African Americans (AAs) in the US experience disproportionately high rates of obesity and heart disease compared to white and Hispanic populations. More AA men and women succumb to cardiovascular disease (CVD) than any other chronic disease condition. While CVD mortality has declined overall, the rates among AAs remain significantly elevated. Addressing these health disparities requires culturally relevant and effective dietary interventions. The African Diet Pyramid, particularly the African Heritage Diet Pyramid developed by Oldways, offers a framework for reclaiming traditional, cultural cuisines and adopting healthful eating patterns.
Understanding the African Heritage Diet Pyramid
The African Heritage Diet Pyramid is a cultural model of healthful eating based on whole, fresh plant foods like colorful fruits and vegetables, especially leafy greens, tubers like yams and sweet potatoes, beans of all kinds, nuts and peanuts, rice, flatbreads, and other grain foods, especially whole grains, healthful oils, homemade sauces and marinades of herbs and spices, and fish, eggs, poultry, and dairy. It’s naturally low in processed sugar, unhealthful types of fats, and sodium, and includes only small amounts of meats and sweets.
Kelly Toups, MLA, RD, LDN, director of nutrition at Oldways, emphasizes that "The goal of the African Heritage Diet Pyramid is to illustrate the ‘big picture’ framework of African heritage diets, inspiring individuals and communities to reclaim their best health."
Key Components of the African Heritage Diet
The African Heritage Diet Pyramid emphasizes the following food groups:
- Fruits and Vegetables: Abundant consumption of colorful fruits and vegetables, especially leafy greens and tubers like yams and sweet potatoes, is the foundation of this diet.
- Whole Grains: Rice, flatbreads, and other grain foods, especially whole grains, are encouraged.
- Legumes: Beans of all kinds are a significant source of protein and fiber.
- Nuts and Seeds: Nuts and peanuts provide healthy fats and nutrients.
- Healthy Oils: The diet incorporates healthful oils.
- Fish, Eggs, Poultry, and Dairy: These are included in moderation.
- Limited Intake: The diet is naturally low in processed sugar, unhealthful types of fats, and sodium, and includes only small amounts of meats and sweets.
The NEW Soul Study: A Practical Application
The Nutritious Eating with Soul (NEW Soul) study, funded by the National Institutes of Health, exemplifies a culturally-adapted approach to dietary intervention. This study partners with local soul food restaurants and chefs to deliver two behavioral nutrition interventions to AA adults with overweight or obesity. Participants are recruited from the community in the Midlands of South Carolina and randomized to follow either a vegan diet emphasizing minimally-processed whole foods from plants or a low-fat omnivorous diet.
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Study Design and Objectives
The NEW Soul study is a randomized behavioral intervention with a recruitment goal of a minimum of 130 participants over two cohorts separated by one year. The primary aim is to examine differences in risk factors at 12 months for CVD (changes in lipids, glucose, insulin, and blood pressure) and body weight between participants randomized to the omni or vegan group. The secondary aim is to examine long-term changes in CVD risk factors at body weight at 24 months.
Intervention Components
The NEW Soul intervention consists of weekly in-person meetings lasting 75 minutes for six months (26 meetings), followed by bi-weekly meetings for six months (13 meetings), and then monthly meetings for the last 12 months (12 meetings). Participants are given a choice of two different meeting times on two different days in order to accommodate work, childcare, and church schedules. Both diets focus on soul food and traditional African cuisine and both emphasize plant-rich, low-fat eating styles. The vegan diet recommends a whole food, plant-based dietary approach, meaning a focus on minimally processed plant foods and avoiding refined foods, including oils. The omni diet follows the Therapeutic Lifestyle Changes dietary guidelines in order to have guidance on portion sizes for foods like lean meats. Both diets are guided by the Oldways African Heritage Pyramid.
Cultural Adaptation
An innovative aspect of the NEW Soul study is that it partners with local soul food restaurants (both omnivorous and vegan) and chefs in order to ensure culturally relevant and palatable versions of each diet. Dinner is provided to participants that is catered from a local vegan soul food restaurant. This allows participants to get a better understanding of the diets in the study.
Addressing Health Disparities Through Culturally Relevant Nutrition
Nutrition plays a major role in advancing health equity. Inadequate access to healthful, affordable foods and preventive health care may partially explain why African Americans are disproportionately affected by chronic disease.
The Role of Traditional African American Cuisine
The traditional African American diet in the South was a combination of African food-ways, influenced by French and Spanish cuisines. The diet was filled with fresh garden vegetables such as cabbage, okra, tomatoes, peppers, and a variety of leafy greens including dandelion, mustard, collard, and turnip greens. Pickling was used to preserve many of these vegetables such as okra, beets, green tomatoes, radishes, cabbage, carrots, and cucumbers, making vegetables available all year long. Traditional cooking from South Carolina and Georgia’s coast-also known as Low Country-featured oysters, crabs, shrimp, sweet potatoes, and Hoppin’ John (black-eyed peas and rice).
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The Impact of Migration on Dietary Habits
During the Great Migration in the early 20th century, African American migration patterns included relocation from Southern farms to Southern cities; from the South to the Northeast, Midwest, and West; and from the Caribbean to US cities as well as to migrant labor farms. This movement from rural communities in the South to large cities in the North and West changed the eating habits of African migrants. Movement from rural to urban areas resulted in increased availability and consumption of foods once reserved for special occasions.
Reclaiming Cultural Cuisines
Reclaiming traditional, cultural cuisines and adopting a healthful eating pattern such as the African Heritage Diet and those highlighted in the DGA has both culinary and health appeal.
Other Diet Options
There are many diet options available to you with each having its own benefits and limitations.
The Mediterranean Diet
This diet is based on the eating habits of the 21 countries which border the Mediterranean Sea such as Spain, France and Portugal. The Mediterranean diet includes fruits, legumes, whole grains, nuts and vegetables while the consumption of poultry, fish and eggs are also encouraged.
The DASH Diet
Because of individual taste and preferences, the DASH diet can be flexible and offers a wide range of options to enable you to get the best nutrients possible.
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The MIND Diet
This diet is a combination of the Mediterranean and DASH diet with a specific aim of improving brain health. Whole grains also contain fiber which have been proven to improve digestive health and movement. Berries contain antioxidants and plant based chemicals which protect the brain. Examples of berries include strawberry, blackcurrant, blackberry and blueberry. The MIND diet allows for moderate consumption of wine, particularly red wine. Red wine is a source of antioxidants, such as resveratrol, which has been associated with cognitive benefits.
The Nordic Diet
The Nordic diet which is popular in Nordic countries such as Sweden, Finland and Norway is an excellent way to manage hypertension. The diet also includes small amounts of dairy products, eggs and game meats, with the occasional red meat and animal fats.
Practical Strategies for Dietitians and Health Professionals
- Be inquisitive and identify cultural barriers: Some of the healthful foods RDs promote often are perceived as “white people’s food” in communities of color, and that healthful eating must be addressed in the context of cultural barriers. RDs should treat each client as an individual and be inquisitive, asking them how and where they get their food and how they include those foods on the plate.
- Use educational materials representative of the client’s ethnicity: Use the African Heritage Diet Pyramid.
- Take the African Heritage Diet CPE course: This course, developed by Oldways, offers an in-depth overview of the African Heritage Diet as an evidence-based, culturally meaningful nutrition intervention guide.
The Importance of Potassium
According to the American Heart Association, many people fall short of the recommended potassium intake which ranges between 2600 and 3400 milligrams. A healthy diet for hypertension focuses on reduced sodium (salt) intake while promoting the intake of potassium rich foods like legumes. The addition of fruits, vegetables and whole grains complete a heart healthy diet for those living with hypertension.
The Role of Physical Activity
Regular exercise has been proven to be a key factor in controlling hypertension. Combine that with physical activity and your overall mortality risk decreases by 18%.
The Importance of Healthy Fats
Fat is an important nutrient which you need for proper bodily development and they are present majorly in food groups like milk, meat and oils. Some fats are considered as healthy fats such as monounsaturated, polyunsaturated and Omega-3 fats while others like saturated and trans fats are considered unhealthy.