March 2012 Issue
Obtaining Health Through Heritage — A Diet Rooted in African Traditions May Be the Path to Optimal Health for African Americans
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
Today’s Dietitian
Vol. 14 No. 3 P. 26
As obesity and chronic disease soar in many cultures around the world, African Americans seem to be the hardest hit. Black women have the highest rates of obesity compared with other ethnic groups in the United States. Specifically, about four of five African American women are categorized as overweight or obese.1
Along with the weight disparity come health disparities: Black adults are twice as likely as white adults to have a stroke,2 twice as likely to be diagnosed with diabetes,3 and 1.5 times as likely to have high blood pressure.4 African Americans not only experience higher prevalence rates of these health problems, but they’re also more likely to die from them. For example, black Americans are 2.3 times as likely to die from diabetes complications.3 And although black women are 10% less likely to be diagnosed with breast cancer, they’re almost 40% more likely to die from the disease.5
Is Soul Food Putting the “Die” in Diet?
Why are African Americans disproportionately affected by conditions that are so common but often preventable? Many experts blame the proverbial soul food diet—the cooking and eating traditions that often include dishes that are deep fried or cooked all day, soaked in fat, and laden with salt, sugar, and calories.
Such severe health problems can’t be attributed primarily to soul food, according to Sara Baer-Sinnott, president of Oldways, a nonprofit organization perhaps best known for creating the Mediterranean Diet Pyramid and other culturally specific dietary guidelines.
“These disparities go beyond eating soul food,” she says. “There are many factors that have led to poor outcomes—economics, changes in family structure, lack of access to healthful food, and perceptions about time needed for cooking and shopping.”
Still, she and her colleagues at Oldways understand that a healthful diet goes a long way in improving overall health. The organization developed a program for African Americans that emphasizes the relationship between diet and general health; educates them about the possibility of improving one’s health through a heritage diet; and promotes healthful, delicious, affordable meals to encourage people in black cultural communities to eat well.
The important word here is communities—plural. There are approximately 40 million people of African descent living in the United States. Some have been in the United States for many generations; others are more recent immigrants from Africa, the Caribbean, or other parts of the world.6 What and how they eat may differ significantly—at least until immigrants become acculturated.
“Scientific studies show that many chronic conditions now prevalent in African American communities appear in [black immigrant] populations as traditional diets are left behind,” Baer-Sinnott says. Studies have shown that when people adopt a more westernized diet, their susceptibility to health problems increases.
For example, research published in a 2010 volume of the Journal of Biomedical Science found that the prevalence of metabolic syndrome in young Tanzanian men increased as they ate more nontraditional foods such as donuts and ice cream and less traditional foods. The same trend can be found in Botswana.7 As younger populations shift from traditional to nontraditional lifestyles, weight, blood pressure, and cholesterol levels—signs of metabolic syndrome—rise. The elderly, who are less inclined to change their eating habits, are actually healthier.
According to Sarah Dwyer, program manager at Oldways and the team leader for the African Heritage & Health Initiative, since Africans who eat traditional foods from Africa are healthier than those who adopt a typical Western diet, the research suggests that a healthful African American diet should go back to its roots. To help develop a cultural model for healthful eating based on the traditional diets of the African diaspora, Oldways brought together a team of culinary historians, nutrition scientists, and public health experts to examine foods Africans ate in Africa as well as how they adapted their diet when they were brought to the Americas during the slave trade.
Healthful Heritage
Culinary historian and cookbook author Jessica Harris says the traditional African diet is largely vegetarian. “There wasn’t a lot of animal protein,” she says. “Dried or smoked fish was found in riverine or ocean areas, and wild game was used as a seasoning unless there was some degree of feasting or festivity.”
Across Africa, a variety of whole grains and starchy vegetables serve as the base for meals. “Millet and sorghum are found in the area around Mali; rice in Senegal, Guinea, Liberia, and Sierra Leone,” Harris says. “Further south in Ghana and the Ivory Coast you find yams.
“The Transatlantic Slave Trade was one of the major ways the food of Africa showed up in various inflections on the plate” throughout the diaspora, says Harris, also a member of Oldways’ advisory board. Enslaved Africans in the Americas cooked and ate in ways that were familiar to them, making do—and often making magic—with ingredients they found around them. In the southern United States, they were given some provisions such as cornmeal, beans, or a bit of pork, but Harris says, “They had to supplement their diet with foraging or growing their own food.” Cabbage, okra, tomatoes, peppers, and a variety of greens were abundant, so they were added to the pot.
