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MODIFYING SOUL FOOD FOR THE DIETARY APPROACHES TO STOP HYPERTENSION
DIET (DASH) PLAN:IMPLICATIONS FOR METABOLIC SYNDROME (DASH OF SOUL)
This article presents results of a community- Jenice Rankins, EdD; Jaleena Wortham, MS, RD;
based participatory study (DASH of Soul) Linda L. Brown, MAg, RD
designed to produce soul food that meets the
nutrient criteria of the DASH diet plan. DASH
of Soul was tested during a 10-month period INTRODUCTION METHODS
with two sub-groups of low-income African
American women: 1) a focus group cooking
club recruited from among ‘‘early adopters’’ of Metabolic syndrome, a cluster of Study protocols were approved by
a previous intervention; and 2) a broader peer anomalies centering on insulin resis- the Florida State University institutional
group dinner club recruited through a health tance with obesity, dyslipidemia, hyper- review board. Each participant signed
center serving the neighborhood of the focus 1 an informed consent form.
group. Methods for the cooking club included tension and type 2 diabetes, is prevalent
10filmed cooking labs to: a) modify traditional 2
among African Americans. Dietary
soul food (MSF) to reduce food energy, total Approaches to Stop Hypertension Study Participants
fat, saturated fat, sugar, and sodium; b) (DASH), a total diet plan based on There were two study groups,
evaluate and improve upon sensory accept- increased intake of vegetables, fruits, a cooking club peer group and a broader
ability; c) integrate acceptable MSF into the
DASHdiet plan (MS-DASH); d) produce VHS- and low-fat dairy foods, and reduced adult population composed of patients
andDVD-formattedMS-DASHcookingshows. intake of fats and sweets,3 has convinc- from a neighborhood health center
Methods for the dinner club included monthly ing implications for lowering diet-re- (NHC). Twelve low-income African-
participation in weekly promotional dinner lated burden in the metabolic syn- American women receiving health ser-
meetings that featured the cooking show and 4–8
a different DASH food group each month for drome. Frequent consumption of vices from the participating NHC were
8 months. Based on computer software anal- soul food, described by a focus group recruited. They were chosen because
ysis, the nutrient composition of a sample MS- of African American women as ‘‘seduc- they were considered to be early adop-
DASH menu developed by the cooking club tive, satisfying, filling, spicy, high-fat, ters based on excellent attendance and
was consistent with nutrient levels for the spiritual, traditional cuisine of Black participation in a prior DASH inter-
DASH diet plan. The authors concluded from Americans, especially southern Blacks,’’ vention.8 Following a program briefing,
the focus group interviews and intercept
surveys that, with continued motivation, the could be a barrier to compliance with 10 of the original 12 women agreed to
potential is good for the study population to the DASH plan.9 Paradoxically, soul form the MSF club. Two women
make MS-DASH a lifestyle choice, reducing food staples such as greens, sweet declined participation, citing either time
their risks for diet-related diseases that cluster potatoes, black-eyed peas, rutabagas, constraints or lack of basic cooking skills
to comprise metabolic syndrome. (Ethn Dis. okra, and tomatoes are central to the perceived necessary for participation.
2007;17(Supp 4):S4-7–S4-12) 10,11
DASH diet plan. Fortunately, al- Prior to implementation, two of the
Key Words: Soul Food, DASH Diet, African ternative ingredients and cooking meth- 10 women withdrew from the study
Americans ods acceptable to soul food lovers have because of health reasons. The remain-
yielded soul food recipes that are accept- ing 8 women began a 10-week work
able to populations of low-income plan to modify traditional foods to
African Americans and meet the stan- reduce calories, fat, saturated fat and
dards of the DASH diet plan.12,13 This sodium contents. One participant died
article presents a process using a focus within the first few weeks of the
group of African American women with program.
From the Department of Nutrition, a high prevalence of metabolic syn- A total of sixty-five subjects in-
Food and Exercise Sciences, Florida State drome to: a) modify traditional soul cluding the founding MSF club mem-
University, Tallahassee, Florida (JR, LLB); food; b) integrate the modified soul bers made up the broader MS-DASH
and the Department of Food Services, foods (MSF) into the DASH diet plan; intervention population. Nearly all were
Escambia County Schools (JW), Pensacola, and c) market the plan to the broader female (n564) and African American
Florida.
target group. Demographic and clinical (n557). Demographic and clinical
Address correspondence and reprint characteristics of the study group, study measures were available from NHC
requests to Jenice Rankins, EdD; 414 participants’ acceptability of the DASH medical records for 50 of the partici-
Sandels Building, Department of Nutrition, diet plan based on modified soul foods pants (mean age, 50.4 6 11.6 years).
