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More Sleep Apnea in African Americans

Sleep Apnea is more common in African Americans

More Sleep Apnea in African AmericansA recent study confirmed there is more sleep apnea in African Americans than in Whites. Sleep apnea (also call Obstructive Sleep Apnea / “OSA”) is a condition where people repeatedly stop breathing while they sleep.  The outcome is a very poor sleep cycle and interrupted sleep.  The lost sleep leads to daytime sleepiness, fatigue, poor concentration, poor energy, increased high blood pressure, heart disease, poor digestion and metabolism, and more.

Scientists found significantly increased sleep apnea patterns, more snoring, more obesity, and poor global functioning in African Americans.  The same study also showed decreased formally diagnosed sleep apnea in African Americans despite the disproportional increased occurrence.

African Americans have a poorer sleep quality overall associated with worse insomnia levels and the highest levels for excessive daytime sleepiness. That can cause difficulty at work, trouble watching movies without falling asleep, difficulty with drowsiness while driving, and so on.  With prolonged loss of sleep, high blood pressure results and with that the increased risk for stroke, heart attack, and sudden death from abnormal heart rhythms.

But CPAP fixes this.

Continuous Positive Airway Pressure CPAP therapy reduces daytime sleepiness, improves depression and quality of life, and reduces deaths.  Overall only about half of people with sleep apnea and have a CPAP machine, use it.  African Americans were over 5 times more likely to not use their CPAP machine than White Americans.

Because modern CPAP machines can monitor (and transmit data) about usage and sleep efficiency. they were able to determine that African Americans that wore the CPAP machine average one full hour less of nightly sleep.

Sleep Apnea in African Americans

Like many health problems, African Americans show significant improvement in CPAP usage when they understand how it works . . . and why it works.  A large study found that only about a quarter (26%) of African Americans were using their CPAP machine at 2 weeks compared to almost half  (47%) of Whites.  They also found that adjusting for income, demographics, and other diseases had no impact on its use.

The finding that AAs with more severe OSA were 3 times more likely to use CPAP than those with mild or moderate OSA possibly is due to subjectively perceived effectiveness.  In focus groups, AA patients said that even with the inconveniences of CPAP, they would use the device if they thought of it as helpful.   AAs with mild or moderate conditions may
not perceive that CPAP is useful.

The study also failed to show a correlation between socioeconomic status in African Americans and CPAP usage . . . there was no difference between wealthier and more educated African Americans and poorer less educated African Americas in terms of compliance and usage.  All were poor.

What makes African Americans avoid CPAP therapy?

The only thing that increased use of CPAP therapy in African Americans was having more severe sleep apnea.  The more severe the episodes of not breathing, the higher the use of the CPAP machine.  In mild and moderate sleep apnea, the patients may not trust their doctor enough to take their advice . . . this could explain the disparity.

I find that my patients prefer a Tap Pap CPAP mask that only goes into the nostrils and is held in place by your upper teeth.

Sleep Apnea in African Americans

This “mask” allows more sleeping on your side and is far more comfortable.  Wearing the CPAP at night and getting a restful nights’ sleep is essential for health.  People are shocked to hear that their heart is enlarged and may be barely functioning all due to poor sleep . . . and wear CPAP therapy can potentially reverse it!

Don’t take a good night’s sleep for granted and ask your sleeping partners about snoring and gaps in breathing.  It could literally save your life.

Is Cholesterol Lowering Medicine Bad for You?

Many of my patients have high cholesterol and are on cholesterol lowering medicines called statins like Lipitor (atorvastatin), Zocor (simvastatin), and Crestor (rosuvastatin).  Occasionally they will come in saying some well-meaning friend told them that “cholesterol medicine is bad for them.”  They ask me: “Is cholesterol lowering medicine bad for you?”

My answer is almost always: Absolutely NOT. But where does notion this come from? Where does it say that statins (what we call this group of medicines) are bad for you?

Some of the interest in statins is purely from its widespread use. Over 30 million people are on statins and some recommendations predicts that over 70 million would benefit.   African Americans have significantly higher heart disease, diabetes, and circulation problems so the odds of an African American being recommended to start a statin are high.

What do statins do?

Essentially, statins lower your cholesterol (total cholesterol and bad cholesterol) and by lowering the cholesterol, the “clogging” of the arteries with cholesterol is lessened.

