Pass the Pain: Epigenetics of Black Health

By: Natasha Duggan, MSPH

Minorities and African Americans in particular are disproportionately affected by various chronic diseases in comparison to their white counterparts. Diseases including obesity, diabetes, cancer and asthma are much more prevalent in the black community. The question is …why?

It is in part due to genetics. Some illnesses like diabetes have a genetic component, meaning risk of disease is passed down in your family through your DNA. However, genetics alone does not account for the disproportion of some diseases found only in certain populations or neighborhoods. These findings can be explained by epigenetics.

Epigenetics refers to the changes that occur in gene expression-turning genes on and off- without changing the actual DNA sequence.1 Epigenetic changes happen naturally but can be influenced by things like age, environmental exposures, and disease. In many instances epigenetic changes are reversible, but they are sometimes irreversible and affect a person for life.1 Exposure to different environmental factors can cause epigenetic changes which result in diseases like cancer, obesity, diabetes, and asthma. Increased and prolonged exposure to adverse environmental factors increases the likelihood of epigenetic changes being irreversible.1

Epigenetic changes go beyond effecting the person being exposed to adverse environmental factors. Epigenetic changes can be hereditary. If a pregnant woman is exposed to certain environmental factors, the epigenetics of her child may be permanently altered, resulting in an increased risk of chronic disease.1,2 One of the most famous and well-studied examples of this is the Dutch Famine. In the later years of World War II, pregnant women who experienced famine gave birth to children with increased incidences of both heart disease and obesity due to the epigenetic changes which occurred while they were still in the womb.1

So why is epigenetics so important to minority communities? Epigenetics partially explain why minority populations are disproportionately affected by some chronic diseases. An example of this includes the effects antibiotics have on infants before they are even born. Antibiotics are the most common drugs prescribed to pregnant women. Scientists have found that when pregnant women take antibiotics they are more likely to have a child with low birth weight2. In turn, these children often under-go catch-up growth in early childhood, which often results in obesity2. Although this phenomena occurs across all races, it is much more common in black women.2

So what is going on to make this happen? The taking of antibiotics while pregnant creates a stressful environment for the fetus, so to ensure its survival epigenetic changes occur.  Once the child is born and is no longer in a harsh environment they tend to become obese due to the fact that the epigenetic changes which occurred when they were still in the womb are still in effect.2  However, it is not just antibiotics that can cause these epigenetic changes. Many pharmaceutical drugs also cause epigenetic changes, increasing the risk of heart disease, cancer, neurological and cognitive disorders, obesity, diabetes, infertility, and sexual dysfunction3. Because of this it is very important to be careful what goes into your body.3

Stress is a major contributor of epigenetic changes. Unfortunately being black in America causes a lot of everyday stress. Although being of a lower socioeconomic class is correlated with higher stress and worse health outcomes, across all socioeconomic classes Black and Latino people were found to be more likely to have high levels of the stress hormone cortisol.4,5,6  Stress can cause a variety of epigenetic changes. Firstly, high stress levels during pregnancy can cause epigenetically induced asthma in infants.4 This is exacerbated by the mother also being obese while pregnant.4 High stress levels (marked by high cortisol levels) have also been shown to result in premature childbirth.6 This is thought to be a possible reason why black women have more premature births than white women.

The scary part about epigenetics is the fact that epigenetic changes can be inherited and can affect your children’s and even your grandchildren’s likelihood of having a disease. With epigenetics being a fairly new field, there is still a lot more research that needs to be done to see the role epigenetics plays in many chronic illnesses. Even though a lot of epigenetics  cannot be changed, it is still important to educate ourselves on what may be responsible for our illnesses and to try to avoid the exposures that we can. Don’t take drugs (pharmaceutical or antibiotics) unless necessary, and adopt effective stress relieving behaviors. The more you know, the more likely you are to make better, healthier decisions.

Natasha Duggan received a B.A. in Psychology from the University of San Francisco and M.S.P.H. with a focus in Tropical Medicine from Tulane University. She is currently working on her Ph.D. looking for potential vaccines against HIV at the University of Miami. She plans to use the knowledge and skills acquired from these different disciplines to work on a vaccine and/or treatments against HIV and make sure that they get to the people that need them the most in countries hardest hit by the pandemic in Sub-Saharan Africa.
 
Resources

1.http://www.whatisepigenetics.com

2.AC Vidal et al. “Association between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring.” International Journal of Obesity 2013; 37,907-913.

3.AB Csoka & M Szyf. “Epigenetic side-effects of common pharmaceuticals: A potential new field in medicine and pharmacology.” Medical Hypotheses 2009; 73, 770-780.

4.RJ Wright et al. “Disrupted prenatal maternal cortisol, maternal obesity, and childhood wheeze.” American Journal of Respiratory and Critical Care Medicine 2013; 187(11), 1186-1193.

5.RJ Wright. “Epidemiology of stress and asthma: From constricting communities and fragile families to epigenetics.” Immunol Allergy Clin North Am. 2011; 31 (1), 19-39.

6.Janell Ross “Epigenetics: The Controversial Science Behind Racial and Ethnic Health Disparities.” The Atlantic March 20, 2014. http://www.theatlantic.com/politics/archive/2014/03/epigenetics-the-controversial-science-behind-racial-and-ethnic-health-disparities/430749/

Pass the Pain: Epigenetics of Black Health

Black & White: Death & Dying by Race & Ethnicity

Is health black and white?

