"My goal is always to show them how they can continue to eat the foods that they've grown up with, that they're accustomed to, and do it in a way that still allows them to achieve the goal, whether it's diabetes management, hypertension, elevated cholesterol. So it's always patient centered." - Constance Brown-Riggs, MSEd, RD, CDE, CDN
Shireen: Constance Brown-Riggs, owner of CBR nutrition enterprises is the author of diabetes guide to enjoying foods of the world and African American guide to living well with diabetes. She is the past chair of the diabetes dietetic practice group of the Academy of Nutrition and Dietetics. Welcome, Constance.
Constance: Thank you.
Shireen: So great to have you on, I want to start out by asking you, what led you to a career as a dietitian as a whole, and then more specifically, a dietician that works with chronic illnesses, with really this mind, body, spirit approach?
Constance: Believe it or not, my interest in the field started as a young girl, my next door neighbor was a home, home economist. So during the school year, she taught Home Economics. And in the summer, she actually covered in a hospital as a dietitian, so while dieticians on vacation she filled in. And I would see her in this beautiful white uniform. And I always loved a white uniform. And back in those days, they were crisp, white uniform. And so that's what sparked my interest. And from talking to her, I found out about home economics, but also more so about working in the hospital, as a dietitian. So that's what sparked my interest in the field. In terms of the mind body spirit approach, that actually came from my experience working on a drug and alcohol rehab unit. And on that unit, I was exposed to, you know, all the principles in terms of drug and alcohol rehab, attended a lot of sessions with the clients and the social worker, and the psychiatrists and so on. And that's when I became more exposed to chronic illness thinking looking at alcohol and drug abuse, in the same aspects, if you will, as chronic illness. And looking at it from the mind body spirit approach. So that's where I initially just kind of married the two put them together. And I've been practicing, since that time, pretty much with those principles, connecting everything starting, you know, looking at the, as I say, the Foundation, which is the body. And then the next layer, if you will, is the mind, and then ultimately the spirit. So whether we're talking diabetes, that's not properly managed, if we're talking high blood pressure, that's not properly managed, anything that's going to affect the body. Caffeine, for example, affects the body. And if there's a problem in terms of the body, it's going to affect the mental state, you think about it, if you've got your blood pressure is raging nine times out of 10, you're gonna have a terrible headache. And if you've got this terrible headache, you're not going to be able to think clearly. And at that point, you're not going to have you know, I call that spiritual connection from the mind. So it's the whole thing, it just goes together in almost any example that you can think of any illness, any abuse, drug abuse, alcohol abuse, any of that it's affecting the body, it's going to affect the mind, and it will ultimately affect the spirit.
Shireen: I love, I love that connection there. As a practicing dietitian, and certified diabetes educator, what is your general approach to chronic illness management, through nutrition?
Constance: I always approach, it will say the patient from the patient centered approach. So the disease may be the same, you know, if we use diabeetus, the diagnosis is diabetes. But after that, everything is very individual. So I always take a patient centered approach. And I happen to be one of those people in general, that ask a lot of questions. That's one of the things my family always tell me, my mother, she'll tell me something. Oh, Mrs. Brown, had to go to the doctor. Well, what did she go for her? You didn't ask her why she went to the doctor, what's going on? So I've just always been inquisitive. And so that's the most important thing, asking the questions. And I should say the most important thing is not asking the questions you want to ask the questions. The most important thing is listening to the answer. And truly being present, and listening to that individual. And then I always want to honor an individual's culture. And so that also goes into asking the questions. You know, what, what types of foods do you eat? When you're feeling good, what types of foods you eat, when you're not feeling good? What do you eat for holidays, special celebrations, you really have to ask all those questions. So you getting to know that individual, and then I never really want to take away from food. My goal is always to show them how they can continue to eat the foods that they've grown up with, that they're accustomed to, and do it in a way that still allows them to achieve the goal, whether it's diabetes management, hypertension, elevated cholesterol, so it's always patient centered. It's not about me, it's about the patient, the individual, the client, and his shared decision making as well. It's It's not me saying, well, you have to do this, I will tell them, well, we have a couple of ways that this can be handled, I'll explain it, and then ask them Well, what do you think, what would you like to do? What would you like to try? So again, it always just boils down to the individual. And I also believe small, gradual changes, that's what works best, whatever the disease, whatever the behavior that we're trying to get them to change. It's small steps, that's what's going to work best for the individual.
Shireen: Now, I want to talk about the books that you've written Constance. So the first one, the African American guide to living well, with diabetes, what, what motivated you to write this book?
