Maria González is a 45-year-old Mexican woman with type 2 diabetes. She tries to follow her doctor’s directions to manage her diabetes and avoid its complications. But she doesn’t want to change her diet; the whole family loves traditional Mexican dishes. Then her doctor sends her for a heart scan—and she decides health is the most important thing.
Maria González, age 45, felt well. Since her health care provider told her she had type 2 diabetes 5 years ago, she did her best to follow their advice. She took her medications for type 2 diabetes and walked almost every day.
But Maria couldn’t quite make a complete switch to a heart-healthy diet. She loved to cook and eat her extended family’s favorite Mexican dishes, even though a dietician had counseled her that the excess amounts of fats and carbs in traditional foods contributed to obesity and heart disease.
The dietician advised Maria to start with small changes in what she and her family ate. Maria should stop cooking with solid fats, including lard. She should also begin to eliminate white rice, flour tortillas, full-fat cheese, pork belly, and fatty cuts of beef. Sweet foods like flan and churros could be served as special treats.
Instead, Maria could begin to add in healthier ingredients:
Black and red beans
Colorful vegetables like peppers and tomatoes
Yams and plantains
Avocado
Brown rice
Lean grilled meat
Corn or olive oil
Maria was hesitant to follow the dietician’s advice, even though Mexican adults have a greater than 50% chance of developing type 2 diabetes, as well as a high rate of its complications: heart disease, kidney failure, and blindness. Family meals and gatherings were an important part of Mexican culture, even if there was often insistence to overeat. In fact, it was considered rude to turn down an offer of food.
Maria’s health care provider understood that as a Mexican female, Maria was likely to put the needs and traditions of her family before her own health. So they referred her to a local hospital for a heart scan to get a coronary artery calcium (CAC) score; the CAC score helps determine the risk of having a heart attack or stroke. The provider hoped that by having a low-dose CT scan of her heart and learning if she had dangerous calcium and plaque in the blood vessels of the heart, they could convince her to make necessary lifestyle changes.
The heart scan was easy. Maria checked in and answered a few questions before she went into the room with the CT machine. She didn’t have to change into a hospital gown, and there were no injections.
The CT technician explained in Spanish what would happen: “You’ll lie on your back on the table of the CT machine with your arms raised above your head. The table will then pass through the center of the CT machine. I will ask you to hold your breath for about 20 seconds.
You may hear a whirring noise as the scan rotates in a spiral around your chest. The CT machine will cover your entire body for a short period of time, but both ends are open so you can see and hear. I will be able to see and hear you, too.”
Maria’s health care provider contacted her later that afternoon and she went for an appointment a few days later. The provider showed her the results of the scan; there were bright spots indicating which blood vessels had blockage. Maria did have heart disease and would need to begin a more aggressive treatment. Her provider would prescribe a medication to lower her cholesterol levels and would monitor her condition closely. She would have to change some daily habits, too. Her exercise routine had to include more than walking most days. And, yes, her diet had to be improved, for her sake and her family’s. Now that Maria saw the harm of a traditional diet, she understood the need to make it healthy.
Maria went back to the dietician, this time eager to learn how to honor her culture, only with different food choices. She wants to be as healthy as possible and to avoid further heart disease, so she can be with her family for many years to come.
REFERENCES
Hispanic/Latino Americans and Type 2 Diabetes. Centers for Disease Control and Prevention, Atlanta, GA. https://www.cdc.gov/diabetes/library/features/hispanic-diabetes.html
Heart-Healthy Eating Latino Style. National Lipid Association. https://www.lipid.org/sites/default/files/heart_healthy_eating_latino_style.pdf
Low-Dose CT Scan for Lung Cancer Screenings. Swedish Medical Center, Seattle, WA
Aguavo-Mazzucato C et al. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953173/#