4400 Auburn Blvd., 2nd Floor, Sacramento, CA 95841
(916) 929-9761

Nutrition Planning

The California Rural Indian Health Board's Department of Family and Community Health Services provides nutrition services and activities for health professionals and paraprofessionals working in Indian controlled health programs.

Stacey Kennedy, MS, RD, is our Public Health Nutritionist. She has experience in nutrition education, wellness programs, diabetes programming, grants management, and has worked successfully on numerous projects at CRIHB. She has a positive working relationship with several California tribes. The CRIHB nutritionist is responsible for planning, implementing, coordinating and evaluating a community nutrition intervention program to reduce the risk chronic disease in California Indian Communities.

The services provided by CRIHB include: nutrition and diabetes programming, nutrition education services, technical assistance on nutrition and wellness related topics, assisting in the development of nutrition education materials (i.e., videotapes, posters, pamphlets, newsletter, and questionnaires). The nutritionist helps to develop, coordinate and conduct training conferences, participates in related nutrition and health education, assist local health programs in the planning, implementation and evaluation of nutrition programs in the areas of diabetes, heart disease, hypertension, cancer, nutrition through the lifecycle, obesity prevention and native foods. For an article about Native Foods, click here.

In the state of California there are over 310,000 American Indians, the largest number of Indians in any state. The AI population has been faced with appalling problems to overcome. The majority live in incessant poverty, sometimes in despair, with many addicted to alcohol and dependent on welfare. Approximately 50% of the population served by CRIHB fall below the Federal Department of Health & Human Services poverty guidelines and 30% of Indian households are on welfare.

The most common health problems encountered in the Native American population served in these areas are, diabetes or complication of diabetes, mental health related problems, obesity, heart related problems, hypertension, hypercholesterolemia, smoking and renal failure. Many AI tribes have experienced an epidemic of non-insulin dependent diabetes mellitus (NIDDM) in recent years. This increased prevalence appears to be related to sudden shifts towards sedentary life-style and increased caloric intake. These changes superimposed on a genetic predisposition to diabetes pose a serious risk factor to Native American children. American Indians have more than double the age-adjusted rate of diabetes (20.8%) than the U.S. general population (9.8%). For more information about Diabetes Programming, click here.

The majority of health problems that plague the AI population can be prevented improved or controlled by nutrition education and intervention.

For the past three years FCHS have been awarded grant funds to conduct nutrition education activities through the Cancer Prevention and Nutrition Section of the Department of Health Services. Nutrition education materials and activities have been completed at American Indian Health Clinics and Head Start sites throughout the State. One of the activities conducted under this grant is the Tribal Head Start Garden Project. This project gives Head Start Programs the opportunity for additional hands on early nutritional experiences that will help to lay the foundation for a lifelong habit of eating nutritious foods. The ultimate goal of this project is to increase the children's intake of fruits and vegetables and to improve dietary habits thereby decreasing the risk of obesity, diabetes and heart disease. For additional information on how to start a garden project in your community click here.

FCHS provides ongoing training, materials and technical assistance on a wide variety of topics. Contact Stacey Kennedy to inquire about nutrition training services or materials.

Diabetes and American Indians

Diabetes is more of a threat to American Indians than any other disease in history. In some tribal communities half of all adults have this serious disease. Many American Indian tribes have experienced an epidemic of non-insulin dependent diabetes mellitus (Type 2) in recent years. The overall prevalence of diabetes among American Indians and Alaska Natives combined is nine percent (approximately 176,000 cases). On average, they are 2.8 times as likely to have diagnosed diabetes as non-Hispanic whites. Available data may underestimate they true prevalence of diabetes in American Indians. Until recently, type 2 diabetes was rarely diagnosed in children and adolescents; however, it is now common among American Indian children ages 10 and older. This increased prevalence appears to be related to sudden shifts toward sedentary life-style and increased calorie intake. These changes, superimposed on a genetic predisposition to diabetes, pose a series risk factor to Native American children throughout California. Complications from diabetes are major causes of death and health problems in most Native American Populations. The serious complications of diabetes are increasing in frequency. Of major concern are increasing rates of kidney failure, amputations and blindness. The death rates for diabetes in American Indians is estimated to be 4.3 times the rate in non-Hispanic whites.

