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OneRouge Community Check-In - Week 181

Every year the results come out and they seem to be getting no better. Louisiana is 5th in heart disease, 10th in cancer, 3rd in strokes, 2nd in kidney disease, and 7th in diabetes rates nationwide. The fiscal costs of fighting chronic disease are expected to reach $612M by 2030. But the costs of losing a loved one or a limb are arguably greater than any amount of money. Yet the disparities in health equity are largely borne by those vulnerable, marginalized, and systematically oppressed people who can least likely afford them. We know we can do better!

Learn more from our featured speakers as we talk chronic disease, access to care, and the impacts poverty has on both in honor of World Diabetes Day and the theme Access to Care:

  • Dr. Robert Dubin - Associate Professor Pennington Biomedical Research Center

  • Floyd Hodoh, MBA - Community Outreach Specialist, Physical Activity & Ethnic Minority Health, Pennington Biomedical Research Center

  • Dr. Robert Newton - Professor Physical Activity & Ethnic Minority Health, Pennington Biomedical Research Center

Enlight, Unite, & Ignite!



ORC 11/10/23

Dr. Dubin: Yeah. I've been, I was a musician before I was a physician, but now being a physician helps fuel my passions because being a guitar player tends to be rather expensive hobby. So yeah, it's nice. I've never lost the love of music and it follows me into whatever I do clinically, it's part of that.

Pepper: That's crazy, cool.

Casey: Yeah, it is. It's interesting. One of my doctors is actually a former Cajun Zydeco player. I don't know yet. And this I agree. I think there's something about when you come across a musician, physician there is definitely a humanist side to the interaction. Because as a musician, especially if you were, if you're, not like a megastar, but you're just like down here with the rest of us. It's a humbling, it's a humbling profession. On stage or behind the scenes and you work with all kinds of people across the board and you can connect with almost anybody around that love music, right? So it's I can see how that frequency would actually transition into your clinical life. Yeah.

Dr. Dubin: You said it. That's it. That's a great statement.

Casey: Yeah we don't want to, we don't want to also bring shine to the other coolest person in the room other speaker today, Floyd, who's, obviously he's incapable of actually talking to three people at one time which he is doing right now, but Floyd, I want to make sure and welcome you to the space, my friend, because we go pretty far back and I tell you what, you talk about you talk about a man of the people Floyd is out there, man, like it doesn't matter what role he's been in since I've known him he works his butt behind off for the good of the people and employed. I'm really glad that you're in this space today with us. I appreciate you being here.

Floyd: Thanks, Casey. Thanks for inviting me. I'm glad to be here. Oh matter of fact my supervisor here and I'm with a community outreach for the ethnic minority lab. It's like Tiffany at the minority lab under Dr. Robert Newton. He gets me motivated. He pushes me. I already got an email this morning to get going and it answers the questions. But it's all fun and good and learning. And in case, we've all been talking, getting together, doing things. I'm going to try to be at your meeting next week also about the Martin Luther King planning. I'm out in the community doing outreach, sharing with people what we do here at Pennington. Helping others with health fairs and everybody needs help. Vendors, exhibitors, and so I'm always out connecting people to make sure things work and everybody gets service and then working with our seniors. That's my big project, working with seniors African American seniors, and letting them know that we do have studies for African American seniors, exercise studies that help offset dementia and Alzheimer's. And Dr. Newton may share more about it, but that's my goal, that's what I'm here to do. Anybody that needs help, that's what I'm here to do. Thank you.

Casey: Awesome, Floyd. And yeah, 100%. And I'm glad to I'm glad that you lifted up and I want to make sure and invite the entire One Rouge community to our in-person meetings next week for the One Rouge Coalition, including next Wednesday, which will be an early preview to MLK Fest planning that Floyd just said at the Delmont Village Library at 11:30, but that will be followed by community lunch together provided by Tony’s.

As an event, we will get into the Capital Area Food Equity coalition agenda, which Floyd we hope that Pennington can also be a big player. And so you can do a two-for-one. We're doing two for one next Wednesday, as said, for your time, and Dr. Newton, thank you for also being here and I would be remiss before I turn it over to Pepper to say, boy, I'm just going to keep you on mute because I have that zoom power. I see that Ohio State sweatshirt. We're going to go ahead and say go tigers and keep you on mute. Go ahead. Pepper. What you got?

Pepper: Good morning. One Rouge. Listen, not that I'm an elitist, I'm just saying I didn't go to LSU, I didn't go. I don't, I'm not from whatever they call this Ohio place. What I can only say is I am glad that y'all are with me on this Friday, and thank you for spending time with me. I am also quite available for tailgating, so whatever it is. Whatever your Saturday faith believes whether it's Tigers or Browns or Buckeyes. I am in full support as long as there's a slider or some sort of pulled pork available. That aside. Thank you for being here. Today we are, ha, interestingly enough, talking about Chronic Disease. We've got Floyd, who's already given us a bit of a preview of the outreach that he does. But also want to hear from folks who are doing the research, who are in the space. And so we've got a couple of really important folks with DRs in front of their names. Dr. Dubin and Dr. Newton. They both have a first name, Robert. So that's how we're going to distinguish them by the DR as a first name and the Newton, excuse me, and the last name. Run a show as always, y'all. I'm gonna start with Doctor Dubin because he's a musician physician and I'm really just liking saying that. Doctor Dubin, if you wouldn't mind letting us know who you are, what you do, and what we should know. Your 5 minutes starts now.

