Mexicans and Central Americans

Which countries make up Central America? Roughly, what are the demographics of immigrants in the United States from the Central America?

Central America makes up an isthmus connecting North America to South America and is made up of seven nations: Belize, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama. About 5% of U.S. Latinos are from these seven nations. The majority of recent immigrants have settled in California, Texas, and Florida. The largest segments of this population are 1.7 million Salvadorans, 1.1 million Guatemalans, 490,000 Hondurans, 366,000 Nicaraguans, and combined, fewer than 350,000 from the other Central American nations. While it is possible that there may be an additional equal number of unauthorized migrants from these countries living in the United States, almost one in every four Central Americans is born in the U.S. Central American immigrants, even those from the first wave, are slow to naturalize, and only 20% of Central Americans in the United States have obtained citizenship.Many immigrants live in neighborhoods where other Central Americans reside, especially in Los Angeles and Miami; however, smaller numbers have settled in Houston, Chicago, Washington, DC, and New York City. While the majority of immigrants before the 1980s were white professionals, more recent refugees are primarily mixed Spanish and Indian heritage or Indian peasants. There are even differences in associations among recent immigrants. For example, Hispanic Guatemalans may assimilate into the broader Latino community, while Mayan Guatemalans, some of whom do not speak Spanish, often establish ethnic enclaves. Substantial numbers of black Central Americans have also immigrated from Belize and Panama.The first wave of Central American immigrants appears to have been a middle-class population with income and education levels well above many other Latino groups. American-born children of these first immigrants graduated from high school in numbers greater than whites. A large number of recent immigrants are employed as migrant farm workers, gardeners, domestic cleaners, dishwashers, and foodservice workers, and in other low-skilled jobs. According to U.S. census data on foreign-born Central Americans, most Salvadorans find work in the construction, manufacturing, and hospitality industries. Only 34% have graduated from high school, and 41% have less than a 9th grade education. Twenty percent of families fall below the poverty line. Guatemalan immigrants share a very similar socioeconomic profile. Honduran immigrants have attained slightly higher levels of education; however, greater numbers of families live in poverty. Foreign-born Nicaraguans also have slightly higher levels of education and more work in retail, education, health, and social service fields. They also have lower levels of poverty. Immigrants from Belize and Costa Rica have similar educational attainment with about 70% graduating from high school, and both groups often work in the education, health, and social service sectors. The poverty rate is 16% for Belize families and 14% for Costa Rican families. Foreign-born Panamanians as a group have been in the United States for a longer period of time and their socioeconomic status is significantly improved over that of other Central Americans: 82% completed high school, 22% have college degrees, two-thirds work in management, professional, or sales and office jobs, and poverty levels are below the U.S. average.

List two regional U.S. foods that are modifications of Mexican recipes. First, describe the possible original dish, and then explain how it is modified.

In Texas, while chili con carne (developed just after the Mexican-American War in the 1850s) has managed to retain slightly more of its Mexican heritage, it is likely to have begun as a chile colorado (red chile stew), and has been tamed by reducing the spicing and diluting the traditional meat dish with beans. Also, barbecued chile-spiced meat kebobs called anacuchos and capriotada with whiskey sauce known as "drunken pudding" are other examples of Tex-Mex creativity. Pan-fried boiled beans, known as frijoles refritos, are incorrectly called refried beans in English and have been modified to many different forms in the U.S. (fat-free, vegetarian, black bean, etc.).

Describe the hot-cold system of diet and health practiced traditionally by Mexicans

