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Santa Maria Sun / Cover Story

The following article was posted on February 26th, 2019, in the Santa Maria Sun - Volume 19, Issue 52 [ Submit a Story ]
The following articles were printed from Santa Maria Sun [santamariasun.com] - Volume 19, Issue 52

Prescribed veggies: Local researchers want to know why diabetes impacts Latinos at disproportionately high rates and whether a healthy diet is the best treatment

By KASEY BUBNASH

The sharp smell of apple cider vinegar wafted through the air as Christine Bisson poured some into a small stainless steel bowl. She threw in a dash of salt and a helping of black pepper, squeezed in half a lemon, and whisked them all together.

Several attendees had gathered in seats around the table where Bisson, a food science and nutrition professor at Allan Hancock College, was presenting her healthy, “diabetes-friendly” cooking tutorial on Feb. 20. As she worked, onlookers straightened their backs and lifted their chins in an effort to see over the edge of Bisson’s bowl.


PHOTO BY JAYSON MELLOM

“Now,” she said as she picked up the bowl and angled it toward her audience so they could see inside, “all these things are really acidic. So we want to balance that with something sweet.”

Some people use sugar or artificial sweeteners, others use honey, but Bisson said she had an even better option: agave.

“Agave is considered to be a low-glycemic food,” she said as she poured some of the syrupy liquid into her bowl and whisked again, releasing a fragrant sweet-and-sour scent into the room.

She went on to explain that “low-glycemic” foods, when consumed, don’t increase blood glucose levels like other sweeteners—including honey. That was an important tidbit for the attendees, who were all there as part of Foodbank of Santa Barbara County’s Healthy Eating for Diabetes program, which helps people who have developed diabetes learn about the disease and the best ways to maintain a healthy lifestyle despite it.

Santa Maria resident Alicia Velasquez was particularly surprised to learn that honey, which she had always considered to be the healthiest possible sweetener, could have a negative impact on her glucose levels.

She’s still learning all there is to know about the disease, even though it’s been a part of her life in one way or another since she was a child.

Velasquez said she was probably about 4 years old when she first heard the word “diabetes.” Her grandmother was diagnosed with it while she and her family still lived in Mexico, and she said they knew almost nothing about how to treat or live with it. Just five years after she was first diagnosed, her grandmother died of diabetes-related complications.

“Now we find out it’s the whole family,” Velasquez told the Sun.

Her brothers, her uncles, and her sister all have diabetes, and they all deal with it in different ways. Her brothers are good about exercising and staying healthy, but her sister—not so much. Velasquez said her sister is losing her vision and suffers painful and irreversible nerve damage, tolls diabetes often takes on its victims.

So when Velasquez was diagnosed with type 2 diabetes about three years ago, she made a promise to herself that she’d learn how to take care of her body and stick to whatever regimen necessary to survive. She joined the Foodbank’s Healthy Eating for Diabetes program in 2017, and has been an active member ever since.

She can feel the difference it’s made.

“It really changed me,” Velasquez said. “Before I felt like an old, retired person, and now I have energy and can go out and do things.”

Velazquez’s experience with diabetes is similar to that of many Latino individuals who are diagnosed with the disease. Although diabetes affects the Latino population at disproportionately higher rates than whites, much of that demographic is left without the necessary tools and information needed to treat the disease and prevent its worst complications.

Doctors at Sansum Diabetes Research Institute in Santa Barbara hope to change that.

Through two soon-to-be-launched countywide programs, Sansum aims to find out why Latino individuals develop diabetes at higher rates than whites and whether consistent consumption of organic vegetables could be more effective and affordable in reducing the risk of developing serious complications.

Researchers began recruiting participants on Jan. 28, and while the programs are open to residents of North County and aim to reach its underserved populations, Sansum has yet to find much-needed partners in the Santa Maria Valley that could set up satellite operations in the area that needs it most.

The research

Roughly 18 percent of U.S. Latinos of Mexican origin suffer from diabetes, according to data collected by the Centers for Disease Control and Prevention in 2016. That’s compared to only about 10 percent of whites.

Though Latinos are more likely to develop diabetes and they represent 16 percent of the U.S. population, they make up only about 1 percent of the patients who participate in clinical trials, according to 2011 data published by the Food and Drug Administration.

“The people who are suffering the most are not actively participating in clinical trials,” said David Kerr, the director of research and innovation at Sansum Diabetes Research Institute.


