High Creatine Kinase in Blacks

Elevated “CK” or Creatine Kinase Level?  In African Americans, This May NOT be a Problem

Posted on by Dr Greg Hall

Creatine kinase (CK) is a chemical/enzyme that exists in human muscle cells, heart cells, and also small amounts can be found in brain cells. Body cells can release creatine kinase (CK) into your bloodstream when they’re damaged or related to normal cell recycling. Many Black men have been told by their doctors they have a substantially “elevated CK level.”   Most are perplexed by the high readings and unfortunately, many medical providers are at a loss when asked to explain the problem. 

What many medical providers don’t know is African Americans tend to have significantly higher baseline CK levels. Essentially, Black Americans can have dramatically higher CK blood levels with Black men having the highest levels.

Research Confirmed: Higher CK in Blacks

A large study done at Vanderbilt University revealed consistently higher CK levels in African Americans with substantially even higher levels in Black men.  Because CK is generally released from the muscle, many believed that the increased muscle mass seen in African American men explained the difference, but after further analysis, the muscle mass explanation didn’t explain the significant difference. 

Normally when you see elevated creatine kinase (CK) levels in the blood, it can be associated with strenuous exercise, excessive alcohol use, some medications, toxins/poisons, and particularly after a heart attack. CK levels are frequently drawn on patients when they go to the emergency department with chest pain presumed to be heart-related.  An elevated CK level in these situations can suggest heart muscle damage that can lead to a heart attack.

Some have seen the CK level be elevated in people taking statin medications. Others find that the elevated CK levels were associated with undiagnosed rheumatologic disorders (called idiopathic inflammatory myopathy).

Higher CK Normal Range in Black Men & Women

The important message is the significantly higher “normal range” for both African American men and women. The table below from research at the University of Pittsburg suggests these different parameters.  Essentially, if an African American man has no muscle aches and pains and a normal physical exam, their CK level can be as high as 1200 IU/L, which is twice as high as a White man.

Higher CK in Blacks
Moghadam-Kia S, Oddis CV, Aggarwal R. Approach to asymptomatic creatine kinase elevation. Cleve Clin J Med. 2016 Jan;83(1):37-42

In all humans, the creatinine kinase (CK) levels decrease with age and this decrease is likely related to loss of muscle mass consistent with aging.

The graph below shows the dramatically different range and distribution of CK levels by race/ethnicity with Black men and women being substantially higher than all other groups.

Higher CK in Blacks
George, Michael D. MDa,*; McGill, Neilia-Kay MDa; Baker, Joshua F. MD, MSCEa,b,c. Creatine kinase in the U.S. population: Impact of demographics, comorbidities, and body composition on the normal range. Medicine: August 2016 – Volume 95 – Issue 33 – p e4344 doi: 10.1097/MD.0000000000004344

The authors reported the following:

“The most notable factor that contributed to higher CK levels was Black race. Previous studies suggested that racial differences in CK may not be due to differences in height, weight, or body mass, but did not evaluate other body composition measures. This study evaluating BMI, waist circumference, and arm circumference, provides additional evidence that racial differences are not explained by differences in muscle mass. Higher CK levels among black individuals might instead be due to differential production or clearance of CK.”

George, Michael D. MDa,*; McGill, Neilia-Kay MDa; Baker, Joshua F. MD, MSCEa,b,c. Creatine kinase in the U.S. population: Impact of demographics, comorbidities, and body composition on the normal range. Medicine: August 2016 – Volume 95 – Issue 33 – p e4344 doi: 10.1097/MD.0000000000004344

High Creatine Kinase in Blacks

Essentially the authors suggest a fundamental difference in either the production of creatinine kinase or its destruction in African Americans . . . and the difference is significant!

The differences in creatinine kinase levels in African Americans have been known for over 40 years, but adjustments in the “normal range” used by laboratories have not been implemented.   When these so called lab “abnormalities” are seen, medical providers begin a range of investigations as well as suggest interventions to patients that imply that something is wrong or abnormal when in reality they simply seeing a normal variant.

Appropriate knowledge of these important differences in the care of African Americans can lead to improved care and much less worry on the part of the patient and provider.

