by Dr. Janet Díaz Martínez PhD, RD, LDN
About the author
Janet Díaz Martínez is a mother of four kids, a registered and licensed dietitian in the State of Florida, and a proud alumna of FIU, where she earned a PhD in Nutrition and Dietetics.
She lived and worked in Mexico for over twelve years as a consulting nutritionist in private and public clinics, government agencies, and in her private practice. The time she spent with Mexican communities confirmed for her the importance of incorporating a patient’s culture and lifestyle into their nutritional plan. In 2010, Janet began to work with the diverse population of South Florida and continues to help her community through her website, Appetite for Happiness.
Janet has published papers in the International Journal of Urology and Nephrology, Journal of Renal Nutrition (JRN), and Current Developments in Nutrition (CDN), among others. She also earned awards from the American Society of Nutrition and the National Kidney Foundation.
Visit Janet's website to learn more about her work.
Flattening the glucose curve: In defense of Cuban carbohydrates for people living with diabetes
May 11, 2020
COVID-19 has made us more aware of how our environment and personal choices affect our health and wellbeing. We hear in the news over and over how pre-existing conditions can increase your risk of severe illness and death. If you are one of the 10% of Americans or 12.5% of Latinx community members in the United States who suffer from diabetes, this can make you feel scared. So, while we brave isolation and the uncertainty that lies ahead, let’s take this as an opportunity to learn some new – and old – ways of making our food habits healthier (and, of course, more Cuban)! We can build resilience while we take control of the risk factors we can modify, including our diet.
Let’s think back to that unforgettable and stressful minute when you first learned from your doctor that you have diabetes or that you are at risk of developing the disease. Most likely, the immediate advice you received was the “diabetes diet” prescription, which summarizes into:“stay away from carbohydrates.” In your mind, this translated to: forget about papa, yuca y boniato; no more pan cubano; and muy poquito arroz con frijoles. As my patients have eloquently put it: “so, what am I going to eat?!”
The advice of simply eliminating or cutting carbs is too simplistic to reflect the real effect of the food we eat on our bodies. The blood glucose (glycemic) response to different carbohydrates varies considerably by source and kind. In other words: not all carbs are created equal! From added sugars to starches to fiber, different carbs have different effects on your blood glucose levels, and the foods you eat them with can make a difference too.
Your body’s secretion of insulin in response to a serving of carbohydrates depends on how easily the foods containing those carbohydrates are digested and the carbohydrates absorbed and metabolized. To make an analogy leveraging our new-found expertise in epidemiology, rapidly absorbed carbohydrates lead to that ominous sharp peak we are all trying to avoid by staying home. Like with COVID cases, a sharp increase in blood glucose overwhelms the system and is dangerous for our health. We can work to “flatten the curve” by consuming carbohydrates, which are absorbed slowly, leading to lower but more sustained increases in blood glucose and lower insulin demands.
Have you heard about resistant starches? They are carbohydrates inaccessible to human digestive enzymes in the small intestine, and so they don’t raise blood glucose levels as sharply as easily digestible sugars. Instead, they are fermented by bacteria in the colon and used to produce many beneficial substances for your metabolism. Some of these resistant starches occur naturally, in green bananas, oats, nuts, and legumes. They may also be formed by cooling and reheating food. Have you ever had ensalada fría de papa con huevo, or ensalada fría de codito con pollo? What about that rice leftover that you reheated next day? Well, those are resistant starches. When you cook, cool, and reheat these starchy foods, you change some of their chemical composition such that your digestive enzymes cannot break them down as easily—thereby lessening their impact on your blood glucose and insulin secretion, and “flattening the curve.”
So, let’s try to re-think that “mala fama” that Cuban foods are not diabetes-friendly, by introducing some Cuban life-hacks into our food preparation:
- When eating rice, cook, cool, and reheat it, then mix it with your favorite vegetables (½ cup cooked rice to ½ cup of vegetables) and keep in mind the rainbow of colors. Maybe try it with some quimbombó (okra stew), which is very rich in fiber!
- Make sancocho or ajiaco with root vegetables – squash, yucca, yams, potatoes – cooked, cooled and re-heated.
- Try fufú de plátano (green plantains are naturally rich in resistant starches) with some fricasé de pollo or
- Cauliflower rice. This one may not sound Cuban, but picadillo used to be “stretched” in Cuba during el periodo especial by adding textured soy protein. Same concept applies here! Why not “stretch” our rice with some finely chopped cauliflower or cabbage?
I have focused this article on the benefits of resistant starches. Yet, you should also keep in mind that a well-balanced diet includes a varied source of carbohydrates, from fruits, vegetables, whole grains, legumes, and low-fat dairy.
We can all transform our feeling of fear into a sense of power and control by focusing on what we can change in our life. The silver lining of these trying times, as I see it, is that they give us all a necessary pause to think about the foods we buy, how we cook and eat them.
So, next time you hear that Cuban food is not appropriate for diabetics think about these ideas for preparing resistant starches—but don’t use them as an excuse to add more fideos to the soup!
Eating healthy - the Cuban way!
April 16, 2020
As we all institute routines of daily disinfection, try to get ahold of protective masks, and worry about toilet paper availability in our local supermarket, there’s one question on everybody’s mind: what can I do to protect myself and my loved ones from COVID-19?
