Colon Cancer in African Americans

Colon Cancer in African Americans

Colon cancer has been called “the disease no one has to die from,” but African Americans continue to have the highest occurrence and the highest death rate compared to other racial/ethnic groups. Studies show that a Black man is 24 percent more likely to get colon cancer than a white man and 47% more likely to die from it. 

Chadwick Boseman died from colon cancer at age 43

Colon cancer also occurs at a younger age in African Americans.  The passing of Chadwick Boseman, the portrayer of the Marvel superhero Black Panther, at the age of 43 came as a surprise and shock to many, but not those in the health arena. We see young Black men and women getting diagnosed with colon cancer too often.  And the stigma of having “cancer” keeps many quiet about their diagnosis.

Pele, who many say was the greatest soccer star, just passed from complications of colon cancer as well.  His passing at 82, is still a great loss to his family and the world. 

Reports have confirmed that Chadwick Boseman fought colon cancer for some years before his death but kept the diagnosis private for personal reasons. As a child, my grandmother had cancer yet survived into old age.  As a young physician,  I asked what type of cancer she had, and she looked at me with disbelief; how dare I ask such a personal question? For many in the Black community, even discussing cancer or its prevention is taboo.

Early Detection is Critical

If colon cancer is caught early, the prognosis is excellent, with over nine out of ten patients surviving five years.  With many cancers, surviving five years is almost equivalent to a cure.  But once it has spread to other organs and tissues, that survival rate plummets to only one out of four living five years.

African American men and women continue to be diagnosed at more advanced stages of colon cancer than other Americans.  Even when adjustments are made for socioeconomic status, African Americans still have significantly lower screening.

Some of the reasons for low screening is an aversion to the methods we use to screen patients. I have had some patients look as if I insulted them by suggesting they get their stool sample tested. 

Colon Cancer in African Americans colonoscopy screening avoidance

“That part of my body is for OUT ONLY!”

In a study that included interviews with Black men ages 45-75 in Minnesota, Ohio, and Utah, researchers repeatedly heard concerns that colonoscopy, which involves the placement of a flexible tube inside the rectum, was associated with “gay sex” or was not masculine. “The stigma is because of the body part they’re examining,” researchers reported.

As an African American man who has had a colonoscopy, it is neither as invasive nor uncomfortable as the legend suggests. In fact, I have no memory of my colonoscopy thanks to anesthesia, and felt absolutely nothing but relief that my screening was successfully completed.  I’ll die from something, but it won’t be colon cancer.  

While I disagree with this dysfunctional and culturally-based viewpoint, I can also respect it as their unique perspective and find a way around it. 

What about “Cologuard?”

Colon Cancer in African Americans colonoscopy screening avoidance

With Cologuard, a person has a complete bowel movement into the container, seals it, and mails it in for testing.  It only uses the “OUT” function of the rectum and shouldn’t offend anyone with those reservations.  Researchers have looked at “multitarget stool DNA testing” (Cologuard is the trade name) performance in African Americans and found it to be “comparable to white patients.”

The Cologuard people then examine the genetic material (DNA) in the human stool and report the result back as “negative” (which of course is good in medicine . . . and don’t ask me why now), or “positive” and you will now need a full colonoscopy to find out if there is a true problem.

Colon Cancer in African Americans colonoscopy
Colonoscopy looks at your entire colon.

A colonoscopy is an outpatient procedure where a specialist looks at the entire length of the colon and rectum with a flexible scope, the width of a finger, with a light and camera at the end.  They can see any pre-cancerous growths and remove them in real time.  If your colonoscopy is normal, you won’t need another one for 10 years.

There are over 16 million colonoscopies done every year in the US with a very low complication rate.  Colonoscopies would clearly be preferred over emergency bowel surgery which is the outcome if screening is avoided and cancer is present.

When should screening begin?