Is Cholesterol Lowering Medicine Bad for You?
Cholesterol in artery

The higher the cholesterol, the more clogging of arteries.  If you clog the arteries in your brain, you get a stroke.  Clog the arteries in your heart, you have a heart attack. Clog the arteries in your legs, you get poor circulation to your feet which could cause infections that could lead to amputation.  By lowering the amount of cholesterol, you lower the chance of clogging . . . anywhere.

Is Cholesterol Lowering Medicine ( statins ) Bad for You?
By BruceBlaus – Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=28761812

Scientists have also found that lowering a high cholesterol also reverses clogging that may have already happened. Mainly, the HDL “GOOD” cholesterol serves this artery-cleaning purpose and by lowering the overall burden of clogged arteries, it can “catch up” with clearing the narrow passages that could lead to total blockage.

What should my Lipid levels be?

When doctors measure your cholesterol (Lipid Panel), they look for a total cholesterol less than 200 and a LDL or “bad” cholesterol of less than 120.  In people with existing diagnoses of diabetes, circulation problems, heart attack, stroke, or a family history of early heart attacks or strokes, we shoot for an even lower LDL that is less than 100 . . . or even lower!

Is Cholesterol Lowering Medicine ( statins ) Bad for You?
Cholesterol in artery

Large studies of numerous patients have shown substantial benefit of cholesterol lowering medicines with significantly decreased heart attacks, strokes, and other circulation related medical problems.

Statins help people with kidney problems too?

Another study showed significant benefit of “statins” to people with kidney problems, and it helped many avoid dialysis.  Kidney problems are very common in the Black community so anything that improves kidney outcomes can be a big help.

African Americans have “better” cholesterol levels.

Curiously, in general African Americans tend to have “better” cholesterol numbers than White Americans.

With disproportionally higher heart disease in African Americans, researchers have wondered how these better lipid profiles coincide with the documented worse outcomes.  The variability seen based on race is yet another curiosity given doctors’ accepted association of bad cholesterol levels equaling worse health, and good levels leading to improved health.

“It is clear that there is further complexity in this relationship among African Americans, who have, on average, a more favorable lipid profile compared to European Americans, yet they do not experience an associated decrease in diseases that are expected to be responsive to reduction in this key risk factor”

Years earlier, scientists attributed elevated Lipoprotein Lipase (LPL) levels, the enzyme responsible for breaking down fat, and lower levels of other components, as principally responsible for the improved cholesterol picture in African Americans.  Others have confirmed that the better lipid profiles in African Americans is not due to diet and lifestyle considerations noting worse fat content in foods and less exercise in African American populations compared to White Americans.

Attempts to drill down to why good lipids do not lead to better outcomes in African Americans have continued to baffle doctors, but the assumption is the impact of uncontrolled high blood pressure, obesity, and higher diabetes rates overwhelm the beneficial impact of the improved cholesterol levels. It is also possible that African Americans patients should start cholesterol lowering medications at different (lower) thresholds.

Less Prescribed & Less Taken

Is Cholesterol Lowering Medicine Bad for You?Unfortunately, African Americans have a poor track record of taking cholesterol lowering medicines when prescribed after a stroke, heart attack, or most other reasons for starting the medication.  And doctors are less likely to prescribe statins in African Americans across the board.  The result is a deadly combination of a doctor that is less likely to give a medication to a patient . . . and a patient that is less likely to take it.  This inconsistency speaks to the trust issues African Americans have with doctors.

Overall statin use and lowering cholesterol saves lives.  Dr. Carol Watson, a Black cardiologist said it best in her article “Let the evidence speak”

“These trials thus confirm that significant benefits can occur from statin use in African Americans. Despite this, however, statins remain underutilized in the African American population, thus those that might stand to benefit most, are least likely to receive these life saving medications.”

So the question: Is cholesterol lowering medicine bad for you?

The answer for African Americans is crystal clear: lower cholesterol leads to fewer heart attacks, fewer strokes, better kidney function, better circulation, fewer amputations, and longer lives.  Don’t get it twisted . . .

 

 

 

 

 

Sleep Differences in African Americans

Sleep Differences in African Americans

There are racial disparities in sleep with African Americans having a shorter sleep duration, a harder time falling asleep, and a tendency to wake up more easily after falling asleep.  There is also a decreased ability to phase shift African Americans sleep cycles when exposed to jet-lag and shift work situations, and the total duration of the cycle was smaller, a study by Eastman and colleagues at Rush University Medical Center found.  Sleep differences in African Americans cause a good deal of suffering.

These researchers surmised that the differences in sleep architecture grew from thousands of years of genetic modifications resulting from, for African Americans, exposure to year-around consistent 12-hour light-dark cycles, versus whites coming for northern regions with significant variability in the day length, dawn, and dusk times.