The Mexican hot-cold system of diet and health is believed to have been derived from the Arab system of humoral medicine brought to Mexico by the Spanish and combined with the native Indian worldview. The Mexican system, applied only to foods and to the prevention and treatment of illness, does not encompass moral or social beliefs. It is based on the concept that the world's resources are limited and must remain in balance and that people must stay in harmony with the environment. Hot has the connotation of strength, while cold has the connotation of weakness. When this theory is applied to foods, items can be classified according to proximity to the sun, method of preparation, or how the food is thought to affect the body. Meals balanced between hot and cold foods are considered to be health promoting while unbalanced meals may cause illness. Thus a typical comida in a rural village would consist of both hot and cold elements: rice (hot), soup (made with hot and cold ingredients), and beans (cold). Although the hot-cold classification of foods varies, items generally considered hot are alcohol, aromatic beverages, beef, chilies, corn husks, oils, onions, pork, radishes, and tamales; cold foods include citrus fruits, dairy products, most fresh vegetables, goat, and tropical fruits. Some foods can be classified as either hot or cold (beans, corn products, rice products, sugary foods, and wheat products), depending on how they are prepared. Illnesses are also believed to be hot or cold, and are usually treated with a diet rich in foods of the opposite classification. Examples of hot conditions are: pregnancy, hypertension, diabetes, indigestion, susto, bilis, and mal de ojo; and cold conditions are pneumonia, colic, and empacho. Some also believe that very cold foods, including cucumbers, tomatoes, and watermelon, can create a sudden imbalance. Sour foods are thought by some to thin the blood and are avoided by menstruating women because they are thought to increase blood flow; acidic foods may also be avoided because they are said to cause menstrual cramps (menstruation is considered a hot condition by some people, and a cold condition by others).