Food and Exercise Sciences, Florida State (MS-DASH), and the comparability of Based on body mass index $30, all
University, Tallahassee, Florida 32306-
1493. 850-644-4792; 850-645-5000 (fax); MS-DASH to DASH diet nutrient except two of the 50 women (96%)
jrankins@mailer.fsu.edu targets are reported. were obese. Systolic blood pressure (BP)
Ethnicity & Disease, Volume 17(Supp 4), Summer 2007 S4-7
A DASH OF SOUL - Rankins et al
and diastolic BP exceeded the respective recipes and an introduction highlighting 2. Nutrient values of a representative
cut-off points of 140 mm Hg and problems of obesity and obesity-related MS-DASH menu (‘‘DASH of
90 mm Hg in 36% and 28% of the chronic diseases in the African American Soul’’) will be comparable to target
participants, respectively. Triglycerides community. The MSF Cookbook is levels of nutrients in the DASH diet
(,150 mg/dL), total cholesterol available online at the Nutrition Neigh- plan,asassessedfromMSFrecipesof
(,200 mg/dL), LDL-cholesterol borhood Website (www.chs.fsu.edu/ a sample Sunday’s menu analyzed
(,130 mg/dL) and cholesterol/HDL nfes/nutrition). using USDAsoftwareforHandbook
ratio (,4.4) were out of range in 25% 8, available at NutritionData.com.
to 35%. On the other hand, only 4 of Community Promotion 3. MS-DASH will be generally viewed
the participants (14%) had unaccept- The cookbook on DVD was in- as a viable lifestyle modification
able HDL cholesterol levels (,40 mg/ troduced to a larger audience in the among cooking club participants, as
dL). But, the fasting blood glucose levels second phase of the project through assessed from focus group discussions
of more than half (55%) of the clients a series of MS-DASH dinners held at with the original MSF club members
were above the acceptable range (65– the neighborhood health center follow- andexitinterviewswithMS-DASH
109 mg/dL). ing an adaptation of an intervention participants (extended club member-
called DASH-Dinner With Your Nutri- ship), as described below.
13
Intervention Methods tionist. Variations to DASH-Dinner Focus group interviews were orga-
methodology included: a) beginning nized into two parts: Part I – Modifying
Recipe Modification each dinner with a different chapter of traditional soul food recipes and Part II
Traditional soul food recipes were the cookbook for successive DASH food – Incorporating MSF recipes into the
obtained from club members. The groups and MSF recipes; b) following DASH diet plan. The process was
principal investigator (PI) provided each dinner with hands-on exercises to guided by a narrated visual presentation
additional recipe options as needed. integrate MSF into a week’s DASH introducing the discussion concepts
Dishes were prepared by individual club menu plan at two caloric levels (2000 rather than the standard hardcopy focus
members in the test kitchen of the to 2100 kcal and 1500–1650 Kcal); c) group guide.
participating university, while each dish committing to follow one or a combina- The intercept surveys were con-
was replicated in the university’s food tion of the different MS-DASH caloric ducted following a closing participants’
lab by teams of club members and plans; and d) ending the evening with appreciation celebration. Entrance ques-
nutrition students. Week 1 featured table talk specifically about perceived tions (4 yes-no questions; 1 multiple
MSF recipes from each DASH food barriers to implementing the MS-DASH choice; and 2 open-ended) focused on
group and general recipe modification plans and suggestions for overcoming reasons for joining the program, atten-
guidelines to reduce fat, saturated fat, barriers cited. As with the original dance at the MS-DASHdinners,andthe
sodium and calories. A single food DASH-Dinner program, university nu- most important things gained from
group was featured in subsequent weeks. trition students assisted with outreach participating in the MS-DASH dinners.
During Week 10, club members in- and implementation activities. About Exit interview questions (1 multiple
tegrated MSF dishes into the DASH one-third of the 65 recruited participants choice question and 4 open-ended)
diet plan. They evaluated MSF on the were regular attendees, missing no more focused on intentions to participate in
basis of taste, texture, aroma and other than one of eight meetings that featured a follow-up program if an opportunity
sensory properties. Comments were also a different DASH food group. arose, what was gained from the closing
solicited for how to improve non- program presentation, and how partici-
selected recipes. Recipe inclusion in Evaluation Methods pants planned to makeMS-DASHapart
the cookbook was determined by group Thegoalofthisstudy wasto evaluate of their lifestyle. No attempt was made to
vote. There was no more than one club the MS-DASH processes, which were match entrance and exit responses as the
member absent at any given meeting deemed successful if the following pro- aim was to assess group reactions.
