Food's role in diabetes debated

Fried pork chops. Monkey bread. Cream cheese chicken casserole.

These are the foods that flavor the pages of Alice Randall’s novel about a black woman in Nashville trying to lose weight. But she’s quick to point out that soul food is not the only disease vector in the city’s diabetes hot zone.

It’s not the dinner Grandma cooked last Sunday so much as the sugary soft drinks from convenience stores and the ready-made, processed foods from drive-through restaurants.

“Those are not soul foods,” Randall said. “Those are commercial, mass-marketed fast foods. There’s nothing elementally soul food about them.”

Soul food and processed sugars are the latest passion topics in the ongoing debate about what’s wrong with the American diet. Medical experts and diet pundits try to identify whether calories, fat grams, carbohydrates or sugars are most to blame for rising rates of obesity and diabetes. Other experts warn there are no easy answers for ending the epidemic.

The ZIP codes in Nashville with the highest rates of diabetes are the African-American neighborhoods north and south of downtown. With the disease more prevalent among blacks than whites, soul food is under scrutiny. But so is the sugar in ready-made, processed foods.

Experts agree that obesity is fueling the diabetes epidemic. Being overweight increases the odds of developing type 2 diabetes. About 80 percent of people diagnosed with the condition are overweight.

In Randall’s work of fiction, “Ada’s Rules,” she drew on her personal quest to lose weight after learning she was prediabetic, which is having a blood glucose level above the normal threshold of 100 but still under the diabetes mark of 125.

Randall is a novelist, not a medical expert. But a physician and author of books on the American diet and its consequences has a similar viewpoint. Dr. Robert H. Lustig contends that sugar-infused fast foods and processed foods are addictive. His new book, “Fat Chance,” takes a pointed look at how sugar is embedded in both grocery store items and takeout menus — foods high in calories but low in fiber.

Soul food is actually a wiser choice over the ready-made diet, Randall said.

“The elemental black foods are the baked sweet potato and the peanut butter,” she said, noting that natural peanut butter has no added sugar.

Trazana Staples, founder of Another Avenue Cultural Resource Center, which advocates for backyard gardens and healthier cooking choices, has a more expansive idea of soul food. She uses substitute ingredients.

“I’ve learned to prepare my greens but not to put meat in them, using herbs, such as cilantro, parsley, rosemary, basil and thyme,” Staples said. “They taste, if not better, just as good. With my sweet potatoes, instead of using white sugar, I use honey. For cornbread, I use almond milk or coconut milk and milled corn, not the processed enriched corn.”

The American Diabetes Association has a pamphlet called “The New Soul Food Recipe Sampler for People with Diabetes.” It includes a recipe for pineapple upside-down cake that has 29 grams of sugar per serving. It’s the kind of recipe that sugar critics would frown upon.

No magic bullet

But if you’re already diabetic, debates about what causes the disease don’t matter as much as managing it, said Ann Albright, a dietitian and exercise physiologist who heads diabetes prevention for the U.S. Centers for Disease Control and Prevention.

“Food is very personal,” she said, calling for diets customized to people’s preferences and cultural backgrounds.

“Otherwise, forget it,” she said. “You might as well hand somebody a piece of a paper in a foreign language, because they are not going to do it. How many times do we hear about the non-compliant diabetic? We have really sunk ourselves in a hole on that whole deal. There’s not a magic diet. There’s not a magic bullet.”

Randall is a bit weary of the focus on soul food.

“It’s not food alone, and I’m not sure it’s food predominantly,” she said.

There are other factors for American-American women, she said, such as being sleep-deprived from working two or three part-time jobs with erratic hours while caring for children. Another issue is not having the time or space to exercise.

“Food traditions connect us back to Africa, to our identity and the sense of our families as powerful, creative beings who are able to provide for us in just the simplest sense,” the Nashville novelist said.

And she’s an advocate for drinking water — at least eight glasses a day. Lynn Stuart, director of teen services for United Neighborhood Health Services, which operates clinics in Nashville’s diabetes hot zone, said too many young people don’t.

“I noticed this past summer, just making home visits in different neighborhoods, on any given day, young people would be just walking down the street with a 64-ounce soft drink in their hand, chugging it down all day,” he said.

Type 2 diabetes, which is linked to obesity, has already surpassed type 1 diabetes, once called juvenile diabetes, as the leading cause of new cases of the disease among Native American children. Federal health officials worry that the tipping point is near for black and Hispanic children.

Dinners based on vegetables could reverse that trend.

Said Randall: “Soil food is soul food.”

This story originally ran in The Tennessean  on January 22, 2013 and USA Today on January 21, 2013.

Photo Credit: John Partipilo / The Tennessean