Dr. Dubin: Thank you, Pepper. It's an honor and I didn't know it was gonna be this fun. I thought it was gonna be boring but That's Baton Rouge, man. Baton Rouge is a hip place. I am originally from Akron, Ohio and I have been a physician for about 30 years and my background is chronic disease. It's diabetes. It's obesity and that those are two big things that define a lot of what Pennington does for research. And not only are those passions and interests of mine, but community involvement. I became a physician to, help people. It was a vocation for me. What better way to help people than to give them better health, make them feel better, let them live longer so that they can do the things that they need to do? My goal here at Pennington is to help progress research that will help people in the community because if you haven't looked at the Louisiana report card for metabolic diseases such as heart disease, diabetes, and obesity, it needs a little work. That's the great thing about Pennington. Pennington is community-based and Pennington is very unique In the position we're in to focus on those chronic diseases. We don't deal with acute diseases like infections and things of that nature. We deal strictly with chronic diseases. So as Floyd had mentioned, the whole community outreach thing is what we're after. We're trying to capture and we don't want to be this Ivy League institution hanging out behind closed doors. We want to be out in the community. We want to be out helping people and we want to be giving the services to the people that need it the most. That's my thing is endocrine, diabetes, obesity, which is a chronic disease. Yeah, that's why I'm here.

Pepper: And we thank you for being here. We are going to have I've already got my questions lined up, but we'll let other people ask them too. Dr. Newton, we have not had a chance to hear from you yet this morning, so if you wouldn't mind letting us know who you are, what you do, and what we should know, your five minutes starts now.

Dr. Newton: Alright, make sure I don't ruin my five minutes. I'm Dr. Robert Newton Jr. I'm a clinical psychologist by training. I went to the University of Florida for my graduate school, so go Gators! It's probably not going to be good this weekend, but we'll see. Miracles do happen, right? I've been in Pennington for 22 years, and really the focus of my research is addressing health disparities in African American adults, and children basically across the lifespan. I think that all of this started for me when I had a realization of the rates of obesity among African-American women. When I was doing some research in undergrad and that knowledge and that desire to want to do something to address health within my community stayed with me through graduate school and evolved to not just obesity in African American women, but all chronic diseases. So we've done projects targeting obesity, targeting diabetes. Now we have two projects and cardiovascular disease, and now we have two projects that are. targeting dementia prevention in African Americans, because all of these are health disparities for our community. And a lot of the work that we do is community-based, so we work with community entities like BREC, like YMCA, churches, neighborhoods, and community centers, because we want to work with these organizations to put on programs. Because my lab isn't really at Pennington, my lab is out in the community, for all the things that we do and the community organizations that we partner with. And I really feel like we need to go where people are, we need to meet them where they're at. We don't need to force them to come to Pennington. They're not going to come to Pennington for forever if they were doing any sort of behavior change. If it's diet, if it's physical activity, you're going to be doing these things out in the community, where you live and around people that you know, feel comfortable with. We address all kinds of health disparities. And then another aspect of the lab so Floyd, as is our community. One of our community, our specialists. And so Floyd is really responsible for recruiting, but we also have an arm and Floyd contributes to this where we just want to get back to the community, provide education, help people to understand what it's like to go through a study but provide education on diabetes, dementia prevention, whatever the health topic is. We put on an event every year for seniors and we try to partner with other organizations with their putting on health fairs. We try to be there to provide education, help volunteer. So yeah, we're very networked within the community. We're going to continue to do those things and hoping that, as Robert said that, I do this because I want to help improve the health of, the people in Baton Rouge. I've been here for 22 years and it doesn't look like I'm leaving anytime soon. So we're going to continue to do our interventions in the community.

Pepper: That is fantastic. All right. We have a question in the chat. And that's going to I have every intention to go in and fast and hard on that one, but I want for somebody to give me a level set. World Diabetes Day is in a couple of days and it's really about access to care. Help me understand what is diabetes? What does it do? How does it work?

Dr. Dubin: Clinically, diabetes in a nutshell can be classified, and everyone typically knows that type one, type two. And yeah, that still holds true. So diabetes I would say Pennington tries to focus mainly on the type two population. Why? Because it's a large population. Why? Because it's not genetic in most cases. It could be, the type ones represent a very unique group. They're all on insulin. They start usually when they're young, so keep in mind that diabetes involves the problems with processing of glucose, sugar, which is one of the three main food groups. Wow, isn't it weird that we all eat a lot of sugar, right? And that's how it always has been. Carbohydrates fulfill usually the largest percentage of our diet. So yes, type ones don't make the insulin needed to get the sugar into the cells so that we could live. Type twos, a little different. They are insulin-resistant, right? They don't, they make insulin usually, but it doesn't work very well. And type twos are usually, but not at all times, they have weight problems. So type twos really fulfill this classic community-based problem we have in the United States with almost three-quarters of the population overweight or obese. And there's a huge correlation with obesity and type 2 diabetes. So yeah it's complicated, but it has to do with glucose and It's a big problem right now.