For example, in Ohio the day length changes from as short as eight hours in the winter to as long as sixteen hours in the summer.  Ohioans are constantly adjusting to time shifts. With thousands of years of exposure to time changes, Ohioans would develop an increased ability to tolerate the changes.  Closer to the equator (like western Africa), the time doesn’t shift nearly as much. The days are 12 hours long all year and there is no need to have an ability to tolerate time shifts.

Therefore “the shifting circadian periods in non-equatorial regions left a genetically modified increased tolerance for variable light-dark productivity hours.” Put simply, people who genetically come from regions near the equator are less able to adjust to time shifts, daylight savings times, jet lag, or anything else that causes a shift in sunrise and sunset.

Sleep Differences in African Americans

Everyone has a “circadian period” which is an innate sleep wake cycle.  We also have an ability to shift that cycle somewhat.  People whose genes come from northern areas of the earth (Europe, Canada, etc.) have an ability to tolerate shifts in time whereas those of us from Caribbean, African, South American regions have much more difficulty adjusting.

In another study, researchers exposed African Americans and White Americans to a 9 hour delayed light/dark sleep/wake and meal schedule, similar to traveling from Chicago to Japan.  Essentially what would take 10 days for full adjustment in White Americans, would take 15 days for African Americans to adjust.

Swing shifts are bad for your health!

The need to adjust to time zone changes is only occasional in most people, and there are methods to make this adjustment smoother, but shift work seen in factory workers, police and fireman, healthcare staff, and other positions place an additional health burden on these workers. Shift working was found to add an additional 40 percent risk of heart disease as compared to non-shift work.

There is also increased weight gain as a result of decreased glucose tolerance from meals consumed in the night.  When eating at night, your body tends to store more of the calories rather than burn them.  Therefore night workers (who have to eat sometimes) tend to be more overweight.  Researchers have also found that shifts workers have worse cholesterol results.

All of this contributes to increased health problems and premature death.

Shift work is more prevalent in the African American community and is also associated with worse health outcomes including:

By incorporating a planned exercise schedule and diet, emphasizing the dangers of smoking (particularly in shift workers), and providing better insight into the social impact of these schedules, can help many shift workers.  And the few individuals that continually fail to adjust to shift work may feel better knowing there is a simple explanation for their troubles.

It’s in their genes.

Low Vitamin D in African Americans

Low Vitamin D in African Americans

Vitamin D is acquired through diet and skin exposure to ultraviolet B light. The skin’s production of vitamin D is determined by length of exposure, latitude, season, and degree of skin pigmentation.  African Americans produce less vitamin D than do White Americans in response to equal levels of sun exposure, and have dramatically lower vitamin D concentrations with some studies indicating up to 96 percent of the African American population as low.  Yet both races tend to have similar capacities to absorb vitamin D and to produce vitamin D when exposed to light. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030388/)

Low Vitamin D in African Americans

Overall when measured, African Americans tend to have lower vitamin D3 levels and are very frequently labeled “vitamin D deficient”, but also have confirmed stronger bones and fewer fractures. Powe and colleagues at the Brigham and Woman’s Hospital in Cambridge Massachusetts looked specifically at this paradox and looked at vitamin D3 and vitamin D-binding proteins.

“Lower levels of vitamin D–binding protein in blacks appear to result in levels of bioavailable 25-hydroxyvitamin D that are equivalent to those in whites. These data . . . suggest that low total 25-hydroxyvitamin D levels do not uniformly indicate vitamin D deficiency and call into question routine supplementation in persons with low levels of both total 25-hydroxyvitamin D and vitamin D– binding protein who lack other traditional manifestations of this condition.”

The result of these studies suggest that having both a low vitamin D level and a low vitamin D-binding protein in African Americans actually causes a ‘re-set’ of true deficiency.  With both being low, it is vitamin D’s bioavailability that drives calcium levels, parathyroid hormone levels, and true bone risk.

Dr. Powe concluded:

“Vitamin D deficiency is certainly present in persons with very low levels of total 25-hydroxyvitamin D accompanied by hyperparathyroidism, hypocalcemia, or low BMD (bone mass density). However, community-dwelling blacks with total 25-hydroxyvitamin D levels below the threshold used to define vitamin D deficiency typically lack these accompanying characteristic alterations. The high prevalence among blacks of a polymorphism in the vitamin D–binding protein gene that is associated with low levels of vitamin D–binding protein results in levels of bioavailable 25-hydroxyvitamin D that are similar to those in whites, despite lower levels of total 25-hydroxyvitamin D. Alterations in vitamin D–binding protein levels may therefore be responsible for observed racial differences in total 25-hydroxyvitamin D levels and manifestations of vitamin D deficiency.”

