Health
Counting carbs?
Avoiding white is a good rule of thumb in the complex world of these energy sources
There are three macro-nutrients or main types of food we consume ā protein, fat and carbohydrates. I have written about two of the macro-nutrients (protein and fat) and have reserved the most misunderstood and neglected for last ā carbohydrates. Anyone interested in healthful eating and living should know the facts and fiction about this crucial and oft-misunderstood nutrient.
Carbohydrates are our first source of energy and provide the fuel necessary to every function and important vitamins, minerals, fiber and a host of important phytonutrients or phytochemicals, essentially ānutrients from a plant.ā They are plant-based micronutrients that contain protective disease-preventing compounds.
But not all carbohydrates are created equal or processed in our bodies in the same manner. And itās important to know which carbohydrates we should eat to our heartsā content and which we should avoid.
Generally avoiding white products is a good rule of thumb. While white products are easily digestible, they often have very little nutritional value, spike insulin levels potentially leading to diabetes and can pack on the pounds. White products to stay away from are white flour, which is refined and processed, sugar and too much salt. Remember, white flour is processed with limited nutritional value, sugar affects your insulin and energy levels and promotes weight gain and more than 2,300 milligrams of salt can lead to high blood pressure, heart disease, kidney disease and stroke.
Whatās more is that white products are often simple carbohydrates, which are often loaded with fat and sugar and will lead to weight gain and zap your energy shortly after consumption. They also tend to have a higher glycemic index, which I will discuss later.
So which carbohydrates are best? As a guideline, fruits, vegetable, 100 percent whole grains, nuts, seeds, legumes and beans. And remember to consume a variety as certain carbohydrates have various effects on the body.
This means avoid those fad diets that eliminate or substantially decrease carbohydrate consumption for weight loss goals ā they simply donāt work. Any diet or eating strategy that stresses over-reduction or limitation of a macro-nutrient will rob your body of essential vitamins and nutrients.
As a general rule you want to get 50-60 percent of your calories from carbohydrates. The Dietary Guidelines for Americans, which is co-published every five years since 1980 by the U.S. Department of Health and Human Services, HHS and the U.S. Department of Agriculture, USDA is an excellent source for nutritional information.
Generally speaking you want to get about half your calories from carbohydrates. So for a 2,000-calorie diet, you would consume 250 grams of carbohydrates. This number is calculated by dividing the number of calories by the number of grams in carbohydrates, which is four.
What about the low-carb or no-carb diet? The bottom line is that diets donāt work and they sacrifice vital nutrients and fiber. Weight gain or loss is quite simply attained through your calorie consumption ā calories in and calories out. If you consume more than 3,500 calories per day without exhausting 3,500 calories, you will gain weight. And while again the types of carbohydrates you consume are important, you will still gain weight if you consume too much of any macro-nutrient.
Furthermore, when you severely decrease or attempt to eliminate carbohydrates from your nutrition plan, your body can go into what is called ketosis, a harmful and potentially life-threatening state that unnecessarily stresses the liver and causes destruction of muscle tissues. (Ketosis should not be confused with ketoacidosis, a dangerous and extreme condition associated with diabetes.)
Another consideration in carbohydrate consumption is the glycemic index, a measure of the effects of carbohydrates on blood sugar levels and how it relates to diabetes. Generally speaking, lower GI foods are better for maintaining a healthy weight and high GI foods can lead to weight gain.
The glycemic index, while often a strong consideration, can fall short for solid nutritional guidance because the glycemic index only charts foods consumed by themselves and does not take into consideration the whole meal. The glycemic index becomes inaccurate when foods are consumed with other foods. Again, here is where calories in versus calories out should be the primary consideration.Ā Also not all foods with a low glycemic index are better than those with a high glycemic index. The glycemic index scale is based on 100 as it relates to insulin processing and for instance, table sugar rates about 65 on the index, whereas carrots are 95.
Not all carbs are not created equal. Any macro-nutrient in excess will lead to weight gain.
Health
Young gay Latinos see rising share of new HIV cases, leading to call for targeted funding
Fernando Hermida diagnosed four months after asking for asylum
Four months after seeking asylum in the U.S., Fernando Hermida began coughing and feeling tired. He thought it was a cold. Then sores appeared in his groin and he would soak his bed with sweat. He took a test.