HEALTHY COOKING
Christine Bisson, a food science and nutrition professor at Allan Hancock College, dishes out a “diabetes-friendly” salad at a cooking tutorial she conducted in Santa Maria’s Salvation Army on Feb. 20. The tutorial was part of the Foodbank of Santa Barbara County’s Healthy Eating for Diabetes program.
PHOTO BY KASEY BUBNASH

Kerr is one of the leading researchers working to address these issues at Sansum, a Santa Barbara-based diabetes research and health care clinic that is in midst of launching two programs—Mil Familias and Farming for Life—dedicated to finding ways to better help local Latino and low-income diabetes patients navigate their symptoms.

During the first program, Mil Familias, Sansum will be recruiting at least 1,000 Latino families affected by diabetes on the Central Coast. The qualifications are simple: The families have to identify as Latino, have to live somewhere on the Central Coast, and at least one family member must have diabetes.

Sansum, he said, will then extensively track each member of the family for an extended period of time, using regular checkups and wearable technology like Fitbits to collect data relating to five categories: genetics, biology, psychology, behavior, and environment. Researchers will find out how their subjects eat, how often they exercise, what kind of environments they’re living in, and whether they struggle with mental health issues, all factors that researchers say play a huge role in whether a person will develop type 2 diabetes.

That information, Kerr said, will be recorded and saved in a “living information bank,” where samples of blood, hair, and skin will also be stored.

“So we’re really going to get a fantastic picture of local Latino families,” Kerr said. “And once we’ve established that, that’s going to allow us to plan interventions to reduce this discrimination.”

One intervention, however, is already planned and will be tested as part of Sansum’s second program, Farming for Life, in which researchers will use fresh vegetables as a low-cost alternative treatment option for low-income locals living with diabetes.

Through the program, Kerr said doctors will be able to prescribe vegetable-based diets to roughly 400 participating food-insecure diabetes patients, those who can’t afford to consistently purchase organic produce. Those patients will then be able to use their prescriptions to pick up a week’s worth of locally grown, organic vegetables at any of Sansum’s “Fresh Food Pharmacies,” one of which will be located in the Unity Shoppe of Santa Barbara.

A healthy diet can significantly reduce the severity of risk factors associated with type 2 diabetes, Kerr said, and it’s much less expensive and causes far fewer side effects than most diabetes medications. Vegetables can also help reduce the risk of obesity, some cancers, and a number of other diseases. And if parents with diabetes chooses to consistently cook with organic vegetables, that reduces the risk that their children will develop the disease later in life.

“There is no downside, from a medical perspective, to increasing vegetable consumption,” Kerr said. “Access and affordability are the two key barriers we specifically want to overcome.”

Sansum completed feasibility pilots of the programs in 2018. During those projects, Sansum followed 100 families to test the Mil Familias program, and 20 families for the Farming for Life program.

Although the findings from those pilot programs can’t be released until they’re independently published, Kerr said both garnered promising results. Many Farming for Life participants specifically saw major improvements to their blood pressure levels, weight loss, and improved control over their diabetes symptoms after increasing vegetable consumption for even a brief period of time.

Families battling type 2 diabetes all across the Central Coast are welcome to sign up for the projects, including those who are documented or undocumented, insured and uninsured. Kerr said researchers are hoping to work in Santa Maria, where the large Latino population could really benefit from Sansum’s findings.

But both projects, Farming for Life in particular, take strong partnerships with community organizations to run smoothly. In Santa Barbara where Sansum’s main office is located, local farms like Fairview Gardens sell organic vegetables to Sansum, which then keeps the produce at its storage and distribution centers, provided by partners like the Unity Shoppe, Santa Barbara City College, and Santa Barbara City Health.

In order to set up a satellite location in North County, Kerr said Sansum needs similar partners in the Santa Maria Valley area—doctors, farmers, food transporters, and distributors willing to dedicate time and energy to the cause.

“We absolutely want to come to Santa Maria,” Kerr said. “So we’re looking for an ambassador in Santa Maria who could really come to the fore and be a figurehead to make it happen in there.”

Getting established 

About 37 percent of patients who regularly visited the Santa Maria Health Care Center in 2018 had either type 1 or 2 diabetes, according to Karen Hougo, an endocrinologist at the clinic. Many of the clients identify as indigenous or Latino, and Hougo said genetics are to blame for much of its prevalence.

The disease is so pervasive in Santa Maria that it has has forced physicians working in the area to shift their focus, in some way or another, onto helping treat and prevent diabetes. The disease impacts so many aspects of a person’s health that it’s impossible not to, Hougo said.