So all of this would suggest that African Americans don’t need Vitamin D replacement or supplements.

Do we need additional Vitamin D or not??

Ken Batai and colleaguesLow Vitamin D in African Americans at the University of Arizona, after studying over two thousand people, found a direct benefit to Vitamin D supplements to preventing prostate cancer in African American men and a pro-carcinogenic effect (inducing effect) of calcium supplementation on the prostate. These findings were strongest in African Americans.

“Calcium and vitamin D are important nutrients, and they may have preventive effects against many health conditions. Although toxicity from high vitamin D supplementation may be low, high calcium intake is associated with increased prostate cancer risk as well as risk of cardiovascular disease and kidney stones. High calcium consumption might be harmful and for prostate cancer prevention, high dose calcium supplementation and fortification should be avoided, especially among AA (African American) men.”

High calcium intake in African American men may actually increase the risk for prostate cancer, but taking vitamin D can reduce the risk.

Diet Differences in African Americans

Diet Differences in African Americans

There are a number of important diet differences in African Americans that need to be considered prior to offering advice regarding improvements or adjustments.  To tell someone to “eat better” without first knowing their current diet is a waste of everyone’s time.

Some of the basic foundations of African Americans’ diet stem from slavery days, but there are also more recent adaptations that have slowly weaved into the fabric of the African American diet.   Some of the changes were economic and others more convenience and culture-related.  To sum up the African American diet by only referring to slave influences is to ignore one and a half centuries of added impacts that made the African American diet what it is today.   Food availability, storage, financial independence, health literacy, and a sense of history and heritage all contribute to the ever changing components of the widening African American diet.

More Cultures Adding Diet Changes

With the ever changing make-up of African Americans, their diet is equally changing. More Africans, Caribbeans, and mixed races folds in a number of cultural nuances that need to be considered.  Even within the African American community, the diets vary greatly. Some sub-cultures eat more rice while others prefer pasta.  Some avoid pork for religious reasons, while other avoid beef due to poor digestion or its increasing cost.

These considerations aside, the basics of the African American diet mirror an American diet.  The “average” meal will have meat, starch, and vegetables in varying proportions.

Adding Meat to Your Vegetables??

African Americans more frequently will have their vegetables cooked rather than fresh.  Because of the scarcity of meat as a main course in slavery days, seasoning these cooked vegetable dishes with fatty cuts of low preference meat (whether smoked or not) quickly became a mainstay in the African American diet.  Having the lean cuts reserved exclusively for the more affluent, African Americans became accustomed to other cuts of meat (ham hocks, neck bones, and ox tails, etc.).

Now that the scarcity of meat is much less of a logistical problem, the ‘habit’ or custom of adding meats to vegetables is now merely a standard way to cook them. String beans, collard/mustard/turnip greens almost always have a smoked (and/or salted) cut of meat in the pot.  Because of a growing aversion to pork products in some circles, a significant number of African Americans use smoked turkey to season cooked vegetables and beans.

African Americas Do Eat More Chicken

The breakdown in terms of specific meats preferred by African Americans show a predominance of chicken and turkey, as well as relatively more fish and pork, but less beef than white or Hispanic American diets.

Diet Differences in African Americans

Overall, African Americans eat less grains, fewer eggs, less vegetables, and much less milk, but they consume significantly more meat and fruits.  By increasing the amount of vegetables, particularly fresh uncooked in the form of salads, more nutritional balance can be brought to the African American diet fairly easily. The increased consumption of fish and poultry (both chicken and turkey) already represents a beneficial existing tradition.

Diet Differences in African Americans

Although African Americans eat relatively fewer vegetables, there are also distinct differences within this category with an increased consumption of fresh green beans, fresh cabbage, and fresh greens when compared with other vegetables.

African Americans Prepare More Meals “From Scratch”

African Americans prepare more meals “from scratch” when compared to majority populations.  This diet difference in African American home cooking leads to comparatively more purchases of cooking items including spices, seasonings, oils, and preparation items including baking powder, flour, extracts, and sugars in multiple forms.