On New Yearās Day 2022, at age 31, Hermida learned he had HIV.
āI thought I was going to die,ā he said, recalling how a chill washed over him as he reviewed his results. He struggled to navigate a new, convoluted health care system. Through an HIV organization he found online, he received a list of medical providers to call in D.C., where he was at the time, but they didnāt return his calls for weeks. Hermida, who speaks only Spanish, didnāt know where to turn.
By the time of Hermidaās diagnosis, the U.S. Department of Health and Human Services was about three years into a federal initiative to end the nationās HIV epidemic by pumping hundreds of millions of dollars annually into certain states, counties, and U.S. territories with the highest infection rates. The goal was to reach the estimated 1.2 million people living with HIV, including some who donāt know they have the disease.
Overall, estimated new HIV infection rates declined 23 percent from 2012 to 2022. But a KFF Health News-Associated Press analysis found the rate has not fallen for Latinos as much as it has for other racial and ethnic groups.
While African Americans continue to have the highest HIV rates in the U.S. overall, Latinos made up the largest share of new HIV diagnoses and infections among gay and bisexual men in 2022, per the most recent data available, compared with other racial and ethnic groups. Latinos, who make up about 19 percent of the U.S. population, accounted for about 33 percent of new HIV infections, according to the Centers for Disease Control and Prevention.
The analysis found Latinos are experiencing a disproportionate number of new infections and diagnoses across the U.S., with diagnosis rates highest in the Southeast. Public health officials in Mecklenburg County, North Carolina, and Shelby County, Tennessee, where data shows diagnosis rates have gone up among Latinos, told KFF Health News and the AP that they either donāt have specific plans to address HIV in this population or that plans are still in the works. Even in well-resourced places like San Francisco, HIV diagnosis rates grew among Latinos in the last few years while falling among other racial and ethnic groups despite the countyās goals to reduce infections among Latinos.
āHIV disparities are not inevitable,ā Robyn Neblett Fanfair, director of the CDCās Division of HIV Prevention, said in a statement. She noted the systemic, cultural, and economic inequities ā such as racism, language differences, and medical mistrust.
And though the CDC provides some funds for minority groups, Latino health policy advocates want HHS to declare a public health emergency in hopes of directing more money to Latino communities, saying current efforts arenāt enough.
āOur invisibility is no longer tolerable,ā said Vincent Guilamo-Ramos, co-chair of the Presidential Advisory Council on HIV/AIDS
Lost without an interpreter
Hermida suspects he contracted the virus while he was in an open relationship with a male partner before he came to the U.S. In late January 2022, months after his symptoms started, he went to a clinic in New York City that a friend had helped him find to finally get treatment for HIV.
Too sick to care for himself alone, Hermida eventually moved to Charlotte to be closer to family and in hopes of receiving more consistent health care. He enrolled in an Amity Medical Group clinic that receives funding from the Ryan White HIV/AIDS Program, a federal safety-net plan that serves over half of those in the nation diagnosed with HIV, regardless of their citizenship status.
His HIV became undetectable after he was connected with case managers. But over time, communication with the clinic grew less frequent, he said, and he didnāt get regular interpretation help during visits with his English-speaking doctor. An Amity Medical Group representative confirmed Hermida was a client but didnāt answer questions about his experience at the clinic.
Hermida said he had a hard time filling out paperwork to stay enrolled in the Ryan White program, and when his eligibility expired in September 2023, he couldnāt get his medication.
He left the clinic and enrolled in a health plan through the Affordable Care Act marketplace. But Hermida didnāt realize the insurer required him to pay for a share of his HIV treatment.
In January, the Lyft driver received a $1,275 bill for his antiretroviral ā the equivalent of 120 rides, he said. He paid the bill with a coupon he found online. In April, he got a second bill he couldnāt afford.
For two weeks, he stopped taking the medication that keeps the virus undetectable and intransmissible.
āEstoy que colapso,ā he said. Iām falling apart. āTengo que vivir para pagar la medicaciĆ³n.ā I have to live to pay for my medication.
