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Arabic Power Point-Diabetes Care Center
- 1. Arabic Food &Culture Lydia Dysart & Alyssa Fritz Henry Ford Hospital Dietetic Interns 2015-2016
- 2. The Arab World 21 Arab States identified by UNESCO: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Malta, Mauritania, Morocco, Oman, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates, Western Sahara, Yemen,
- 3. Facts About the Arab World “Arab” – referring to anyone who speaks Arabic as their first language Over 300 million worldwide Muslims, Christians, and Jewish Arabs “Arab Americans” – Americans of Arab descent Lebanon, Syria, Palestine Arrived in the late 19th century Largest community is in the Detroit-Dearborn area: 300,000-350,000 in the Greater-Detroit area 1/3 of the city of Dearborn
- 4. Islam Monotheistic Middle East religion beginning the 7th century Five Pillars Faith, Prayer, Charity, Fasting, Hajj 1.5 Billion followers worldwide
- 5. Islamic Holidays Al-Hijra Islamic New Year Ramadan The month of fasting - fast from sunup to sundown Eid-ul-Fitr: Festival of Breaking the Fast End of Ramadan – celebratory meal Eid-ul-Adha: Festival of the Sacrifice
- 6. Ramadan Chabbakia-Fried dough, sesame seeds, honey Mujadarra- lentils and rice, yogurt Konafah- pastry made with phyllo dough and cheese Paomo- bread and mutton soup Khyar Bi Laban- cucumber yogurt salad Qatayef- Arabic pancake filled with sweet cheese and nuts
- 7. Eid-ul-Adha: Festival of the Sacrifice Asian Muslims celebrate with sheer korma, a sweet dish made with milk, vermicelli and biryani. In Bosnia and Herzegovina stuffed vegetables called dolma is served. Uighur Muslims prepare traditional Xinjian Noodles
- 8. Ramadan – Implications for Diabetes Fasting - one meal at sunrise, one meal at sunset Quran exempts certain groups from fasting for health reasons Risks Hypoglycemia – highest risk in those taking insulin or certain medications Hyperglycemia – highest risk after overeating at night Dehydration Tips Monitor blood glucose levels throughout the day – end the fast if <70mg/dl Continue taking medications – dose/times may need to be adjusted by doctor Dawn meal – whole grains + protein + fat Dusk meal – limit dates to 1-2 per evening, drink lots of water, be cautious of overeating
- 9. T2DM in Arabic-Speaking Countries Dramatic increase in prevalence past 30 years Wealth Urbanization Decreased physical activity Changes in nutrition 280,000 diabetes-related deaths per year
- 10. Risk Factors Obesity 78.5% of people with diabetes are overweight 45.7% are obese Modernization Urbanization 25.5% have diabetes in urban areas vs. 19.5% in rural areas Highest rates in wealthiest countries Education Marriage Physical Inactivity
- 11. Risk Factors Food Consumption: Dates, milk, fresh fruits and vegetables, whole wheat bread, fish high saturated fat, refined carbohydrates, low dietary fiber 1990-2007: Average energy consumption per person is 2780kcal/day
- 12. Prevalence Among Arab Americans in Dearborn, Michigan Sample size: 542 subjects in Dearborn, randomly selected 95% immigrants, in US for 11 years (mean length) Mean age: 38 years Glucose tolerance assessed with two hour 75 g oral glucose tolerance test Higher in men than women Abnormal Glucose Tolerance: Affects 41% of the population 20-75 years of age; >70% those >60 years of age Higher rates than white, African American, Hispanic populations in US High prevalence of diabetes and impaired glucose intolerance + low detection rates = prevalence expected to increase Need for increased public awareness and regular surveillance for diabetes, need to develop culturally sensitive community- based interventions aimed at prevention and management
- 13. Diabetes in Arabic Population Responsibility Fatalism- belief that events are controlled/predetermined by fatalism. Social Acceptance Status and social acceptance are highly valued in Arabic population- Illnesses like diabetes could evoke feelings of shame Single men and women may avoid care Role of the RD Motivational interviewing- find culturally appropriate ways to help the patient take their medication, carbohydrate count, or choose different foods Educate patient– diabetes is unrelated to infertility or impotence.