EATING THE RIGHT WAY
Santa Maria resident Alicia Velasquez (center) digs in to taste a “diabetes-friendly” salad made as part of a healthy cooking tutorial at Santa Maria’s Salvation Army on Feb. 20. County programs focused on diabetes education have helped her learn about her disease and how to live with it, she said.
PHOTO BY KASEY BUBNASH

While there are medications that can help when taken religiously, Hougo said lifestyle is a bigger barrier for many patients. Medications can be costly—Hougo said the average person with diabetes spends about $17,000 a year on health care—but most patients of the Santa Maria Health Care Center qualify for Medicare and the discounted rates that come with it.

She’s found that everyday costs and making changes to long-standing habits can be more challenging for many of her patients. Some can’t afford to buy fresh produce on a regular basis. Many of those who can, work multiple jobs, have large families, and don’t have time to cook. It’s easier and more affordable to order a pizza, pick up a burger, or purchase premade microwavable foods that are filling and can be heated and eaten quickly.

“What our society considers food really does sabotage our work,” Hougo said, adding that for many patients, ending lifelong habits of eating poorly and exercising infrequently can seem next to impossible. “But I do see it done on a regular basis, so I do know the human spirit can overcome that hurdle.”

There are a number of programs throughout Santa Barbara County and in Santa Maria dedicated to making this transition to healthy eating and living easier for residents.

Dignity Health hosts regular diabetes support groups and healthy living classes, and the Foodbank hosts its Healthy Eating for Diabetes program, which consists of a series of weekly classes that educate attendees on diabetes, nutrition, and cooking. Those who attend three of the four classes are then eligible to receive six months’ worth of biweekly, diabetes-friendly groceries free of charge, which are high in fiber and low in carbohydrates and fats.

Daisy Basulto, who recently took charge of coordinating the program, said at one of its quarterly socials on Feb. 20 that many program participants are Latino and Spanish-speaking, so the Foodbank tries to keep culture in mind when putting the grocery packages together and conducting cooking demos. In addition to introducing participants to agave syrup at the Feb. 20 event, Hancock food science and nutrition professor Bisson also told the roughly nine participants in attendance about flaxseed tortilla chips, which she said are more nutrient dense than the usual corn or flour.

The Foodbank also tracks participants’ health throughout the program, offering regular screenings and blood sugar tests, which Basulto said helps the Foodbank and participants see how their lifestyle changes are working.

While it’s similar to Sansum’s Farming for Life program, the Foodbank’s program is being carried out on a much smaller scale. And while the Foodbank employs staff members such as Basulto who speak Spanish and are well-known in the local Latino community, it can still be hard to recruit participants.

Building trust among the local Latino population can be difficult for nonprofits, according to Mary Conneely, Sansum’s diabetes coordinator and promatores supervisor, especially with those who have recently moved to the U.S. That’s something Sansum is woking to overcome.

Conneely, who lived in Bolivia for most of her life before moving to the U.S. nearly a decade ago, didn’t have a job when she first arrived. But as the founder of a women’s organization in Bolivia, Conneely had past experience working with underserved populations. So when she saw an opening at Sansum, she thought she’d make a good fit.

Her professional and personal experiences played into that decision, she said. Her parents both died in their 40s, and several of her siblings and other relatives have been diagnosed with diabetes, she said, including one brother who died of complications associated with the disease.

Despite her own experiences with diabetes and moving to the U.S., Conneely said it isn’t easy to establish trust with the target clientele in Santa Barbara County. She speaks Spanish, but as a Bolivian, her culture varies greatly from that of the Mexicans who make up much of the county’s Latino population.

When she first started at Sansum, she’d have to make 100 calls just to get 30 people to show up for a healthy cooking or diabetes-friendly nutrition class, she said.

“They are afraid to go to any of these organizations because they’re afraid they’ll be turned in and deported,” Conneely said.

But over the past 12 years, Conneely and the team at Sansum have cultivated close relationships with locals, some of whom have attended so many events and classes regularly over the years that they’ll be working with Sansum to coordinate the center’s Farming for Life and Mil Familias programs.

Some of those regulars, who originally started attending classes because they themselves were diagnosed with diabetes or had family members with the disease, have trained and received certificates to become promotores.

