Black Men, Diabetes, and the Hazards of Holiday Eating

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A fun fact about me: I have hardly run into an entree of macaroni and cheese I did not like. Yes, I have thoroughly enjoyed some servings of macaroni and cheese better than others, but generally, I have been a fan of the combination of elbow macaroni and assorted cheeses my whole life.

When I was a child, mac and cheese was one of the few meals I would even eat. When my mom was not making it for dinner, she would have microwavable versions from the grocer’s freezer. I would be content with just a plate of macaroni and nothing else, no meat, no vegetable, no bread, nothing. It was literally something I could have eaten seven days a week.

As I got older, my taste for various kinds of pasta developed. If you had some noodles and some alfredo sauce or marinara, you had me at your dinner table. Whether it was fettuccine, lasagna, ziti, ravioli, or whatever, if it was something that would appear on an Olive Garden menu, I was all in. Then, 2018 happened, and I was forced to do an about-face about the consumption of my favorite genre of food.

In fall 2018, I was diagnosed with Type 2 diabetes, an illness that impacts roughly 32 million Americans. Type 2 diabetes, which differs from Type 1 diabetes that develops very early in life, can be undetected for an extended period of time. It is brought on when the pancreas is resistant to the insulin hormone the body naturally produces.

When I was initially diagnosed, my A1C level, the indicator that determines blood glucose levels, was marked at 10.9 over a three-month period. An average A1C level is below 5.7. My primary care physician told me that I was very close to needing to take insulin, but if I changed my eating habits, incorporated more exercise and began taking a daily pill (prescription medicine Metformin), I could reverse course before needing regular injections

I began my treatment process aggressively changing my eating habits, which mainly focused on a reduction in carb intake. That was hard for me as a pasta aficionado. The first A1C reading I got three months after my diagnosis saw a significant drop. The next reading was a minimal decline. The one after that saw an increased number, then another drop, and finally a reading that placed me in the pre-diabetic range.

Needless to say, it has been a balancing act of maintenance to avoid needing a daily syringe of insulin. I hated getting shots growing up and I spent the majority of my teenage years and early adulthood giving my mother insulin shots, so I knew I was not interested in going down that path.

The Not-So-Sweet Impact of Diabetes on Black Men

According to various medical reports, Black Americans have a 50 percent chance of developing diabetes in their lifetime. Diabetes is listed as the fifth deadliest disease in the U.S., and Black men are on pace to be at the center of the diabetic epidemic by 2050 if trends of diagnoses continue as they are.

There are various factors that contribute to the high probability of Black Americans becoming diabetic. Family history, food deserts, poor dietary habits and poverty are but a few determinants that make Black folks more susceptible to this potentially fatal disease.

For Black men specifically, a cultural aversion and distrust of medical professionals often leads to a resistance to being checked even when early signs begin to surface. By the time many Black men are aware of their diagnosis, the damage is often irreversible, and chances of living a non-medicated, long life are compromised.

Holiday Eating and the Discomfort of “Comfort Foods” for Diabetics

November is designated as National Diabetes Month, a time when communities across the country raise awareness about diabetes. November is also the kick-off to the holiday season and foods that are filled with some of the most unhealthy ingredients for diabetics to indulge in.

In many Black households, Thanksgiving Day typically looks like a large gathering of family and friends enjoying a multi-course meal that sometimes damn near devolves into an eating contest. This year due to COVID-19 restrictions, the gatherings will be much smaller in households across the nation. That does not mean that menus will be minimized or that healthier food options will automatically make it to the table.

When Black folks do Thanksgiving, there are certain staples that make it to the table: Turkey, candied yams, macaroni and cheese, various types of dressings, cakes, ham, potato salad, possibly a casserole, sodas and, very likely, brown liquor. Depending on what region of the country you live in, there are also specialty foods native to the area. For example, in south Louisiana, gumbo is often a fixture for holiday dinners.

I have found myself at many family gatherings filling my plate with multiple servings because these annual events are the times you’re supposed to eat yourself into a state of slumber. Back when my body was free of chronic illnesses, it was par for the course for me to fill up on carbs and sweets and a minimal amount of vegetables. When I became of age, I would top off my meal with a “nightcap” of alcohol.

My diabetic body often struggles to adjust to the new norms of healthier eating on a regular basis, and that struggle is amplified around Thanksgiving and Christmas. The cost of relapsing into bad habits is elevated blood sugar readings and A1C levels. The risks associated are serious business.

That’s How We Eat Around Here: Black Dietary History

Much of Black America’s poor dietary habits began at the same time as pretty much every other sociological factor that disenfranchised us: during slavery. What is now defined as “soul food” has its origins in the type of foods enslaved Africans ate. Slave owners kept ingredients and foods that contained the best nutritional value for themselves and pass down the remains of whatever was left from animal slaughter to the enslaved.