Compare and contrast the staple foods of Mexico's different regions

The cuisine of Mexico is very diverse. While many inaccessible regions have retained their native diets, others have held on to traditional foods and food habits in spite of Aztec or Spanish domination. The diets of other areas differ due to the availability of local fruits, vegetables, or meats. It is difficult to characterize Mexican foods in general because the majority of poor Mexicans have little variety in their diet and some subsist almost entirely on corn, beans, and squash. However, some foods can be found, in varying forms, throughout Mexico. The Aztecs' staple grain was corn. In addition, legumes, fruits, and vegetables were plentiful; turkeys and dogs were domesticated for meat; and some game, such as deer, peccary, and rabbits, was available. The average Indian ate a mostly vegetarian diet of corn and beans and a consistent source of fat or oil was the notable deficiency of the Aztec diet. The Indians who originally inhabited the Mexican Planes (northern and central regions of Mexico, which make up almost half the nation) were believed to eat a diet that consisted of corn, beans, squash, greens, cactus fruit (tuna), and young cactus leaves (nopales). They also hunted small game and ate domesticated poultry, such as turkey. They adopted piñons (pine nuts or pignolis), pumpkin, and plums when the Mexican Indians mixed with the Indians of the American Southwest and produced some specialties of the region, such as hominy-based stews known as pozoles, and salads made with sliced, cooked nopales. Traditional preparations emphasize natural flavors of the ingredients, and when sauces are used, they feature simple seasoning as a result of the limited variety of foods available. The Spanish introduced longhorn cattle, dairy cows, and wheat to the northern plains, making it the only area in Mexico where beef is frequently consumed, often served as steaks, or in stews. Another preferred way to prepare beef is to air-dry it in thin slices (cecinas), which can be used in stews or soups, fried, or used as fillings for other foods. In Chihuahua, beef is shredded and then fried to make a snack known as móchomos. In the Monterrey area, spit-roasted goat and sheep, cabrito al pastor, is served. In Guadalajara, kid or lamb stewed in a sauce flavored with roasted chiles and vinegar, birria, is a specialty, and barbacoa is a method of pit-roasting meats that are first wrapped in maguey leaves. Cow cheeks (or the whole head) and kid are commonly prepared this way in the more northern sections, while lamb is preferred in the more central regions. Fish is an important part of the diet in the Baja Peninsula and along the Gulf of California and Gulf of Mexico coasts. Red snapper is a specialty, cooked in orange sauce, as a filling in tacos, or served chilled, marinated in vinegar with onions and chilies. On the eastern coast, shark is shredded and layered between tortillas and beans in the dish from Campeche, known as pan de cazón. Shrimp and clams are other favorites. In the more inland areas, fish from freshwater lakes, such as pescado blanco, a small whitefish, is popularly served fried or added to soups. Cheese is more common in the north than in other parts of Mexico. One specialty is queso flameado, a fondue-like dish sometimes topped with chorizo crumbles and served with fresh tortillas and salsa. Wheat products are more popular in the north as well, particularly wheat tortillas. Buñuelos, circles of sweet pastry dough fried until they slightly puff and then sprinkled with sugar and cinnamon, or broken up and added to a hot cinnamon-laced syrup, are a very popular dessert of northern Mexico. Café con leche is a common accompaniment. In the arid countryside, the sap of the maguey cactus (century plant) is credited with being a reliable substitute for fresh water and is called aguamiel or "honey water." The best-known beverage of the region is tequila, produced in the central-western state of Jalisco around the towns of Tequila and Tepatitlan from the maguey subspecies Agave tequiliana. In tropical Mexico, the southern coastal areas of eastern Mexico including hot lowlands and tropical forests, seafood and freshwater fish are prominent in the cuisine. Red snapper with a Spanish-influenced sauce of tomatoes, garlic, onions, olives, capers, and chiles is a specialty. Another favorite is arroz a la Tumbada, rice cooked and seasoned with tomatoes and garlic, topped with fresh fish, shrimp, octopus, crabs, and clams, and often served in individual clay pots. Tamales and tostadas stuffed with shrimp are also popular, and some areas eat black iguana. A variety of produce is also available in this area, such as tomatoes, green tomato-like tomatillos, chayote squash, onions, jícama (a sweet, crispy root), bananas and starchy plantains, carambola (star