Your chances of getting diabetes are even greater if:

• You are overweight
• You have a family member with diabetes or
• You had diabetes during pregnancy (gestational diabetes)

CRIHB Diabetes Program Activities

The CRIHB physician, public health nurse and registered dietitian distribute, advise on and review five grant application packages to be submitted to IHS as one application for the IHS Special Diabetes for Indians funding. This provides the tribal organization with any necessary technical assistance to produce a quality diabetes program.

The CRIHB physician, the public health nurse and the registered dietitian also conduct on-site diabetes presentations, program wide diabetes conferences, and site visits for health program staff and community members. Training offers the latest information on medications, diet, exercise, foot care and more. Updated, culturally appropriate educational materials are developed or purchased and provided to CRIHB member programs.

The CRIHB Diabetes Team consists of the physician, the public health nurse registered dietitian, clinical nurse and RPMS trainer. The Team meets monthly to assist with AI clinic programming and training efforts. This year CRIHB will conduct a Regional Training for California American Indian Diabetes programs. This Statewide training will be held in Sacramento at the CRIHB office. For more information contact Stacey Kennedy at (916) 929-9761 or e-mail at stacey.kennedy@mail.ihs.gov

Smoking & Diabetes:


The negative effects of smoking are heightened among people with diabetes. The combined cardiovascular risks of smoking and diabetes are as high as 14 times those of either smoking or diabetes alone.

Despite the negative impact of smoking, the prevalence of smoking among people with diabetes remains equivalent to that in the general population. In fact some studies report smoking prevalence among adults with diabetes to be even higher than that in the general population. In addition, smoking cessation appears to be less frequent among people with diabetes than among members of the general population who quit smoking at a rate of 5% per year.

Enhancing a patient's capacity for optimal health is a major goal of diabetes care. Preventing tobacco use and providing smoking cessation counseling must be incorporated into routine diabetes management.

Smoking Cessation Counseling and Diabetes Care:

We know that smoking has a significant impact on the health of patients with diabetes. Ironically, patients' priorities about managing other aspects of the diabetes (exercise, diet, and medication) and their capacity to do so may make them reluctant to quit smoking.

Smoking cessation counseling by health care providers has been shown to have a significant impact on the reduction of smoking prevalence among patients with diabetes. Five steps can be implemented to ensure patients capacity for successful smoking cessation.

1. Ask all patients about smoking at every opportunity: Address tobacco use at every visit. If patients have never or do not currently smoke, health care providers should encourage continued abstinence, especially in adolescents.

2. Advise patients who quit to smoke. Stress smoking cessation as component to diabetes care. Health care providers should communication to patients an understanding of the difficulty of quitting, especially in the presence of chronic diseases. In addition providers should explain the harmful physical consequences associated with smoking and diabetes.

3. Assess smoker's readiness to quit. Health care visits are frequently limited by time constraints and the need to address multiple issues. Smoking cessation occurs in several distinct stages.

4. Aim smoking cessation interventions based on readiness to quit. Multiple strategies delivered consistently over time have proven to be very beneficial in promoting cessation.

5. Arrange follow-up visits for all patients who smoke. Smoking cessation interventions should be followed by positive reinforcement after quitting occurs. Many smokers in all populations cite the use of nicotine as an anxiety -reducing strategy or mood elevator. The higher prevalence of depression among smokers in general and those with diabetes in particular suggests the need for careful assessment of depression as a predisposing factor to smoking relapse. Counseling patients to find alternative strategies for dealing with periods of emotional stress (walking, meditation) has added benefit of promoting overall diabetes control.

Weight gain may also accompany cessation. Nicotine enhances the metabolic rate, tending to reduce weight. These effects, and fear that quitting may cause weight gain, may discourage smokers with diabetes from quitting. Such patients should be counseled that the risks of smoking far outweigh the risks of modest weight gain, even for those with diabetes. Heath care providers must emphasize that smoking cessation is a priority for optimal diabetes care and reassure patients that if post-cessation weight gain occurs, it may actually be a sign of a return to normal (non-nicotine altered) metabolic function.

Conclusion

Patients with diabetes are active members of the health-care team, responsible for self-management activities. Since they are frequent consumers of health care information, effective translation of this information is vital to optimizing health care status.