African Americans Need to Walk More! More Daily Steps Tied to Better Overall Health

Posted on by Dr Greg Hall

Regular exercise has always been associated with better health. Still, with newer smartphones, watches, and “wearables,” we can now measure more accurately how much walking and exercise we get in a day. Unfortunately, we in the Black community do not get near enough exercise or even simple walking.

A study done at Rutgers University showed that the percentage of Blacks achieving physical activity guidelines was low and continued to decrease further with age. The highest amount of exercise was seen in the youngest in our community and started to decrease steadily from age 15 to age 65 and beyond.

Single Black Men Exercise the Most

Black men of all ages exercised significantly more than Black women. The researchers attributed this difference in gender to several factors, including neighborhood safety, child-rearing responsibilities, concerns about personal appearance, and other cultural dynamics.  

Black men that were “never married” exercised more than “married men.” In contrast, women who were “married/living with a partner” exercised more than “never married” and “no longer married” women. Go figure that out!

Employment is Good for Your Health

Unsurprisingly, “employed” people were more physically active across all demographics. Arising in the morning with a purpose and the activities inherent in being employed is good for your health. Walking is a big part of being employed with steps being counted associated with parking, job duties, breaks, socialization, and more while at work.

Education & Money is Good for Your Health

Also not surprising was the data that showed higher education and income are associated with more exercise and better health.

Increasing Your Daily Steps is a Great Start!

A study published this week showed that getting 9800 steps in a day was associated with a dramatically lower risk for dementia and getting as low as 3800 steps still showed a 25% reduction in risk. Most smartphones have a “steps counter” that is free and already measuring your steps (whether you know it or not). Take a look and see where you stand (or step).

Let’s Get Started!

It’s time to start benefiting from health research and incorporating more exercise in the form of walking into our daily routine. Married men need to get off of the couch and represent! Black women of all ages and social engagement need to know that their mental and physical health depends on their activity level . . . and there should be no excuses.

Low Potassium and African Americans

Posted on by Dr Greg Hall

Potassium doesn’t get enough credit as a very beneficial nutrient to good health and potassium deficiency (low potassium) has been directly related to high blood pressure, heart problems, diabetes, muscle weakness, fatigue and much more.

Multiple studies have confirmed that African Americans are much more likely to lack potassium and low potassium can be linked to higher blood pressures, diabetes and a number of other health problems that impact the Black community.

As much as high sodium (“salt”) can be a problem, low potassium can also be a problem . . . a big problem. Potassium is an essential mineral that has many functions in your body. For example, it is central to muscle contraction, it maintains healthy nerve function, and regulates water balance in your body. With all of those essential functions, it is a wonder that so many people, including African Americans are low in potassium. 

Curiously, low potassium has also been linked as a diabetes risk in African Americans. A large study at John Hopkins found that African Americans with lower potassium levels had a higher risk for diabetes.  The author said “”we now know lower serum potassium is an independent risk factor for diabetes and that African-Americans have, on average, lower potassium levels than whites.” 

Previous studies have also found that lower potassium was directly linked to higher blood sugar levels. The higher the blood sugar, the higher the risk for diabetes . . . and high blood pressure. Yet another study found that taking a potassium supplement directly lowered the blood pressure of Black patients. Lowering your blood pressure reduces your risk of heart disease and stroke.

The CDC says that increasing your potassium intake can reduce your risk of heart disease and stroke by lowering blood pressure. Conversely, consuming too little potassium (and too much sodium) can increase your risk of heart disease and stroke.

Foods that are rich in potassium include beans, leafy green vegetables (greens, spinach, etc.), potatoes, sweet potatoes, yams, squash, beets, broccoli, and bananas.

Low Potassium, African Americans

It is important to note that salt-substitutes are generally swapping potassium for sodium so using them in moderation can also be a benefit.

Always check with your doctor before changing your potassium intake because people with kidney problems, heart problems, or take certain medications may make things worse if their body has trouble processing the increased potassium. People on dialysis or have poor kidney function, for example, have to be vigilant about not getting too much potassium (as well as protein and sodium), and are frequent prescribed a low potassium diet.

Sequence Multivitamins for African Americans were formulated to replace science-confirmed vitamin and mineral deficiencies seen in our community . . . AND has added POTASSIUM.