One way to prevent HIV is preexposure prophylaxis, or PrEP, which is regularly taken to reduce the risk of getting HIV through sex or intravenous drug use. It was approved by the federal government in 2012 but the uptake has not been even across racial and ethnic groups: CDC data show much lower rates of PrEP coverage among Latinos than among white Americans.
Epidemiologists say high PrEP use and consistent access to treatment are necessary to build community-level resistance.
Carlos Saldana, an infectious disease specialist and former medical adviser for Georgiaās health department, helped identify five clusters of rapid HIV transmission involving about 40 gay Latinos and men who have sex with men from February 2021 to June 2022. Many people in the cluster told researchers they had not taken PrEP and struggled to understand the health care system.
They experienced other barriers, too, Saldana said, including lack of transportation and fear of deportation if they sought treatment.
Latino health policy advocates want the federal government to redistribute funding for HIV prevention, including testing and access to PrEP. Of the nearly $30 billion in federal money that went toward things like HIV health care services, treatment, and prevention in 2022, only 4% went to prevention, according to a KFF analysis.
They suggest more money could help reach Latino communities through efforts like faith-based outreach at churches, testing at clubs on Latin nights, and training bilingual HIV testers.
Latino Rates Going Up
Congress has appropriated $2.3 billion over five years to the Ending the HIV Epidemic initiative, and jurisdictions that get the money are to invest 25 percent of it in community-based organizations. But the initiative lacks requirements to target any particular groups, including Latinos, leaving it up to the cities, counties, and states to come up with specific strategies.
In 34 of the 57 areas getting the money, cases are going the wrong way: Diagnosis rates among Latinos increased from 2019 to 2022 while declining for other racial and ethnic groups, the KFF Health News-AP analysis found.
Starting Aug. 1, state and local health departments will have to provide annual spending reports on funding in places that account for 30 percent or more of HIV diagnoses, the CDC said. Previously, it had been required for only a small number of states.
In some states and counties, initiative funding has not been enough to cover the needs of Latinos.
South Carolina, which saw rates nearly double for Latinos from 2012-2022, hasn’t expanded HIV mobile testing in rural areas, where the need is high among Latinos, said Tony Price, HIV program manager in the state health department. South Carolina can pay for only four community health workers focused on HIV outreach ā and not all of them are bilingual.
In Shelby County, Tennessee, home to Memphis, the Latino HIV diagnosis rate rose 86 percent from 2012 to 2022. The health department said it got $2 million in initiative funding in 2023 and while the county plan acknowledges that Latinos are a target group, department director Michelle Taylor said: āThere are no specific campaigns just among Latino people.ā
Up to now, Mecklenburg County, North Carolina, didnāt include specific targets to address HIV in the Latino population ā where rates of new diagnoses more than doubled in a decade but fell slightly among other racial and ethnic groups. The health department has used funding for bilingual marketing campaigns and awareness about PrEP.
Moving for medicine
When it was time to pack up and move to Hermidaās third city in two years, his fiancĆ©, who is taking PrEP, suggested seeking care in Orlando, Fla.
The couple, who were friends in high school in Venezuela, had some family and friends in Florida, and they had heard about Pineapple Healthcare, a nonprofit primary care clinic dedicated to supporting Latinos living with HIV.
The clinic is housed in a medical office south of downtown Orlando. Inside, the mostly Latino staff is dressed in pineapple-print turquoise shirts, and Spanish, not English, is most commonly heard in appointment rooms and hallways.
āAt the core of it, if the organization is not led by and for people of color, then we’re just an afterthought,ā said Andres Acosta Ardila, the community outreach director at Pineapple Healthcare, who was diagnosed with HIV in 2013.
āĀæTe mudaste reciente, ya por fin?ā asked nurse practitioner Eliza Otero. Did you finally move? She started treating Hermida while he still lived in Charlotte. āHace un mes que no nos vemos.ā Itās been a month since we last saw each other.
They still need to work on lowering his cholesterol and blood pressure, she told him. Though his viral load remains high, Otero said it should improve with regular, consistent care.
Pineapple Healthcare, which doesnāt receive initiative money, offers full-scope primary care to mostly Latino males. Hermida gets his HIV medication at no cost there because the clinic is part of a federal drug discount program.