- 14. Diabetes in Arabic Population Desirable Body Type Overweight is associated with “health”– strength, prosperity, wealth prestige Westernization changing idealistic body image but mainly in youth, not in adult population with diabetes Hospitality and Generosity Maintain good social status. Food rituals—host offers unrestricted food (in quantity and variety) and it is customary to convince guests to eating much more than they are capable of.
- 15. The Role of the RD Understanding the cultural context of the disease Values: conformity, associated with social honor Patient with diabetes with this background may not be skilled in self management Patient may perceive RD or CDE to be authority figures Cause fear of admitting problems or asking questions– feelings that they are unqualified to participate Providing quality care Demonstrate a peer-type relationship with patient Involve the patient in their care– what are their perceived barriers, what are foods that they enjoy eating, what is their plan of action?
Editor's Notes
- There are 21 Arab States identified by UNESCO. Languages spoken by these different states include Arabic, French, Kurdish, Maltese, and English, to name a few. Arab states: http://geography.about.com/od/lists/a/arab-countries.htm Picture: http://www.maozisrael.org/images/content/pagebuilder/23459.png
- “Arab” is both a cultural and a linguistic word. It refers to anyone who speaks Arabic as their first language. They are NOT a race, rather are defined by their culture and history. They are mostly Muslims but there are also millions of Christian Arabs and thousands of Jewish Arabs too. Arab Americans are Americans of Arab descent. Most originate from Lebanon, Syria and Palestine, however there are many from Egypt, Yemen, and Iraq as well. They began to arrive to America in the late 19th century and the largest community of Arab Americans resides in the Detroit-Dearborn area. http://www.adc.org/2009/11/facts-about-arabs-and-the-arab-world/
- Islam is a religion that developed in the Middle East in the 7th century. They worship one God, Allah, and follow the teachings of the Quran. They are unified by the Five Pillars which are the fundamental practices of Islam. It has expanded significantly from its birthplace in the Arabian peninsula to include Africa, Asia, Europe and the Americas. http://www.patheos.com/Library/Islam
- Al Hijra celebrates the Islamic New Year, marking the Hijra when Muhammad set up the first Islamic state. It is a low-key event celebrated less than other major festivals. http://www.bbc.co.uk/religion/religions/islam/holydays/alhijra.shtml Ramadan is the ninth month of the Islamic calendar when Muslims fast during the hours of daylight. Fasting is intended to teach self-discipline, restraint and generosity and to remind them of the suffering of the poor. It is common to have one meal before sunrise and another directly after. The end of Ramadan is marked by a celebration called Eid-ul-Fitr – the Festival of the Breaking of the Fast. They have special services and processions as well as a celebratory meal eaten during the daytime – their first in a month. http://www.bbc.co.uk/schools/religion/islam/ramadan.shtml Eid-Ul-Adha is the festival of Sacrifice. To celebrate they sacrifice a goat and share meat with family, friends and the less fortunate. They also pray in the Mosque and give money to charity. http://www.bbc.co.uk/schools/religion/islam/eid_haj.shtml
- Two meals- before dawn and after sunset. The second meal is heartier and heavier. The second meal is often started off with dates and then continued with eating/drinking throughout the night until the next morning’s before dawn meal. Both meals contain fresh fruit, vegetables, halal meats, breads, cheeses, and sweets. Muslims in different areas may celebrate with different foods. Examples of foods that may be served include: dates, pistachios, dried fruits, fresh fruit/veg, chabbakiea-dessert of fried dough with sesame seeds and honey, sherbets made from fruit juices water and sugar, lavash bread, chapatis unleavened flat bread with vegetables and meats, tabbouleh (bulgur wheat), pastry with phyllo dough and cheese, fava beans with garlic spread on beans, porridge made of meat, wheat, letils. http://www.thekitchn.com/ramadan-when-its-ok-to-eat-and-94989
- http://www.ibtimes.co.uk/eid-al-fitr-2014-famous-foods-around-world-break-end-ramadan-fast-1458610
- http://www.joslin.org/info/Ramadan-and-Diabetes.html Ramadan can be problematic for people with diabetes due to fasting during day time hours. The Quran states that certain people do not have to fast, like children and pregnant or breastfeeding women. This would also include people with poorly controlled diabetes, Type 1 diabetes on insulin or Type 2 diabetes on mixed insulin regimen or those with very high or very low blood sugar levels. It should be discussed with one’s doctor before they begin fasting to learn how their diabetes may be affected. Certain risks are involved including very low or very high blood sugar levels and dehydration. Hypoglycemia is most likely to occur in people on insulin or certain medications. They should limit physical activity while fasting and be active after sunset. Hyperglycemia is more likely to occur during the day after the fast is broken when people are more likely to overeat. Limiting concentrated sweets and being mindful of portion sizes is important. Dehydration may be a problem during long, hot summer days. Drinking sugar-free, caffeine-free beverages frequently is suggested. Tips to manage your diabetes during Ramadan include frequent monitoring of blood sugar levels and continuing to take medications as prescribed by your doctor. The dawn meal should consist of a mix of whole grain carbohydrates plus protein and fat to slow digestion and promote fullness. The dusk meal often starts with eating dates and drinking water. Limit dates to only 1-2, drink plenty of water, and keep portions in mind.