Your primary care provider should begin talking to you about colon cancer screening at age 45.  If you have family members with a history of colon cancer, or an inflammatory bowel disorder like Crohn’s disease or ulcerative colitis, it should be even earlier than age 45. People who have had radiation to the stomach or pelvic area are also at risk for colon cancer.

Colon Cancer in African Americans colonoscopy screening avoidance

Many people still wonder why cancer screening is needed?  Many say: “I feel fine and I will call you once I have a problem.” The answer is simple, the earlier a cancer is found, the less of a problem it causes. Small cancers usually do not cause symptoms.  

Some others feel that any cancer found means a death sentence . . . and that is not true. Early and small cancers of the lung, breast, colon, and others can simply be removed.  With modern medicine, early cancers are much more easily treated.  Large and late-detected cancers are more likely to give you symptoms, have spread to other organs, and more often result in death.

Colon Cancer in African Americans

What About My Diet?

Immigration studies strongly support a major role for environmental factors (urban living, diet, etc.) as the root cause of increased colon cancer in the United States.  People migrating from regions with a low prevalence of colon cancer, like Africa, to countries with a high prevalence, like the US, acquire the higher colon cancer prevalence of their new country within twenty years or less. 

African Americans have 13 times the risk of colon cancer compared to native Africans. 

Our high red meat consumption (beef, pork, and lamb) coupled with an elevated animal fat diet (chicken skin, hot dogs, lunch meat, butter, gravies, sauces) drives up the risk.  That combined with decreased fiber consumption makes up the majority of the difference.

Vitamin D has numerous health effects, including strengthening bone, fighting infections, lower diabetes risk, and better blood pressure control, but African Americans have much more vitamin D deficiencies.  Higher levels of vitamin D are also associated with a lower risk of colon cancer.

We Need to Get Over It!

Culturally, some African Americans have a defeatist attitude regarding good health. “I’ve struggled so much in my life; if I die, I die.”  But this attitude unnecessarily leads to more struggle, suffering, and premature death. Breaking the cycle of seeing more African Americans die unnecessarily due to dysfunctional thinking is ALL of our responsibility.  We cannot sit back and continue to watch while other communities take full advantage of what modern medicine affords. 

Colon Cancer in African Americans colonoscopy screening avoidanceYes, the Tuskegee study happened.  Yes, bias and poor communication still exist in physicians today. But we as African Americans need to rise and move past these injustices.  We shouldn’t avoid modern medicine; we should embrace it.  If someone experiments on us, we can sue them. If a doctor acts dismissive toward us, find another doctor.  It’s that simple. “Don’t throw the baby out with the bath water.”

Ignoring medical advances only preserves the health disparities we so dislike.  

Cancer Screening is Key

Get screened for colon cancer, breast cancer, lung cancer, and prostate cancer as suggested by your primary care provider.  Let’s leave our dysfunctional biases behind.

 

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

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.

Better Black Health Podcast

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

The Best Multivitamins for African Americans

Which multivitamin should I take?  As a physician, I get this question multiple times a day, every day. And the answer would frequently depend on who was asking.  Are they younger or older?  Male or female?  How is their diet?  What race are they? What family disease risks exist? All of these issues influence my answer, and the final answer is yes, there is one best multivitamin for African Americans to take:  Sequence Multivitamins.

Sequence Multivitamins were designed to meet the needs of African American men, women, and the unique needs of older adults.

Vitamin D Deficiency

Because my patient practice is 90 percent African American, the vast majority are severely vitamin D deficient.  The normal range for vitamin D levels in the blood is 20 to 80 pg/ml.  As an example, I am African American and my initial vitamin D level was 9 pg/ml. Most of my patients also have very low vitamin D levels . . . in fact I’m surprised when I see a normal level in a Black patient. In contrast, most of my patients of other races/ethnicities generally have normal vitamin D levels. 