fruit), cherimoya (custard apple), guanábana (soursop), guava, mamey (a type of plum), mango, pineapple, yuca (a tuber also called cassava or manioc), zapote (the fruit of the sapodilla tree), and avocados. Avocado flesh is added to soups, stews, and salads, but they are most popular in guacamole, mashed avocado with onions, tomatoes, chile peppers or ground chiles, and cilantro, used as a side dish, a topping, or a filling for tortillas. More than 90 varieties of chile peppers, varying enormously in degree of hotness, are also found in the region.The Yucatán peninsula was isolated from the rest of the country by dense, mountainous jungles until modern times, and some regional favorites date from this time. One popular preparation method is to steam foods wrapped in banana leaves, called píbil. Salbutes, small corn tortillas (some made with black bean paste so that they are black in color), can be fried until they puff up, then layered with lettuce or cabbage, tomato, onion, bell pepper, and píbil-cooked meats. In some versions, the black beans are stuffed inside the pocket of the puffed tortilla, a treat known as panucho. Citrus fruits flavor some dishes of this region. In chicken píbil, the poultry is marinated in sour orange juice, garlic, and cumin before steaming. A popular sliced pork dish, poc chuc, also uses sour orange juice to tenderize the meat before grilling. Bitter lime juice is featured in a specialty of the area called sopa de lima, a chicken and vegetable soup made with bits of fried tortillas. Lime juice is also found in frijoles con puerco, a traditional pork and black beans dish. Citrus juice is also used to pickle some foods, including vegetables such as onions, and other items, such as fish and oysters. Achiote is the other hallmark seasoning of the region, a bright-red, nutty-flavored seed that is mixed with sour orange juice and mild spices to make a flavorful paste called recado colorado, used to coat foods before cooking. The long coastline of the Yucatán along the Gulf of Mexico is an abundant source of seafood; shrimp are also a local specialty as is grouper with recado baked in banana leaves. Fish soups are also common. Eggs are prominent, served with tortillas, black beans, cheese, tomato sauce, and fried plantains, or wrapped in tortillas and served with a pumpkin seed sauce. Sauces of the region are often thickened with toasted squash seeds.Foods of southern Mexico are similar to the foods of the Yucatán in that they are more tropical and more Indian-influenced than the foods of other regions. Cacao trees are cultivated in this area, and accordingly, chocolate flavors both savory and sweet dishes. Renowned sauces of the region, moles, sometimes include unsweetened chocolate and other typical ingredients include chiles, tomatoes, nuts, raisins, sesame seeds, avocado leaves, and seasonings. Complex, spicy sauces provide the base for thick stews with added pork, beef, poultry, or game. In Oaxaca, mole manchamanteles is a deep-red sauce with yams, pineapple, plantains, and chicken or pork and mole negro includes dark roasted chiles, blackened tortillas, and chicken. The best-known mole in Puebla is Poblano de guajolote, a rich brown sauce served with turkey. Other variations include mole amarillo (an orange-colored sauce), mole coloradito (a brick-red version), and mole verde (made with green chiles and tomatillos), which is popular along the coast, while hoja santa provides a peppery, anise flavor to the sauce. The most popular meats of southern Mexico are poultry, goat, and pork. Pork cut into thin strips can be coated with ground chiles to make cecina enchilada or served as a topping on crunchy, platter-sized baked tortillas called tlayuda, which also includes layers of black beans (more popular in the south than pintos), cabbage, salsa, tesajo (thinly sliced beef), asiento (bits of pork skin fried in lard), chorizo and cheese. Game, such as venison and quail, are also eaten in some areas. One delicacy of the region is chapuline: grasshopper pan-fried with chiles, garlic, salt, and lemon juice and traditionally served with beer or mescal. Hot chocolate, coffee, atole (a warm drink of thin, sugared cornmeal and milk gruel) and horchata (a sweetened rice-based drink) are favorite beverages. Ice creams, including those made with fresh vanilla bean, fruit ices, and chocolate flan, are popular.Although it is grown in the south, coffee is the most common beverage in all of Mexico. Soft drinks and fresh fruit blended with water and sugar, called aguas naturales, are also popular. Adults drink milk infrequently, except in sweetened, flavored beverages such as hot chocolate with cinnamon, or coffee with milk. The most popular alcoholic beverage in Mexico is beer, and the Mexican wine industry is also developing rapidly. In addition to tequila and mescal, whiskey is typically served at gatherings.