“Because of the climate in the Caribbean, they had more opportunity to grow things that were closer to Africa, like yams,” Harris continues. The Caribbean diet included tropical fruits like papaya and guava as well as rice and pigeon peas. In South America, tubers such as yucca and cassava as well as okra, peanuts, and plantains were part of the plate.8
The result: a varied culinary legacy based on African retentions and the creative resourcefulness of Africans replanted in the Americas—all of which is reflected in the African Heritage Diet Pyramid that Oldways and its advisory team of experts introduced in November 2011.
Baer-Sinnott describes the pyramid as “an evidence-based practical tool designed to help African Americans reframe their daily diets based on the healthful eating patterns of their ancestors.”
As in other pyramids, the African Heritage Diet Pyramid illustrates which foods should be eaten in abundance and those that should be eaten less frequently. Based on staples from the African diaspora, the African Heritage Diet promotes beans and peas, whole grains, fruits, peanuts and nuts, vegetables, and tubers. Because of their nutritional benefit and overwhelming appearance throughout the diaspora, greens have been placed in a category all their own.
The pyramid suggests fish and seafood be added to the plate at least two times per week as a rich source of omega-3 fatty acids that can help lower blood pressure and protect against heart disease. Like other traditional heritage diets, this pyramid suggest that eggs, poultry, and other meats be eaten in small portions or used to garnish other dishes.
Herbs and spices also are given a prominent position in the pyramid to promote the use of homemade sauces and to boost flavor without adding salt. Healthful oils and dairy also are encouraged in small quantities, and sweets top the pyramid as foods to eat only occasionally.
The result is a plant-based diet low in unhealthful fats, sugars, and sodium; high in nutrient-dense whole foods; and robust in flavor. It naturally mirrors medical recommendations such as the 2010 Dietary Guidelines while fully embracing African-based food ways that are centuries old.
Putting the Pyramid Into Practice
To help black families apply the information from the pyramid to the plate, Oldways developed 12 “plates of expression”—examples of the kinds of savory, spicy dishes that have an important place in the realm of healthful soul food.
“These plates also depict real foods and real meals that translate the science of the pyramid into a healthful delicious plate,” Baer-Sinnott says. Examples include healthful recipes for Hoppin’ John from the American South, West African peanut soup, grilled snapper with mangoes from the Caribbean, and Moqueca de Peixe (Brazilian fish stew).
The pyramid doesn’t focus solely on food; it also advocates a holistic approach to a more healthful life. The base of the pyramid illustrates people engaged in enjoyable activities such as exercise, gardening, cooking, and sharing family meals—activities that go hand in hand with a nutritious diet to promote good health.
Claiming History, Claiming Health
Angela Ginn, RD, LDN, CDE, a spokesperson for the Academy of Nutrition and Dietetics, says the response among her patients has been most positive.
“I see people who are Guyanese, Trinidadian, Jamaican—from all areas,” she says. “When they see the African Heritage Diet Pyramid, their response is one of nostalgia: ‘This is what I ate when I was home’ or ‘This is what I ate when I went to my grandmother’s house. ‘”
Ginn believes that a diet option with cultural connections resonates more with her patients because, among African Americans, a meal isn’t just the food on the plate; it’s a whole experience. “If I can put an experience around healthful eating—feeling good about your past and bringing it to everyday—that will help make it more of a lifestyle,” Ginn says. Then it’s not just a diet; it’s a way of life patients can embrace, sustain, and be proud of.
— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of The African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.
Resources
Oldways has many resources available for RDs about the African Heritage Diet Pyramid, including the following:
• African Heritage 101 brochure
• African Heritage Diet Pyramid poster
• Grocery list
• Setting Up an African Heritage Kitchen guide
• Recipes for the 12 Plates of Expression
• Diaspora food glossary
Visit www.oldwayspt.org for more information.