Diet Differences in African AmericansThe more “home cooking” done in African American kitchens leads to less consumption of pre-processed or ready-to-eat foods which is considerably beneficial.  Conventionally, when people think of processed and ready-to-eat foods, they generally equate them with poor nutritional quality and lower socio-economic status.  Poti, Mendez, and colleagues looked at the nutritional value of “processed foods” and found they have “higher saturated fat, sugar, and sodium content” when compared to lesser processed foods.  Because of the higher proportion of African Americans that are poor, many assumed that they too consume more ready-to-eat foods, but studies reveal that, in fact, African Americans buy less overall ready-to-eat and/or highly processed foods when compared to European Americans.

More Sugary Sweetened Drinks

By PepsiCo, designed by Edward F. Boyd – Downloaded from https://www.usatoday.com/money/books/reviews/2007-01-22-pepsi-book_x.htm?csp=34, Fair use, https://en.wikipedia.org/w/index.php?curid=11103395

One glaring exception in the purchasing of pre-processed foods was African Americans’ tendency to purchase a much higher proportion of pre-processed sugary beverages when compared to white Americans, and a much lower volume of milk and dairy purchases.  Marketing campaigns targeting African Americans like the one to the right from the 1940’s is just one of many that drove up the consumption of surgery beverages.

Other exceptions include a significantly higher consumption of bacon and sausages.  Finally, there was also an increased purchasing of processed sweeteners including sugar, syrups, jams and jellies in African American consumers.

While there is far more diet differences in African Americans to cover, the best way to advise a patient on their diet is to first know their specific diet . . . don’t generalize . . . interview.  Find out what, exactly, they eat, and then devise an alternative plan with suitable substitutions.  Very few people will be able to completely change their diet, and providers should not expect this because it is unrealistic.  But we should be able to give helpful advise based on a detailed interview.

Check out this great video on cooking oils and the dangers of reusing oils !!

Salt Sensitivity and Your Health

Salt Sensitivity and Your Health

Salt sensitivity is defined as significant changes in blood pressure in response to salt in a diet.  75 percent of all African American patients with high blood pressure are salt sensitive compared to 50 percent across all races with hypertension.  The vast majority of African American patients with hypertension are salt sensitive and their salt use needs to be discussed and investigated.

Studies have consistently found salt sensitivity increases with age, and is more common in people that are overweight, have a history of “heart problems,” and have serious kidney problems . . . all of which are increased in African Americans.

Studies have additionally found that salt-sensitivity alone is associated with increased death, even in salt-sensitive people who don’t have high blood pressure.

Many foods found in African American homes are high in salt including:

  • Canned Soup
  • Vegetable Juices
  • Bouillon cubes
  • Gravies
  • Soy Sauce
  • Olives
  • Pickles
  • Canned Vegetables
  • Barbecue Sauce
  • Ketchup & Mustard
  • Ready-to-Eat Breakfast Cereal
  • Bread & Rolls
  • Pancakes & Waffles
  • Pizza
  • Processed Nuts
  • Chinese Restaurant Fast Food
  • Spaghetti Sause
  • Cold Cuts
  • Cheese
  • Bacon
  • Hot Dogs & Sausages
  • Salad Dressings & Marinades
  • Smoked meats
  • Ham
  • Raw Chicken Breasts (they are frequently injected with a high sodium flavoring solution)
  • Store-bought Baked Goods

Researchers have also found that being overweight make salt-sensitivity worse.

The increased salt sensitivity is also made worse by having a low potassium.  A study from Columbia University in New York showed “salt sensitivity in Blacks may be worsened by dietary deficiencies in potassium or a need for increased potassium requirements compared with whites.”

What can I do to fix this?

A modest reduction in salt intake (half normal consumption: 5 to 6 grams) for a month has been shown to make significant and sustained reductions in blood pressure.  In fact, African Americans showed the most pronounced blood pressure reductions in response to salt restriction with a drop of 8 mm Hg systolic (the first number in a blood pressure reading) over 4 mm Hg diastolic (the second number in a blood pressure reading) averaged across as array of studies.  Imagine what a bigger salt restriction would do?

The lower blood pressure readings in African Americans after dietary salt restriction is significant and can be maintained over time. Try these Lays Potato Chips with half the salt rather than the regular.

Take the time to look for lower sodium alternatives for seasonings and use other seasonings like garlic power, onion powder, and cayenne & black peppers. 

If you are hesitant to start a medication to bring down your mildly elevated blood pressure, spend some time looking at how much salt is in your diet, and then try to decrease this by half.