Low Potassium, African Americans

Vitamin D Deficiency is Associated with Stroke Risk in African Americans

Posted on by Dr Greg Hall

Recent studies have found a correlation between vitamin D deficiency and stroke risk as well as stroke severity. A study just published found that people with the highest vitamin D levels had fewer strokes and if they had a stroke, it was less severe.  People with low vitamin D levels had more strokes with more severe symptoms. 

As you know, we get most of our vitamin D from the sun, but urban living, colder/cloudy weather, and lactose intolerance (so we can’t drink “Vitamin D Milk”) have all resulted in wide-spread African American vitamin D deficiency.

African Americans Have Low Vitamin D Levels

Four of five African Americans have low levels of vitamin D, and we also have the highest rates of heart attack, stroke, and circulation problems. Risk factors for low vitamin D levels include older age, darker complexion, obesity, and limited sun exposure.

Studies have shown that hemorrhagic stroke patients (those strokes caused by a bleed rather than a blood clot) often suffer from low vitamin D levels. Another study suggested that putting stroke victims on vitamin D helped their recovery somewhat.

Biologically, vitamin D reduces total cholesterol and fat in blood as well as improves inflammation which helps your blood vessels stay healthy.

A Direct Effect Has Not Been Shown

To be clear, there has yet to be a study that showed taking a vitamin D supplement led to fewer strokes. These research studies are only able to find correlations and from these associations, they “suppose” that raising your vitamin D level will lead to better health.  Some researchers believe that poor health leads to low vitamin D levels and that is the reason sicker people have low vitamin D. 

Vitamin D levels have been positively associated with improved cardiovascular health, especially with reduction of stroke risk. Until the controversy is settled, everyone agrees that leaving a low vitamin D alone is not a reasonable option. 

Vitamin D is best increased through natural means . . .  sun exposure, a healthy diet, etc. Foods high in vitamin D include salmon, herring/sardines, cod liver oil, tuna, mushrooms, and fortified beverages (milk, orange juice, and cereal).

Good Vitamin D Levels Help in COVID Patients

Another study looked at COVID patients and vitamin D deficiency and found COVD illness directly related to vitamin D level.  COVID-19 is greatly associated with increased stroke and heart attacks so having a normal vitamin D level was somewhat protective against severe COVID disease.  Obviously the absolute best way to avoid COVID-19 is through getting an approved vaccination.

Sequence Multivitamins for African Americans have a science-based formula to best replace deficiencies in the Black community. Go to SequenceVitamin.com for more information on the multivitamin that is best for you.

Multivitamins May Help African Americans Avoid Alzheimer’s Dementia

Posted on by Dr Greg Hall

A new study is showing benefit from taking a multivitamin once a day in slowing the progression of dementia in older individuals.  It has long been known that vitamin D deficiency is directly linked to Alzheimer’s Dementia and African Americans have the highest rate of vitamin D deficiency as well as Alzheimer’s Disease and some have called it a “silent epidemic.”

Research suggests that Alzheimer’s disease may be two to three times higher in older African Americans when compared to Whites. Studies also show that the disease progresses much more slowly in African Americans and people with it live significantly longer.  These curious facts lead doctors to think that the cause for the mental decline may be different.

Alzheimer’s occurs in African Americans at a comparatively younger age and robs too many older adults of their independence, dignity, and resources.  It has been linked to hypertension (high blood pressure), depression, diabetes, smoking, and some genetic factors.  In fact, the risk for Alzheimer’s Disease is 44 percent higher if you have a close relative with dementia.

There are also studies that show a higher consumption of fruits and vegetables, taking cholesterol-lowering medicine, and high social engagement may help ward off dementia.  A Mayo Clinic article addresses the connection between vitamin deficiency and dementia and given the widespread deficiencies we see in the Black community, there is certainly no harm in taking the right amount of vitamin D. 

The article also outlines that the National Institutes of Health recommends adults age 70 and younger need 600 international units (IU) of vitamin D daily, and adults over age 70 need 800 IU daily.  These recommendations are too low for African Americans who need much higher doses to achieve normal vitamin D levels.

Sequence Multivitamins for African Americans contains a much higher amount of vitamin D more closely aligned with what the Black community needs. Sequence also replaces deficiencies in vitamin C, potassium, magnesium and zinc that are widespread in the Black community.  Go to SequenceVitamin.com or purchase the multivitamin for men over 50 at Amazon or the women over 50 on Amazon here.