Foods With Cultural Significance
Foods of Western and Central Africa
Influences: Portuguese, Asian, Indian, Middle Eastern
• Grains: millet, sorghum, wheat, rice
• Beans: black-eyed peas, chickpeas, lentils
• Tubers: cassava, manioc, yams
• Vegetables: leafy greens, cabbage, okra
• Fruits: watermelon, tamarind, plums, dates, figs, pomegranates
• Meats: beef, lamb, goat, camel, poultry, wild game
• Oils: shea butter, sesame oil, palm oil
• Milk: cow, goat, sheep, camel
Diaspora Foods: American South
Influences: French, Spanish, African, Haitian, British
• Grains: rice, grits, cornmeal
• Beans: black-eyed peas, kidney beans
• Tubers: sweet potatoes
• Vegetables: dandelion, watercress, other leafy greens such as cabbage, okra, tomatoes, peppers, green beans
• Fruit: apples, berries, watermelon
• Seafood: oysters, crabs, shrimp
• Meats: beef, chicken, pork, wild game
Afro-Caribbean Foods
Influences: French, African, British, Spanish
• Grain: rice
• Beans and peas: pigeon peas, black beans, kidney beans
• Tubers: breadfruit, yams, plantains, pumpkins
• Vegetables: leafy greens such as callaloo, okra
• Fruit: papaya, guava
• Seafood: salt fish and conch, red snapper
• Meat: chicken, goat, beef, pork
Afro-South American Foods
Influences: Native American, Spanish, Portuguese
• Grains: rice, corn, wheat
• Beans: black beans, pinto beans, red beans
• Tubers: yucca, cassava
• Vegetables: okra, cabbage, kale
• Fruits: mangoes, guava, acerola
• Seafood: red snapper, codfish, shrimp
• Meat: beef, pork, poultry, chicken
West African Peanut Soup
Recipe courtesy of Oldways
Serves 6
Ingredients
2 T olive oil
2 medium-size onions, finely chopped
2 large red or green bell peppers, finely diced
6 large garlic cloves, minced
1 (28-oz) can crushed tomatoes, using the liquid
4 cups vegetable broth
1/2 tsp pepper
1/2 tsp chili powder
2/3 cup extra crunchy peanut butter
1 T fresh cilantro
Directions
1. Heat olive oil in a large pot over medium heat. Cook onions and bell peppers until lightly browned and tender, adding in garlic when almost done to keep the garlic from burning.
2. Stir in tomatoes and their liquid, vegetable broth, pepper, and chili powder.
3. Reduce heat to low, uncover, and simmer for 15 minutes.
4. Stir in peanut butter and cilantro until well blended, and serve.
Nutrient Analysis per serving
Calories: 262; Protein: 10 g; Carbohydrate: 24 g; Fiber: 7 g; Total Fat: 16 g; Saturated Fat: 3 g; Trans Fat: 0 g; Cholesterol: 0 mg; Sodium: 297 mg
Moqueca De Peixe (Brazilian Fish Stew)
Recipe courtesy of Oldways
Serves 4
Ingredients
Four 1/2-inch fillets of any whitefish, like cod
2 garlic cloves, minced
2 lemons or 4 T of lemon juice
A pinch of salt and black pepper (to taste)
2 onions, finely sliced
1 small green bell pepper, seeded and sliced into strips
2 tomatoes, diced
1 tsp coriander
1 T tomato paste
1/3 cup of olive oil
3/4 cup of light coconut milk
Directions
1. Rinse the fish and place it in a bowl with garlic, lemon juice, salt, and pepper. Let the fish marinate while you prep everything else.
2. Place the oil in a pan and sauté the onions, green pepper, tomatoes, coriander, and tomato paste. When the onions are translucent, bring the sauce to a boil and add the fish fillets and the marinade. Lower the heat to medium and cook for 5 to 8 minutes. When the fish is almost done (about 5 minutes), add the coconut milk and bring the mixture to one last boil for a minute or so.