Atrial Fibrillation in African Americans

Atrial Fibrillation in African Americans

Atrial fibrillation in African Americans, also called “A Fib”, effects one in nine before the age of 80 and is the most prevalent arrhythmia in the US and is associated with significant bad outcomes that include stroke, heart failure, and increased death.  Surprisingly, studies also confirm a decreased atrial fibrillation incidence in African Americans (41% lower risk of being diagnosed than European Americans) but a greatly increased occurrence of stroke and sudden death in African Americans with atrial fibrillation. So compared to whites, African Americans are less likely to get atrial fibrillation, more commonly called “A Fib”, but if they get it, are more likely to have complications. This is just one of many “important differences” that exist in the care of African Americans.

“Racial Paradox?”

Some have suggested that the decreased incidence of atrial fibrillation in African Americans is actually under-diagnosis, but others have called it a “racial paradox” where despite atrial fibrillation being a result of increased high blood pressure, diabetes, over-weight, heart failure, and heart attacks, all of which are higher in African Americans, the incidence of atrial fibrillation is surprisingly lower.

Atrial Fibrillation In African AmericansAfrican Americans were also less likely to be aware they have A Fib, and much less likely to be treated with blood thinners like warfarin (Coumadin, Jantoven) that prevent the heart attacks and strokes that having A Fib causes.   Even more surprising was this decreased use of warfarin in African Americans was regardless of whether the person had insurance or made more money.   It is truly stunning that a medication to prevent strokes is used LESS in a group of people who are prone to have MORE strokes and this was found in a study by Meschia and colleagues who looked at over 30,000 patients:

“We also found that among those who were aware that they had AF (atrial fibrillation) and who had confirmation of the diagnosis of AF, (African Americans) were about one quarter as likely to be treated with warfarin as whites. In striking contrast, risk of stroke as stratified by the CHADS2 score was not a predictor of warfarin use. The fact that risk of future stroke did not significantly alter the likelihood of warfarin use would seem to reflect an evidence-practice gap.”

A Higher Risk for Death

The risk for death in the presence of atrial fibrillation (A Fib) in the first four months after diagnosis was very high with heart disease, heart failure and stroke accounting for the most of the deaths, the study also found.  The risk for hospitalization in African Americans from atrial fibrillation doubled as did the risk for recurrent stroke, and related dementia from repeated “little strokes” (multi-infarct dementia).

What is the Best Medication for A Fib?

So the medical evidence would suggest that African Americans should receive MORE treatment with blood thinning medications like warfarin and other newer medications like dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban (Eliquis) . . . and in fact they receive LESS.

Some of the complaints about warfarin is the need to have relatively frequent blood tests to confirm the “thin-ness” of your blood.  These tests called “PT / INR” shoots for an INR between 2.0 and 3.0.  Less than 2.0 means your blood is “too thick” and more than 3.0 means it is “too thin.”  The newer medications to replace warfarin do not need blood tests.

Keep in mind that African Americans have an increased risk for complications from bleeding on some of these newer medications like dabigatran (Pradaxa), rivaroxaban (Xarelto), or apixaban (Eliquis), so although it can be more inconvenient with frequent blood draws, warfarin may be best for now until more information is available. There is also significant evidence that there are warfarin dosing differences between European Americans and African Americans that need to be anticipated and considered.

What You Need to Know . . .

While this topic may seem a little confusing, here are the main points:

  1. If you have atrial fibrillation (A Fib), you are at a much greater risk for stroke or another major event.
  2. Being on a blood thinner, like warfarin, can significantly decrease your risk for stroke (or another event).
  3. Being on a blood thinner increases your risk for bleeding . . . but not as much as it decreases your risk for stroke. So while you risk a bleed, your risk for stroke is much higher.
  4. The newer “blood thinners” do not require as many lab tests as warfarin, but they also may not be as safe in African Americans (this is controversial and not clear).

Here is a video on anticoagulation and warfarin:

 

Kidney Disease in African Americans

Kidney Disease in African AmericansKidney disease in African Americans

Kidney disease in African Americans is one the most dramatically different occurrences of a disease, and results in significant suffering and death.  Generally kidney disease is the result of diabetes and high blood pressure, and given the increased number of both of these in African Americans, there is a six to twelve-fold increased occurrence compared to whites.  Additionally, there is a 17-fold greater rate of high blood pressure as a cause of kidney failure in African Americans.  If you have high blood pressure or diabetes, or both, your risk for kidney failure resulting in needing dialysis is MUCH higher if you are African American.
Having diabetes and high blood pressure that is controlled on medications almost erases this increased risk. This is why it is critical that if you have high blood pressure, you should take medication to bring it down. If you have diabetes, you should make sure your blood sugars are controlled because if you don’t, your risk for needing dialysis is very high.
Kidney disease in African Americans

Risk for Requiring Dialysis is High

While African Americans are 13 percent of the general population, we make up 35 percent of all patients on chronic dialysis.  Diabetes as the leading cause of kidney failure and high blood pressure is the second most common cause.
Not having medical insurance or access to medical facilities and the increased number of people with high blood pressure contribute greatly to kidney disease in African Americans.  Having high blood pressure but being on the wrong medications can contribute as well.