Promotores are bilingual community health workers who teach classes, conduct blood sugar and biometric tests, and help Sansum engage the Spanish-speaking community in its programs. Sansum celebrated 17 promotores who finished 10 weeks of diabetes training at the end of January, Conneely said, and several of those promotores are continuing on to work as especialistas for Sansum’s Mil Familias program.

Especialistas are key to the Mil Familias program, Conneely said, and are tasked with interacting directly with families to collect data, answer questions, and connect patients to resources when necessary. Each participant contributes personal details throughout the duration of the Mil Familias program, and especialistas are charged with making those patients feel safe and comfortable giving that information away.

Because most especialistas joined Sansum’s programs as regular Santa Barbara County residents struggling with diabetes, Conneely said it’s easy for them to connect with patients involved in the Mil Familias program.

While Sansum hosts promotores classes all over South County and in Lompoc, it hasn’t made it to Santa Maria yet, where Conneely said there is a huge need for diabetes and health education.

“It’s much easier to survive when you can learn to properly take care of yourself,” she said.

Education as prevention

A program like Farming for Life could have helped Maria Galvez—but now it’s too late.

She’s lived with type 2 diabetes for nearly 25 years, and the decades of being heavily medicated wore her body down. Her kidneys are failing, and she’s been on an organ transplant waiting list for about two years. Her family members offered their organs, but it didn’t work out.

She can’t work, had to retire early, and her husband, Pedro, also had to quit working to care for her full time.


FARMING FOR LIFE
Fairview Gardens is a Santa Barbara-based organic farm partnering with Sansum Diabetes Research Institute to provide low-income, type 2 diabetes patients with weekly supplies of organic vegetables.
PHOTO BY JAYSON MELLOM

Galvez, who only speaks Spanish and spoke with the Sun through a Spanish to English translator, lives in an affordable housing development in Paso Robles that houses low-income, farmworker families. She and her husband live on Social Security and supplementary income, she said.

Galvez takes insulin every day and has for quite some time, but her doctors told her it was likely the medications for high blood pressure—a very common side effect of diabetes—that caused her kidney problems.

Now three times a week, Galvez has to go through dialysis, an extensive process that manually removes the excess water and toxins usually cleaned out of blood naturally by the kidneys. The sessions last five hours each, Galvez said, and it’s painful.

The aftermath—extreme fatigue, pain, and weakness—is the worst part. Because her kidneys are failing, she is no longer allowed to take many of the medications she once took, including most used to ease pain.

Galvez, who had just been through dialysis before speaking with the Sun on Feb. 12, sat in a chair at the end of her kitchen table as she spoke. A plastic tablecloth adorned with photos of relatives and grandchildren lay across the table, and a basket filled with pill bottles, tubes, and bandages acted almost as the centerpiece.

She spoke quietly and moved slowly, and closed her eyes for long periods of time as she talked about the life she once had. She used to visit her sons in Visalia, but she can’t travel anymore. She used to help out with housework and loved going out with friends and singing karaoke. Now she’s just trying to survive.

Although Galvez said she always liked vegetables, maybe if she had known which ones to eat and how to cook them her blood pressure wouldn’t have been so high, and she wouldn’t have had to take those meds for so long.

Galvez is just like thousands of other patients who develop serious complications over time because of diabetes and medications for it.

Through Mil Familias and Farming for Life, Sansum researchers hope to find ways to reduce these complications and improve quality of life for diabetes patients, largely through education, according to Namino Glantz, Sansum’s project manager. While there is significant research on diabetes and ways that lifestyle changes can impact the disease, Glantz said that research is rarely disseminated in way that is accessible to Latino and Spanish-speaking Americans.

“They’re not receiving the benefits and information from that research,” Glantz said. “They don’t find out the results.”

In an effort to address that, Sansum will take research as it is published, in very technical and clinical terms, and translate it both into Spanish and lay language. From very technical to understandable, from very long documents to short and concise blurbs about diabetes in Latino families.

It will be a one-stop resource for Latinos and anyone interested in diabetes research, she said, including politicians, who she hopes will be able introduce sweeping public health policy changes that, like veggies, could do more than medication to help. Some politicians, including U.S. Rep. Salud Carbajal (D-Santa Barbara), have already voiced support for the research being done at Sansum.

Despite all the work that’s being done, it will be difficult for North County residents to participate without a satellite program set up in Santa Maria, a step that Glantz said is a priority for Sansum.

“We really need to provide these resources and research opportunities for the large Latino population there,” she said.

 

Contact Staff Writer Kasey Bubnash at kbubnash@santamariasun.com.










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