Sunday, November 05, 2017

Learning from Transnational Observations of Diabetes Management

Diabetes is just as common in Serbia as it is in Mexico and the United States (and I'm focusing here on Diabetes Type II).  Diabetes, worldwide, is not rare, but, instead, it is considered a common chronic disease.  In a Serbian article published online, Sanja Stamendovic wrote,  "The Institute of Public Health of Serbia released data according to which 12.4% of the adult population suffer from some form of diabetes, 95% of total diabetes cases are Type II Diabetes.  It is assumed that 36% of adults with diabetes aren't aware of their condition,"  (click here to read full article). These statistics are from 2015 which means that numbers are possibly higher.

In Novi Sad, Serbia, the grocery stores carry foods that are marketed specifically for individuals with diabetes.  Below is a photograph I took at the neighborhood grocery store.  This package of "diabetes cookies" or "biscuits" is one example. Although the label says "diabetes biscuits," that does not necessarily mean these will be the answer to a healthy nutritious diet, nor will it taste very good.  I was able to translate the nutrition label, and the carbohydrate count was still high for each biscuit.

The open markets in Novi Sad offer a rich abundance of nuts which are excellent for diabetes management.  Walnuts, almonds, pumpkin seeds are excellent sources of protein and fat (healthy omega 3 fats).

Below is the freshest kind of walnut-- right off the tree.  During a hike at Fruska Gora with Serbian friends, they pointed out all the walnut trees and handed me the walnut below.

It may have looked ugly, but see the lovely gift it held within.  After smashing the shell with my shoe, I was able to extract what turned out to be the most flavorful walnut meat.  

It's been helpful in Novi Sad to have purchased a food processor (see below).  And this is key to staying healthy-- figuring out one's own diet and having the essential tools to make cooking quick and easy.  However, without education about food, without the means to have equipment like this, glucose numbers go up, more people are diagnosed.  In the book, Making the Mexican Diabetic, by Michael Montoya, he focuses on the lack of food options, of places to exercise (and I don't mean gyms-- I'm talking about parks, open spaces to walk, ride one's bike, run), the lack of education on simple and complex sugars (what is a carbohydrate), which all contribute to more gente diagnosed with diabetes.

And in all countries I've either researched or are currently researching, (Mexico, U.S., now Serbia)-- I find that an overwhelming amount of food companies manipulate the term "diabetes" (as in the Serbian "diabetes biscuits" above) to sell their product instead of offering truly nutritious and carbohydrate "wise" items. And when they do-- when I find great products, they often don't last on the shelf.  

That said, most diabetes activists continually write about the importance of cooking one's own food-- taking back your diet. The best example I've given in the past is Luz Calvo and Catriona Esquibel's cookbook, Decolonize Your Diet.  Their introduction underlines my comments here.

A photograph here of almond butter I made here in Serbia with the help of a food processor.
The food processor is partially visible behind the almond butter!  
In Novi Sad, food is sold everywhere outside of the more normative supermarkets.  There's the open markets where farmers sell their products every day.  It isn't like in the states where farmer's markets are only on Saturdays or only happen during certain times of the year.  Here, it is year round.  The product is what changes depending upon the season.  Below are fall fruits: pomegranates, plums, etc.

Bakeries or Pekaras are everywhere in Novi Sad and Belgrade.  I have had a variety of their delicious pastries to taste to see how it would affect my glucose numbers.  Some, of course, caused me to have higher numbers than others.  It was nice trying the Serbian bakery items.  And I may continue to do so every once in a while.  But on a daily basis, I stay away from bread.  Bread most often contains high carbohydrates without much nutrition and a high glycemic load (click here for definition of "glycemic load").  They are pretty, however, like the Serbian one below that reminds me of a Mexican "cuerno."  This bakery item will contain anywhere from 30 - 40 carbohydrates. 

After a month of getting to know the open "farmer's" markets here, the regular shopping centers, the street vendor's fresh food offerings, I wonder how it is that Serbia is suffering from diabetes.  There are so many options for healthy eating.  Here are some examples (and then I'll explain my initial thoughts on diabetes -- both from what I've read and what I've observed).  

Lovely Basil!  Basil is so fragrant here.  
I'm not photographing the plethora of meat (smoked, dried, as well as fresh) that is offered here.  Serbians are major meat eaters.  This is an example.  These are fried pork rinds and are eaten like potato chips.  I was offered one and I took a very small taste.  Not my thing-- mainly because just barely crunching into one, my mouth received what felt like a tablespoon of grease.  And when it comes to meat or the grilling of vegetables, oil and grease seem to be the main ingredient.

Here I am at the open market with my favorite mushroom seller.  Whenever she sees me coming now, she smiles and begins pointing to shiitakes and other mushroom delights.  I've been making a lot of mushroom soup -- so very healthy and filling.  Mushrooms are exceedingly beneficial to those of us with diabetes because of its medicinal components.  

Also in my soups, I am adding cabbage these days-- another healthy vegetable and Serbia sells cabbage in droves!  I took this photograph just outside my apartment complex.  The truck has been coming almost every day and people are buying!

Here is another photograph of the truck right next to my apartment complex.  This woman (in the red jacket) is buying that large bag of cabbage.  The seller here has placed the bag on a scale.  

Butternut squash is also quite popular right now in the open markets.
You can buy it whole, sliced, or shredded (note the bags with shredded squash above).  
I was very happy to find that Serbia also offers chiles and also spicy foods.  Southern Serbia, as I learned,
has more spicy offerings due to the Turkish influence there.  But overall, if you want some spice, it's here!  