This method of attaining sustenance, though refined over the years, was passed down throughout generations. Using a little lard here, a little extra butter there, an added pinch of sugar where extra sugar was not needed, became the cultural norm for meals prepared in Black homes. As our family histories became synonymous with diabetes, hypertension, heart disease, and other dietary-related ailments, we almost embraced it as a cultural hazard of Blackness and a small price to pay for eating the way we wanted to.

But with every full belly and satisfied palette came the potential for an early grave based on years of over-indulgence. We often sit down for holiday meals with a doctor’s warning ruminating in the back of our minds. Still, we will risk the outcome to savor the taste of foods we love as a reward for enduring the bitter taste of dehumanization.

This is an especially common line of thinking amongst Black men.

A Doctor Speaks on Diabetes and Holiday Eating

Dr. Rani Whitfield, a board-certified family physician in Baton Rouge known as “Doc” or “Tha Hip Hop Doc,” is a nationally-renown physician and activist who uses hip hop culture and music to convey messages of healthy living in his community and beyond. I asked Doc about how can Black men like myself that suffer from Type 2 diabetes enjoy our holiday eating without feeling guilty about what we choose to indulge in or putting ourselves in a risky situation with our blood sugar.

“Truly there’s no food you cannot have, but it’s just about being smart about it”...limiting portion size...fill up on vegetables and water and use sweets as a treat,” he said.

Dr. Rani Whitfield ("Tha Hip Hop Doc")

Among several things, Doc also strongly advised self-control.

“We have a tendency of ‘wolfin’, trying to eat everything to get another plate..slow it down, make sure you’re chewing your food slowly [to] get full faster that way you don’t want to go back for seconds and thirds,” Doc said.

“Tha Hip Hop Doc” primarily emphasized portion control and taking to-go plates to avoid being a glutton at the dinner table.

“Don’t try to do it all in one sitting.”

Beyond giving me advice on how to eat during the holidays, Doc also gave me critical insight into how and why diabetes has such a profound impact on the Black community and how Black men are often trapped in its clutches.

“We have to always keep in mind the social determinants of health, where we eat, live, play, worship has an impact,” Doc offered.

In referencing the history of Black health in the U.S., Doc pointed to research that speaks directly to the ways diabetes has done significant damage to Black people.

“There were some studies that were done that compared African Americans to European Americans, and why Blacks may have more diabetes than those groups. Even when they control the socioeconomic factors and all the excess, Type 2 diabetes was still higher in Black folks,” he said. “So there’s the genetic component, family history can play a role and the socioeconomic factors.”

Doc also told me about how, when he first began his practice, cultural conditioning kept many Black patients from seeking him out, as many of his future patients started out under the care of white physicians. His connection to the Black community through his work in health advocacy would later bring patients, particularly ailing Black men, to his office who had been improperly cared for on account of institutional racism within the medical field.

“I’m already attuned to talking to brothers about those things [diabetes, hypertension, and heart disease] when they come in, some doctors don’t address these things like I might, or other African American physicians might do,” Doc said.

As a proud alumnus of Meharry Medical College, a Historically Black College, Doc learned that cultural competence and conversing with patients about their medical history is more than half the battle in helping them get the treatment they need.

“Eighty percent of the diagnosis is done based on history. That’s what we were taught at Meharry Medical School. Eighty percent of my diagnosis is going to come from a conversation with a patient and not from putting hands on them,” Doc said.

Doc also reminded me of the connection between diabetes, stroke and the dangerous place many of his patients have found themselves in by delaying necessary treatment.

“Diabetics even controlled [of their treatment] are twice as likely to have a heart attack or stroke as those who are not diabetic,” Doc advised. “I’m seeing the complications of diabetes come in the office, and it’s not necessarily [them] complaining like ‘damn this is what happened, how can I have prevented it Doc’...well you could have prevented several months ago or several years ago when we talked about controlling your blood sugar, exercise, and [getting] proper rest.”

He also spoke about barriers that often prevent Black men from being able to care for themselves as sufficiently as their white male counterparts, but was honest about how even when not accounting for socioeconomic inequity, it can still be quite the task to get Black men to do what is necessary to properly care for themselves.

“That stuff [certain diabetic maintenance] is not always possible for everybody. Folks working two jobs, COVID got folks laid off, you don’t have money to afford certain things,” Doc said. “But in a perfect world some of these guys even when they have the access to do these things, they’re not doing them.”

I took some time to reflect on Doc’s thoughts on what a perfectly healthy world for Black people would look like if there were no inequities in the healthcare system. I was reminded that even though Black Americans have been historically disenfranchised in the medical world, just as in every other facet of American society, it is still incumbent on me to do the things that I need to do in order to ensure that my holiday memories are extended.

So, I guess I’ll have to have fewer servings of mac and cheese if I want to remain on a positive trajectory of reversing my diabetes.

The struggle is real.

About the Author

Donney Rose is a poet, essayist, Kennedy Center Citizen Artist Fellow, advocate, and Chief Content Editor at The North Star. He believes in telling how it is and how it should be.