Better Black Health Podcast

Posted on by Dr Greg Hall

People continue to ask me about health issues and why Black Americans’ health is inferior to every other racial or ethnic group. My podcast Better Black Health covers many of these important topics. The environmental dynamics of being Black drives up our blood pressure, increases our risk for cancer, and makes us struggle with our weight and diabetes. The Better Black Health podcast is also on Spreaker and Spotify to allow easy access to this vital information.

Why do African Americans have a greater cancer risk with smoking . . . and why do so many smoke menthol cigarettes? There is a potential genetic reason behind this huge disparity. And stopping smoking was much harder when there was a household partner or family member who still smoked.

Why do Blacks distrust healthcare providers (doctors, NPs, etc.) at such a high rate? How does our history with medical providers drive this dysfunctional relationship?

The first episode looks at a curious case of high blood pressure and the potential causes including alcohol, sleep apnea, and heart disease.

A follow up episode looks at the vitamin needs of African Americans.

In future episodes we will look at diabetes, obesity, STD’s, bias, and whole lot more as it relates to African American health and ways to Better Black Health. This podcast is proudly sponsored by the National Institute for African American Health. Check out our podcast HERE

Continued Smoking After Cancer Raises Recurrence Risk

Posted on by Dr Greg Hall

African American cancer survivors should make a deliberate effort to stop smoking because cancer recurrence or return was much higher in cancer patients who continued to smoke. In this study done at Wayne State in Detroit, Black patients were more likely to continue to smoke after being diagnosed with cancer and were more likely to continue if their partner continued to smoke.

A longer smoking history and living with a smoker increased the odds of continued smoking after cancer diagnosis. Over all, lung cancer survivors were most likely to quit after diagnosis.

These findings are similar to other ethnic populations and highlight that continued smoking after a cancer diagnosis is both common and highly risky. Stopping smoking must remain a primary priority to patients diagnosed with cancer because by continuing smoking, their risk for the cancer returning and spreading is much higher.

Health care providers like doctors and nurse practitioners should emphasize the importance of both the patient and other house members (wife, husband, adult children, etc.) stopping smoking because their success rates are linked.

Do Sound Machines for Sleep Help?

Posted on by Dr Greg Hall

There is definitely a science to sleep and why sounds can both improve or interrupt a good night’s sleep.  The internet is filled with people who report greatly improved sleep with sound producing devices, long-playing internet videos, and other media.  The sound of ocean waves, constant rain, or even a partners’ breathing has been reported to promote a more restful sleep.  Curiously, when sleep experts at the University of Pennsylvania Perelman School of Medicine recently pulled together research in the field, they found “the quality of evidence for continuous noise improving sleep was very low.”  Their disclaimer added that more research is needed in higher numbers to either fully discredit or completely support the use of “noise” as a clinically beneficial sleep aid.

What are the potential benefits?

There are components of sleep that improve or detract from its quality.  By minimizing the onset, and the interruptions in sleep, it is presumed that the duration of the restorative components (REM sleep and non-REM) will improve. Deep sleep, which is the most restorative and a component of non-REM sleep, shortens with age and its reduction has been liked to poor health including obesity, diabetes, hypertension, heart disease, and more. By improving overall sleep duration by reducing interruptions and decreasing the time it takes to go to sleep, it is hoped that a better quality of life ensues. 

What type of noise is best to listen to on a sound machine? White noise, pink noise, or any other types.

There is a science behind the various noises and why they may help sleep.  White noise is a balanced frequency of sounds that has a higher overall pitch.  Because higher pitched sounds are more easily heard by the human ear, a balance of sounds with give an overall higher pitch. Pink noise is proportionately decreased as the pitches increase in an effort to better “balance” what is actually heard. Pink noise therefore has a lower, and some say, more soothing, tone. To takes this concept even further (and more soothing), Brown noise  (Brownian noise) decreased the frequency even lower than pink noise. There is no scientifically reported evidence that one noise is better than the others . . . just personal preference.

How does the experience of listening to a sound machine differ from sleeping in silence?