Pepper: So everybody deals with obesity and there's a question in the chat that is about adult obesity rate in Louisiana. 36 percent of adults are obese. First, fact check, is this still true? And then second, what does obesity even mean? What is obese?

Dr. Newton: So is it true that 37 percent I don't have the figures in front of me, but I think that's accurate in terms of obesity. So what is obesity? Obesity is a really it's risk factor. You have it's a combination of your height and your weight. There's a formula that we use to determine and really what it does is it shows you when you become at risk for developing certain conditions, certain chronic diseases. And so it's supposed to be really a measure of your adipose tissue. So I should say this, BMI, which is what most people use to calculate obesity, is this ratio of your height and your weight, and it shows your risk for developing chronic disease. Technically obesity is adipose tissue, and what we consider excess adipose tissue. Everybody has adipose or fat tissue within the body. But when it becomes, when you have such an amount that it puts you at risk for health problems, that's when you would be classified as obese. And there are different classifications, which, are class one, class two, and class three, and of course, as you increase class, you increase your risk of developing chronic disease. So it's essentially too much fat tissue in the body.

Pepper: Fascinating. Now, I am going to in the interest of full disclosure, I am sharing that I was diagnosed as diabetic last year. I guess it was not. I guess it was in August at the time. I was 150 and I wore a size eight. I was told by a physician that I was indeed obese. I was 30 percent overweight So help me as we start diving into these questions around what is the messaging that we are bringing to the community as well as what yeah, theoretically have an understanding of what it means for too much fat tissue to be in the body. But help me with questions about how this comes first, right? Is it obesity or is it malnutrition? Is it diabetes? And are there causal links between them or are these just ancillary links?

Dr. Dubin: Rob and I could split that. I'll start with your case. If you don't mind, full disclosure, you're unique because if you're 150 unless you're super short you're not obese. You could calculate your BMI and I bet it's not in the obese range. Secondly, as I mentioned before, diabetes is an extremely variable disease. I'm a little concerned that your doctor basically made those statements. Now, granted, he might be on the line now and I don't want to get into a fight with him or her. But, what I'm trying to say is that diabetes is extremely variable. If I'm sitting in the clinic and someone comes in who weighs 150 pounds and doesn't look large, I'm, I'm asking questions here. Family history. Let's check some labs. Let's see if your pancreas is getting tired because something's not right with your whole scenario here. I'll be happy to help talk to you off the record, but Rob could talk a little bit more about the second part of that question.

Dr. Newton: Yeah let me start with your, you have to be under four feet to technically be considered obese. Yeah, at that weight. So he might, he or she, the doctor may have confused overweight with obese, because remember there's a category where you're overweight but not technically obese. Nonetheless, you can take that up with Dr. Dubin. In terms of the relationship between the two, so again it's a risk. So as you become as anyone has a higher BMI, they are more at risk for. chronic disease, hypertension, diabetes cardiovascular disease, but it's not a guarantee. So these are just relationships. So there are many people who are very who would not be considered overweight or obese and have diabetes and there are or other chronic diseases, high cholesterol, etcetera and there are many people who are the healthy quote unquote obese where they do classify by as being obese, but yet they have no chronic disease at all. And these are relationships, they're not guarantees. And I think what's important to remember is that behind all of this, it, there's, people have individual behaviors that they're doing. Physical activity, diets, smoking, like all these things happen. You exist in an environment, right? We don't all exist in vacuums. So we have things that are going on around us. We're You know, our financial situation, our access to health care, the structural environment around us, the social environment around us, all of these things, policies, all of these things also play a role in development of chronic disease, management of chronic disease. So it's not individual behaviors and it's not a guarantee that if you are obese, you will become X, Y and Z. So there's, it's a multitude of situations that can affect one's ability. Or not ability, but what if, one is at risk or has a chronic disease?

Pepper: Thank you. I'm 5’6 and three-quarters. I live tall, but I have recently come to understand that does not make one tall. It was jarring. Nevertheless, there is a question in the chat with the expanded use of diabetic medication for weight loss. Do any of the speakers envision an access issue for low or no income populations being able to afford these drugs.

Dr. Dubin: Yeah, community area. Yeah, let me just say, and I don't know what Rob's experiences in this access to therapy, but I'm right there and I see it every day and it's ridiculous. And I would actually tell you that it doesn't affect It affects everybody. I have Medicare patients that, are pretty affluent that can't get these drugs because they're so expensive. And then there may be other patients who have whatever healthcare plan they have. And if they don't have any healthcare plan, it's pretty bleak because yeah, it's a lot of these are newer drugs and the pharmaceutical companies, rightly. They're trying to get their money back. So it's hard. I think it's going to deal with policy. As Rob said, I think policy is going to drive this if we really want to address this obesity pandemic epidemic in the state of Louisiana. And if these treatments are effective, then we need to do our best to try to get them in the hands of the right people. That's I think the big thing.

