Why African Americans are at Risk for Diabetes

Diabetes runs in my family, so I have experience with the illness. My maternal grandmother has diabetes. My mother developed gestational diabetes and had an 11-pound baby as a result, later she developed type 2 diabetes. My paternal grandmother had diabetes and died after having a hypoglycemic event which was treated with more insulin by inexperienced doctors and led to insulin shock.

As a child I was terrified of this illness. I knew it was in my blood and the prevalence of it in my family made me feel like developing the illness was inevitable. I remember measuring out sugar in my tea, restricting how many Sprites™ I could have per day, and the emergency Sweet & Low™ packets my mother would give to me to keep in my backpack. But despite all my efforts I still feel like it is not enough. There is a biological or environmental difference between my peers and I which makes my family and I more susceptible than others. I will explore these differences in this paper.

In the US women and African Americans are at the highest risk for diabetes. I believe that it is because of a culture which promotes overweight women, sugar, and poverty. In a CDC study titled, Do Black Women’s Religious Beliefs About Body Image Influence Their Confidence in Their Ability to Lose Weight?, it is explained that overweight black women in America are the least concerned about their and have the highest self-esteem (pp. 1). In 2018, 50 percent of African Americans were obese, a number that exceeds other races by a small percentage. According to an article titled, “Mechanism Linking Diabetes Mellitus and Obesity,” fat tissue can secret hormones that affect insulin sensitivity. Non-esterified fatty acids (NEFAs) which is an element of fat stores in the body increase in bigger people and that increase is directly linked to an increase in insulin insensitivity. NEFA leads to a loss of function in pancreatic beta cells as explained in this quote, “the continuous exposure to NEFAs is related to significant malfunction in glucose-stimulated insulin secretion pathways and reduced insulin biosynthesis.” If obesity can increase one’s risk of diabetes, then a fatter population who is unwilling to change is more likely to be diabetic.

African Americans are also poorer than their white counterparts in every state. Poverty promotes a sedentary lifestyle coupled with low quality, highly processed foods which results in obesity.  To further support my assertion, Mississippi, the poorest state in the US, also has the highest rates of obesity at 39.5 percent and West Virginia, the second poorest state, is tied with Mississippi with an obesity rate at 39.5 percent. In an article called, Obesity and Poverty Paradox in Developed Countries, the authors explained that obesity in developed nations is because of “…the easy availability and low cost of highly processed foods containing ‘empty calories’ and no nutritional value.” The empty calories being referred to is sugar. Sugar is a cheap ingredient with many benefits to food manufacturing. It absorbs water which reduces microbe activity, preserves colors in frozen foods, adds bulk and texture to baked items, and enhances the taste of low-quality ingredients. Sugar is one of the easiest consumables to produce; table sugar is made by pulverizing sugarcane and then boiling it until crystals form. This process is so simple the average American could do it in their kitchen. Effortless production and multiple uses make sugar a necessity in foods for low income communities. A survey in 2005 called “Interrelationships of Added Sugars Intake,” concluded that a low socioeconomic background was linked to higher added sugar consumption in diet. The random clustered survey of 28,948 participants revealed that African American women and men reported the highest rates of sugar consumption in America. Asian Americans, a group with the highest income, reported the lowest added sugar intake. The assumption to make is quality of food increases with quantity of income.

The questions asked in the 2005 survey pertained to soda and fruit juice because a previous survey in 2001 indicated that these items contributed to the majority of added sugar consumption. Consumption of sugary beverages increases a person’s chances of developing type 2 diabetes by up to 25 percent as shown in a meta-analysis by the Journal of Diabetes Investigation. Table sugar is a disaccharide made of fructose and glucose. When table sugar is consumed, enzymes in our bodies break apart the dimer. Studies show that it is the fructose, not glucose, that leads to type 2 diabetes. A study performed by the Journal of Clinical investigation had subjects consume sugary drinks with just fructose or glucose which composed of 25 percent of their energy intake. Fat in the liver and in the abdomen surrounding organs increased by 10 percent after 10 weeks for those that drank beverages with fructose. Insulin sensitivity also increased in the animals consuming fructose but not with those that consumed glucose. The liver, being the only organ that can break down fructose, can become overworked, turning the fructose into fat. This explains why fatty liver was observed.

 The results of the studies imply diabetes will increase. Sugar is now being replaced with high fructose corn syrup 55 (HFCS), which has a 5 percent high concentration of fructose than sugar. The switch will affect lower income people the most since HFCS is reported to taste sweeter than table sugar. Less HFCS is needed to produce a desired flavor making it cheaper than sugar. A peer reviewed article from the Global Public Health journal in 2012 concluded that type 2 diabetes increased by 20 percent in countries with HFCS widely available.