The clinic is in many ways an oasis. The new diagnosis rate for Latinos in Orange County, Florida, which includes Orlando, rose by about a third from 2012 through 2022, while dropping by a third for others. Florida has the third-largest Latino population in the U.S., and had the seventh-highest rate of new HIV diagnoses among Latinos in the nation in 2022.
Hermida, whose asylum case is pending, never imagined getting medication would be so difficult, he said during the 500-mile drive from North Carolina to Florida. After hotel rooms, jobs lost, and family goodbyes, he is hopeful his search for consistent HIV treatment ā which has come to define his life the past two years ā can finally come to an end.
āSoy un nĆ³mada a la fuerza, pero bueno, como me comenta mi prometido y mis familiares, yo tengo que estar donde me den buenos servicios mĆ©dicos,ā he said. I’m forced to be a nomad, but like my family and my fiancĆ© say, I have to be where I can get good medical services.
Thatās the priority, he said. āEsa es la prioridad ahora.”
KFF Health News and The Associated Press analyzed data from the U.S. Centers for Disease Control and Prevention on the number of new HIV diagnoses and infections among Americans ages 13 and older at the local, state, and national levels. This story primarily uses incidence rate data ā estimates of new infections ā at the national level and diagnosis rate data at the state and county level.
Bose reported from Orlando, Fla.. Reese reported from Sacramento, Calif.Ā AP video journalist Laura Bargfeld contributed to this report.
The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is responsible for all content.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
A Project of KFF Health News and the Associated Press co-published by Univision Noticias
CREDITS:
Reporters: Vanessa G. SƔnchez, Devna Bose, Phillip Reese
Cinematography: Laura Bargfeld
Photography: Laura Bargfeld, Phelan M. Ebenhack
Video Editing: Federica Narancio, Kathy Young, Esther Poveda
Additional Video: Federica Narancio, Esther Poveda
Web Production: Eric Harkleroad, Lydia Zuraw
Special thanks to Lindsey Dawson
Editors: Judy Lin, Erica Hunzinger
Data Editor: Holly Hacker
Social Media: Patricia VĆ©lez, Federica Narancio, Esther Poveda, Carolina Astuya, Natalia Bravo, Juan Pablo Vargas, Kyle Viterbo, Sophia Eppolito, Hannah Norman, Chaseedaw Giles, Tarena Lofton
Translation: Paula Andalo
Copy Editing: Gabe Brison-Trezise
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF ā an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Commentary
Asian American and LGBTQ: A Heritage of Pride
May is Asian American, Native Hawaiian and Pacific Islander Heritage Month
Asian Americans and Pacific Islanders (APIs) are the nationās fastest growing racial minority group by 2040, one in 10 Americans will be of Asian ancestry. And, while many Americans think that anti-Asian hate and racism towards Asian Americans has disappeared, the community disagrees.
The Asian American Foundation which found that Asian Americans are continually subjected to hate, violence, and discrimination, baldly reveals that disparity.
- 33 percent of Americans think hate towards Asian Americans has increased in the past year, compared to 61 percent of Asian Americans themselves.
- In the past year, 32 percent of Asian Americans across the country reported being called a racial slur; 29 percent said they were verbally harassed or verbally abused.
- Southeast Asian Americans report even higher incidences of being subject to racial slurs (40 percent), verbal harassment or abuse (38 percent), and threats of physical assault (22 percent).
- Many Asian Americans live in aĀ state of fear and anxiety withĀ 41 percentĀ of Asian American/ Native Hawaiian/Pacific Islander (AANHPI) believing they will likely be the victims of a physical attack dueĀ to their race, ethnicity, or religion. These numbers are disturbing.Ā Ā
I serve as the only Asian American Pacific Islander member on the U.S. Commission on Civil Rights. And, I am the first and only queer AAPI on the U.S. commission. I am deeply honored to both serve my country and represent my Asian Americans and Pacific Islander community.
Last year, the commission investigatedĀ the Federal Response to Anti-Asian Racism in the United States. With congressional authorization, the report documented the experiences of AANHPIs in the U.S. since the dubbing of COVID-19 as the “China Virus” infecting people with the “Kung Flu” by government leadership. Words matter, as this report shows.