- Over the past 3 decades, the prevalence of T2 diabetes has increased dramatically in Arabic-speaking countries. This correlates with industrial development. With great economic growth, they have become more reliant on a Western-style fast-food diet, access to cheap migrant labor, and greater opportunities for sedentary lifestyles. The increase in T2DM accounts for nearly 280,000 deaths per year, with about half of all diabetes-related mortality occurring in people under the age of 60. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407623/
- Obesity is the major risk factor for developing T2DM. An estimate from NHANES reported that almost 80% of people with diabetes were overweight and about 45% were obese. As the Arab world has modernized, they have become exposed to a more Western lifestyle. There are more people with diabetes living in urban areas compared to those in rural. The prevalence is greatest in the Arabian Gulf area which has some of the richest countries in the Arab world. The level of education increases ones awareness of T2DM risk factors, complications, management and lifestyle choices. Close to 30% in Kuwait were illiterate while 15% were better educated. Also, marriage has the ability to affect the lifestyle of some couples as they become less active, eat together and reinforce each others increased intake. The increased availability of cars, use of mechanized home and farm appliances, access to cheap labor, computer usage, televisions, and gaming devices has encouraged sedentary lifestyles. Limited access to sporting/exercise facilities and cultural barriers deter women from engaging in physical activity. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407623/
- As the economy has improved and the Middle East has become more westernized, their food choices have changed drastically. These changes are associated with a high rise in the prevalence of chronic disease and obesity. In the Arabian Gulf, increased food intake is part of the socialization process and is linked to customary large gatherings where meals consist of rice and meat (high carb/fat) are shared. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407623/
- http://care.diabetesjournals.org/content/26/2/308.long#T1 Objective- to examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan. Research Design/Methods—Glucose tolerance tests classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria.
- http://www.idf.org/sites/default/files/attachments/article_253_en.pdf Fatalism- may cause the patient to not take responsibility for their disease state, may not work to prevent with diet and exercise changes. Can cause lack of motivation and initiative in taking care of the disease. --RD can use this to their benefit, because despite this mentality, the Koran also speaks to emphasize free will and responsibility…may be able to use that to their advantage, and also showing people success stories of people who have made lasting changes. Social acceptance—feelings of shame relating to an association of diabetes and impotence in men and infertility in women. Single men/women are at risk of having a tainted image/social status. ---Single men and women may avoid taking diabetes meds or changing eating habits so that they don’t’ draw attention to themselves so that others may not suspect that they have diabetes
- Desirable body type-patient’s may be unmotivated to lose weight due to the cultural values regarding body type. Weight loss is also seen as undesirable because it could mean that the person has an illness or diabetes– which has negative social consequences. Hospitality—hosts will offer unrestricted amounts of food and try to have the guests eat as much as possible by putting more on their plate, continuously passing food around – guests are expected to allow this and eat from all dishes. --Tips to avoid overconsumption: Eat slowly, “save” carbohydrates for the end of the day, wrapping snacks in napkin and putting them in pocket or purse is culturally acceptable (if snacks are offered it is customary to accept it) Take small sips of sweetened beverages offered Offering excuses unrelated to diabetes as why they may not be able to engage in social eating – toothache Incorporate snacks and foods that would be served into a person’s meal plan if this is a type of lifestyle that they engage in often.
- Cultural context– Arabic culture values conformity, uniformity, and homogeneity. Because independence is not practiced, patients may not have a good skill set in decision making if there are too many options (food, treatment) Seeing RD or CDE as authority figure could be detrimental to care. The patient may not be truthful, may not ask all questions, or they may make overreaching goals to please the practitioner.