and no club member was absent more cess hypotheses were supported:
than twice. Club members produced 1. Starting with traditional soul food
a cookbook on DVD that included recipes, the MSF club will create RESULTS
a chapter for fats and sweets and other a variety of acceptable MSF repre-
chapters on each of the other DASH senting each DASH food group, as Recipe Modification
food groups. The DVD-based cook- assessed by their endorsement of Thirty-nine recipes were unanimous-
book contained seven chapters showing recipes for inclusion in the MSF ly agreed upon for inclusion in the MSF
preparation of each food group’s MSF cookbook as described earlier. Cookbook. One third of the modified
S4-8 Ethnicity & Disease, Volume 17(Supp 4), Summer 2007
A DASH OF SOUL - Rankins et al
Table 1. Standard substitutions for modifying traditional soul foods to reduce food energy, fat, saturated fat, and sodium
Basic recipe modification guidelines
Instead of Use
1. Shortening to coat pans Vegetable spray
2. Butter, margarine, oil Liquid butter buds or low/fat free margarine
3. Whole milk Skim milk, evaporated skim milk or plain non-fat yogurt
4. Full fat cheeses Low fat cheeses
5. Sour cream Fat-free sour cream or ‘‘mock’’ sour cream (16 oz non-fat cottage cheese, 2
Tnon-fat yogurt, 2 T lemon juice blended until smooth or fat-free yogurt
6. Nuts Reduce amount by K or substitute grape nuts cereal
7. Baking chocolate 3 T cocoa powder plus 2 t of water for each ounce
8. 1 whole egg 2 egg whites
9. Seasoning vegetables with fatty meats Season vegetables with fat-free chicken broth (store bought; or home
made, chilled and skimmed of fat)
10. Meat with skin on Remove skin prior to cooking
11. Dark meat poultry White meat
12. Frying foods Bake or broil them
13. Fatty ground meat Lean ground meat
14. Stews and casseroles that are heavy on meat and light on vegetables Go heavy on vegetables and light on meat
15. Mayonnaise and salad dressings Reduced-fat mayonnaise and salad dressing
16. Sugar-sweetened desserts Substitute half of the sugar with an appropriate sugar substitute
17. Sugar Reduce sugar by 25% and increase sweet spices or use sugar substitutes
18. Fruits packed in syrup Use fruit packed in its own juice or water
19. Whole portion of pie or cake Dilute with fresh, frozen or canned fruit
20. Full portion of traditional soul food Half portions
21. Canned foods Fresh, frozen alternate
22. Salt Salt substitutes, and low sodium salt
23. Garlic salt, onion salt, celery salt Fresh or powdered alternate
24. Red meats (ie, bacon, sausage and luncheon meats) Turkey, chicken, fish
recipes were vegetable favorites such as General recipe substitutions used to listed in Table 3 in comparison to the
collard greens, okra and tomatoes, and modify traditional soul food dishes are nutrient levels for the MS-DASH sample
rutabagas. Four recipes combined vege- outlined in Table 1. Most of the sub- menu.14 The energy content of the
tables with other DASH food groups: stitutions centered on reducing food DASH of Soul day’s menu (2059 kcal)
broccoli and cheese from the dairy energy from dietary total fat and saturat- was quite comparable to the targeted level
group; teriyaki vegetable grill with sea- ed fat (substitutions 1–15). Three sub- of 2100 kcal. Total fat as a percentage of
food from the meat group; stir-fried stitutions were intended to reduce food total kcal for DASH of Soul (22.3%) was
vegetables and chicken from the meat energy from sugar (16–18) and two were less than the DASH target of 27%; as was
group; and stewed vegetables with beef intended to reduce food energy from percent of kcal as saturated fat (2.4% vs
from the meat group. Five of the fruit- both fat and sugar (19 and 20). Re- 6%), monounsaturated fat (10.6% vs
based recipes were obtained from duction of sodium in traditional soul 13%) and polyunsaturated fats (5.2% vs
www.dole.com and were accepted with- food recipes is achieved with substitu- 8%). Total dietary fiber for DASH of
out significant modification. Several tions 21–24. In a previous study using Soulof30 gexceededthetargeted DASH
recipes were combinations of fruit with the recipe substitutions outlined in level (24 g). With respect to mineral
´ Table 1, total food energy and food levels, DASH of Soul also fared well.
cheese, pasta, meat, or grain. The sauteed
apple recipe is an original fruit dish. The energy from fat were reduced by 37.2% Total sodium was 13% lower (2,216 mg
remaining nine dishes were light desserts and 55.3%, respectively in modified for the day) than targeted levels. Potassi-
of sweets, fats, sugars, grains and milk. versions of traditional soul foods, while umexceededthegoalby11%(4594 mg).
