When are we finally going to acknowledge that Southern food is actually healthy?
A study on diet in the US compares the worst of Southern and Black American cuisines against the best of the Mediterranean diet. Why? An open letter to the researchers of the REGARDS Study.
Background: The REGARDS Study (Reasons for Geographic And Racial Differences in Stroke) is a national project with over 30,000 participants and researchers at universities across the United States. The purpose is to discover why people in certain regions experience stroke more than others, and to learn why black Americans experience stroke more than white Americans. A recent REGARDS paper published in the Journal of the American Heart Association concludes that a “Southern diet” is more likely to lead to a sudden heart event than a Mediterranean diet. Read about it here.
Dear Drs. London, Shikany, Judd, and colleagues, and Ms. LaMotte,
I’m Shaun Chavis, founder and CEO of LVNGbook, an Atlanta-based health engagement startup that helps people eat to prevent or manage chronic conditions in culturally appropriate ways.
I’m a former cookbook editor for Time, Inc., where I specialized in healthy cookbooks for brands like Weight Watchers and Cooking Light. I was co-editor of the Southern Living healthy cookbook, Slim Down South. I was also the inaugural diet editor at Health magazine. I have a Master of Liberal Arts in Gastronomy from Boston University, where I studied food history, food anthropology, cultures and cuisines. I also have a culinary degree from Boston University. I have been an occasional member of the Southern Foodways Alliance and the Association for the Study of Food and Society. I am an advisor to Women Advancing Nutrition, Dietetics and Agriculture (WANDA). And, I’m the daughter, grand-daughter and great-niece of Black and Native American farmers in the South.
I recently read this CNN article and this statement from the American Heart Association about your recently published REGARDS study in JAHA on sudden cardiac death and the Southern diet. I have several questions and concerns and I would appreciate your response to them.
1. How did you decide to use the term Southern to define a diet that “includes high intake of fried foods, organ meats, processed meats, egg and egg dishes, added fats, high-fat dairy foods, sugar-sweetened beverages, and bread”?
This description of Southern food reflects just a segment of what Southern food is — most of these are among the nutritionally indulgent foods that have been commercialized for profit. Even though your study looked at several different dietary patterns and categorized what people eat, the way this is described in the Heart Association’s statement and in the media doesn’t reflect that, and consequently mischaracterizes Southern food.
Traditional Southern food includes elements of European, African, Native American, and Central American cuisines. Southern food is also the product of long growing seasons and plenty of produce including okra, greens (collard, mustard, turnip), sweet potatoes, tomatoes, peppers, corn, various beans and peas, peaches, berries, citrus, squashes, melons, and so much more. The South is home to a lot of freshwater fish and seafood, including shrimp, catfish, oysters, crawfish, crabs, clams, spots, croakers, pompano, and many other varieties. The South produces whole grains like rice and corn; it also produces nuts and seeds like pecans, peanuts, and sesame seeds. I’m curious why none of these foods are acknowledged in your description of Southern food. If you were to read older cookbooks by Southerners, you’ll see they wrote about eating indulgent foods like cakes, pies, cobblers, and fried chicken only on special occasions. (For an example, see the works of chef and cookbook author Edna Lewis.) Fried chicken was a spring treat; people didn’t have frying chickens available year ‘round. I’ve written about teaching healthy Southern food for the International Association of Culinary Professionals and am happy to send you my article upon request.
Southern food can’t be defined as one cuisine, as the South is home to many culinary traditions — Texas cuisine isn’t the same as New Orleans cuisine, or Carolina Low Country cuisine, or Floridian cuisine. Within Southern and Black American food traditions, there are a number of variations shaped by health concerns and religious beliefs: There are communities of Southerners and Black Americans who are devoted pescetarians, vegans, or vegetarians, for example; and restaurants, personal chefs, Facebook groups, websites, Instagram accounts, cookbooks, coaches, and meal prep services that support these health-conscious approaches to eating.
It’s a harmful inaccuracy to define all these cuisines with one short and very limited description.
2. Are you using “Southern” to mean “Black American” in describing diet?
I’d like to share with you that there are several Black American cuisines, not one; and that Southern food and Black American cuisines share common elements but are not the same. For more, please read Soul Food: The Surprising Story of an American Cuisine, One Plate at a Time by Adrian Miller, The New Encyclopedia of Southern Culture, Vol. 7: Foodways edited by John T. Edge (to which I contributed), or Black Food edited by Bryant Terry.
I also noticed in the JAHA paper that you have food styles grouped in five categories, including Southern, and that the study doesn’t use any regional name or tradition for any of the other four categories. I wonder if you would consider using a consistent naming convention for all the categories and change the word “Southern” to something more descriptive of that definition, such as “high fat” or “high fat and sugar.”