Dr. Newton: With any sort of medication that's being released onto the market, you do have that segment of the population that's going to have health care and the segment that does not or somewhere in between. And yes, for those people who have health care, they're going to have greater access to it. Or if you have a more stable financial situation and you can afford, those medications, then yes that's going to affect that population. And unless there's ways, policies that those who don't have health care can get those medications. And don't forget, it's not just getting the medication, it's taking the medication. So there's things that go into that. And so when you have policies that allow people to have the medications, there also has to be things in place where people understand how they're supposed to take it properly, check up with their doctor to make sure, if anything's going wrong, because people experience side effects, they stop taking it. And so there's a multitude of things that go into medication management and seeing the effects of a medication across socioeconomic strata.

Pepper: So speaking of socioeconomic strata, what is the messaging that we are bringing to folks who are in poverty, who have chronic disease, whether it is diabetes or cardiovascular disease, or is it obesity? What, how are we reaching them? How are we helping them to improve their health, excuse me, improve their health? And is it just telling them to be thin? Because there's a question in the check. Can we discuss the fixation on how become, how being thin becomes a barrier to true healthcare? What what are we telling community?

Dr. Newton: So that's I think that's a complicated. Question when you're asking, are we telling people to just be thin? I think that there is this thin ideal that exists within America and, but I think there's also a lot of pushback towards that. And so it honestly depends on what message people are paying attention to and at what age. So we know that certain ages, people are more impressionable than at other ages. And so you may evolve from having a thin ideal to not having a thin ideal as you get older. Or it could be vice versa. And I think in terms of lower income communities I think that there are researchers, I know that there are researchers who are trying to do investigations into low income communities in order to try to bring, knowledge to that community, resources to those communities to allow them to be able to improve health, just like in any other community. So these efforts have been going on for, decades, really. Now, are they, the same level, the same, number of those studies being done as in populations that are middle class or upper? Probably not, but it's not because researchers aren't trying. I think it's because This is who tends to get into studies, who has the capability of getting into some of the studies that we do, even when they're community based. I can tell you from experience that although we, in our studies, have community based interventions, we have a community information team that informs us. We are doing outreach into all aspects, all socioeconomic strata within Baton Rouge. We tend to get middle and upper class people into our studies as of late. And we're trying. But there are certainly some barriers to working effectively in lower income populations. But I assure you that researchers are strategizing different ways to reach that population effectively.

Dr. Dubin: Pepper, one of the things that we need to get our arms around, in this quandary, this debate, this problem, is food insecurity. Because when we're dealing with You use the word poverty, low income. Who out there doesn't get hungry, right? I do. I get hungry. And when I get hungry, man, I need food. So we're sending a mixed message out there to a lot of people, these new medications, what do they do? They knock out your appetite so you don't need essentially. I think it's a very profound problem we have because I think on one end of the spectrum, you got a food problem and yeah, you want to eat healthy. Yeah, you want to have good food resources. And then on the other end of the spectrum, you've got this thin thing going on, which to me, yeah, it's not part of the conversation. It muddles everything up. It makes everything ridiculous. That's not what we're dealing with. And that's really the problem with the medications now, right? These people want to take them to lose weight, to slip in their bikini, and we need to get these meds and that, like Dr. Newton said, medical management and people that really need them, it's not easy. This is a tough problem we're faced with.

Pepper: No, absolutely. And that's, and I think both of you for not only being candid, but for also being reasonable, right? Generally, especially those of us who don't walk around with medical degrees or have a PhD behind their name, it becomes a different conversation and you show up and say, all right, maybe, not me in particular, say I'm 150 pounds over what, I am supposed to be, but question in the chat. Has this BMI even started to adjust for data around indigenous, black, thin bodies, anything that would be other than the focus on male and caucasian data points?

Dr. Newton: They, so in short, yes, they have made adjustments of BMI categories for Asian Americans. And we know that the correlation is not as wrong with African Americans in terms of the BMI related to chronic disease. I don't want to get too focused on the conversation about BMI. Even if we look at Asian Americans, if we look at Hispanic Americans, and we look at indigenous people, we look at non Hispanic white Americans, as you're, as you get to be heavier, as you carry more adipose tissue, you are at greater risk. That, that's, that's the point. Across the board, you're at greater risk. Now, those That this is universal. And so you want to encourage people to reduce their weight, but nothing that's obsessive, we're not asking people to become, have an eating disorder here and have anorexia in order to try to improve their health. That's not what we're suggesting. We're a lot of things that we're doing is behavior change. And we know that, with behavior change, if you drop three to 7 percent of your weight, then you're healthier, you're at lower risk. dropping 3 percent of your weight is not going to point from a BMI of 38, which would be in the class two to a BMI of 30, which is class one. That's not what's gonna happen. But you're just shifting things a little bit to reduce your risk of developing chronic disease. On my end.

Pepper: Excellent. Thank you. Thank you. All right. So there is, I'm scrolling back up because I dropped down to the bottom. So I'm gonna have to swing back. Has Pennington done any work on access to lifesaving health hair in the carceral environment

Dr. Newton: In the what environment?

Pepper: Carceral incarcerated.

Dr. Newton: Oh, okay. Oh, okay. Sorry, not that I know of honestly, not my 22 years. I don't recall a study being done in people who are incarcerated.

