by Kevin Chappell
Nearly 21 million people in the United States, or 7 percent of the population, have diabetes. And another 54 million people are believed to have the beginning stages of diabetes.
Every minute of every day, another American develops type 2 diabetes. Among African-Americans, the numbers are even more daunting. One in 7 Blacks has the disease, and African-Americans are twice as likely as Whites to develop diabetes.
At the rate that diabetes is progressing, it is predicted that for every two African-American children born today, one will develop diabetes--type 2 diabetes, which used to be called "adult onset diabetes."
But with more Black children than ever before being diagnosed with diabetes, medical professionals are rethinking their entire approach to the disease--and raising the question: Has diabetes become an epidemic in Black America?
"We're seeing shortening of life spans, people are dying earlier from heart disease, strokes," says Dr. Duane Smoot, chair of the medical department at the Howard University Hospital.
"There are just so many problems associated with diabetes. It causes aging of your blood vessels, so hardening of the arteries occurs more frequently. It causes people to have more problems with aging. We talk about aging gracefully, but with this disease, it makes it more difficult to have a good quality of life.
We have very firm data that tells us that diabetes itself had reached epidemic proportions in this nation as a whole, but more specifically in the African-American community."
Dr. Wayman Wendell Cheatham, medical director at the Medstar Research Institute in Washington, D.C., agrees. "We should be very, very concerned. I am terribly concerned," Cheatham says.
"Diabetes is a major killer. It doesn't only cause people to lose their vision, lose their kidneys, lose their limbs, diabetes reduces life expectancy significantly. People die of heart attacks and strokes because diabetes. It is one of the more underlisted causes of death of all causes ... With the trend line that we're on, it's a terrible epidemic."
Dr. James Gavin, past president of the American Diabetes Association, defines an epidemic as a disease that spreads "beyond a local population, lasting a long time and reaching people in a wider geographical area," he says. "Many classify diseases as a pandemic once the disease reaches worldwide proportions."
So what caused this explosion of diabetes in the Black community?
Gavin and others believe that genetics have played a large role. However, given that the population gene pool shifts very slowly overtime, the current epidemic of diabetes can't solely be attributed to genes.
Many health professionals are attributing a large part of the problem to the drastic slowing of active lifestyles, and the drastic shift in diet to one that now consists largely of processed foods.
The result: Black children and adults, particularly females, are more overweight now than ever before. One study on physical activity found that, by the age of 18, Black girls have a decline in physical activity twice that of White girls the same age.
"Obesity and diabetes go hand in hand," says Dr. Joyce Richey, diabetes researcher and assistant professor at the Keck School of Medicine at University of Southern California.
"The obesity issue is the trigger, and we have a genetic background that sets off that trigger. The result is a diabetes epidemic ... When you become obese, you become less responsive to the insulin that your body is putting out. Then your body realizes that you are becoming resistant, and starts putting out more insulin. Diabetes occurs when your beta cells become so impaired that you are not able to compensate for that resistance that you have."
Richey and other researchers are working feverishly to unravel the mystery of fat, particularly what is it about fat, or in fat, that triggers diabetes. "What we are finding out is that we've always thought of fat as being dormant, taking up space for sure, but not much else," she says.
"But what we are finding out [now] is that fat is like an organ that is secreting things into our system. Fat is not good, especially belly fat. That's the fat that is very unhealthy."
Richey says eating healthy and increasing physical activity are keys to stemming the diabetes epidemic. Catching the disease in its earliest stage is also key. When the disease is in its "pre-diabetes" stage, actions can be taken to prolong, if not prevent, its onset.
A landmark study sponsored by the National Institutes of Health indicated that people with pre-diabetes lowered their risk of developing type 2 diabetes by more than half by losing 5 to 7 percent of their body weight, getting at least 30 minutes of physical activity five days a week and eating healthier.
In addition to lifestyle changes, researchers are also developing new classes of drugs that decrease the rate of developing diabetes if taken early in the disease's progression. Other drugs restore the ability of the pancreas to make insulin more normally and release it more normally.
But presently, nothing can replace the self-determination of a person to keep his or her diabetes in check. Just ask Regina Barrett. The Washington, D.C., native has battled diabetes for five years. And so far, she's winning the fight.
"The changes that I have made are lifestyle changes," says the 51-year-old. "They are not temporary. They are things that, if I want to continue to feel good, if I want to do the best that I can, I have to do. I want to know that I have done all that I possibly can to fight the disease. Right now, I feel healthy, even having diabetes."
DIABETES By The Numbers
*DEATHS: Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. This ranking is based on the 73,249 death certificates in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 224,092 deaths. Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death. Overall, the death rate among people with diabetes is about twice that of people without diabetes of similar age.