Describe the food staples of Central America

The foundation of the early Mayan diet was corn and beans, supplemented with squash, tomatoes, chiles, tropical fruit, cocoa, and some game. Indian foods were particularly important in the development of Guatemalan cuisine but gradually become less significant south of Central America. Rice was introduced by the Spanish and later became a staple in most regions. While beans are eaten daily, black beans are especially popular in Guatemala, and red beans are common in other nations. Beans are served simmered with spices, pureed, or fried and are often paired with rice. In Central America, corn is eaten mostly as tortillas.Enchiladas are open-faced sandwiches similar to Mexican tostadas, and typically feature meat covered with pickled vegetables such as cabbage, beets, and carrots. Known as mixtas in Guatemala, the tortilla is spread first with guacamole, then topped with a sausage and pickled cabbage. El Salvador's stuffed specialty, pupusas, is a thick tortilla filled with chicharrónes, cheese, or black beans, sealed with another tortilla, fried, and traditionally served with pickled cabbage. Tamales are also common, often stuffed with poultry or pork, and are called nactamal in Nicaragua, where the dough is flavored with sour orange juice and the filling includes meat, potatoes, rice, tomatoes, onions, sweet peppers, and mint. Black tamales are served on special occasions in Guatemala, stuffed with a mixture of chicken, chocolate, spices, prunes, and raisins.Empanadas, small turnovers made with a wheat flour dough and filled with a savory meat mixture, are popular. Introduced from Mexico, French bread is eaten regularly in the form of small rolls in Honduras and Guatemala, and in El Salvador, it is used with native turkey and pickled vegetables to make sandwiches. Coconut bread is a specialty on the Caribbean seacoast. Rice is often fried before boiling, cooked with coconut milk, or, in Costa Rica, served as pancakes.Soups and stews are also popular throughout Central America, often including fruit or fruit juices. Beef, plantains, and cassava in coconut milk; spicy beef stew; beef in sour orange juice; pork and white bean stew; chicken cooked in fruit wine; mondongo (Nicaraguan tripe soup); and sopa de hombre ("a man's soup") made with seafood and plantains in coconut milk are a few specialties. In Guatemala, the stews of meat and poultry, such as pepián and jocon, are thickened with toasted squash seeds. Meat, poultry, and fish are frequently roasted as well.A variety of fruits and vegetables, such as bananas, coconut, plantains, yuca (cassava), tomatoes, sweet peppers, cabbage, chayote squash, mangoes, oranges, and avocado predominate; however, cabbage, cauliflower, carrots, beets, radishes, green beans, lettuce, spinach, pumpkin, breadfruit, passion fruit (granadilla), pineapples, mameys, and nances (similar to yellow cherries) are also common. In addition, flowers from yucca, palms (pacaya buds), and loroco (Fernandia pandurata) are eaten as vegetables throughout the region. Starchy fruit from the peach palm (pejibaye) and spiny palm (coyoles) are especially popular in Costa Rica and Honduras. Onions and garlic flavor many dishes. Salads and pickled vegetables are common as appetizers, side dishes, and on sandwiches.Coffee is grown throughout the region and is a popular drink, usually consumed heavily sweetened. Hot chocolate is another favorite, and fresh milk, if consumed, may be sweetened with added sugar. Refrescas, cold beverages, are made in tropical fruit flavors, such as mango and pineapple. Tiste, a Nicaraguan favorite, is made with roasted corn, cocoa powder, sugar, cold water, and cracked ice. Beer is widely available. Fermented beverages include boj (from sugar cane) and chicha (a wine made from fruit or grain, fortified with rum), and venado (a common distilled drink made from sugar cane).Snacks and desserts consist of sweets, such as the praline-like candy called nogada, sweetened baked plantains, ices made with fruit syrups, custards, rice puddings, and cakes or fritters flavored with coconut or rum.

