and was caring for her grandkids. I asked if the doc tried any other drugs first and she said these were the first she ever "ate". So I am assuming the doc went straight to the top of the heap regarding expense. Also sounds like she was never given guidance on healthy food choices or changes. (usually the first thing to do in first diagnosing diabetes-unless sugar was dangerously high). And now I have to repeat expensive blood tests that will probably hit the 300$ range just to see if I can get her numbers lower with diet manipulation. (there are even supplements like krill oil, Coq10, red yeast rice, plant sterols, fiber that have a great track record in lowering cholesterol test results and will come out alot cheaper than the prescription meds dont believe me?-Dean Ornish's work on reversing heart disease with group therapy, mostly plant based diet, yoga and exercise has been approved since 2010 for bypass candidates on medicare.....thats without taking medicine) As I posted in a blog about loving pork, speaking with a popular TV cooking host, it seems as if viewers are more interested in "home cooking" and not concerned about substituting quinoa for rice, wheat berries for bread, fish for beef. This is the standard thinking for many patients that are first to immigrate to the US. Their kids, the first generations here are easier to convince of changing eating patterns. So how do I get the oldies to keep traditional food but buy into manipulating macronutrients? Here it goes-Seven Strategies to be applied over seven days:
1-Meatless Mondays.....traditional US approach to cutting back total volume of weekly red meat. Have to be creative 4 days a month, not much to ask-discuss fav "alternative" dishes on sunday before going grocery shopping.
2-Fish Fridays...............same US approach to decreasing red meat, try to stick with roasted or baked. With no other options ok to add fried but ask to use good quality oils with high smoke points (consider grape seed and organic non gmo canola since olive oil doesnt tolerate high temps) The best fish for high omega 3 content will be Sockeye Salmon, Sardines, Herring, Anchovies, Mackerel, Alaskan Halibut, Alaskan Salmon. Watch the farmed fish as they usually have pesticides and antibiotics.
3-Cut the Kanin (rice)...rice is essential to every meal in the traditional Filipino kitchen. Certain rice is known to have a very high glycemic index. (the speed at which the food group is digested and absorbed to raise blood sugar) There are some rice species that have a low GI.....like jasmine or better yet, basmati. Decreasing the GI or speed which food gets us our sugar highs will allow the pancreas to survive decades without turning into a diabetic gland. In easier terms, lower GI means longer full feeling. Decreasing volume will decrease total calories consumed at the end of the week. An option Ron Bilaro personally uses is to substitute wheat berry for rice. Yes texture is different as well as taste but the choice still gives the meal substance and the whole wheat is a great fiber that pulls cholesterol out of the circulation. (....and Ron tells me at 40+, this is the healthiest he has ever felt) Real world application of this is to cut down on breads and potatoes-when was the last time you went to a restaurant starving and gobbled 2 orders of bread before the meal even came out, then ate the whole meal since you "paid for it". 1/2 cup of cooked rice per meal only!!!!
4-Fill up with Prutas (fruits)........as a tropical country, Pinoys are very familiar with seeing a variety of fruits in the market all year long. The problem is if you are in a northern US state, fruit will have to be transported a distance (2000 miles sometimes) so you may have to shop at specialty stores in winter (Whole Foods Market, Marianos, Mexican or Asian grocery chains). Pick 2-3 servings of Prutas per day to eat for breakfast and lunch.
5-Garnish with Gulay (vegetables).........this is where we can excel due to the wide variety of veggie dishes sauted and accented with spices. Many times a meal in their own right. Turkey/chicken can always be substituted for beef or port in the meat accented dishes. As stated above, the older Filipinos will probably not go for this knowing the texture is "different". But then again, dont tell them and let's see if they notice. Trickery can be easy with dishes like Bolabola (meatball and vermicelli in clear broth) or even Lumpia Shanghi (Filipino eggroll). A special mention goes out to the use of Tokwa (tofu). Asian culture is big in using tofu (bean curd) in many dishes and health benefits have been repeatedly studied with positive results. Just try to avoid the processed tofu and stick more with whole soy foods and natural soy products (non genetically modified) Pick 3-4 Gulay servings per day.
6-Salad or Sopas (soup)...................in summer cool with salad, in winter warm with soup. Both smaller side dishes or as main entre will help with satiety. Keeping the stomach happy releases hormones of love and satisfaction. (oxytocin and serotonin....sound familiar? This is the same action you get with zoloft and prozac without the side effects! Good to balance the decrease in rice. Hint: it allows you to feel satiated/full so you don't attack the rest of your meals and eat like a hungry animal.
7-Fat-busting Fiber...............yes, fat does give a sense of fullness and it is important in inflammation. Goals in the last decade have been to increase awarenss of the imbalance of too much omega6 and too little of omega3. Our grain raised cattle and pork have a terrible abundance of omega6 in their diet......you are what you eat so unhealthy slow moving pig/cow will pass onto you the same crap it eats. Recent WPRI.com article has revealed the plight of the American farmer for the price of grain feed. This article (click here) speaks of one American farmer feeding bulk "2nd hand" candy to fatten up cattle before slaughter. Owner Joe Watson says his cattle are healthy with the new feed.....notice Mr Watson's weight in the interview. So if you happen to eat Mr Watsons cattle, do you really think that yummy tasting prime rib is giving you anything that will help fight cancer and heart disease? Read on adding fiber/grain sources to the tune of 25grams for women or 35 grams for men daily. If tastebuds are not happy.....well at least take an omega 3 oil supplement (fish, krill or flax) as a daily regime until your next cholesterol and sugar blood test. Click here to calculate daily fiber suggestions for your age.
Make the portion smaller, make the plate seem like it's holding alot of food (smaller size/contrasting color to food/dividers on the plate-forgive me Emily Post) and have something to refer to in measuring volume that can easily be referenced in future meals. (For example, a small tea cup on the table will remind one of how much cooked rice is allowed in a meal....then theres the idea of having tea to slow the whole feast down so as not to devour everything then feel unsatiated.) Timing is always important, even if there is no hunger for breakfast or lunch, it is important to stimulate the digestive tract to produce juices and enzymes, there is a physiologic cascade that begins and prepares the body for the next meal and activities of the day. I have alot of truck drivers that come in thin as a rail, coffee and tobacco users that say they only need to eat dinner. I tell them it is certainly a cool skill to be able to push away hunger but this is not a regular human schedule, they should do what they have to do to work however.........the body is going ask you to pay the price of poor nutrition sooner or later. If its later, it will be so incidious that you wont notice how much damage has accumulated until an event has already occurred (diabetes, stroke, heart attack or early cancer) The longer you wait, the bigger the mountain to climb.
The above measures are just a frame work for an average Filipino diet but if you break it down, the concept can be applied to any culture (short of the occasional vegan or wheat allergic patient.) Read through, see how you can substitute dishes from your heritage, combine with nutrition in your locale and reliable dietary facts available from your doctor or registerd dietician. (just need to ask for help and commit to change.....stick with it until the next season and enjoy the differences!)
Happy eating! Healthy living! Mabuhay! (Long life!)
-DrRic