Well designed studies have failed to fully account for the excess proportion of kidney disease in Blacks.  Anatomically, despite equivalent age, blood pressure, and other factors, African Americans tend to have reduced kidney blood flow. Despite similar dietary salt intake, the kidney’s processing of bodily fluids are somewhat different in African Americans compared to whites.  Reducing salt in your diet can greatly improve health.

A Possible Genetic Cause?

The Tsetse Fly transmits the African Sleeping Sickness. By International Atomic Energy Agency

Some of the increased risk for kidney disease in African Americans is attributed to a genetic variant (APOL1) found in more than 30% of African Americans and largely absent in white Americans.  It is thought that this gene offered protection from African Sleeping Sickness (a frequently deadly disease known in medical circles as African trypanosomiasis) that was carried by the Tsetse fly. Basically, having this gene gave protection from the African Sleeping Sickness and was beneficial in African regions where the tsetse fly lived.
Scientists believe that the increased risk for kidney disease seen in African Americans is equal to the increased occurrence of the same gene that offered protection from the deadly African Sleeping Sickness.

Obesity Can Lead to Kidney Problems Too

In addition to these genetic differences, researchers also suspect that increased obesity in African Americans is driving up kidney disease.  They found that as your BMI (Body Mass Index is calculated based on your weight and height) gets higher, the risk for kidney problems increases.

With all of the kidney disease in the African American community, there is one last bit of curious news.  African Americans have a better survival rate on dialysis than white Americans.  This paradox of improved survival in African Americans after initiation of dialysis has puzzled researchers.  Researchers at the Wake Forest School of Medicine suggest that the improved survival may also be due to the very gene that causes the problem . . . the APOL1 gene.  In this case the APOL1 gene gives protection against hardening of the arteries while on dialysis.

Kidney Disease in African AmericansHere’s What You Need To Do . . .

Kidney disease in African Americans can be a confusing topic to understand and there is a lot to consider.  The most important points are:

  1. If you have high blood pressure, take your medicine and watch your salt intake so that your pressure stays normal. That will allow your kidneys to stay normal.
  2. If you have diabetes, take your medicine and watch your diet so that your blood sugars stay normal.
  3. Watch your weight because the bigger you are, the higher your chance for kidney disease.


Lactose Intolerance in African Americans

Lactose Intolerance in African Americans

Lactose Intolerance in African AmericansThree out of four African Americans are lactose intolerant.  Lactose intolerance means that if you drink milk, or eat yogurt, or have cheese in large amounts, you will get bloated and later have loose gassy stool.  If you are not near a toilet (of your choice), this can be an embarrassing problem.  The stomach’s reaction to not being able to digest lactose (a sugar in dairy products) is to simply flush it through its system.   For a majority, lactose intolerance in African Americans simply leads to the avoidance of milk and milk-related products like yogurt and cheeses.

The significantly decreased intake of milk and dairy products in the African American diet presents a potential increased health risk as “moderate evidence shows that the intake of milk and milk products is associated with a reduced risk of cardiovascular disease, type 2 diabetes, and lower blood pressure in adults”.  Constance Brown-Riggs in her article “Nutrition and Health Disparities: The role of Dairy in Improving Minority Health Outcomes” has recommendations for African Americans to consume three to four servings of low-fat dairy daily.

If only one serving of dairy causes stomach upset and loose stool . . . what will three servings cause?  That question is what many African Americans ask themselves, and the answer has been very clear.  African Americans drink significantly less milk and eat substantially less cheese and yogurt when compared to the rest of the American population.

The decreased dairy consumption leads to decreased intake of essential nutrients that are found in milk and cheeses. Studies show that African Americans’ intake of the required nutrients calcium, vitamin D, and potassium were all lower than white and Hispanic Americans.  And it has been well known in medical circles that African Americans have significantly lower vitamin D levels in their blood.