*HEART DISEASE AND STROKE: Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.
*HIGH BLOOD PRESSURE: About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.
*BLINDNESS: Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
*KIDNEY DISEASE: Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002. In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease. In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.
*NERVOUS SYSTEM DISEASE: About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
*AMPUTATIONS: More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 non-traumatic lower-limb amputations were performed in people with diabetes.
*ESTIMATED COSTS OF DIABETES IN THE UNITED STATES: $132 billion, with $92 billion in direct medical costs and $40 billion in indirect costs (disability, work loss, premature mortality).
*TYPE 1 AND TYPE 2 DIABETES: Type 1 diabetes (also known as juvenile-onset diabetes) accounts for 5 percent to 10 percent of all people with diabetes. Type 2 diabetes accounts for the majority of people with diabetes--90 percent to 95 percent.
How DIABETES Is Ravaging The African-American Community
*Thirteen percent (3.2 million) of all African-Americans aged 20 years or older have diabetes.
*Twenty-five percent of African-Americans between the ages of 65 and 74 have diabetes.
*African-Americans are 1.8 times more likely than Whites to have diabetes.
*One in 4 African-American women over 55 years of age has diabetes.
*African-Americans are almost twice as likely as Whites to develop diabetic retinopathy (blindness).
*African-Americans are as much as 5.6 times more likely than Whites to suffer from kidney disease as a result of diabetes complications.
*African-Americans are 2.7 times more likely than Whites to suffer from lower-limb amputations.
Source: American Diabetes Association
Tuesday, September 14, 2010
Monday, June 14, 2010
Study Examines Unhealthy Behaviors in Response to Stress
May 18, 2010
When people are under chronic stress, they tend to smoke, drink, use drugs and overeat to help cope with stress. These behaviors trigger a biological cascade that helps prevent depression, but they also contribute to a host of physical problems that eventually contribute to early death.
That is the claim of University of Michigan social scientist James S. Jackson and colleagues in an article published in the May 2010 issue of the American Journal of Public Health.
The theory helps explain a long-time epidemiological puzzle: why African Americans have worse physical health than whites but better psychiatric health. "People engage in bad habits for functional reasons, not because of weak character or ignorance," says Jackson, director of the U-M Institute for Social Research.
"Over the life course, coping strategies that are effective in ‘preserving’ the mental health of blacks may work in concert with social, economic and environmental inequalities to produce physical health disparities in middle age and later life."
In an analysis of survey data, obtained from the same people at two points in time, Jackson and colleagues find evidence for their theory.
The relationship between stressful life events and depression varies by the level of unhealthy behaviors. But the direction of that relationship is strikingly different for blacks and whites.
Controlling for the extent of stressful life events a person has experienced, unhealthy behaviors seem to protect against depression in African Americans but lead to higher levels of depression in whites.
"Many black Americans live in chronically precarious and difficult environments," says Jackson. "These environments produce stressful living conditions, and often the most easily accessible options for addressing stress are various unhealthy behaviors.
These behaviors may alleviate stress through the same mechanisms that are believed to contribute to some mental disorders — the hypothalamic-pituitary-adrenal cortical axis and related biological systems."
Since negative health behaviors such as smoking, drinking alcohol, drug use and overeating (especially comfort foods) also have direct and debilitating effects on physical health, these behaviors — along with the difficult living conditions that give rise to them — contribute to the disparities in mortality and physical health problems between black and white populations.
These disparities in physical health and mortality are greatest at middle age and beyond, Jackson says. Why? "At younger ages, blacks are able to employ a variety of strategies that, when combined with the more robust physical health of youth, effectively mask the cascade to the negative health effects," Jackson said.
"But as people get older, they tend to reduce stress more often by engaging in bad habits." Black women show heightened rates of obesity over the life course, he points out.
In fact, by the time they are in their 40s, 60 percent of African American women are obese. "How can it be that 60 percent of the population has a character flaw?" Jackson asks.
"Overeating is an effective, early, well-learned response to chronic environmental stressors that only strengthens over the life course. In contrast, for a variety of social and cultural reasons, black American men’s coping choices are different.
"Early in life, they tend to be physically active and athletic, which produces the stress-lowering hormone dopamine. But in middle age, physical deterioration reduces the viability and effectiveness of this way of coping with stress, and black men turn in increasing numbers to unhealthy coping behaviors, showing increased rates of smoking, drinking and illicit drug use."
