For a variety of reasons, I’ve recently begun trying to eat a low glycemic index diet. It means eating foods that don’t lead to an immediate spike in blood sugar levels, thus trying to avoid foods like bread, white rice, and refined sugars. Upon beginning this endeavour, I immediately realised two things about maintaining a low-GI diet–it’s expensive, and it’s stressful. And that led quickly to the next question–if a well-off and reasonably healthy person like me feels this way, what about the many, many people from socioeconomically disadvantaged backgrounds living with diabetes?
A recent study by Breland et al. (2013) explores this issue through focus group discussions with African-American and Latino residents of East Harlem (New York) who are living with diabetes. Nothing the study reveals is especially surprising, but it brings together a number of complicated issues and emotions surrounding access to both healthy food and helpful medical dietary guidance:
- Participants reported not only that high quality healthy food was too expensive for them to purchase often but also that grocery stores selling such food were too far away from their homes and workplaces to visit regularly. Some participants attributed the latter to large supermarkets’ unwillingness to open stores in minority neighbourhoods.
- Participants found their conversations about diet with medical professionals frustrating, with little tangible or personalized advice, little advice that patients could relate to. For example, though patients were told to limit portion sizes when eating, they left the doctor’s office with no sense of what a small or a large portion might be. In general, patients were not convinced that dietary changes could actually affect blood sugar levels; as one participant put it, “You can eat what you want because if you’re gonna have diabetes you’re just gonna have it anyway.”
- Diet suggestions that seemed unrealistic (“foods or preparation methods were unfamiliar or recommended portion sizes were “not enough to live on.””)
were easily dismissed, and participants instead relied on home “remedies” such as drinking lots of water to bring down blood sugar levels.
- There are social costs to changing one’s diet–it involves cooking a separate meal for oneself, since family members are often unwilling to change their eating habits.
- The health benefits of a low-GI diet are not immediately apparent, whereas the economic and social costs are often obvious. The health cost of restricting food portions or skipping meals–hunger and low blood sugar–is painfully clear.
- Participants attributed their condition to a vicious cycle between stress and diabetes, believing not only that stress both “caused and exacerbated diabetes” but also that eating healthily would, on the whole, make things worse because of the stress it causes.
- Racism and economic discrimination were seen as central to every aspect of this discussion. Racism and economic discrimination drive up levels of stress, they make it harder to access healthy food, they make it more difficult to access health care, and then to receive helpful advice from medical professionals. These links, and the emotions surrounding them, are very deeply rooted in historical discrimination; as one African-American participant put it: Our diet goes way back, back to slavery days when the massa was eating the good healthy meals that the black nanny was cooking for them. They ate healthy foods, and what was left from those meals were thrown to us…You know, the cracklin’ bread, chicken feet…So the diabetes started as far back then, and it came right on up through, as [another participant] said, through our blood lines.
Here is a pdf of Breland et al. 2013–it’s very readable, so take a look if you’re interested in the issue.