A study published by the University of Pennsylvania looking at vitamin D deficiency by race/ethnicity showed:

  • 82% of African American had vitamin D deficiency
  • 62% of Hispanic Americans had vitamin D deficiency
  • 31% of White Americans had vitamin D deficiency

Four of five African Americans are vitamin D deficient compared to less than one in three White Americans.  The majority population, who most vitamin companies naturally target, have nutritional needs that are substantially different.  Vitamin D deficiency is also associated with increasing diabetes, hypertension, prostate cancer, breast cancer, colon cancer, and more.  African Americans have the highest risk for all of these diseases.  

Given these stark differences in blood levels of this critical vitamin, the approach to its replacement is also different.  The USDA currently recommends 600 international units daily for vitamin D for everyone age 1 to 70 years.  Most multivitamins start with the USDA recommendation when designing their content. 600 IU is entirely too low a replacement dose for most African Americans.  The amount of vitamin D to take to correct these significant deficiencies is over three times higher.  African Americans should take 2000 IU daily.

Vitamin C Deficiency

Other vitamin deficiency patterns exist as well in African Americans.  A study conducted at Duke University Medical Center found that “in African Americans, but not whites, lower levels of beta-carotene and vitamin C were significantly associated with early markers implicated in cardiometabolic conditions and cancer.”

Higher vitamin C levels were also protective against lead exposure due to the vitamin’s ability to inhibit the intestinal absorption of lead as well as its ability to promote urinary excretion of lead.  Essentially vitamin C acts as a barrier to lead absorption.  Environmentalists confirm that urban air, soil, and water tend to hold comparably higher lead levels due to a history of industrial presence in cities and their closeness to neighborhoods mostly populated with African Americans. Increasing the vitamin C content in a multivitamin for an urban population disproportionately exposed to lead is a sound approach to population health.

Vitamin E May Be Bad for You

Interestingly, there are also significant risks and poor health outcomes associated with certain vitamins.  Vitamin E supplementation was studied in over 130,000 people and those that took 400 IU (the most common supplement dose) or higher, had an overall higher risk of dying from any cause. Vitamin E supplements were also shown to significantly increase the risk of prostate cancer in healthy men.  Given that African Americans have the highest death rate of any racial/ethnic group (including prostate cancer) in the United States, taking a vitamin that potentially increases these already bad outcomes, makes no sense. Unlike most other multivitamins, Sequence Multivitamins has no vitamin E.

Vitamin K Promotes Blood Clotting

Vitamin K is critical for normal blood clotting but African Americans have an increased propensity to form adverse blood clots after surgery and associated with strokes, heart attacks, and other embolisms, therefore additional vitamin K in a multivitamin for this population should also be avoided. Unlike most other multivitamins, Sequence Multivitamins has no vitamin K.

Help Avoid Diabetes ?

There are also vitamins and minerals that provide glucose stability to people with diabetes. According to the National Institute of Health, African Americans are twice as likely to develop diabetes than White Americans, and first line treatment involves metformin for over half. Metformin can lead to folate and vitamin B12 deficiencies. Sequence Multivitamins has the added folate and vitamin B12 that older African Americans with high diabetes risk need.   Keeping diabetes stable helps to avoid the related bad outcomes including heart, kidney, and stroke-related risks.  Magnesium has also been shown to improve diabetes control and stabilize blood vessels. Sequence Multivitamins has significantly more magnesium.

Heart Risks in African Americans

Potassium has shown benefits in cardiac rhythm stability, blood pressure control, and electrolyte balance. There has been data that suggests African Americans have lower potassium levels overall which could be related to the increased incidence of diabetes, and helpful in preventing heart or stroke problems. Sequence Multivitamins has added potassium for this purpose.

Chromium has promising data that it positively impacts diabetes control across populations.  With African Americans having significantly higher risk for diabetes, adding chromium to the Sequence Multivitamins formula was a plus.

Due to its distinctive ability to neutralize free radicals, lycopene is believed to give measurable protection against cancer, atherosclerosis, diabetes, and other inflammatory diseases.  Evidence suggests that lycopene consumption is associated with decreased risk of various chronic diseases that disproportionately impact African Americans.