3. Serve hot, alone or over brown rice, with a watercress salad. Shellfish can be substituted for whitefish.
Nutrient Analysis per serving
Calories: 191; Protein: 10 g; Carbohydrate: 7 g; Fiber: 1 g; Total Fat: 15 g; Saturated Fat: 3 g; Trans Fat: 0 g; Cholesterol: 23 mg; Sodium: 8 mg
Healthy Hoppin’ John
Recipe courtesy of Oldways
Serves 4
Ingredients
1 cup dried black-eyed peas (or 1 15-oz can)
41/2 cups water
1 T olive oil
1 small onion, chopped
2 garlic cloves, minced
1 tsp salt
1 cup uncooked brown rice
1/2 tsp cayenne pepper
1/2 tsp black pepper
Directions
1. Soak the black-eyed peas.(It’s best to soak the peas for 6 to 8 hours before cooking.) In the morning, carefully comb through the black-eyed peas with your hands (for any small stones or bad peas) and rinse them thoroughly in a bowl. Cover them with water and let sit for the day. Drain the water from the peas.
2. In a deep sauce pot, sauté onion and garlic in olive oil for 1 to 3 minutes, until translucent (do not brown).
3. Add peas, salt, brown rice, and 3 1/2 cups of fresh water to the pot and bring to a boil. Lower heat to simmer, and add the cayenne and black pepper. Cook for 45 minutes, covered, adding water as needed.
Nutrient Analysis per serving
Calories: 177; Protein: 7 g; Carbohydrate: 28 g; Fiber: 5 g; Total Fat: 5 g; Saturated Fat: 0.7 g; Trans Fat 0 g; Cholesterol: 0 mg; Sodium: 600 mg
Grilled Red Snapper With Mangoes
Recipe courtesy of Oldways
Serves 4
Ingredients
2 to 3 T of olive oil
5 T fresh cilantro, finely chopped
3 T fresh lime juice
11/2 tsp grated lime peel
2 pinches of salt, divided
2 pinches of pepper, divided
1 large mango, peeled, cut into thick wedges
4 5- to 6-oz red snapper fillets
1 tsp of cumin seeds
1 lb green beans
2 red bell peppers, cut into slices
8 large red-leaf lettuce leaves
Directions
1. Stir the oil, cilantro, lime juice, and lime peel in small bowl to make the vinaigrette. Add pinches of salt and pepper.
2. With half of the vinaigrette, cover all sides of the mango slices first and fish fillets second, saving the rest to drizzle on after they’re cooked.
3. Sprinkle fish and mango with the rest of the salt and pepper and cumin seeds. Grill or broil fish on one side, turning them over after about 6 minutes, when the fish centers look cooked-through and the mango is soft and beginning to brown.
Green beans and peppers
1. In a medium-size pot, boil a small amount of water. Put washed green beans and bell peppers into a strainer and steam over the water, covered, for about 6-8 minutes.
2. Place 2 lettuce leaves on each of 4 plates. Top them with the fish and mango, and have the green beans and peppers on the side. Drizzle the remaining vinaigrette over everything.
Nutrient Analysis per serving
Calories: 265; Protein: 32 g; Carbohydrate: 14 g; Fiber: 8 g; Total Fat: 9 g; Saturated Fat: 2 g; Trans Fat: 0 g; Cholesterol: 53 mg; Sodium: 31 mg
References
1. Obesity and African Americans. The Office of Minority Health website. http://minorityhealth.hhs.gov/templates/content.aspx?ID=6456. Last updated January 25, 2011.
2. African Americans and stroke. National Stroke Association website. http://www.stroke.org/site/PageServer?pagename=aamer. Accessed February 6, 2012
3. Diabetes and African Americans. The Office of Minority Health website. http://www.minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=5&ID=3017. Last updated September 14, 2010. Accessed February 6, 2012
4. Heart disease data/statistics. The Office of Minority Health website. http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=3&lvlid=6. Last updated November 19, 2010. Accessed February 6, 2012
5. Cancer and African Americans. The Office of Minority Health website. http://www.minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlID=51&ID=2826. Last updated September 2, 2011. Accessed February 6, 2012
6. Black or African American populations. Centers for Disease Control and Prevention Office of Minority Health & Health Disparities website. http://www.cdc.gov/omhd/Populations/BAA/BAA.htm. Accessed December 18, 2011.
7. Garrido RA, Semeraro MB, Temesgen SM, Simi MR. Metabolic syndrome and obesity among workers at Kanye Seventh-Day Adventist Hospital. S Afr Med J. 2009;99(5):331-334.
8. Edelstein S. Food, Cuisine, and Cultural Competency. Boston, MA: Jones & Bartlett; 2011.