The COVID-19 pandemic presents an opportunity to evaluate our routines and how they may be putting us at risk of disease. To me, an important component of this reflection is our diet. As a dietitian and nutritionist, my job is to translate the best available evidence in food and nutrition science into easy-to-understand recommendations on how to maintain a healthy and nourishing way of eating to live longer and happier.
So, while we hunker down with loved ones at home, why not revisit some of our tasty Cuban staple recipes?
Recently, I have been showered with questions from my patients, friends, and family, asking: what can I eat to fend off this virus? Could changing my diet make my immune system stronger? Does eating my usual foods—chicharrones, yuca, pan cubano con mantequilla, or pastelitos—put me at higher risk if I were to get infected?
There is no single food, diet, or supplement that can prevent you from catching COVID-19. Good hygiene remains the best means of avoiding infection. However, as dietitians we encourage maintaining a healthy, balanced diet in order to support immune function and control pre-existing risk factors.
Here I have summarized some simple advice:
Eat a whole food, nutrient-dense diet and cut out “empty” sugar and refined starches. More beans, whole grains, vegetables, fruits, nuts and seeds; less processed flour-based foods.
While we all have our favorite stuck-at-home, hurricane-season snacks, these often fall far from the category of “healthy.” This is of special concern during this crisis because our supply of nutrients and dietary factors is crucial for the immune system to function properly. One extreme but very well-studied case is that of patients suffering from multiple nutritional deficiencies (malnourished patients); these patients are at higher risk of infection and recover worse from diseases than patients without deficiencies. Vitamins, minerals and dietary factors like vitamin A, C, D, E, B12, folate, copper, iron, zinc, selenium and probiotics are known to play important roles in immunity. If you eat a healthy diet rich in beans, whole grains, starchy and non-starchy vegetables, fruits, nuts, and seeds you can definitely meet the recommended intakes of all those micronutrients.
Try to replace grains with root vegetables, especially refined grains such as white bread. Root vegetables are a good carbohydrate alternative to fulfill your energy needs, and they also provide important antioxidants and minerals like potassium, magnesium, vitamin C, and vitamin A.
Not all comfort food needs to be unhealthy! Why not make some yuca con mojo, puré de malanga, or mashed green plantains during this quarantine?
Ensure adequate, healthy protein intake.
Whatever your preference, whether animal or plant-based, you should eat approximately 0.8-1 gram of protein/kg/day. If animal protein is your choice, eat clean and unprocessed meats.
We Cubans love our traditional meat dishes, from ropa vieja to the famous lechón asado. However, these foods come with hidden risks: they tend to be high in fat and eaten in large quantities. After all, it is hard to compare portions of chicharrones de puerco to the recommended fist-sized steak. COVID-19 seems to pose a special danger to those suffering from cardiovascular conditions, hypertension, and diabetes. So, it is especially important to re-evaluate our meat choices at home, regardless of our medical history. Why not opt for some equally traditional but healthier dishes?
You can mix animal protein with vegetables and prepare versatile chicken, fish, or meat stews like fricasé, picadillo con verduras, or fufú con carne. Or perhaps you are lucky enough to remember abuelas and abuelos who used to make remedios of caldo (broth) when we were sick. You can use grass-fed animal bones (chicken or beef) with vegetables for an incredibly delicious, nutrient-rich broth. Do not forget to eat both the recommended quality of protein and the recommended portion. As a rule of thumb, add two cups of chopped vegetables for every 4 ounces of meat/chicken/fish.
You can also make plant-based protein dishes using legumes, nuts, and seeds which contain a healthier mixture of fat and protein. We Cubans have mastered the art of cooking and eating any type of beans. If you are my age (47 years old) you grew up eating arroz, chícharo y huevo, potajes con viandas, and sopa de lentejas con plátano. These popular dishes are rich in protein and fiber, and better for your cardiovascular health than most meats.
Aim for a rainbow of color in your plate—eat multiple servings of colorful fruits and vegetables.
Let’s admit it, the Cuban diet is not known for plentiful portions of diverse vegetables. If fact, if you see a colorful dish with green, yellow, and red, it probably just has 3 types of bell peppers or lettuce, tomato and avocado. Fruits and vegetables are a great source of vitamins, minerals, and phytonutrients with numerous health-protective properties and should not be an overlooked component of our diets. We can find a diversity of colors not only in bell peppers, but also in sweet potatoes, celery, carrots, beets, and leafy greens. You should try to eat at least one cup of cruciferous vegetables like broccoli, brussels sprouts, and
cauliflower per day. Prepare yours with sabor criollo and incorporate them into your favorite stew, imbuing them with the familiar flavors of a sofrito using garlic, cumin, onion, green peppers, oregano, and bay leaves. Remember to wash fresh produce before use with hot water and soap, but never with commercial cleaning products like bleach or disinfectants.
Drink plenty of fluids, including herbal teas like té de manzanilla and get sufficient sleep and regular exercise!
Remember, we Cubans are resilient by nature; we have weathered worse times, we know how to be creative, and we have mastered survival in times of scarcity. We were born optimists—and most importantly, we know how to cook!