The difference between silence and consistent invariable noise is not as great as some would think.  The issues with sleeping in silence is the potential interruptions by sound.  The “noises” I have described work to potentially drown out the sound variabilities in life. True silence has no interruptions and is consistent. These various noises work to make urban (or even rural) existence less variable in sound and thus more conducive to uninterrupted sleep.

Displaced: Why African Americans Need Their Own Multivitamin.

Posted on by Dr Greg Hall

As descendants from Africa, African Americans were genetically conditioned to best survive in a hot, sunny, mineral rich land.  The continent of Africa is known for its fertile land and renowned as the “richest continent in the world” in terms of natural resources. The days are sunny and generally consistent in length throughout the year.  Living in a mineral rich land, your body adjusts its absorption of vitamins and minerals according to it’s exposure in the environment.  In Africans, their absorption is blunted because the environment is so fertile with sun, nutrients and minerals. When relocated to North America, with its variable daylight, urban dynamics, and processed food and water, African Americans are now displaced from the environment that their system was best designed to thrive.

Low Vitamin D and Increased Health Problems

With vitamin D generally coming from the sun, the shift from Africa to North America was dramatic . . . and so was the drop in vitamin D in Black Americans.  Low vitamin D has been linked to more severe COVID illnesses, increased diabetes (type 2), increased prostate cancer, increased colon cancer, worsened asthma, and more.  The graph below from a study done at the University of California at Berkeley shows significantly higher vitamin D levels in both men and women in Africa and Jamaica that are consistent with those of white Americans . . . whereas the levels in Chicago Blacks were much lower.

Low vitamin D levels in African Americans
Vitamin D levels in people of African ancestry living in 4 cities compared to white Americans

Blacks in America need vitamin D supplementation to offset the significantly decreased vitamin D we get from the diminished sun in North American cities. It is proposed that the added vitamin D will help to offset some of the worsened diseases we see in African Americans.

Zinc

Africa has also been known to have high zinc reserves. In fact in some mining areas in African, the mineral content of “heavy metals” in the water was too high.  From a biological perspective, the people living in these high mineral content areas needed to develop a way of decreasing their absorption of too much minerals, including zinc.  In a study done looking at prostate cancer tissue in Black Americans versus whites, researchers found significant fewer zinc absorption (“transport”) channels in the prostates with the more aggressive cancer, and this decreased zinc transport occurred much more often in African Americans than whites.  Overall, zinc has the highest concentration in the body in the prostate, and scientists report that the high zinc in the prostate acts to suppress tumor formation.  The graph below shows the higher prostate cancer incidence in green as well as the higher mortality (red) by race/ethnicity.

Increased prostate cancer in Black American men
Prostate Cancer Incidence & Mortality

African American men should take zinc daily.

Vitamin C

Vitamin C has long been known to benefit a number of health conditions including boosting immunity (your ability to fight infections), slowing atherosclerosis (hardening of the arteries), decreasing gout attacks through lowering uric acid levels, as well as improving lead clearance from the body.  Taking vitamin C on a daily basis either in the form of high vitamin C foods or supplements is highly recommended.

Avoid Vitamin K

Increased blood clotting in African Americans
A blood clot in an artery.

It has long been known that African Americans have a higher tendency to form blood clots.  These increased blood clots can lead to several problems:

Vitamin K promotes blood clotting. While biologists have insisted that vitamin K doesn’t cause “too much clotting” there have been no studies in African Americans to confirm this.  Given the lack of vitamin K deficiency in the US, there is no reason for an African American to take added vitamin K.

Sequence Multivitamins for African Americans

I developed Sequence Multivitamins with these and many other facts in mind.  It is the first science-based multivitamin for African Americans and uses research, population data, and 25 years of treating Black patients as evidence. Sequence Multivitamins were developed for men, women, men over 50, and women over 50.   

MD Newsline just featured Sequence Multivitamins on their website as a game-changing approach to nutrition in the Black community.

https://mdnewsline.com/sequence-multivitamins-a-multivitamin-for-african-americans/

Sequence Multivitamins for African Americans have increased vitamin D, vitamin C, magnesium, potassium, and zinc to compensate for the migration from Africa to North America and the dramatic adjustments that many of our bodies are still making! And it leaves out vitamin K to potentially avoid an increased risk for blood clots.

Go to SequenceVitamin.com.

https://youtu.be/PEuhRlfZyCs