This report has a deep personal connection for me. I am the survivor of a hate crime of 25 years ago for being gay, and the victim of a hate crime for being Asian 25 months ago
The Stop AAPI Hate Coalition reported that bias incidents against individuals who are Asian and lesbian, gay, bisexual, transgender or queer (LGBTQ) were most prominent between 2019 and 2022, highlighting the intersectional nature of these incidents. For example, two transgender Asian women stated:
āI was with my new boyfriend at a restaurant. When we walked in the server started calling me names ā¦ a b—h, ch—k, tra—i.e. ā¦ He said I have a big fat p—s, and told me to go back to China. Then my boyfriend proceeded to walk in the restaurant and when I took a step forward, the server hit me, so I left.āĀ
āLeft a restaurant with friends in the Asian district of town. A man began to follow me calling out āHey you fāgot c—k!ā and āCome here you virus!ā I began to walk fast towards a crowd until he stopped following me.ā
To address these and other equally appalling experiences, I helped shepherd the bipartisan Commission on Civil Rights recommendations to the president, Congress, and the nation that:
- Prosecutors and law enforcement should vigorously investigate and prosecute hate crimes and harassment against Asian Americans, as well as Asian Americans who are LGBTQ.
- First responders should be trained to understand what exactly constitutes a hate crime in their jurisdiction, including the protections of LGBTQ people.
- Federal, state, and local law enforcement and victim services should identify deficiencies in their programs for individuals with limited English proficiency.
Greater language access will make an enormous impact for the Asian American community as one in five Asian individuals speak a language other than English at home. A third (34 percent) is limited English proficient. The most frequently spoken languages are Chinese, Korean, Vietnamese, Tagalog, Thai, Khmer, Bengali, Gujarati, Hindi, and Punjabi.
For me, this report comes full circle. Since 1988, Iāve lobbied for passage of LGBTQ-inclusive federal and state laws to prevent hate crimes. Since 2001, I’ve supported South Asian and Muslim victims of post 9/11 violence. In response to the shootings at the Pulse nightclub in Orlando, Fla, in 2016; Atlanta Spa in Georgia in 2021; and Club Q in Colorado Springs, Colo., in 2022, Iāve trained over 3,000 lawyers, law students, and community leaders on hate crimes law.Ā Ā
And yet, our work is not yet done.
May is Asian Pacific American Heritage Month. June is LGBTQ Pride Month. Despite these challenges, we are resilient. Let us join together in celebrating our Heritage of PrideĀ
Glenn D. Magpantay, Esq., is a long-time civil rights attorney, professor of law and Asian American Studies, and LGBTQ rights activist. Glenn is a founder and former Executive Director of the National Queer Asian Pacific Islander Alliance (NQAPIA). He is principal at Magpantay & Associates: A nonprofit consulting and legal services firm. In 2023, the U.S. Senate (majority) appointed Glenn to the U.S. Commission on Civil Rights to advise Congress and the White House on the enforcement of civil rights laws and development of national civil rights policy.
The Centers for DiseaseĀ Control and Prevention has issued a health advisory regarding a deadlier strain of theĀ Mpox virus outbreakĀ which is currently impacting the Democratic Republic of Congo.
According to the CDC, since January 2023, DRC has reportedĀ more than 19,000 suspect mpox cases and more than 900 deaths.Ā The CDC stated that the overall risk to the U.S. posed by theĀ clade I mpox outbreakĀ is low.
The risk to gay, bisexual, and other men who have sex with men who have more than one sexual partner and people who have sex with men, regardless of gender, is assessed as low to moderate the agency stated.
While no cases of that subtype have been identified outside sub-Saharan Africa so far, the World Health Organization said earlier this week that the escalating epidemic in Congo nevertheless poses a global threat, just as infections in Nigeria set off the 2022 outbreak according to a WHO spokesperson.
The spokesperson also noted that as Pride Month and events happen globally, there is more need for greater caution and people to take steps at prevention including being vaccinated.
The CDC advises that while there are no changes to the overall risk assessment, people in the U.S. who have already had mpox or are fully vaccinated should be protected against the type of mpox spreading in DRC. Casual contact, such as might occur during travel, is not likely to cause the disease to spread. The best protection against mpox is two doses of the JYNNEOSĀ vaccine.
The CDC also noted the risk might change as more information becomes available, or if cases appear outside DRC or other African countries where clade I exists naturally.
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