Many members of the diabetes online community are making an effort, often succeeding, to eat a “healthy diet.” I put that term in quotes because there’s no consensus in the community about what a healthy diet is.
The low carbers view carbs almost as poison but don’t worry about fat, even saturated fat. The low fatters are the opposite and see fat as almost poison but carbs, especially high-fiber carbs like whole grains, as good. There are many other iterations of a “healthy diet,” but that’s not what I want to write about.
I think most of us, despite our disagreement about the perfect ratio of carbs, protein, and fat, would agree that fast food is not healthy. I think we would agree that highly processed food is not healthy. I think we would agree that a diet totally devoid of any fresh foods is not healthy. I think we would agree that a diet high in both fat and carbohydrate and thus also high in calories is not healthy.
Some of us eat only organic food, and only grass-fed meats and eggs. Some of us have gardens and eat a lot of food right out of our gardens. Clearly this is healthy, not only because the food is superfresh but because tending a garden provides a lot of exercise.
But what if you can’t afford organic food, and especially not organic grass-fed meat? What if you can’t even afford much protein at all? What if you can’t afford fresh vegetables? Or what if even if you can afford protein foods and fresh vegetables, they aren’t for sale in your neighborhood?
This is the problem faced by many inner-city residents, where the only nearby convenience stores, or bodegas, usually stock sodas, beer, chips, and other snack food, and only a little real food like bananas. And what produce they do stock is often not fresh. Many of the residents don’t own cars and hence can’t drive long distances to good supermarkets where there’s not only more food but the food is cheaper. And studies have shown that “food insecurity” (meaning you worry about being able to get enough nutritious food for your family for reasons of availability or ability to pay) is related to poor metabolic control. Here is one such study.
In order to examine these problems and how people with type 2 diabetes view the situation, Jessica Breland (who kindly provided me with the full text of the article) and colleagues organized a series of focus groups with residents of East Harlem, NY. The groups included 37 African American and Hispanic people with diabetes ranging in age from 27 to 80; they had had diabetes for an average of eight years.
The researchers used a model called Common Sense Model of Self-Regulation (CSM), which assumes that perceptions of medical care (including nutrition) are based on personal experience. Thus “patients are unlikely to adhere to advice if medical recommendations are not validated by or are inconsistent with personal experience.”