All nutritious offerings!

Eggplants are plentiful!
After seeing all these wonderful offerings, how could people have diabetes here?  Well, one answer is similar to the U.S. and Mexico: there is a lack of education on what causes diabetes, and once one is diagnosed, there is a lack of education on how to manage it.  Instead, just like in the U.S. and Mexico-- the medical profession is braided up with pharmaceutical companies, so instead of offering education, newly diagnosed individuals are immediately put on meds.  Time also is included in this issue because individuals will tell me, "Who has time to cook?" or "Just give me the pill and let me go on with my life" or "I'm choosing the pill because I like what I eat, I like what I drink."  Of course, everyone has a choice.  However, the majority of individuals diagnosed with diabetes are not given many possible choices except to do what they've been doing before diagnosis.  I find that unfair to the individual and just another way for the pharmaceutical companies and food companies to continue to profit.  Also-- the same kind of misinformation happens here where people think that buying and cooking one's own food is more expensive than just buying fast food.  If there were workshops offered to help disprove this along with the teaching of "time efficient" cooking strategies while also introducing new and delicious recipes, perhaps this would help.  

As for Serbia and diabetes: So far, I observe a very heavy meat and fat diet (meat plus everything cooked in oil), so many bread products (as I said, a bakery on every corner).  Another factor is smoking.  I did not know, until I arrived, that Serbia is ranked one of the highest in cigarette smoking.  On the positive side, Serbia is slowly becoming more aware and there are "no smoking" restaurants and markets are smoke free.  

The positive-- Serbians are very active:  they walk, ride their bikes, they run.  I love seeing all ages on bicycles-- not just individuals between 5 and 40.  The elderly are out there looking great with baskets on their bikes transporting their vegetables back home or elderly walking spritely down the street or with a partner or in groups.  It's great to see. 

In my initial conversations with Serbians about diabetes, there is a plethora of misinformation.  Some people have told me that diabetes is due to "dirty blood."  When I ask what that means, they cannot tell me. The idea of blood being "dirty" also leads to shame, which is why some people tell me it doesn't exist or they tell me Serbians don't like talking about diabetes or being thought of as having it. I think about what people in the Balkans have been through in the last 20-30 years-- the stress of war, of migration, of major economic stresses-- all contributing to a variety of diagnoses, one of which can be diabetes.  Just recently, a Serbian told me that when she lived abroad, she didn't talk too much about what she had experienced with the bombings here. She seemed to feel a sense of shame, she said.  

And this leads me to my own ignorance-- my inability to fully understand a people who have (still) so recently been through war (genocide!), and how trying to manage diabetes is simply an infinitesimal piece within this much larger context.  

In the novel, Ministry of Pain, the author Dubravka Ugresic writes, "I wept in my innermost being over the imaginary tangled web that bore the arbitrary label of Eastern, Central, East-Central, Southeastern Europe, the other Europe.  I couldn't keep them straight:  the millions of Russians who had disappeared into Stalin's camps, the millions who had perished in the Second World War, but also the ones who had occupied the Czechs and the Czechs who were occupied by the Russians and the Hungarians (they too occupied  by the Russians) and the Bulgarians who fed the Russians and the Poles and the Romanians and the former Yugoslavs, who basically occupied themselves.  I was beating my head against the wall of a generalized human loss.  Like a Balkan keener, I wailed my agony over one and all, only my agony was mute.  I grieved for the Zagreb, Sarajevo, Belgrade, Budapest, Sofia, Bucharest, and Skopje facades that were coming down.  I was touched by the endearingly bad taste of a chocolate wrapper of my youth (to say nothing of the literal bad taste of the chocolate), I bemoaned the swatch of a melody that happened to ring in my ear, a face that emerged at random from the darkness, a sound, a tone of voice, a line of verse, a slogan, smell, or scene.  There I sat, staring into the landscape of human loss and weeping my heart out" (233).  

A Serbian friend reminded me that in restaurants here, you are either offered carbonated water or, what they call "STILL" (non-carbonated) water.  She said to me-- "and that is how many of us remain here after the war:  'STILL.'"  

Gracias, dear La Bloga reader, for reading and considering my observations so far regarding diabetes within a transnational context.  Wishing you good health!  ¡Buen Salud!


msedano said...

How I am enjoying your views from your part of the world. That fresh produce makes my heart sing! And the thought of walnut tress growing wild in the forest brings pure delight to me out of memory of a huge productive nuez in an uncle's back yard, and gunny sacks of walnuts Tio Vicente would send every year. oh, yes. i would go walkabout every day into the forest and return with a belly and pocketful of walnuts. provecho!

diabetic cookies? they look as awful as gluten-free cookies.

looking forward to the next dispatch from Novi Sad.

Amelia ML Montes said...

Gracias, Em!

Daniel Cano said...

Amelia, does diabetes cause the same amount of illnesses to Serbians as it does to Americans, lost limbs, blindness, organ failure, and death? Thanks for covering this. Excellent info.

Amelia ML Montes said...

Saludos Daniel. Gracias for your comment. The answer is "yes" regarding complications from diabetes. No one ever dies "of" diabetes, but instead they die of what you are describing: gangrene leading to amputations, blindness, organ failure (usually kidney disease). Here is the latest WHO finding on diabetes in Serbia: