Barbecued pork or fried chicken served with a heaping side of mac and cheese or creamy potato salad, sweet tea and peach cobbler — these Southern classics, loaded with as much history as flavor, have become comfort foods for Americans from all over.
But a study published Tuesday in The Journal of the American Medical Association suggests that Southern cuisine isn't serving African-Americans, whose ancestors imagined and perfected it, very well. The Southern diet may be at the center of a tangled web of reasons why black people in America are more prone to hypertension than white people.
Researchers from the University of Alabama at Birmingham crunched data collected from nearly 7,000 men and women older than 45 living across the U.S. — not just in the South — over the course of a decade. Their goal: to figure out why black Americans are at greater risk for high blood pressure.
Over the course of the study, 46 percent of black participants and 33 percent of white participants developed hypertension — and diet seemed to explain much of the disparity.
Black participants were much more likely than white participants to eat a Southern-style diet, which the researchers defined as one that heavily features fried foods, organ meats and processed meats, dairy, sugar-sweetened beverages and bread. And this diet was more strongly correlated with hypertension than any other factor the researchers measured, including participants' levels of stress and depression, exercise habits, income or education level.
"If you think about [the] disparity — African-Americans' life expectancy is about 3.5 or 4 years less," says George Howard, a professor of biostatistics at the University of Alabama at Birmingham, who led the study. Hypertension — which can lead to heart attacks, stroke and kidney failure — is a big contributor to that, Howard says.
Approximately 75 percent of black men and women develop high blood pressure by their mid-50s, compared with 55 percent of white men and 40 percent of white women of the same age. "Figuring out why is sort of the holy grail of research," Howard says. "And this study tries to take a stab at it."
In some ways, the findings weren't terribly surprising, says biostatistician Suzanne Judd, also of the University of Alabama at Birmingham, who co-authored the study. A diet high in fat, salt and sugar would increase the risk of hypertension for anyone, of any race. What does surprise Judd is "how this one particular style of eating explained so much of the difference between the rates of hypertension for black and white participants."
What it really came down to was the fact that while people of both races ate some amount of Southern-fried comfort food, African-Americans, on average, were eating much more of it — with the highest consumers eating something fried, overly salted or doused in fatty dairy every day.
"This has led me to wonder — what are we missing?" Judd says. Could it be a matter of access to healthy options in minority communities?
This recent study didn't measure that, nor was it able to calculate how several factors can work together to increase blood pressure. While higher levels of stress in black participants didn't seem to correlate strongly with hypertension in this new JAMA study, other research has found that the stresses of racial discrimination can affect blood pressure in direct and indirect ways. "If you think about it, stress can, for example, affect how well people sleep, which can lead them to overeat or crave unhealthy food," Judd says.
And then there's also the possibility that the food reveals something about the social history of those who eat it, Judd adds. African-Americans who eat soul food on a regular basis may be more likely to have descended from generations who suffered slavery, discrimination, poverty — and the health consequences.
What it all comes down to, for Thomas LaVeist, a dean and professor of health policy and management at Tulane University, "is the fact that diet is cultural." To truly untangle the relationship between disease and the Southern diet, he says, you have to start by understanding African-American foodways.
"See, the traditional African-American Southern diet was really designed for survival," he says. "African-Americans were not able to access a balanced, nutritious diet during slavery and during Jim Crow. What they had was organ meats and parts of slaughtered animals that others didn't eat, and greens they grew themselves. And what they did is take those scraps and turn it into what's now an internationally renowned cuisine."
That is, and should be, a matter of pride for the black community, LaVeist says. "But the thing to realize is the food that once helped sustain African-Americans through a truly insane period of history isn't well-adapted to the food environment today, or the health challenges of today."
Indeed, adds food historian Adrian Miller, "Southern food, the way it's traditionally prepared, has been high in sodium, sugar and fat." But those who adhere to the Southern way of cooking and eating are justifiably reluctant to deny themselves a cuisine that's tied to their identities and history.
"What I've been trying to promote is moderation. So, not rejecting soul food, but remembering that some of the heavier stuff was first conceived of as celebration food — we're not meant to eat them every day," says Miller, the author of The President's Kitchen Cabinet: The Story of the African Americans Who Have Fed Our First Families, from the Washingtons to the Obamas. "And maybe studies like this are an opportunity for us to revisit the core roots of this African heritage food that's based on vegetables: greens, sweet potato and beans. It's a reminder that Southern food doesn't have to be one thing."