Constance: Well, I just again, always looking to try to counsel from the perspective of the individual, what foods they typically eat, what they like to eat, looking at those types of things, there was not a book out, that really addressed African Americans, and looking at it from their food choices, from even the way we can get physical activity in the way African Americans perceived Wait, there was nothing really a comprehensive book that addressed all of those issues. I couldn't find educational tools that depicted African American everything was kind of, you know, for lack of a better word will say whitewashed. And, you know, so everything looked exactly the same, there was nothing that resonated with African Americans. And actually, the first educational tool that I developed was the diabetes cell food pyramid. And the idea there was to simply not reinvent the wheel. But to take that pyramid. And instead of having foods that African Americans didn't typically eat at least African Americans from the south, I put pictures of black IPS, cornbread, foods that people from the south would typically eat. Now, of course, not everyone coming into my office is from the south, nor does everyone eat traditional foods from the south. But for those that did eat that way, I had an educational tool for them. So that was the first thing and from that, I actually went on to write the book, I developed several other educational tools, but it all led to the African American guy to living well with diabetes. And again, there, you know, there's just was not at that time, another book that addressed it, and I addressed it, again, from the mind, body and the spirit perspective, actually open in the introduction, it talks about one day at a time. And that's a very common spiritual song. Well, it wasn't necessarily a spiritual song when it was written. But it is a song that is sung in many black churches, Baptist churches and so on. And so I started talking about that, but that also applies to living with diabetes one day at a time. That's, that's it. So it's all tied in everything that I do, is tied in looking at the cultural perspective, trying to help that individual honor their culture along the way, and that's the important thing. I love it.
Shireen: I love it. Your, your second book, diabetes guide to enjoying foods of the world and in fact, we're for listeners here, here on the podcast today that there's a special treat to that end coming up at the end of the episode. But specifically for this book, I mean, what was your motivation around this one,
Constance: Again, honoring the culture, thinking of people with diabetes specifically, you know, thinking that they have to give up the foods that they've grown up on, or foods that they want to try. And we know ethnic cuisine tends to be the healthiest cuisine. So the goal was twofold. To help individuals with diabetes, understand, yes, you can eat these foods, you can have Moroccan food, or you can have Chinese food or whatever it is in terms of the ethnic groups, and there's actually 11 different cuisines in the book. And the goal is, again, to honor the culture, let that individual, show them how they can include these foods in their diabetes meal plan, and still be successful at managing their diabetes. That's the goal. So everything just kind of ties into the culture of the individuals’ culture and honoring that culture.
Shireen: Love it. What are the problems you've seen in healthcare relating to this lack of cultural competency, really, in the, in the field, and how have these problems really changed, if at all, in your time, as a dietitian?
Constance: It's, you know, historically, you bring up cultural competence. And right away, it causes people to recoil. And, you know, and to say, Well, I treat everybody the same. And that's because they don't understand cultural competence. So I can't tell you how many times I've heard that refrain, I treat everyone the same. I don't discriminate. But the problem is, you're treating everybody the same, you're not honoring that individual's culture. And then when they're, as they call it, oftentimes non compliant, they're non compliant, because you're not providing culturally competent care for the individual. So it's cultural competence is important. But I think more than cultural competence is cultural humility. Because when you think of cultural competence, it's kind of academic. And professionals tend to feel well, if I'm culturally competent, you know, I understand everything there is about the culture, that's not getting it. Because we know within cultures, there's that individuality, as well. And so it's more if you're coming from a place of cultural humility, you recognize you don't know everything, you're more apt to listen. And that's part of it. And to understand the individual's historical frame, where they're coming from. quick example, in terms of, you know, we're living through the COVID era now, and the vaccines are available, but how many African Americans are reluctant to taking the vaccine? So cultural humility will allow you to explore, well, what is this all about? And then you look at the history, and you see, you know, Tuskegee, and all those things that have caused African Americans to be very skeptical about, you know, healthcare in general, and specifically, you know, thinking in terms of the vaccine, so if you're coming from that place of cultural humility, you're going to listen, and and work from there, as opposed to just saying, well, you everyone needs a vaccine. Why do you, why aren't you taking it? So again, cultural humility is, is most important.
Shireen: What solutions if any do you have for both the patients and providers when talking about cultural competency?
