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.

Click to Listen to Better Black Health on Google

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:  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. 

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. VitaCode’s Sequence Multivitamins hopes to make a difference . . . making them the single best multivitamin for African Americans.

Limiting the Risk of COVID-19 Infection in African Americans

While wearing a mask in public, washing your hands, social distancing, and covering your cough/sneeze greatly decreases your risk for contracting COVID-19, there a some other less-proven approaches that also need discussion and consideration.

A good amount of theoretical approaches to minimize the spread and severity of COVID-19 have been published. Given this new coronavirus has limited confirmed supplement approaches to prevention and treatment, providers are using foundational knowledge regarding populations and viral infections, and hypothesizing (or guessing) what might be effective.

African Americans have been disproportionately impacted by COVID-19 with a much higher hospitalization rate and mortality.  At the core of worse outcomes in African Americans is poorly controlled chronic diseases like diabetes, hypertension, and COPD.  But there is also firm population data that points to trends in vitamin and mineral deficiencies that may also contribute to poor outcomes.  Using what we know about these trends and the fundamentals of infections (both viral and bacterial), and also keeping a keen eye on safety, here is what I have been recommending my patients consider.

Zinc (10 to 15 mg) one to three times a day when COVID-19 exposure risk is high

Zinc is an essential trace element that is critical for a variety of biological processes and proper immune function. Studies have consistently shown zinc deficiencies in African Americans and believe the dramatically increased rate of HIV and hepatitis C in African Americans represents an impaired immune defense linked to lower levels of zinc. Zinc’s antiviral activity has been confirmed against a variety of viruses and the science of how zinc either prevents infection or slows viral spread is well established.

There is also emerging evidence that zinc’s antiviral and antibacterial activities may help slow coronavirus spread and ease the complications that result from an infection. The improved antiviral immunity conveyed by zinc could be particularly impactful during the COVID-19 pandemic. Some suggest that the increased severity of COVID-19 in African Americans may reflect a low zinc status and the Mayo Clinic confirms that zinc is clearly more beneficial in populations that have deficiencies.

Vitamin D (2000 IU) once daily

The most dramatic vitamin differences by race or ethnicity relate to vitamin D levels which nutritionists agree is deficient in four of five African Americans. The widespread vitamin D deficiency is somewhat related to the melanin in darker skin, widespread lactose intolerance (also genetically driven) as well as urban living leading to decreased sun exposure.

The lack of vitamin D has been associated with an array of bad outcomes including increased stroke, heart disease, pre-term birth, and a host of cancers including lung, colon, ovarian, breast, and prostate. Low vitamin D has also been associated with a higher risk for lupus (SLE), multiple sclerosis, diabetes and hypertension.  African Americans have the absolute highest risk for diabetes, hypertension, stroke and the cancers listed.  The lack of vitamin D has also been linked to worse outcomes in COVID-19 infections, but its association may simply be a marker for the chronic diseases listed above.  Most African American patients, particularly the elderly and those with limited sun exposure and the potential for exposure to COVID-19 should consider taking vitamin D at 2000 IU daily.

Famotidine (20 mg) once daily

In a study at Columbia University, patients hospitalized with COVID-19 that had famotidine, the acid blocker also known as “Pepcid” within the prior few days had better outcomes.  They concluded that “famotidine use was associated with a reduced risk of clinical deterioration leading to intubation or death”.  This mechanism of action is not random.  Researchers note that famotidine is known to inhibit viral replication in some instances.  There are also first-hand accounts of rapid improvement after COVID-19 infection.  Given its safety (and over-the-counter availability), its use in a COVID-19 exposed vulnerable population can be justified.

While this information is far from confirmed, its science has a good foundation. Given African American’s well-established vitamin D and zinc deficiencies in the face of a “curiously high” infection rate, these largely safe measures, may make a difference. As always, check with your provider before starting any of these supplements or vitamins as your individual case may warrant a different approach.

Sleep Differences in African Americans

Sleep Differences in African Americans

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

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

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

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

Sleep Differences in African Americans

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

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

Swing shifts are bad for your health!

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

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

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

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

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

It’s in their genes.

Low Vitamin D in African Americans

Low Vitamin D in African Americans

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

Low Vitamin D in African Americans

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

“Lower levels of vitamin D–binding protein in blacks appear to result in levels of bioavailable 25-hydroxyvitamin D that are equivalent to those in whites. These data . . . suggest that low total 25-hydroxyvitamin D levels do not uniformly indicate vitamin D deficiency “

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.

Do we need additional Vitamin D or not??

Four of five African Americans are vitamin D deficient compared to less than one in three White Americans.   Vitamin D deficiency is associated with increasing diabeteshypertensionprostate cancerbreast cancercolon cancer, and more.  African Americans have the highest risk for all of these diseases.  

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

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

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

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.

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

Diabetes Differences in African Americans

Diabetes Differences in African Americans

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??

Diabetes Differences in African AmericansMost 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.

“The relationship between mean blood glucose and HbA1c may not be the same in all people. Indeed, the published regression line from the “A1c-Derived Average Glucose” (ADAG) Study demonstrated a wide range of average glucose levels for individuals with the same HbA1c levels.” 

Diabetes Differences in 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:

“Among African Americans from 2 large, well-established (studies), participants with sickle cell trait had lower levels of HbA1c at any given concentration of fasting compared with participants without sickle cell trait. These findings suggest that HbA1c may systematically underestimate past glycemia in (African American) patients with sickle cell trait and may require further evaluation.” 

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?

More Genetic Differences . . .

A recent study of over 160,00 patients looked at specific genes and how they impacted the diagnosis of diabetes. One in particular, the G6PD gene variant, was found to significantly impact the results of HbA1c tests in African Americans. This specific gene variant is almost totally unique to people of African ancestryIn fact, about 11 per cent of African Americans carry this gene variant.

“The issue with the G6PD genetic variant is it artificially lowers the value of blood sugar in the HbA1c test, and can lead to under-diagnosis of people with type 2 diabetes. We estimate that if we tested all Americans for diabetes using the HbA1c test, we would miss type 2 diabetes in around 650,000 African Americans.”

Between the 10% of African Americans with sickle cell trait and the 10% with the G6PD gene variant trait, a huge number of African Americans with diabetes are being un-diagnosed or diagnosed late with advanced diabetes.   Diagnosing diabetes as soon as it strikes, gives everyone (the doctor and patient) adequate time to prevent complications before they occur.

If you have just been diagnosed with diabetes, I have a great video that will get you off to a good start below.

If you want to know about other genetic differences look HERE.

 

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.

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 . . .

 

 

 

 

 

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.