As you can see, a good deal of thought and research went into developing the formula for Sequence Multivitamins. Their formulas for men, women, men over 50, and women over 50 means there is a multivitamin best for almost anyone. Health disparities, premature death, and chronic illness has been a way of life for too many African Americans. Sequence Multivitamins hopes to make a difference . . . making them the single best multivitamin for African Americans.

The MD Newsline, a national publication for physicians is now recognizing Sequence Multivitamins for African Americans as a preferred multivitamin for the Black community.

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 !!

Heavy Smokers at Higher Risk for Diabetes

African American smokers have higher risk for diabetes

A large study consisting of over five thousand African Americans found that those African Americans who smoke more than a pack of cigarettes in a day were at increased risk for diabetes.  This ground-breaking news was published in the Journal of the American Heart Association. African American smokers have higher risk for diabetesThe study group included current heavy smokers, former smokers, and “never” smokers, all of whom were African Americans, and followed them over the course of  several visits. At the end of the study, they looked to see who had developed diabetes. Both former and non-smokers had similar occurrences . . . which is good news for people who have stopped smoking. African Americans who smoked more than a pack a day of cigarettes had a much higher occurrence of developing diabetes (up to 40 percent higher!!). The increased smoking was associated with “impaired pancreatic beta cell function.” The pancreas is where insulin is made and proper insulin secretion is how sugars are absorbed into the body. The researchers go on to say:
“Although smoking cessation should be encouraged for everyone, certain high‐risk groups such as blacks who are disproportionately affected by diabetes mellitus should be targeted for cessation strategies.”

Are you at risk for diabetes?

Being over-weight and having a strong family history of diabetes puts many African Americans at increased risk for developing this disease. Now we can add heavy smoking to the list! While African Americans have lower teenage smoking rates, they have high adult rates, longer smoking duration, and lower cessation rates when compared to Whites.  Almost half (42%) of newly diagnosed patients with diabetes were African American who smoked whereas only 29% (less than a third) that were White smoked. African American smokers have higher risk for diabetesIn general, smoking is associated with a lower body weight so many African Americans resist stopping smoking because of a fear of weight gain.  Many also fail to realize the smoking addiction aspect.  But in reality the increased smoking actually increases the risk for diabetes.  Smoking is known to produce “pot bellies” which in medical circles is known as “visceral adiposity” and that type of obesity (like in the photo) greatly increases the risk for diabetes. If diabetes “runs in your family” and you or someone you love is smoking, tell them about this new information and how stopping now can actually DECREASE their risk for diabetes!! Need more information about Diabetes in African Americans? Click HERE African American smokers have higher risk for diabetes

Lactose Intolerance in African Americans

Lactose Intolerance in African Americans

Three out of four African Americans are lactose intolerant.  Lactose intolerance means that if you drink milk, eat yogurt, have cheese, or any other dairy-based product in large amounts, your digestive system will have difficulty digesting it.  Most people report feeling bloated and later have loose gassy stool (sorry . . . but these are the facts).

Sequence Multivitamins for African Americans
Sequence Multivitamins for African Americans — “Because our needs are different”

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.

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.

Dr. Hall’s Podcast “Better Black Health” discusses multiple issues related to African American health . . . take a listen.

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. Look at my article on “Diet Differences in African Americans” for more details.  Also check out the multivitamins I designed to compensate for the decreased vitamin D due to lactose intolerance and urban living — SEQUENCE Multivitamins for African Americans. 

The impact of leaving African doesn’t end with vitamin D, look at Displaced: Why African Americans need their own multivitamin. 

Sequence Multivitamins for African Americans
Sequence Multivitamins for African American men, women, and the unique needs of men and women over 50.

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 this 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 . . .

 

 

 

 

 

Are you on the right blood pressure medicine? 