What are the most common health problems of Mexican and Central Americans and their decedents living in the United States? How may acculturation to the American diet contribute to these problems?

The most common health problem of Mexicans and Central Americans are overweight (obesity) and health issues that often accompany obesity: diabetes, heart disease, angina, hypertension, arthritis, and others. In 2008, 30% of men and 45% of women of Mexican descent were obese. Overweight in children has also been reported at rates often equal to or slightly higher than those for whites, between 17% and 27% for both boys and girls. In addition, the risk of developing diabetes mellitus is doubled for the Hispanic as compared to the white population. Prevalence of type 2 diabetes in Mexican Americans is also double that for whites, and overall, comorbidity in Mexican American elders is high, including heart disease, angina, hypertension, and arthritis. Complications such as vision impairment, reduced mobility, and incontinence are troublesome. Death rates from diabetes are estimated to be over 64% higher for Hispanics than for whites, and diabetes mortality rates are higher for Mexican Americans than for any other Hispanic group. One study found that Mexican Americans have very high rates of metabolic syndrome, a clustering of conditions that leads to type 2 diabetes and heart disease, including insulin resistance, hypertension, and dyslipidemia. Although there appears to be a lower incidence of dyslipidemia in Mexican Americans than in whites, treatment rates are significantly lower in Mexican Americans. In addition, the incidence of ischemic stroke and intracerebral hemorrhage is higher for Mexican Americans. A higher prevalence of gallbladder disease has been found in Mexican Americans, and a higher rate is found in those born in the U.S. compared to those born in Mexico. Cavities and gingivitis are common among Americans of Mexican descent, and alcohol intake was found to increase by 47% when comparing Mexican Americans who were born in Mexico and the first generation of Mexican Americans born in the U.S.The longer a subject's family lives in the United States, the poorer the subject's health and the more likely the subject is to engage in risky behaviors, even after controlling for neighborhood, family, education, and income variables. Mexican Americans born in the United States with U.S. parents had significantly higher rates of health problems (including obesity, asthma, and missing school due to illness) compared to those who were born in Mexico. Some nutritional problems have been identified in both new and acculturated Mexican immigrants. Of all ethnic groups in the U.S., Mexican Americans have the highest component scores on the USDA Healthy Eating Index (HEI), indicating good compliance with the old Food Guide Pyramid recommendations, especially dietary variety and high fruit consumption; however, they also have a high intake of sodium. Respondents born in Mexico had slightly higher scores than U.S.-born respondents. Unfortunately the HEI also found that dietary quality may decline with acculturation, as fat and cholesterol intake increases while intake of beta-carotene, vitamin C, and fiber decreases, primarily due to increased consumption of high-fat snacks, fried foods, eggs, cheese, and milk and decreased consumption of legumes, fruits, and vegetables. Low protein consumption (total protein intake has been shown to decline with the length of stay in the United States) combined with low iron and vitamin C intakes can potentially result in low hemoglobin levels among young children and pregnant women. In addition, low consumption of dairy products can cause deficiencies of calcium and riboflavin. Although the traditional Mexican diet includes good sources of vitamins A and C, thiamin, niacin, vitamin B6, folate, phosphorus, zinc, and fiber, reported low intakes of these nutrients by Mexican Americans is likely caused by inadequate income or lack of traditional ingredients, which limits consumption of these nutrients. Intestinal infections are a leading cause of death in Mexico and may be increased among new arrivals. Deficiencies among pregnant women may be improved with the use of supplements; however, nutritional inadequacies may contribute to other diseases. In the southwestern United States, the mortality rates for pneumonia and influenza are higher for persons with Spanish surnames than for whites, and deaths of Latinos from tuberculosis in New Mexico and Los Angeles have been nearly double those of whites in those regions.In the U.S., Chicanos and Mexicans who are well established often become more acculturated than those who are not, adapting a diet with a high intake of red meats, white bread, sugared cereals, caffeine-containing beverages, and soft drinks when compared to their socioeconomic counterparts in Mexico or white neighbors. Studies on Latinos in southern California (predominantly Mexican American) and Mexican Americans living in Washington have found higher intakes of fast foods, convenience items, salty snacks, chocolate, and added fat at the table with bread and potatoes, combined with lower intakes of beans, peas, fruits, and vegetables associated with acculturation. A comprehensive study detailed these changes in a very large sample of Mexican Americans, finding that the greatest dietary changes occurred between the first generation born in Mexico and the second generation, born in the U.S. Dietary changes between the second and third generations were less significant. On the other hand, intake of some items remains relatively constant between generations, particularly those of beef, green vegetables other than salad, and some fruits (bananas, apples, oranges and orange/grapefruit juice, and cantaloupe). Specific changes seen between Mexican-born subjects and first-generation U.S.-born subjects include reduced consumption of legumes, most vegetables, rice, and pasta, while consumption of breads, cereals, margarine, mayonnaise, butter, potato chips, and french fries increased. Intakes of eggs and American-style cheese also increase. Positively, U.S.-born subjects replace whole milk, preferred among Mexican-born subjects, with low-fat or non-fat milk. While soda intake is high in all generations, the U.S.-born subjects prefer diet sodas. Coffee is popular in all groups, and alcohol intake in general increases, with beer consumption among males especially popular (increasing 51%). Extra income is usually spent on meats, especially more expensive cuts such as steaks and pork chops, and processed meats, such as hot dogs and bologna. As tortilla consumption has declined, breads and breakfast cereals have become more popular with all family members. Sandwiches are a common lunch item, and meats and cheese have become more prevalent at meals while beans are eaten less frequently, and vegetables are served as side dishes. Snacking has been found to increase, especially in the evenings, and appears to be associated with level of education as college graduates are more likely to snack daily than those who attended only elementary or high school. Soda, Kool-Aid, juice, beer, and coffee are consumed with meals or snacks throughout the day, and while milk is considered a "superfood" for children, adults, especially men, may consider it to be a juvenile drink and reject it completely, or by saying that they are allergic to it (it is estimated that two-thirds of Latinos are lactose intolerant).