Dr. Dubin: I'm not aware of any in Pennington that there was. Classical study done back in the 60s with overfeeding but is the question related to anything specific within that population that maybe we could address because that is a, that's, there was a article in the advocate from, I believe two days ago about the health care and one of the local prisons, right? Did you guys see that and how they were having a lot of problems? Yeah that's a whole.

Pepper: Yeah, it really is a whole thing. I remember there were that there were some drugs that were being administered to some incarcerated folks. Was it a study? Hep, there we go. It was Hep C. It was Hep C that was being distributed within the prison systems and the question came from Reverend Anderson who's got her hand up, so go ahead, Reverend Anderson.

Rev. Anderson: I was just gonna give a little bit more clarity on that, that we know that in our jails and prisons, we have a higher percentage of people that struggle with diabetes and other health issues. And as the state has continued other than the DLC system, and 50 percent of that is in local jails, has gone to either privatized what's called jail health care. And the article that you alluded to is a longstanding issue of both access to adequate health care and the allowance of non licensed physicians and other players in that arena. So my question had to do with it's a higher impacted population with less resources. And I just wondered if there'd been any work or even any, data analysis on the number of diabetics in that system, the number of individuals that are receiving medications any work in that area.

Dr. Dubin: Rev. Anderson. I know that there are experts in this area of health care, and I'm certainly not one of them, but I do have an interest in this based on some personal experiences that I've had. And yeah, this is huge. This is a whole different segment within the population that I think needs a lot of attention. And it has to start somewhere. I'm new to Louisiana. This might be a good project for me. To get involved with and, I don't know if Dr. Newton has any other comments on this, but Pennington this could be a good opportunity for Pennington to possibly get involved.

Dr. Newton: Yeah, I again, I don't know of any work that's been going on in Pennington, and I don't know of any plans, but certainly, we've started projects from scratch before, and, if we had a dedicated, investigator or two who wanted to go down this road. They certainly, Pennington is not going to say no. It certainly could be an avenue of further research.

Pepper: There's a question from a longtime listener for first time caller in the chat. Is there any Pennington conversation around not only having healthy and accessible food but also comprehensive diabetic training including potential emergency And this comes from a person with diabetes who has had experiences of low blood sugar that has, over the years, placed him at extreme risk.

Dr. Newton: So is the question asking does Pennington do training on how to handle those risk situations? Is that what the question is about? Okay. Thank you. Oh, that's a great question. I, it may be a part of some of the health fairs that go on because we have women's health day, women's wellness day, and we have men's health day, or I'm not sure if it's men's wellness day, but nonetheless, we have those days specifically for men and women. We have, the hospitals come in and they do talks. And so it might occur at some of those events that we have on campus. Is there a, I don't know of a specific program that Pennington has an education program that basically says this is what you do for an emergency situation, but we do have experts in diabetes and endocrinology who might know resources in the community that we could refer an individual to who was worried about or concerned about emergency events. So if that's a concern, just let me know exactly who you are. Send me a direct message, and I can get you in contact with those investigators at Pennington who might know community resources.

Dr. Dubin: I echo those comments from Dr. Newton. There are groups that are involved with emergency care for diabetics, such as the American Diabetes Association. There are groups within the state. that I can't give you specific resources, but I'm sure they do have some help for patients in these situations. Usually, if patients are having problems with low blood sugar and hypoglycemia, they're going to need to work through their healthcare team. That's usually, a very personal problem that if they're getting insulin and so on. And I echo what Doctor Newton states in terms of any questions. If Pepper could give people my contact, I'm happy to talk to them.

Pepper: Fantastic and perhaps a mini concert. Yay. Yes. There's a question in the chat that is on the heels of discussions where we're talking about. Y'all mentioned food access, right? And healthy eating. What does this even look like? If we are to rely upon what media tells us or the media visual markers of health it's disordered eating. How do we achieve true healthy eating? Versus and what's the proper language around food education in order to encourage folks to do better than what they are doing now.

Dr. Newton: I think that, this has been a mantra for a long time, but do all things in moderation, right? You want to make little changes. People are not used to making it and not typically going to adhere when they make drastic changes to their dietary intake. So if you just say to yourself I've done this a million times, right? Like I'm just not getting sugar. And then a week later, I'm like, eating on a Snickers bar, because you just can't make extreme changes like that. So I might say, I'm going to limit my sugar, like Saturdays, like that's much more manageable than trying to make extreme changes. So I think the message really should be about, making changes that you can make to live a healthier lifestyle. And it's really about a lifestyle, not a diet, not something you're doing for a period of time to lose some weight to, to fit into a dress or to, have a type of body for the summer for the, when you go to the beach, but it's a lifestyle. And the the guidelines that we have for dietary intake on my plates. I Think that is very reasonable in terms of making sure that people get the proper amount of vegetables and fruits and protein and limiting, the amount of sugars and fats that you get. And so it's really, I think, having a message that says you can make these small changes to improve your health, rather than a message that says you have to make all these drastic changes, or else there's going to be these negative outcomes. So that's what I would propose and what we try to do in our studies is nothing radical, nothing drastic, just making health, changes. And we realize that people have different kinds of diets, right? So there's, culture affects the way that people eat. It affects everything about eating. It's seen eating together or preparing a meal is seen differently by different cultures. We're not asking people to change your cultural beliefs, we're asking people if you have a meal that you're making, and it is typically fried, fry it less frequently, okay, use a different kind of ingredient to fry, those kinds of things, we're not saying, if you're eating, a certain kind of meal to just get rid of it that would be what I would suggest. That's what we try to get across.