High Blood Pressure in African Americans

When it comes to the treatment of high blood pressure in African Americans, there are a number of important differences. For reasons that are not entirely clear, many African Americans patients respond differently from white patients based on the hypertension medication used.

Evidence from studies suggests that African Americans do very well with thiazide diuretics (a “water”pill) and they should be used often for the treatment of high blood pressure (hypertension).  Thiazide-type diuretics (chlorthalidone) was better at reducing blood pressure and preventing cardiovascular events like a heart attack or stroke than an ACE (lisinopril) in African Americans as found in the “Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack” (ALLHAT) trial.

right blood pressure medicineBest Stroke Prevention in African Americans

For ideal blood pressure control, the thiazide-type diuretic dose should be equivalent to chlorthalidone 12.5 to 25 mg/day or hydrochlorothiazide 25 to 50 mg/day because lower doses have not been found to be as effective.  Overall, calcium channel blockers (amlodipine) have also shown great effect in African Americans as an initial choice, and are more effective in decreasing strokes than water pills. right blood pressure medicineThus an African American male would be best served by amlodipine first line given the stroke prevention potential, and a African American female better served with a thiazide diuretic initially to get to goal more efficiently.

ACE Inhibitors are not preferred

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blocker (ARB) medications are less effective in African Americans for blood pressure control and are sometimes associated with worse outcomes.  A large study of over 400,000 patients done at the New York University School of Medicine compared outcomes in African Americans and white Americans with three distinct groups:

right blood pressure medicineTheir study  showed that ACE inhibitors were associated with a significant increase in stroke, heart failure, and combined cardiovascular disease when compared with calcium channel blockers or thiazide diuretics in African Americans. The worse outcomes with angiotensin-converting enzyme (ACE) inhibitors were similar to that of B-blockers in this population.

 

Because ACE inhibitors are commonly listed as “first-line” medications for hypertension control in national and international guidelines and recommendations, it should be noted that this principally is based on their response in white populations.  Based on these large African American-inclusive studies and a number of considerations (including cost, co-morbid conditions and disease propensities), the National Institute for Health and Clinical Excellence clinical practice guideline suggests calcium channel blocker therapy initially in African Americans, and substitute a thiazide-like diuretic in the event of edema or intolerance “or if there is evidence of heart failure, or a high risk of heart failure.”

Putting all of these risks aside (imagine that??), ACE inhibitor blood pressure response in African Americans is usually less when compared to calcium channel blockers, thiazide diuretics, or even B-blockers. Researchers suspect that the low blood pressure response is related to “high sodium intake in salt-sensitive” patients, but others have suggested that hypertension in African Americans may just be different.

More Side Effects in African Americans

African Americans have a greater risk of ACE-related cough, and a higher rate of stopping due to cough compared to other racial groups. African Americans were also more prone to develop ACE-related full allergic reactions.

High Blood Pressure in African Americans

When considering all of these issues with ACE’s and ARB’s in African Americans, it should be noted that they are essential for preventing kidney disease in people with diabetes, and certain other kidney related problems.  So if you don’t know why your on an ACE or ARB, call your physician and ask.  The renal-sparing benefits of the ACE and ARB medications is still very valid when used to slow renal/kidney function decline (particularly in kidney disease due to high blood pressure), and they should still be used for kidney protection in African American patients with diabetes and similar conditions.

Please don’t just stop your medications based on this article, check with your provider to get your particular and specific advice. Use this article as a starting point for your discussion. Some providers are aware of these differences, and others may not be fully aware.

African Americans, Vitamins & Heart Health

African Americans also tend to be more deficient in potassium and magnesium and that can negatively impact your heart health.  Vitamin D and vitamin C deficiencies have also been connected to poor heart issues.    Consider Sequence Multivitamins for African Americans as a multivitamin that replaces what you need.

Sequence Multivitamins for African Americans
Sequence Multivitamins for African Americans — “Because our needs are different”

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.