Food, Culture, and Diabetes in the United States
Karmeen D. Kulkarni, MS, RD, BC-ADM, CDE
Introduction
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Introduction
Nutrition Considerations for...
Nutrition Considerations for...
Nutrition Considerations for...
Summary
REFERENCES
What do people in the United States eat? Is it meat and potatoes? Things have changed in the United States as the population has grown to include many different ethnic and cultural groups, and this has resulted in diverse food preferences and eating habits. Asian Indians are one of the fastest growing immigrant groups in the United States. African Americans are numerically the largest minority group, although the Latino population is expected to be larger than the African-American population by the middle of the next century.1
Culture is defined as the knowledge, beliefs, customs, and habits a group of people share. These are not inherited behaviors, but learned. Culture is passed on from generation to generation.1 Each ethnic group has its own culturally based foods and food habits. These traditions have been influenced and adapted through contact with the mainstream culture.
Conversely, the foods of mainstream culture have been influenced by the presence of these ethnic cultures. Fast-food restaurants and other take-out restaurants now offer such wide-ranging selections as pizza, tacos, falafel, tandoori, egg rolls, and hamburgers.1
Thus, the American diet is a combination of many cultures and cuisines. To understand it, one must not only study the traditional foods and food habits of the many minority groups, but also the interaction between the majority culture and the cultures of these smaller groups.
Seventeen million people in the United States have diabetes. Key to the increasing prevalence of diabetes is the rapid growth of the disease in high-risk populations such as African Americans, Native Americans, Latinos, and Asian Americans. The growth in obesity, as well as an aging population, have also contributed to this increase.2,3
This article examines the ethnic and regional food practices of three larges segments of the U.S. population: African Americans, Asian Indians, and Mexican Americans, all groups with a high incidence of type 2 diabetes. The incidence of type 2 diabetes is also high and increasing among Chinese Americans and Native Americans, who also have unique food preferences, habits, and issues. However, discussion of these groups is beyond the scope of this article.
Nutrition Considerations for African Americans
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Introduction
Nutrition Considerations for...
Nutrition Considerations for...
Nutrition Considerations for...
Summary
REFERENCES
The rate of type 2 diabetes among African Americans is 1.6 times higher than that of the total U.S. population. This may be related to higher obesity rates among African-American women.4 Diabetes educators should be aware of the increased incidence of type 2 diabetes, hypertension, and obesity in African Americans.4 All of these conditions require nutrition intervention and skill in the cultural aspects of working with these clients.
The African-American diet is based in part on certain health beliefs that have been passed down through generations and are still observed today. Socioeconomic status and education level are important in the meal planning and nutrition education of African-American patients. Financial and physical constraints, available cooking facilities, and family support also should be taken into consideration. Health literacy is also key, especially when educators are communicating with patients about food choices and their likely impact on health.5
Traditional African-American fare, sometimes referred to as "soul food," is based in part on food practices and customs listed below. Many of these customs and practices are shared by white Americans in the southern United States, particularly those of lower socioeconomic level or living in rural areas.
* A variety of green leafy vegetables, such as collard, mustard, turnip, and dandelion greens; kale; spinach; and pokeweed are known collectively as "greens" and are a staple of soul food.
* Corn is a mainstay food item.
* "Vegetable plates," which traditionally consist of vegetables and starches and are served with cornbread or yeast rolls and "spring onions" (scallions) or sliced raw or cooked yellow onions.
* Starchy vegetables, including dried beans (pinto, navy, lima, butter, kidney); fresh or dried peas (black-eyed, field, green, crowder, butter); beans with pork; corn; and sweet or white potatoes are quite popular. These foods have a high protein content, especially when combined with grains. Popular combinations include "hoppin john" (rice with black-eyed peas), red kidney beans and rice, and succotash (corn with lima beans).
* Grains such as rice, grits, cornbread, biscuits, muffins, dry and cooked cereals, and macaroni are also basic.5
* Meats are often breaded and fried. A variety of beef and pork cuts, poultry, and fish are consumed, as well as oxtail, tripe, and tongue. Frying has traditionally been a preferred method of meat preparation because of the short cooking time, a feature that is practical during the heat of summer.
* Whole milk, commonly referred to as "sweet milk," and buttermilk are popular choices. Buttermilk is a common ingredient in biscuits, cornbread, and batter for fried chicken. Two percent and nonfat milk and powdered milk are also becoming more popular because of the increasing awareness of the need to reduce total fat, cholesterol, and saturated fat in the diet.5
For many African Americans, decreasing the cholesterol, fat, and sodium content of the diet and focusing on weight management are significant goals to help reduce the risk of diabetes complications. Toward that end, it is helpful that African-American fare emphasizes vegetables and complex carbohydrates.
Helping patients modify recipes for foods they typically eat is valuable in achieving and maintaining adherence to recommended dietary changes. A study at the diabetes clinic of Grady Memorial Hospital in Atlanta, Ga., found that the primary reason for patients not following food recommendations was that the recommended diet was not familiar to them and contained unfamiliar food choices.6
A reproducible handout offering nutrition information for African-American and southern traditional clients can be found on p. 193. Table 1 provides an example of typical and modified meals for an African-American patient.
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Table 1. Sample Dietary Modification for an African-American Patient With Diabetes |