Dr. Dubin: I agree 100 percent try to make simple changes. The other thing that I've found personally and I preach is getting out and moving. You don't have to join a gym, just get out. Is it, policy, is it safe to get out and walk around? Do you have access to places where you can walk around. So those are things I think our patients and our listeners have to get a little bit more empowered, I think is a good word. This is really a hard situation for patients because we live in a society that I sit at a chair 10 hours a day, man, it's ridiculous. and as I mentioned before, I get hungry and when I get hungry, hey, watch out. Forget it. If it's fried so you gotta empower yourself a little bit and plan, basic stuff. I like what Doctor Newton states. Keep it simple and stick with the whole relationship with food. If you've got a problem, ask yourself, What is my relationship with food? Because that's, I know it's deep. It sounds deep, but it is true. It's cultural, it's religious, right? Sunday, man I take in most of my calories on Sunday and I can tell you why, but you don't want to hear about it. Yeah, it's a good thing.

Pepper: I was on board until we started talking about maybe not fry as often. Whoever heard of not hard fried catfish? That, you know what? It's too much. It's too much.

Dr. Newton: That catfish one, once a month, once every two weeks, you have to do it every week.

Pepper: Okay, we'll see. Now, we're no longer friends. No, I'm only teasing. It's really about eating the rainbow. Is that the that's the message essentially. A diversity of different types of things things that are culturally appropriate, things that do really put you around the table. I would suggest, even though this is not something that you've said, maybe pure processed things, right? That might have less sodium and less sugar built into them.

Dr. Newton: Yeah, if you look at my plate, you'll see all those recommendations. The processed foods. Show off. Yeah, a lot of those things.

Dr. Dubin: The challenge to all of this, guys, is this isn't easy. If it was easy, we wouldn't have this problem and it can be expensive. That's the whole paradox to this socioeconomic thing we got going here, Whole Foods, Trader Joe's, this whole high end food thing, and I'm guilty of that. We as a community, I think we really have to find some different strategies here that work for people one on one, that are going to help them plant based eating. Yeah. That's not something people usually want to hear, but from a doctor's standpoint, that's what we're telling people try to eat more fruits and vegetables. Yeah. Maybe try not to eat as much and then take a walk basic stuff, but it's going to take time. And I highly recommend it's Dr. Newton mentioned. I'm going to do. And I listened to a report yesterday that said there are an approximate number of a hundred thousand Louisianans that are undiagnosed with diabetes. And I think this is diabetes awareness month, right? And it's if you're having these symptoms, right? urinating increase, thirst increase, vision changes, very basic clinical stuff. Pepper go see somebody get your blood sugar checked right and see if you're one of those 100 thousand people because that's I know we're getting ahead of the horse here, it's it's out there.

Dr. Newton: A lot of interesting questions and thoughts in the chat. I'm just able to look for all this.

Pepper: Yeah. I'm going through. I'm going through as many as I can because sometimes they come fast and curiously but Jasmine asking questions about added sugar in the grapes. They taste like cotton candy. That's just the way they come but that's the way which does make me think. So I want to circle back to a question that Jen's asking, but before then, way back when in the land that when the time that dinosaurs were on the earth and I was a child, the only grapes that you could get that weren't imported in Louisiana were muscadine grapes. And anybody who's ever had a muscadine knows that the skins are thick. and the flesh is super duper sweet. That was also the only kind of wine we made with Muscadine wine. Oh, and the seeds are as big as your head, but help me, because it feels as if, right? So there's a comment down towards bottom about how our food is less nutrient dense is. Are muscadine grapes bad for you? Are they high in sugar content or is it really just in relationship to the rest of the food? Were we eating poorly to start is the bottom line and now have we corrected that or were we eating well to start and we have undone eating properly? If this is, if we are really talking about We're really talking about diet and food access.

Dr. Newton: I will say that I'm not a dietician. I don't like in terms of the macronutrients and we're muscadine grapes that are worse for you than the current grapes. I could not tell you. That's a very specific question that we have people who can answer that question. And so people want that very specific question answer. For them. We can answer that. Certainly, we have experts who can. So shoot me a direct message with that particular question. But in general, there's been a confluence of issues that relate to why I guess you could say our health has changed over time. So remember earlier, 1700, 1600 things of that nature. You obviously had less processed foods, but you also had more activity. and probably better sleep. Okay. And so over time we have, with our industrialized western society, we now, as Dr. Gubin said, like we sit 10 hours a day. We're always on some sort of social media. There's emails that you get all the time. People are responsible for answering pressures for work or greater. So we sleep less. We're more stressed. We don't exercise as much. process foods that we're taking in as well as high calorie energy dense foods. And so when you have this combination over time, that's going to lead to health problems. Plain and simple, because our society has changed. We don't have, you want to step it up even further, we don't have policies within the United States where we're all forced to do exercise every day, right? So we don't have a two hour lunch break or one hour's exercise and one hour's food. We don't have early morning exercise. We do before work, like you're supposed to be at work before your boss gets there after they leave. You're supposed to work the entire time. If you get a 30 minute break, you're lucky. So things have changed vastly in our society, which has contributed to health problems and food systems have changed as well.