Routine diabetes management provides an excellent means of promoting smoking cessation or abstinence as a priority of care. A health-care environment that optimizes the effect of routine diabetes care by providing systematic counseling for smoking cessation will result in a reduction in cigarette use among this high-risk population.

What is Diabetes?

• Diabetes means having too much sugar in the blood.
• Your body changes the food you eat into blood sugar.
• Body cells and muscle use blood sugar (glucose) for energy -but only when it is in the cells.
• The body handles glucose very carefully, it maintains an internal supply for use in case of need.
• After a meal, the blood glucose rises, the pancreas notices and releases the hormone insulin. This singles the body's tissues to take up the surplus glucose.
• When the blood glucose concentration drops and cells need energy a pancreatic hormone floods the blood stream. Thousands of enzymes respond and they release a surge of glucose into the blood for use by all the other cells.
• Some people cannot get the blood sugar into their cells and muscles.
• The blood sugar builds up in the blood and they get high blood sugar.
• There may not be enough insulin or the insulin may not be working to unlock the receptors.
• Most of the glucose stays in your blood.
• This is called hyperglycemia also know as high blood sugar.
• Without glucose in your cells, the cells can't make the energy to keep the body running smoothly.

How you can control your blood sugar

• Insulin and other medications help to lower blood sugar by moving the blood sugar into the body's cells.
• Medications work best when you also:

Meal Planning Tips

• Space meals throughout the day
• Eat foods that are high in fiber
• Avoid simple sugars
• Eat some low-fat protein with each meal or snack
• Eat foods low in fat
• Cooked foods raise blood sugar higher than raw, unpeeled foods.
• Don't skip meals.
• Change habits slowly
• Read labels for fat and sugar content

Healthy Snacks

• Cereal & Skim Milk
• Cheese & Crackers
• Fresh Fruit & low Fat Cottage Cheese
• Graham Crackers and Skim Milk
• Sugar Free Ice Cream
• Peanut Butter & Rice Cakes
• Popcorn
• Pretzels
• Sugar Free Pudding
• Sandwich
• Frozen Yogurt

Why Exercise?

• Decrease your overall risk of cancer and heart disease
• Increases your life span by about seven years
• Increase your immune system function by increasing your white blood cell count
• Decreases depression and anxiety
• Increases mental efficiency and speed
• Increases your ability to be assertive and spontaneous in the world
• Increases your ability to relax deeply and promotes health sleep
• Increases your insulin sensitivity (the opposite of insulin resistance, therefore decreasing your risk of adult onset diabetes, obesity and Hypertension

Nutrition Council of California Indian Clinics

Goals: to promote quality nutrition care throughout California Native American Communities by supporting the continuing education and communication of the nutritionist who work in the Native American communities. This is accomplished by providing the nutritionist with orientation, education, insights and examples of effective nutritional programs for the Native American communities.

Background on the Council: The Nutrition Council was formed in 1987 to help facilitate the networking and some continuing education of nutritionists who work within 638 Contract facilities in California. The group plans and implements yearly meeting for nutritionists. To see the By-laws click here.

In the past the California Area Office of Indian Health Services has supported the programs. Due to the down sizing of the Area Office there is no longer a nutrition consultant/advocate. The Area Office has also withdrawn monetary support of this annual meeting as many of the clinics have pulled their tribal shares. The NCCIC now relies on the support of the American Indian clinics in California to send a nutrition representative to the yearly meeting. For information of the NCCIC Annual Meeting click here.

Prevention of diseases is key to decreasing health care cost and improving the quality of life in Native American communities. Nutrition is a primary means of preventative care for many chronic diseases prevalent in the Native American communities. Diseases such as diabetes, hypertension, hyperlipidemia and cardiovascular disease can be prevented and controlled with proper nutrition intervention. Nutrition is also fundamental in the lifecycle of the community, from prenatal to elder nutrition.

Communication of ideas and training of nutrition professionals to optimally present culturally specific and culturally sensitive education is essential to successful nutrition interventions within Native American communities. For a copy of the NCCIC membership roster click here.

Nutrition Council
of California
Indian Clinics
Annual Meeting

Join us at the Delta King in
Sacramento, California


June 15th, 16th and 17th
Contact Margaret Bregger at
mbregger@crihb.ihs.gov for more information

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