A Genetic Link for Lactose Intolerance??

Lactose Intolerance in African AmericansThe choice for African Americans to avoid milk and related products is not voluntary.  Lactose intolerance in African Americans may be due to a genetic design.  Research has shown that the proportion of people that are lactose intolerant can be tied to their region of genetic origin.  Put simply, regions where dairy herds could be raised safely and efficiently produced people that could digest lactose. Harsher climates in African and Asia restricted the availability of milk, and produced people with much more lactose intolerance, a study at Cornell University found.  Researchers found a wide range of lactose intolerances with as low as 2 percent of the population of Denmark descendants as unable to have dairy products compared to nearly 100 percent of the people with Zambian African origin.  Their survey “found that lactose intolerance decreases with increasing latitude and increases with rising temperature”.

Lactose Intolerance in African Americans
Red = Lactose Intolerant, Green = Lactose Tolerant, Brown = 50/50

Newer information has revealed that maybe there are not as many purely lactose intolerant African Americans as previously thought.  Nutritionists have advised that adding milk to a larger meal helps with successful digestion.  Some find that having smaller amounts of dairy over time improves digestion and decreases symptoms.

Lactose Intolerance Solutions

Lactose Intolerance in African AmericansOthers advise to simply take a lactose enzyme supplement (Lactaid, for example), and the problem is solved because milk, yogurt, or cheese is then easily broken down normally and naturally . . . while the dairy products again provide improved nutrient supplementation.

Other ways of replacing the missing nutrients resulting from low dairy consumption has become fairly easy due to multiple milk equivalents including soy, almond, coconut, and other ‘milks’ that can be used as part of a healthy breakfast.  All have been ‘fortified’ with calcium and vitamin D if needed.  Oatmeal and/or whole grain cereals with milk equivalents can make a fast and nutritionally efficient meal.

A ‘new’ problem is that African Americans consistently eat fewer breakfasts, and therefore the “opportunity” to have milk, yogurt, cheese, or milk equivalents has substantially decreased.

Making a point of having the required serving of calcium and vitamin D in the form of a dairy (or dairy-like) product is the next nutritional priority of African Americans seeking a long and healthy life.

 

Strokes in African Americans

 Strokes in African Americans

Most strokes in African Americans occur due to high blood pressure and a much higher number of African Americans have uncontrolled blood pressure.  A quarter of all strokes occur in the presence of atrial fibrillation (a fib) and while representing 13 percent of the US population, African Americans experience almost twice that percentage of all strokes (26%).

Strokes are Worse in Blacks

And when a stroke occurs, African Americans have them earlier in life and present with more severe and disabling conditions.    The “Cardiovascular Quality and Outcomes” group concluded that “compared with other race/ethnicity groups, (African American) patients were less likely to receive IV tissue-type plasminogen activator <3 hours, early antithrombotics, antithrombotics at discharge, and lipid-lowering medication prescribed at discharge,” a study looking at over 200,000 patients showed.

Not surprisingly, with these prescriptive deficiencies in play, data analysis also showed a persistently increased re-hospitalization rate in African Americans at both 30 days and one year for all causes.  African Americans also have a 2.4 times higher rate of recurrent strokes than white Americans, and the highest death rate of any racial group.
Stroke patients overseen by neurologists were almost 4 times more likely to receive IV clot dissolving medicine than those seen by non-neurologists for all races and ethnicities (study from the Baylor College of Medicine ), but unfortunately African Americans were half as likely as whites to be seen by a neurologist when presenting with a stroke.

Aspirin to reduce Strokes in African Americans

Aspirin use is decreased among African Americans as compared to whites while the indications for aspirin use are actually higher in African Americans. More African Americans should be taking aspirin because it reduces the risk of stroke, heart disease, and colon cancer. And this was proven at the low dose of 81 mg.  The risk for gastrointestinal bleed is much lower than the risk of stroke, heart attack, etc.
African Americans over age 40 should be taking aspirin to help with the increased incidence of colon cancer, heart disease, and strokes.

Overall, prevention experts (USPSTF ) recommend referring adults who have stroke risk factors and are obese to intense behavioral counseling to promote a healthy diet and more physical activity. That means going to your doctor and having a detailed conversation about what you do . . . and what you eat.  For example, by decreasing your intake of salt and fried foods, lowering the blood pressure and getting proper exercise, strokes in African Americans can greatly decrease.

Take a look at this video that explains why you need to start your medicine, keep taking it, and come in to make sure it is doing what it’s supposed to be doing. Take care.