Dr. Dubin: Well said. Pepper, I would recommend against identifying one food as a culprit because it's not. One food. It's not a grape. It's not, gluten. There's all these theories out there. Oh, it's this. This is your problem. You're eating tomatoes. No. It's a lifestyle and I agree with Rob. We've gotta be, just looking for ways to improve what's happening. I think some of these questions coming in are like, where do we get these resources? Where do we get help? Because, yeah, you need to speak to a dietician. Dr. Newton and I, we're not that smart. We can't sit down and tell you the nutrient value of grapes. I know one of the questions came through regarding nutrition in schools. I know that the the county health departments and some of these other places were, are usually, they usually have people available now, how accessible are they and so forth? I'm not sure. Schools. I don't know. I know Rob can answer that because he has experience in this area.

Dr. Newton: Oh, forgive me. I was answering the chat.

Dr. Dubin: Oh, okay. Yes. School resources for students and stuff in terms of dietician support and so forth.

Dr. Newton: Schools don't really have dietician supports, within the school system. As far as I know and have experienced, so that's going to have to come from the outside. And, I can already hear people saying what about low income, populations or populations that, have less access to resources. Yes, they will be. To some extent, less, um, able to, they have fewer resources to reach out to, but there are still, certified diabetes educators and nutritionists who do, essentially volunteer, do work in the community. And so finding those dietitians in the community at health fairs or other events are things that under resourced communities can go and get the same information.

Pepper: Y'all are so cool. I also am not smart enough to know what's in a grape. We're gonna figure it out together. But I've got, I don't know, thirteen messages, thirteen questions in the chat. I'm not gonna be able to get to all of them. I did say that I wanted to ask the question that came up earlier. That is about the fat phobia and lifting it up not because Not because everybody is having this experience, but because those who do experience fat phobia really do have negative experiences and don't want to go to doctors. They don't want to actually be seen. How does the actual, the process, right? Because both of you mentioned it, how is it negative impact negatively, excuse me, impacting proper medical care? What's being done to address weight bias? do you know?

Dr. Dubin: I Could speak for that because I've seen it firsthand. And it's a very deep rooted, problematic issue based on the fact that doctors aren't trained in this area of obesity management or metabolic management, unless they take special training. So I would guarantee you nine times out of 10, if you have a problem, And if you go to your primary care doctor, they're probably going to blow you off unless you've got somebody who knows what's going on. They're probably going to tell you eat less and exercise more or maybe they're going to hand you a pamphlet and say, call this number. But unless you're seeing somebody who's really engaged, who would really sit down with you to start the conversation, then you end up getting. what pepper calls fat phobia. We called stigmata in medical care and it's rampant, right? You can't get a C. T. Scan if you weigh over 450. Yeah. How would you like to be told? We don't have a scale that accommodates your weight. We're going to have to send you to the veterinarian where they weigh the horses. Yeah, I've heard those comments from patients. You want to talk about stigmata chairs, right? So we're trying to address those things, Pepper. We're trying to make our offices more friendly for patients so they don't feel left out because it's easy to get left out. You can't sit down in the chair. The blood pressure cuff doesn't fit. We know we've got a problem identifying it and fixing it. We're not there yet.

Pepper: It sounds like y'all are on the right path. Pennington's Diabetic Clinic has a great program. I see. So we are at 927. There were some questions about gestational diabetes and how does this impact your long term care? And to be honest with you, I'm not really sure which of these questions is more important, but I do want to know as we talk about things like Diabetes, access to care food, and cultural relationships, what does this mean for our new neighbors? So maybe non negative English speakers, what are we, and how are we providing them care in community? What are we, do we just translate a couple pamphlets, do we have folks who can talk with them? Help me understand, what are we doing?

Dr. Newton: So with immigrants or non native speakers, there are different programs. Okay, so translating information into another language, yes, is one way that people are trying to address the problem. Similar where you have an under resourced population, finding those free resources. Can be helpful. There are different investigators around the world who are addressing, health disparities and for immigrant populations, we do not have an active program at Pennington addressing this. But, um, I think that's largely because the population until recently hasn't really been large enough. And you also have to have access to a community, right? You can't, we can't just go into a community and say, Hey, we want to do this for research. We have to have trust. We have to build trust. We have to work with the community. We have to have there's gatekeepers, individuals who are invested in the community that you need to get work with. So this process of getting into new environments takes time. And it's likely that we will be more involved in more diverse populations. Again, it's going to take time.