The economic implications of obesity and diabetes keeps families in a cycle of generational poverty. In the words of James Baldwin “Anyone who has ever struggled with poverty knows how extremely expensive it is to be poor”. In 2012, the annual medical expenditure per person for diabetes was $13,700. The US Department of Health and Human Services states that the US federal poverty line per person is $12,500. If a person who is suffering from diabetes makes $13,000, then they cannot afford diabetes treatments, but they also make too much to be awarded government assistance. They cannot work more to supplement the loss of income due to medical bills since people with chronic illnesses take time away from work when faced with complications of that illness causing them to miss out on much needed income. The American Diabetes Association in 2012 claimed that diabetes resulted in up to 7 percent of workdays missed. If a person works 8 hours a day 5 days a week on minimum wage at $7.25, 7 percent of missed workdays is the equivalent of $1056 removed from their annual salary. Patients may go into medical debt or the unpaid portion of their care can become a burden on the family. The family will have less disposable income, be thrown further into poverty, and increase other family members’ chances of developing type 2 diabetes. One person’s issue becomes a community problem.

In medical anthropology, we are taught that healthcare is not a mechanical process and diseases never affect two people the same way. There is a link between disease vulnerability and social vulnerability and the link between certain groups of people and diabetes is poverty. Diabetes has always been considered a disease of affluence because to overconsume one must overspend. From a global point of view, that is the case as diabetes only affects developed nations. But within those nations diabetes is a disease of impoverishment. Diabetes affects those that cannot afford good quality foods and good quality medical care.

References

Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 587–591. https://doi.org/10.2147/DMSO.S67400

American Diabetes Association (2013). Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care, 1033-1046.

 

Bauer AG, Berkley-Patton J, Bowe-Thompson C, Ruhland-Petty T, Berman M, Lister S, et al. Do Black Women’s Religious Beliefs About Body Image Influence Their Confidence in Their Ability to Lose Weight? Prev Chronic Dis 2017;14:170153.

Goran, Michael I, Stanley J. Ulijaszek & Emily E. Ventura (2013) High fructose corn syrup and diabetes prevalence: A global perspective, Global Public Health, 8:1, 55-64, DOI: 10.1080/17441692.2012.736257

Institute of Food Technologists (IFT). (2015, August 18). Five reasons why sugar is added to food. ScienceDaily. Retrieved June 4, 2020 from www.sciencedaily.com/releases/2015/08/150818131807.htm

Silverman, Jacob, "How Sugar Works" 30 March 2009.
HowStuffWorks.com. <https://science.howstuffworks.com/innovation/edible-innovations/sugar.htm> 4 June 2020

“Sitagliptin: MedlinePlus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 Mar. 2015, medlineplus.gov/druginfo/meds/a606023.html.

Stanhope, K. L., Schwarz, J. M., Keim, N. L., Griffen, S. C., Bremer, A. A., Graham, J. L., Hatcher, B., Cox, C. L., Dyachenko, A., Zhang, W., McGahan, J. P., Seibert, A., Krauss, R. M., Chiu, S., Schaefer, E. J., Ai, M., Otokozawa, S., Nakajima, K., Nakano, T., Beysen, C., … Havel, P. J. (2009). Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. The Journal of clinical investigation, 119(5), 1322–1334. https://doi.org/10.1172/JCI37385

Thompson, F. E., McNeel, T. S., Dowling, E. C., Midthune, D., Morrissette, M., & Zeruto, C. A. (2009). Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005. Journal of the American Dietetic Association, 109(8), 1376–1383. https://doi.org/10.1016/j.jada.2009.05.002

Wang, M., Yu, M., Fang, L., & Hu, R. Y. (2015). Association between sugar-sweetened beverages and type 2 diabetes: A meta-analysis. Journal of diabetes investigation, 6(3), 360–366. https://doi.org/10.1111/jdi.12309

Wilcox G. (2005). Insulin and insulin resistance. The Clinical biochemist. Reviews, 26(2), 19–39.

Żukiewicz-Sobczak W, Wróblewska P, Zwoliński J, Chmielewska-Badora J, Adamczuk P, Krasowska E, Zagórski J, Oniszczuk, A, Piątek J, Silny W., Obesity and poverty paradox in developed countries. Ann Agric Environ Med. 2014; 21(3): 590–594. doi: 10.5604/12321966.1120608