The researchers from the University of Alabama at Birmingham looked at data from over 17,000 Caucasian and African-American people over the age of 45 who had never suffered from heart disease. They asked the participants, who lived in regions throughout the country, to fill out food frequency questionnaires; all participants also had physical exams. The team touched base with the participants periodically over the next six years to see whether any had developed heart disease.
What emerged in the analysis of eating habits was five distinct patterns:
- The Southern pattern: Fried foods, fatty foods, added fats, eggs, processed meats, such as bacon and ham, organ meats (e.g. liver), and sugary drinks
- The Convenience pattern: Easy-to-fix foods like pasta dishes, Mexican food, Chinese food, and pizza.
- The Plant-Based pattern: High in fruits and vegetables, cereals, beans, yogurt, poultry and fish.
- The Sweets pattern: Foods with more added sugars, desserts, chocolate, candy, and sweetened breakfast foods.
- The Alcohol/Salads: Characterized by beer, wine, liquor, green leafy vegetables, tomatoes and salad dressings.
And here are the significant results: People who reported high adherence to a Southern style diet had a 56% increased risk of developing coronary heart disease than people who ate it the least. And this was true even when the team accounted for variables like, age, sex, race, education, household income, region, energy, smoking, and physical activity. Southern diet eaters were also more likely to have hypertension, dyslipidemia (dysregulation of blood fats), and diabetes, but again, even when these variables were taken out, the association between a Southern diet and heart disease still stood.
It’s worth mentioning who the average Southern-diet consumer was: He tended to be male, over the age of 65, African-American, a non-high school graduate, living on an income less than $20,000/year, and be a resident of the “stroke belt,” including North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana. The geographic element isn’t surprising, but the fact that the average Southern diet consumer was also of lower socioeconomic status and older may mean they don’t feel they have a lot of other alternatives regarding food choice.
Still, the connection was present in people of all socioeconomic (SES ) classes, so there’s clearly a link worth paying attention to – and there are several likely mechanisms to explain it. The Southern diet is typically high in processed meats, which are high in salt and in nitrates, which are in turn linked to heart risk. The high sugar content of the diet may also lead to negative effects, like insulin resistance and inflammation. Finally, a potentially high trans fats intake could also make one more prone to heart disease.
It’s hard to convince people to change diet habits that have been with them for a lifetime, and not all suggestions are useful. One health expert, in response to the study, suggested that “one might encourage Southern food eaters to opt for oven-fried nut-crusted chicken. Or New York-style collard greens simmered with extra virgin olive oil, tomatoes, garlic and organic vegetable stock.” Perhaps the stroke belt’s upper echelon can take this advice, but it seems unlikely that advice like this would be useful to someone whose income is less than $20,000/year, as were many of the participants in the study who were at the highest risk.
Smaller and more feasible changes might have a greater effect. ”Regardless of your gender, race, or where you live, if you frequently eat a Southern-style diet you should be aware of your risk of heart disease and try to make some gradual changes to your diet,” said study author James M. Shikany. “Try cutting down the number of times you eat fried foods or processed meats from every day to three days a week as a start, and try substituting baked or grilled chicken or vegetable-based foods.” For most people eating any kind of less-than-ideal diet, Southern or not, the smallest changes are usually the place to start.