3. Why did you choose to compare your definition of Southern cuisine to the Mediterranean diet?
Your description of Southern food—fried foods, organ meats, processed meats, egg and egg dishes, added fats, high-fat dairy foods, sugar-sweetened beverages, and bread— can also apply to Mediterranean food.
French, Spanish, Italian, Greek, North African, and Israeli people eat organ meats, including gizzards, intestines, brains, and livers. Italy and Spain are famous for many varieties of cured meats that are part of their culinary heritage. French croissants and other laminated pastries are layered with butter; French soups and gratins are made with cream, butter, and cheese. French sauces largely rely on combinations of oil, butter, eggs, and cream with other ingredients. The Italians fry vegetables, balls of rice, veal cutlets, meat-stuffed olives, and seafood. European countries along the Mediterranean also produce high fat dairy foods including hundreds of cheeses. Moroccan mint tea is typically so sweet, it’s syrupy, and people drink glasses of it multiple times a day. In Italy, Greece, Lebanon, Israel, Syria, Egypt, and North African countries, some of the most loved desserts are fried, rolled in sugar, drenched in syrups, or layered with melted butter. Some of the more unhealthy foods in the Southern diet have origins in the cuisines of Mediterranean countries; for example, the Southern favorite, macaroni and cheese, was originally a French gratin. The New Orleans’ muffuletta sandwich is made with Italian cured meats and Sicilian bread, both introduced by Italian immigrants to Louisiana.
So why are you using the Mediterranean diet as a model healthy diet?
If you’re using the Mediterranean Diet Pyramid, you’ll notice that few if any of those unhealthy Mediterranean foods are on it. The Mediterranean Diet Pyramid was designed to show people how to healthfully enjoy Mediterranean food.
The same organization that developed the Mediterranean Diet Pyramid, the Oldways Preservation Trust in Boston, also developed an African Heritage Food Pyramid, in collaboration with prominent scholars, nutritionists, and culinary professionals who specialize in African and African American culture and cuisines. It was designed to show people how to healthfully enjoy the cuisines of the African diaspora, including Black American cuisines.
My question for you is, why are you conducting this study on strokes, Southerners, and Black Americans using a limited description of Southern food and comparing it to (and ultimately directing people to eat in the style of) the Mediterranean Diet Pyramid, instead of comparing it to the African Heritage Food Pyramid, or a diet based on the healthy food in the South? I see an early mention of an alternate Mediterranean Diet in your paper, but it’s not clear if that was what was actually used in the study.
4. Have you considered the harm of a study that ultimately directs people to divorce themselves from their own food traditions and local food systems, and gives care providers justification for doing the same?
Or have you considered the tremendous power of showing people they can find health right around them — that it’s inherent in their own cultural traditions, and readily available in their local food systems and economies?
The United Nations acknowledges the important connections between culture and health in the UNESCO Universal Declaration on Cultural Diversity. The World Health Organization has recognized in a policy brief that “…the systematic neglect of culture in health and health care is the single biggest barrier to the advancement of the highest standard of health worldwide.”
Please understand that I assume your intent with the REGARDS study is a good one — finding ways to prevent strokes and heart disease, particularly among Southerners and Black Americans — but I wonder if you’ve considered all the interpretations and consequences of the comparisons you’ve made in your recently published paper.
There is a long tradition in the United States of using nutrition and food as a tool of cultural hegemony. Let me share an example from 1922, a cookbook called Foods of the Foreign Born in Relation to Health. The author, Bertha Wood, writes based on the idea that foreign foods inhibit good health (including ingredients used in Mexican cooking such as tomatoes and peppers; and, honestly, since these ingredients are indigenous to the American continents, can they really be called foreign?), and that new immigrants would be healthier and adapt to American lifestyles better if they would eat a Eurocentric American diet. Woods makes statements such as “Only lack of variety and the use of hot flavors keep their [Mexican] food from being superior to that of most Americans,” and “As the Mexicans come north or intermarry, it would be better for the children and adults to learn to eat the simpler foods of the American people, boiled or baked, with less spice and fat.” She encourages dietitians to persuade Mexicans to eat more “cereals, baked or broiled fish, and meat and vegetables” and to “gradually reduce the amount of tomato or pepper for flavor until it becomes a bland dish.” Despite the friendly tone of voice in the book, it perpetuates the idea that a Eurocentric American diet is superior to the diets of Mexicans and immigrants, demonizes these food traditions, and perpetuates stereotypes about both the cuisines and the people themselves. It encourages assimilating people into a food tradition that isn’t theirs, instead of supporting them in finding ways to healthfully enjoy the cuisines they’re familiar with.