Recipe modification sessions were sodium was reduced by 58.8%. Calcium exceeded the goal by 24%
filmed and edited into the production (1290 mg). Magnesium (387 mg) met
of 500 VHS-formatted and 50 DVD- MS-DASH Sample Menu 90%of the targeted amount.
formatted MFS Cooking Shows, which A sample Sunday DASH meal plan
were distributed to program partici- incorporated with MSF (‘‘DASH of Focus Group Interviews
pants, local and state agencies, and Soul’’) is illustrated in Table 2. Contents The seven MSF Club members
intermediary distributors. of the DASH diet plan nutrient levels are unanimously agreed that the cooking
Ethnicity & Disease, Volume 17(Supp 4), Summer 2007 S4-9
A DASH OF SOUL - Rankins et al
Table 2. Modified soul foods integrated into the DASH diet plan: Sample Sunday Menu
;
-----------------------Food Groups -----------------------------
DASHof Soul Sunday Amount G V F D MFP NSBP FO S
Breakfast:
Grits 1/2 c 1
´
Sauteed tomatoes 1/4 c 1/2
*Soulful fruit salad 1/2 c 1
Whole wheat cheese (1 slice, low fat) toast 1 slice 1 1
Chilled milk (skimmed or 1%) 8 oz 1
Lunch:
*Oven fried cat fish 3 oz 1
*Mexican corn 1/2 c 1
*Okra and tomatoes 1/2 c 1
*Corn bread 2 slices 2
Sliced strawberries 1/4 c 1/2
Fat-free Cool Whip 2 Tbs
Splenda-sweetened tea 1 c
Dinner:
*Baked skinless chicken thighs 3 oz 1
*Collard greens 3/4 c 1.5
*Baked sweet potato, small 1 1
*Low-fat corn bread 1 cube 1
´
*Sauteed apples 3/4 c 1.5 1/2 1/2
Snacks:
*Tea cakes 1 1 1 1
Skim or low-fat milk 1 c 1
Nuts (1.5 oz ) and raisins(2 oz) 3.5 oz 1 1
Total DASH servings 6 5 4.0 3 2 1 1.5 1.5
Recommended DASH servings
1600 kilocalories 6 3–4 4 2–3 1–2 3/week 2 0
2000 kilocalories 7–8 4–5 4–5 2–3 2 or less 4–5/week 2–3 5/week
* Denotes recipes found in the Modified Soul Food Cookbook (www.chs.fsu.edu/nfes/nutrition)
3 G5grains; V5vegetables; F5fruits; D5dairy; MFP5meat, fish, poultry; NSBP5nuts, seeds, beans and peas; FO5fats and oils; S5sweets.
club activities were well worth their time family and community health. A few something new that I can use to
and effort. The women commented on sample comments are listed below: improve my health and to keep my
improved cooking skills, increased nu- N ‘‘Modifying the recipes was easy and children healthy.’’
trition knowledge, as well as motivation fun. I really enjoyed getting together N ‘‘Adopting the dishes must be a grad-
and empowerment to affect individual, and the best part for me was learning ual process. Don’t try to get the
family to accept all of the recipes at
one time. Approach it like changing
from whole milk to skim milk. It is
Table 3. Nutrient levels for modified soul foods integrated into the DASH diet plan easier if you try 2% for a while and
(DASH of Soul) compared to target nutrients then 1% instead of going straight
Nutrient Target DASHof Soul Sunday from 2% to skim.’’
Total calories 2100 2059 N ‘‘I will start by promoting the
Total fat % kcal 27 22.3 modified tea cakes to friends and
Saturated fat % kcal 6 2.4 family because they will remember
Monounsaturated fat % kcal 13 10.6 their grandma preparing them but
Polyunsaturated fat % kcal 8 5.2
Total dietary fiber (g/d) 24 30 they haven’t had them for a long
Sodium (mg/d) 2500 2216 time. Also since they haven’t had
Potassium (mg/d) 4140 4594 them in a while, they won’t be prone
Calcium (mg/d) 1040 1290 to compare the taste to the real
Magnesium (mg/d) 430 387
thing.’’
S4-10 Ethnicity & Disease, Volume 17(Supp 4), Summer 2007
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