Constance: I think from the patient perspective, it's, you're not necessarily going to find a healthcare provider that has, that she has the same ethnic background that you do. If you can, that's great, that's a step in the right direction still doesn't necessarily mean that you will get along with that healthcare provider. You know, we have different personalities and so on, but you stand a better chance. But again, if you're seeing someone that you don't share the same cultural background, you may need as a patient to be proactive, and make sure that you're giving them all the information they need, so that they can help you in the best way possible. Oftentimes, patients just don't like to ask a lot of questions, and that's not really helpful, then they're not satisfied. The healthcare provider is not satisfied, because they're not getting, you know, looking at the outcomes that they'd like to see. From the health provider perspective, it's really and if you're not already aware, is to become more aware of cultural competence, what it means. And part of that cultural competence and cultural humility is looking inside at yourself, as an individual, examining what your cultural biases are, we all have biases. And so it's really to look inside that self examination. And that will help you as an individual, as a healthcare provider be a better healthcare provider. But again, those things, it's very difficult for many people to, you know, examine themselves and to think about, you know, the fact that I'll know I'm not biased, it's implicit bias, you know, that's the problem. We're not necessarily aware of it until we really think and think hard, and we all have biases.
Shireen: Mm hmm. And I think the idea is not what I'm taking away from this is not to say I don't have a bias, but to understand exactly what that bias is.
Constance: Exactly, exactly. And where it came from, you know, a lot of our biases are from family interactions, from the time we were little children, different things that we hear different things we pick up, all of that stays with us. And so it's unconscious when we're not aware of it, but it's there. You take the time to explore, you'll recognize and be honest with yourself most important.
Shireen: What are the outcomes when individuals feel their chronic care is not being managed by their health care provider in a way that is culturally relevant to them?
Constance: Oftentimes, they turn back, they turn off, and they won't go back for the, for the appointment, where they're skipping appointments, they're just not engaged. And that certainly is unhelpful to bad individual patient, but it happens so often. I, I tell people all the time, if you have a provider that doesn't, you know, resonate with that provider, they don't resonate with you. There's, you know, you just feel things off, you're not getting from that encounter, what you feel you should be getting, find another provider, you can do that, you have that option. Again, so often people feel well, you know, I can't change doctors, I have to stay with this doctor. No, you do not. You don't have to stay with that doctor. You don't have to stay with that dietician, that diabetes educator, you find someone that you resonate with, because that's when you're going to have your best outcomes. And that's what we're looking for the best outcome for the individual.
Shireen: So what are your recommendations for individuals to ensure that their doctor or dietitian can best help them within their, you know, the patient's own cultural identity? What do you, what recommendations do you have for that?
Constance: Well, again, it's really opening up being open and honest. You know, in my culture, point, example, if, if the dietitian gives you a meal plan, with foods that you have no idea what those foods are, be open and honest. Well, I don't know what this is, I don't eat this in my culture. You know, this is what we eat every day. This is what we eat for holidays. Let them know this is type of meat. This is the type of vegetable that we eat, bring pictures in to show your dietician or diabetes educator, let them know what it is. And if you're keeping a food diary, which generally they will ask you, if it's a dietitian, that's going to help as well because then they get to see and hopefully they will ask questions, if there are things there that they don't understand what those foods are, how they fit, or, you know, is it a carbohydrate? Is it more of a non starchy vegetable, that type of thing, but really, it's that verbal communication, that's where it starts.
Shireen: So with that, are there any resources you recommend for individuals looking for culturally relevant you know, chronic illness management? I know you mentioned the the pyramid which by the way, love, are there other resources that you recommend for individuals
Constance: There's actually other pyramids and old ways PT dot org. They've got great pyramids, that their whole philosophy is looking at the old ways, the traditional heritage Heritage Foods. And so they have an African African heritage pyramid, they have a Latin pyramid, they have an Asian pyramid, the Mediterranean pyramid, and also vegetarian as well. So that's a great resource all on one site. They have recipes, shopping list, you name it, they have it all there. So that's one central location. And I would highly recommend that
Shireen: Perfect. With that Constance, unfortunately, we're toward the end of the episode. At this point, I'd love to ask you that. How can our listeners connect with you and learn more about your work?
Constance: They can connect with me on Instagram or Twitter, it's at eating soulfully. So that's Instagram, Twitter, Facebook will probably catch you there as well. And the website is www dot eating soulfully.com. And softly not just in terms of soul food, but Soulfly from a cultural perspective.
Shireen: Got it. All right. So with that, for all of our listeners, thank you for sticking around to the end of the episode, we do want to announce that Constance’s book, Diabetes Guide to Enjoying Foods of the World. She is doing a giveaway with us here for all of you out there listening to us, head over to our Instagram. We're going to be doing the giveaway on there. So you'll read the rules for the giveaway all of that. Do definitely check this out on our social media on Instagram. We're at Yumlish underscore so we'll see you there after this episode. And so with that constant Thank you so very much for your time it was, it was such a pleasure. I feel like this episode could have been an hour long, there was just so much to talk about. Really appreciate your time here with…
Constance: My pleasure.