Compare the traditional health beliefs and practices of Mexicans and Central Americans.

Traditional health care in Mexico incorporates elements of Indian supernatural rituals with European folk medicine introduced from Spain. Beliefs and practices are closely interrelated with the culture, and most Mexican Americans are familiar with conditions specific to the culture, often using traditional cures. They consider health to be a gift from God. Illness is almost always due to outside forces (unless one is being punished by God for one's sins), and an individual must endure illness as inevitable. Prayer is appropriate for all illness, and pleading the saints for intervention through the lighting of candles on behalf of a sick person is common.In addition, health care is traditionally sought from a hierarchy of healers: treatment is first discussed with mothers, grandmothers, wives, or older female neighbors who are the health experts in each family. Home remedies, especially teas prepared in a therapeutic manner for maximum healing properties, are usually tried before turning to outside help. Over-the-counter remedies (Pepto-Bismol, Alka Seltzer, Vicks VapoRub, laxatives, and enemas) are also used. If a cure is still not found, an herbalist, massage therapist, occupational therapist, or midwife who also specializes in the care of small children may be consulted. Traditional herbal remedies, homeopathic cures, and amulets are available at pharmacies, and therapeutic items may also be sold at religious fiestas. The services of a healer are sought if an ailment is still not responsive to these cures. Healers are esteemed members of each community and customarily not only see patients without an appointment but also do not charge for their services, although they may accept gratuities. Their healing powers can be seen as God-given at birth, learned, or received through a "calling" and they may be sought for a broad range of complaints (marital problems, infertility, alcoholism, and business failure) as well as for specific illnesses (diabetes and cancer), and are important in diagnosing the underlying causes of a condition, which may be natural or supernatural in nature. It is believed that illness such as diabetes could be the result of an individual's lifestyle and would therefore yield to biomedicine, or due to evil spirits or witchcraft, in which case biomedicine is ineffective. Healers specialize in somatic ailments and are essential to curing illnesses due to supernatural causes. In regions where witchcraft is practiced, a healer can counteract the hexes or spells of a person who works on behalf of the devil. Faith is crucial to the success of a healer and prayer is his or her primary treatment; the lighting of candles or wood or metal effigies formed in the shape of the afflicted body part may also be used. Cleansing rituals are applied in certain conditions. It is often believed that illness is due to excessive emotion, dislocation of organs, magic, an imbalance in hot or cold, or an Anglo disease, such as pneumonia and appendicitis. Treatment is based on the cause of the illness.It is believed that illness, such as smoldering anger or shame, can be associated with a specific event, creating a physical, physiological, or psychological response of anxiety, depression, sadness, lack of appetite, paleness, shaking, headaches, bad dreams and too much sleep, and ennui; however, the most typical form of the disorder is susto. An individual is so frightened by a ghost that the soul leaves the body and this is considered to be a serious condition. Mild susto is sometimes treated at home with sugar or sugar water. More serious susto, particularly when the soul is involved, must be cured by a curandero and may require lengthy treatment. Susto is also believed to be a cause of nervios, a condition that affects primarily adult women. Symptoms include crying attacks, sleep problems, headache, trembling, sadness or hopelessness, ill-temper, lack of appetite, stomach ache, feeling of choking, chills, itching, and general body ache. Nervios responds best to sedatives (provided by a biomedical physician), prayer, or massage. Unlike susto, nervios cannot be cured by a traditional healer. Nervios is often a chronic condition in response to poor diet, alcoholism, drug use, or other underlying health behaviors. Some Mexicans believe that nervios can cause diabetes if not cured. There are many other illnesses known in the Mexican culture, such as bilis (excess bile spills into the blood), envidia (caused by emotion of envy among one's friends and neighbors), caida de la mollera (displacement of organs in infants), mal de ojo (evil eye), mal aire (bad air or wind), mal puesto (witchcraft), and empacho (a digestive ailment characterized by nausea, gas, and weakness). Treatment may include traditional methods such as prayers, herb teas, lighting candles, massage, sedatives, or sweeping with herb bundles. If they are ineffective, a curandero is usually employed.Many Central Americans believe a good diet, especially consumption of fruits and vegetables; fresh air; and regular hours are necessary to preserve health. Although the concept of structured exercise is unfamiliar to some Central Americans, exercise is considered important by many Guatemalans and Panamanians. Health is viewed by many Central Americans as a balance between the spiritual and social worlds and as a gift of God. Accordingly, prayer is often used to restore harmony during illness. In addition, some Nicaraguans believe witchcraft has the power to heal illness. On the other hand, Guatemalans consider illnesses to be caused by outside forces including those sent by Satan to punish unbelievers and sickness due to witchcraft. Traditional healers include curanderos and sabadores, jeberos (herbalists), espiritistas (treat witchcraft with prayer), and priests (also sought to help with prayers for health). The balance of hot and cold is also important for health, but can be disrupted by sudden exposure to extremes in temperature or strong emotions. It is believed that, in addition to susto and mal de ojo, other folk conditions associated with anger and general distress, including bilis and cólera, precipitate stroke. Ethnic groups in Nicaragua have been found to use traditional healing practices, and in the culturally diverse region of Nicaragua's east coast, more than 200 plants with traditional medicinal uses have been identified. Guatemalans believe the quantity and quality of a person's blood maintains their strength. Over-the-counter remedies, such as analgesics and cough suppressants, are commonly used by Guatemalan Americans even though they are considered weak by Guatemalan standards.