Racial disparities in physical illnesses and mortality are not really a result of race at all, Jackson says. Instead, they are a result of how people live their lives, the composition of their lives. These disparities are not just a function of socioeconomic status, but of a wide range of conditions including the accretion of micro insults that people are exposed to over the years.
"You can’t really study physical health without looking at people’s mental health and really their whole lives," he said. "The most effective way to address an important source of physical health disparities is to reduce environmentally produced stressors — both those related to race and those that are not.
We need to improve living conditions, create good job opportunities, eliminate poverty and improve the quality of inner-city urban life. "Paradoxically, the lack of attention to these conditions contributes to the use of unhealthy coping behaviors by people living in poor conditions.
Although these unhealthy coping behaviors contribute to lower rates of mental disorder, over the life course they play a significant role in leading to higher rates of physical health problems and earlier mortality than is found in the general population."
When people are under chronic stress, they tend to smoke, drink, use drugs and overeat to help cope with stress. These behaviors trigger a biological cascade that helps prevent depression, but they also contribute to a host of physical problems that eventually contribute to early death.
That is the claim of University of Michigan social scientist James S. Jackson and colleagues in an article published in the May 2010 issue of the American Journal of Public Health.
The theory helps explain a long-time epidemiological puzzle: why African Americans have worse physical health than whites but better psychiatric health. "People engage in bad habits for functional reasons, not because of weak character or ignorance," says Jackson, director of the U-M Institute for Social Research.
"Over the life course, coping strategies that are effective in ‘preserving’ the mental health of blacks may work in concert with social, economic and environmental inequalities to produce physical health disparities in middle age and later life."
In an analysis of survey data, obtained from the same people at two points in time, Jackson and colleagues find evidence for their theory.
The relationship between stressful life events and depression varies by the level of unhealthy behaviors. But the direction of that relationship is strikingly different for blacks and whites.
Controlling for the extent of stressful life events a person has experienced, unhealthy behaviors seem to protect against depression in African Americans but lead to higher levels of depression in whites.
"Many black Americans live in chronically precarious and difficult environments," says Jackson. "These environments produce stressful living conditions, and often the most easily accessible options for addressing stress are various unhealthy behaviors.
These behaviors may alleviate stress through the same mechanisms that are believed to contribute to some mental disorders — the hypothalamic-pituitary-adrenal cortical axis and related biological systems."
Since negative health behaviors such as smoking, drinking alcohol, drug use and overeating (especially comfort foods) also have direct and debilitating effects on physical health, these behaviors — along with the difficult living conditions that give rise to them — contribute to the disparities in mortality and physical health problems between black and white populations.
These disparities in physical health and mortality are greatest at middle age and beyond, Jackson says. Why? "At younger ages, blacks are able to employ a variety of strategies that, when combined with the more robust physical health of youth, effectively mask the cascade to the negative health effects," Jackson said.
"But as people get older, they tend to reduce stress more often by engaging in bad habits." Black women show heightened rates of obesity over the life course, he points out.
In fact, by the time they are in their 40s, 60 percent of African American women are obese. "How can it be that 60 percent of the population has a character flaw?" Jackson asks.
"Overeating is an effective, early, well-learned response to chronic environmental stressors that only strengthens over the life course. In contrast, for a variety of social and cultural reasons, black American men’s coping choices are different.
"Early in life, they tend to be physically active and athletic, which produces the stress-lowering hormone dopamine. But in middle age, physical deterioration reduces the viability and effectiveness of this way of coping with stress, and black men turn in increasing numbers to unhealthy coping behaviors, showing increased rates of smoking, drinking and illicit drug use."
Racial disparities in physical illnesses and mortality are not really a result of race at all, Jackson says. Instead, they are a result of how people live their lives, the composition of their lives. These disparities are not just a function of socioeconomic status, but of a wide range of conditions including the accretion of micro insults that people are exposed to over the years.
"You can’t really study physical health without looking at people’s mental health and really their whole lives," he said. "The most effective way to address an important source of physical health disparities is to reduce environmentally produced stressors — both those related to race and those that are not.
We need to improve living conditions, create good job opportunities, eliminate poverty and improve the quality of inner-city urban life. "Paradoxically, the lack of attention to these conditions contributes to the use of unhealthy coping behaviors by people living in poor conditions.
Although these unhealthy coping behaviors contribute to lower rates of mental disorder, over the life course they play a significant role in leading to higher rates of physical health problems and earlier mortality than is found in the general population."
Thursday, May 27, 2010
Poverty Goes Straight to the Brain
By Brandon Keim
Growing up poor isn’t merely hard on kids. It might also be bad for their brains. A long-term study of cognitive development in lower- and middle-class students found strong links between childhood poverty, physiological stress and adult memory.