Dr. Dubin: My opinion on this is rather unusual based on the fact that some of these immigrant populations actually have, they have a good program, right? Some of these immigrants that are coming, let's just say, maybe from the Middle East, maybe from Asia. Some of them have some really good things happening with their diets that Maybe we don't want to mess with, right? Because if they start eating at McDonald's, then they're going to join the rest of us. So I think you have to look at the whole spectrum and really customize it for that patient. Because, as Rob had said earlier, Asians have a little. different kind of situation with their BMI and they have diabetes Vietnamese. I saw a post. We did a clinical study. I don't have enough time to go into it, but yeah, I think Pennington needs to get more into that because we are such a melting pot and it's important to have those resources available. So patients are comfortable. Working with us and communicating with us and maybe that's a good Closing thing pepper is you know Maybe penny could be a little bit of a bridge here to help with some of this stuff, right? because we specialize. This is our area and maybe if we're able to really push some of these initiatives forward with the help of Floyd and Dr. Newton and myself and everybody else that's here, we could really be a difference for the community and help those individuals that need it the most. Amen. Yes.

Pepper: This is fantastic. All right. So Thank you. Thank you. Dr. Newton for hitting these comment. These questions in the chat. That means that I don't have to I see you working diligently. It's fine.

Dr. Dubin: We need to get a jam session going. We need to get one road jam session going.

Pepper: I am all about it. I could possibly play the kazoo. Let's do it. I don't know what's happening. better recorder. But we've got some actual musicians around and so thank y'all so much. I appreciate you taking this time to hang out with us. Casey, you're off video. I don't know if you've got anything that you wanna share. Oh, yeah.

Casey: Yeah, I was gonna say I was like I know Doctor Tuck and blow his horn. We got a couple of percussion players, but I am just going to say thank you to our speakers. That was a, I feel today felt like we know some of these things on the surface, but we didn't know a lot of the things that the depth that we just got. And so I really appreciate it. And very mindful and thoughtful questions on the chat. And it was a great one Roots Friday morning. Appreciate y'all.

Pepper: You know how much I enjoy y'all spending a morning with me. Thank y'all so much. I appreciate you for taking the time. Yes, if there are any questions, happy to pass them on or I wanna say that Floyd's already dropped his email in the chat. If y'all wanna drop yours in the chat, that's fine as well. I don't need to be a middle man, woman, person in between. And with that said, what's going on this week in Baton Rouge?

Floyd: I will be in Saint Gabriel tomorrow. For their Thanksgiving special that they're having for the community. And most of you all that's the big thing going on this weekend. They're having a Thanksgiving special at the St. Gabriel Community Center. I'll forward that to everyone, the flyer. This, I think it's my first time going to that event. I think it's the first time they're having that event. And I know most of you all may know Deetra. She's the one spearheading that. That's the only thing I know of going on this weekend. That I have on my calendar.

Pepper: Gorgeous. Morgan?

Morgan: Hello all. We have the opening reception for the Nature's Liminality exhibit by one of our Artist Guild members, Emily Seba, tonight at our offices from 6- 9pm. We would love all of you to attend, but especially those who are within the healthcare space because she is phenomenally adept at her drawings skills and illustrations of anatomically correct, pieces. And I just would love for us to all share space together.

Pepper: Wonderful. Thank you. Reverend Anderson?

Rev. Anderson: Good morning. This was so wonderful. And Pepper, you are always just so wonderful. Just a couple of things. One is it is Veterans Day being recognized today, and actual date is tomorrow. And I put a note in the chat that while early voting is not happening today because of the recognition that it will, the last day will be tomorrow. And that is a great way to honor a veteran is by making sure that we vote. Second thing is that. On November the 17th at 10 a. m. at the 19th, J. D. C. Is going to be the recovery courts graduation. I am the community advocate and I make a big push to ask community partners to come out, be cheeks in the seats and Encourage people in a very real way. We ask people to participate in these programs and then they complete them. They can't get a job. They can't get received back into the community. So it really is important that people who have no connection actually show up at these events and understand the power of them. And then last but not least is our magnificent Capitol Museum. The bus boycott exhibit. Thank you. Is going to end this month and everybody should go down on 4th Street and visit it because it's an amazing museum and because we have those kind of assets.

Pepper: I gotta tell you, Reverend Anderson, I went to the Goodwood Library and see that you can check out actual paintings, portraits, like wall art. I am a fan now. A huge fan of the local library.

Rev. Anderson: So wait a minute, I didn't turn you into a fan many years ago? How is that possible? No! I knew they had books, but every library's got books. We have always had so much more than books.

Jasmine: Oh, sorry. I didn't know you said me. Pepper. It blanked out on my end. Sorry. So Kinetics has their benefit auction tonight. It is an annual fundraiser and it is a lot of fun. It starts at seven o'clock and I hope to see some of you there. And go.

Casey: I would like to add the Amen to Jasmine. Go to Kinetics tonight to support the Baton Rouge Gallery. Go to the Goodwood Library tonight for the Baton Rouge Green Gala. And then on Saturday for all the non-football fans. The Laurie Gala is at the FA Family, youth service Center tomorrow night from six to 10:00 PM. Go and support our one Rouge partner and Marcella and that entire incredible organization tomorrow night.

Pepper: Gorgeous. Thank you all so much. I appreciate you being here. You know how much I love you spend a part of your Friday mornings with me for those of you who are monitoring the chat. There are email addresses and contact information and answers to all the questions. So thank you for taking care of that and yeah. Go forth. We'll see y'all back here next Friday. Same bat time, same bat channel. Thank you.


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