Comparing the most unhealthy dishes of Southern food to the best elements of the Mediterranean diet communicates a similar message and has a similar impact. And in the case of Foods of the Foreign Born in Relation to Health, we now know that Bertha Woods’ assertions are not true. A traditional Mexican diet (before American commercialization) helps improve inflammation and insulin resistance. I’m sure you’re familiar with The China Study, promoting the health benefits of the Chinese diet. As for traditional African and African American foods and cuisines, the Oldways actually mentions UAB in discussing their healthfulness:
“Diet is in many cases a prominent factor in chronic diseases like these. The ‘Southern Diet’ — characterized by researchers at the University of Alabama–Birmingham as heavy in fried foods, processed meats, and heavily-sweetened beverages — is often seen as the ‘traditional’ diet for many African Americans. But in fact, a healthier, more solidly traditional model can be found by looking to the foods brought to the New World by Africans, along with those they adopted here. In truth, African Americans on average eat more leafy green vegetables than other Americans and more legumes like black-eyed peas. By starting with these healthy habits and looking to Oldways’ African Heritage & Health Pyramid for additional inspiration, African Americans can take pride in a way of eating that uniquely reflects the wisdom of their ancestors.”
In performing customer discovery for starting my company, LVNGbook, I interviewed over a hundred people living with chronic conditions. Many, including people from or with roots in Jamaica, Puerto Rico, Cuba, Mexico, Colombia, New Orleans, and Nigeria, told me the food lists they get from care providers don’t reflect their food traditions. Eating food that’s unfamiliar to them forces many people to cook two meals a night—one for the person with the condition based off the Eurocentric list they get from the doctor or dietitian, and one based on the family’s food traditions. It’s expensive, it’s time consuming, and the patients feel guilt for eating their own traditional food, or experience a sense of loss over leaving their own traditions behind. Some try to modify recipes and recommendations from dietitians to resemble their own food traditions, with little guidance or idea about whether their modifications are compromising their health goals. In the end, none of these approaches supports long term, sustainable diet change. Adherence to dietary change for chronic disease is as low as 20 percent by some measures. However, if people can eat food that’s similar to what they’re familiar with, they are more likely to stick to dietary behavior change. LVNGbook’s mission is to help people eat healthfully in ways that reflects their own culinary traditions, and that mission starts with recognizing the healthfulness in every cuisine.
As a journalist, I can’t tell you how many press releases I’ve seen cross my desk that describe Southern and Black American diets as unhealthy; the description has changed so little over the years, it’s become a hackneyed boiler-plate characterization that’s perpetually ignorant to the roots, nuances, health benefits, and evolution of Black American and Southern cuisines. These press releases influence what journalists write about, and that goes on to influence public thinking and discourse, giving social, cultural, and commercial power to European and Eurocentric traditions and foods. (Consider what’s happened to the accessibility, sales, and prices of olive oil since the Mediterranean Diet Pyramid has been so well publicized.) The American Heart Association statement about your study addresses food cost and access, and by praising the benefits of a Eurocentric diet, you’ve just recommended foods that are unfamiliar, expensive, and inaccessible to many of the people that are the focus of the REGARDS study. Why not recommend a diet based on regionally grown and healthful American ingredients that are more accessible and more affordable? Health is social, too, and by encouraging people to divorce themselves from the food traditions around which so much socialization happens, you are undermining one of the major ways in which people learn about and practice good health in everyday life.
Speaking personally as a culinary professional and food journalist who is also a person of color living in the South, it is so disheartening to know there are Southerners and Black Americans who actually feel shame and even hate toward their culture’s food traditions. They refuse to eat foods like watermelon, sweet potatoes, black-eyed peas, and collard greens — all healthful foods that are grown in this region — because they are associated with slavery, poverty, and stereotypes. Your study, along with any press releases, abstracts, and other related communication, has the potential to impact these perceptions and associations.
I am genuinely interested in your response to my questions and concerns. And I am sincere in imploring you to please stop characterizing Southern and Black American food traditions as unhealthy without also acknowledging the healthy ingredients and healthy ways that people enjoy these cuisines. Please take care and be aware of the implications your work has on race relations, doctor-patient relationships and bias in healthcare, health equity, culture, local economies, and traditions. In addition to the Oldways Preservation Trust, the Culinary Institute of America in collaboration with the Harvard School of Public Health and chefs from around the world hold regular conferences that discuss research about the health inherent in different culinary traditions. Their events feature prominent chefs who demonstrate how to prepare healthy foods in various cuisines. It’s an event designed for health professionals and journalists that might be a valuable resource to you. I hope that you would consider collaborating with food anthropologists familiar with Southern and Black American cuisines, that you might study the impact of healthy approaches to these cuisines, and encourage people to embrace the healthfulness in their own traditions and regionally produced foods. The power you would give people in doing so would be immensely restorative, it would equip care providers and health educators who work in diverse communities with practical solutions, and it would promote long-term, accessible, affordable health and health equity.
This is an open letter available on Medium.
