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.
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.
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: VitaCode’s 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.
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.
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. VitaCode’s Sequence Multivitamins hopes to make a difference . . . making them the single best multivitamin for 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.
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.
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/)
“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 “
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.
Ken Batai and colleagues 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.
There is a multivitamin designed just for African Americans. Sequence Multivitamins has high vitamin D, vitamin C, magnesium and much more of what African Americans need, while leaving out those substances that may be harmful.
There has been some startling discoveries lately in the differences in how diabetes is diagnosed and treated in African Americans. Because of genetic nuances that we normally may ignore as insignificant, hundreds of thousands of African Americans remain under-diagnosed and under-treated for diabetes.
Diabetes already occurs at an unusually high rate in African Americans and we are 80 percent more likely to be diagnosed than White Americans. Of those with diabetes, there is a higher tendency for organ damage (heart disease, kidney failure, or blindness, for example) than Whites. The prevalence of visual problems, kidney problems, leg amputations, and overall hospitalizations are dramatically higher in African Americans with diabetes.
The CDC reports that African American men die at over twice the rate of any other race or gender group from diabetes. It was also found that these differences were not solely due to the African American diet, genetic differences played a part as well.
Diabetes is diagnosed at an earlier age (median age 49 vs. 55.4 in White Americans) and this earlier age is significant because the development of diabetes complications is directly related to both blood sugar control as well as the total time a person has the disease. By getting diabetes earlier, there is more time to get complications. Make sense??
Most research dealing with the increased diabetes in African Americans points to increased insulin resistance when compared to White Americans. This means your body has insulin but is “resistant” to its normal function.
A recent study of over five thousand African Americans curiously showed that heavy smoking (more than a pack of cigarettes a day) significantly increased their risk for diabetes by worsening the insulin resistance. Former smokers and people who never smoked had a much lower risk for diabetes compared to the heavy smokers.
HbA1c (Hemoglobin-A-One-See), the blood test used to diagnose and track diabetes, is generally a point higher in African Americans (8.9 in White Americans and 9.8 in African Americans), and when controlling for socioeconomic status, quality of care, self-management behaviors, and access, African Americans still have higher HbA1c levels.
Another study by Saaddine and colleagues looked at younger patients age 5 to 24 years and found that African American youths consistently had higher HbA1c levels even without diabetes.
HbA1c is Different in African Americans
In all, HbA1c value differences in African Americans essentially equates to a 0.4% difference (higher) for glucose matched White American patients. So a HbA1c of 7.0, the normal threshold to diagnose diabetes, is really 7.4 in African Americans. Diabetes should have been diagnosed when the HbA1c was 6.6. Put simply, the accepted relationship between HbA1c and the coinciding blood glucose used by doctors and laboratories is different for African Americans.
If these facts aren’t confusing enough, another study found the HbA1c levels are “less dependable” when they are “near normal” in African Americans. High and low HbA1c levels tend to be much more accurate when estimating the average blood sugars.
Because of the limitations of HbA1c measurements in some situations and the racial differences discussed above, some of the patients with a HbA1c level between 5.5% and 7% will clearly have diabetes, and others will not.
Another curiosity with HbA1c has to do with patients with a sickle cell trait:
Given that one in ten African Americans have sickle cell trait, it is important to consider their trait when interpreting the results of a HbA1c. In the end, people with sickle cell trait can be tricky to diagnose diabetes. Many doctors neglect to ask if someone has sickle cell trait because, outside of genetic counseling before having children, there has conventionally been little impact on other disorders. Is your doctor aware of this genetically-based difference?
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.
The 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.
In 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
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).
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.
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??
The 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”.
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
Others 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.
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.
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.
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!
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.
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
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 . . .
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.