The findings support a neurobiological hypothesis for why impoverished children consistently fare worse than their middle-class counterparts in school, and eventually in life, particularly African-American children who suffer disproportionately from racism related poverty and stress.
"Chronically elevated physiological stress is a plausible model for how poverty could get into the brain and eventually interfere with achievement," wrote Cornell University child-development researchers Gary Evans and Michelle Schamberg in a paper published Monday in the Proceedings of the National Academy of Sciences.
For decades, education researchers have documented the disproportionately low academic performance of poor children and teenagers living in poverty. Called the achievement gap, its proposed sociological explanations are many.
Compared to well-off kids, poor children tend to go to ill-equipped and ill-taught schools, have fewer educational resources at home, eat low-nutrition food, and have less access to health care.
At the same time, scientists have studied the cognitive abilities of poor children, and the neurobiological effects of stress on laboratory animals. They’ve found that, on average, socioeconomic status predicts a battery of key mental abilities, with deficits showing up in kindergarten and continuing through middle school.
Scientists also found that hormones produced in response to stress literally wear down the brains of animals.
Evans and Schamberg’s findings pull the pieces of the puzzle together, and the implications are disturbing. Sociological explanations for the achievement gap are likely correct, but they may be incomplete.
In addition to poverty’s many social obstacles, it may pose a biological obstacle, too.
"A plausible contributor to the income-achievement gap is working-memory impairment in lower-income adults caused by stress-related damage to the brain during childhood," they wrote.
To test their hypothesis, Evans and Schamberg analyzed the results of their earlier, long-term study of stress in 195 poor and middle-class Caucasian students, half male and half female.
In that study, which found a direct link between poverty and stress, students’ blood pressure and stress hormones were measured at 9 and 13 years old. At 17, their memory was tested.
Given a sequence of items to remember‚ teenagers who grew up in poverty remembered an average of 8.5 items. Those who were well-off during childhood remembered an average of 9.44 items.
So-called working memory is considered a reliable indicator of reading, language and problem-solving ability — capacities critical for adult success.
When Evans and Schamberg controlled for birth weight, maternal education, parental marital status and parenting styles, the effect remained. When they mathematically adjusted for youthful stress levels, the difference disappeared.
In lab animals, stress hormones and high blood pressure are associated with reduced cell connectivity and smaller volumes in the prefrontal cortex and hippocampus. It’s in these brain regions that working memory is centered.
Evans and Schamberg didn’t scan their human subjects’ brains, but the test results suggest that the same basic mechanisms operate in kids.
"Brain structures change with stress and are affected by early-life stress in animal models," said Rockefeller University neuro - endocrinologist Bruce McEwen. "Now there are beginnings of work on our own species. The Evans paper is an important step in that direction."
McEwen also noted that, at least in animals, the effects of stress produce changes in genes that are then passed from parent to child. Poverty’s effects could be hereditary.
The findings, though compelling, still need to be replicated and refined. "They’re not really saying which causal events were stressful. They’re just measuring biological markers of stress," said Kim Noble, a Columbia University psycho-biologist who studies the relationship between child poverty and cognition. Other mental consequences of poverty also need to be measured.
"I think that different cognitive outcomes have different causes," said Noble. "Something like working memory might be more associated with stress, whereas language might be associated with hours spent reading to your children."
But Noble still said the study "was very well-done. They have an impressive data set." And though some details remain incomplete, she said, evidence of connections between poverty and neurobiology are strong enough to justify real-world testing.
"Policy changes that affect environments that might affect cognitive development and brain change — that’s the ultimate future of the field," she said.
Growing up poor isn’t merely hard on kids. It might also be bad for their brains. A long-term study of cognitive development in lower- and middle-class students found strong links between childhood poverty, physiological stress and adult memory.
The findings support a neurobiological hypothesis for why impoverished children consistently fare worse than their middle-class counterparts in school, and eventually in life, particularly African-American children who suffer disproportionately from racism related poverty and stress.
"Chronically elevated physiological stress is a plausible model for how poverty could get into the brain and eventually interfere with achievement," wrote Cornell University child-development researchers Gary Evans and Michelle Schamberg in a paper published Monday in the Proceedings of the National Academy of Sciences.
For decades, education researchers have documented the disproportionately low academic performance of poor children and teenagers living in poverty. Called the achievement gap, its proposed sociological explanations are many.
Compared to well-off kids, poor children tend to go to ill-equipped and ill-taught schools, have fewer educational resources at home, eat low-nutrition food, and have less access to health care.
At the same time, scientists have studied the cognitive abilities of poor children, and the neurobiological effects of stress on laboratory animals. They’ve found that, on average, socioeconomic status predicts a battery of key mental abilities, with deficits showing up in kindergarten and continuing through middle school.
Scientists also found that hormones produced in response to stress literally wear down the brains of animals.
Evans and Schamberg’s findings pull the pieces of the puzzle together, and the implications are disturbing. Sociological explanations for the achievement gap are likely correct, but they may be incomplete.
In addition to poverty’s many social obstacles, it may pose a biological obstacle, too.
"A plausible contributor to the income-achievement gap is working-memory impairment in lower-income adults caused by stress-related damage to the brain during childhood," they wrote.
To test their hypothesis, Evans and Schamberg analyzed the results of their earlier, long-term study of stress in 195 poor and middle-class Caucasian students, half male and half female.
In that study, which found a direct link between poverty and stress, students’ blood pressure and stress hormones were measured at 9 and 13 years old. At 17, their memory was tested.
Given a sequence of items to remember‚ teenagers who grew up in poverty remembered an average of 8.5 items. Those who were well-off during childhood remembered an average of 9.44 items.
So-called working memory is considered a reliable indicator of reading, language and problem-solving ability — capacities critical for adult success.
When Evans and Schamberg controlled for birth weight, maternal education, parental marital status and parenting styles, the effect remained. When they mathematically adjusted for youthful stress levels, the difference disappeared.
In lab animals, stress hormones and high blood pressure are associated with reduced cell connectivity and smaller volumes in the prefrontal cortex and hippocampus. It’s in these brain regions that working memory is centered.
Evans and Schamberg didn’t scan their human subjects’ brains, but the test results suggest that the same basic mechanisms operate in kids.
"Brain structures change with stress and are affected by early-life stress in animal models," said Rockefeller University neuro - endocrinologist Bruce McEwen. "Now there are beginnings of work on our own species. The Evans paper is an important step in that direction."
McEwen also noted that, at least in animals, the effects of stress produce changes in genes that are then passed from parent to child. Poverty’s effects could be hereditary.
The findings, though compelling, still need to be replicated and refined. "They’re not really saying which causal events were stressful. They’re just measuring biological markers of stress," said Kim Noble, a Columbia University psycho-biologist who studies the relationship between child poverty and cognition. Other mental consequences of poverty also need to be measured.
"I think that different cognitive outcomes have different causes," said Noble. "Something like working memory might be more associated with stress, whereas language might be associated with hours spent reading to your children."
But Noble still said the study "was very well-done. They have an impressive data set." And though some details remain incomplete, she said, evidence of connections between poverty and neurobiology are strong enough to justify real-world testing.
"Policy changes that affect environments that might affect cognitive development and brain change — that’s the ultimate future of the field," she said.
Racism Related Stress
According to Utsey (1998), race-related stress is the discomfort experienced by African Americans who observe or directly experience racial discrimination in their daily lives at the individual, cultural, or institutional level.
The cumulative effect of the stress and strain of daily racism has been shown to negatively affect the health and well-being of Black people and diminish their quality of life (Ponterotto, Utsey, & Pedersen, 2006).
Harrell (2000) utilized the term ‘racism-related stress’ (rather than race-related stress) to emphasize the link between stress and racism, thereby focusing on the environmental experience of racism rather than just on the racial group membership of an individual.
The multidimensional layers of racism (individual, institutional, and cultural), as described by Jones (1997), is a basis for much of the literature on race-related stress.
Individual racism typically occurs on the personal level, where racial prejudice is acted out, either consciously or unconsciously within some interpersonal interaction.
Institutional racism is an institutionalized version of the individual act of racism in which institutional practices and policies are based in the belief of racial superiority of one group over another.
Cultural racism is demonstrated through the assertion of the dominant group's cultural heritage and values (i.e., traditions, language, arts, values) over the values, beliefs, and traditions of all other groups. These levels of racism are both insidious and chronic and likely test the individual and collective resources and resolve of Black people.
Racism-related stress, perceived discrimination, and racism have been linked with many psychological and health related variables such as negative self-esteem, concentration difficulties, intrusive thoughts about specific racism encounters, and increased risk for mental and physical illness such as depression, anxiety, hypertension, or headaches (Clark, Anderson, Clark, & Williams, 1999; Essed, 1990; Landrine & Klonoff, 1996; Lopez, 2005; Outlaw, 1993; Utsey, Ponterotto, Reynolds, & Cancelli, 2000).
The cumulative effect of the stress and strain of daily racism has been shown to negatively affect the health and well-being of Black people and diminish their quality of life (Ponterotto, Utsey, & Pedersen, 2006).
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