Before you answer… Did you know that there are differences in death rates based on race? On average, at birth a white person may expect to live 5 years longer than a black person in the United States. This gap grows to a 10 year difference when comparing life expectancy of white women (81 years) to black men (71 years) [1, 2].

Why is this the case?

Well for starters, the leading causes of death differ down both race/ethnicity and gender lines. For instance, homicide makes the list as one of the top five killers of black men, but does not make the list for white men (nor either group of women). Diabetes makes the list as one of the top five killers of black women, but does not make the list for white women (nor either group of men) [3]. However, when comparing death rates between blacks and whites for the same disease, blacks still tend to have worse health outcomes. In fact, according to 2012 data, the U.S. Department of Health and Human Services Office of Minority Heath states “the death rate for African Americans was generally higher than Whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide” [4].

But really, why is this the case?

It comes down to what researchers refer to as ‘social determinants of health’. This term translates into how where you live, work, and play shapes your health. Moreover, these differences may in part be explained by health inequity, “difference or disparity in health outcomes that is systematic, avoidable, and unjust” [5]. For instance, it is common knowledge that many black people in America are living in poverty. This fact is tied to societal oppression dating back to slavery. Poverty manifests in predominately black neighborhoods, leading to limited access to resources such as healthy food, safe environments for physical activity, and quality health care services. As declared by Dr. Martin Luther King Jr., “of all the forms of inequality, injustice in health care is the most shocking and inhumane.” BUT, poverty does not explain it all. Even when a 2015 study compared breast cancer survival rates between low socioeconomic status white women with high socioeconomic status black women, black women still suffered from worse health outcomes [6]. Thus, factors beyond poverty, such as racial discrimination (e.g. subconscious differences in treatment by health care professionals) must be considered.

What can be done?

First and foremost, health education and health inequity awareness must become common knowledge. Children and adults, men and women, black and white must all understand what constitutes health, so that health is not only seen as the physical absence of a pathogen, but more holistic and inclusive of mental, emotional, environmental, and social health. Professionals and patients must work together to actively address gaps in sociocultural competence/humility through being open and honest with each other. Particularly, physicians have a responsibility to treat “humanity as [their] patients” [7]. Thus, systematic discrimination must be deconstructed for the assurance of ‘justice for all’. While health policy should be at the forefront of the conversation to combat these issues of social justice, communities must also consider their power in determining their destiny. Black communities, as they have done in the past, must begin to gather, organize, and mobilize to persevere.

Now, with all of this in mind… you tell me, how long should health continue to be black and white?

Rhoda Moise is a graduate of Pennsylvania State University with a B.S. in Biobehavioral Health and a passion for health promotion. She has been trained to approach health from an interdisciplinary perspective from proteins to people. Through her doctoral studies as a PhD student at The University of Miami, she intends to combat health disparities by conducting research which provides empirical evidence that demands alteration in standing policy.

References

1 http://www.cdc.gov/nchs/nvss/mortality_tables.htm

2 http://www.cdc.gov/nchs/data/dvs/LEWK3_2009.pdf

3 http://www.cdc.gov/nchs/nvss/mortality_tables.htm#lcod

4 http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

5 http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html

6 Keegan, T. H., Kurian, A. W., Gali, K., Tao, L., Lichtensztajn, D. Y., Hershman, D. L., … & Gomez, S. L. (2015). Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. American journal of public health, 105(5), 938-946.

7 http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/declaration-professional-responsibility.page

Black & White: Death & Dying by Race & Ethnicity

Health Isn’t One-Size-Fits-All

By: Delphine Gervais, LCSW

This May will mark five years since my mom was “officially” diagnosed with stage 4 breast cancer and two years since she transitioned.  There were plenty of days that I replayed the rush to the hospital, the exposure of her upper body to the doctors, the shock at what I saw. I remember the doctor questioning my mother, “When did you feel the first lump?”  I remember hearing my mother respond, “four years ago”. (hence my reference to the word “official”).  My mother was a resourceful Haitian woman, who never missed a doctor’s appointment and who never missed out on an opportunity to eat healthy.  Olive oil was a staple in our home.  Processed food was not.  She did everything she knew how to live a fit life.  In her mind, that lump negated every effort,  and it was then that her life completely changed.

For the purpose of conversation, I opt to turn my lense to black women and what their attitudes towards receiving services imply for their ultimate well being.  The stats are not favorable for communities of color.  Heart disease, cancer, hypertension, mental health–people of color lag behind in prevention and are dying at faster rates for lack of both prevention and intervention services.  In the case of breast cancer, although screenings among black women tend to be on level with those of their white counterparts, follow-ups for negative results were much lower.  Death rates among black women are 42% higher than their white counterparts.  It is one thing to schedule and conduct one’s mammogram every year.  Everyone can do that.  It’s another thing to follow up after receiving some not so favorable results.

I didn’t believe my mother loved me and my brother less because she didn’t seek the help she needed.  It couldn’t have been an easy pill to swallow to suffer in silence. Help seeking behaviors among African-American and Afro-Caribbean women have historically been a point of concern among those in the health profession.  The cultural construct surrounding help seeking behavior for physical or mental health concerns boils down to “it’s nobody’s business but mine.” If you couple that with the religious and spiritual impact on decision-making and you likely have a woman who will keep secrets from her loved ones and bear the entire emotional burden of disease.  To say that women of color reject the notion of prevention or intervention services is a fallacy.  It is best to first understand that normalizing health seeking behavior is the first order of business.

Imagine walking into a space where medical jargon is thrown at you left and right.  Machines are beeping.  People hurry about their work day, some stay long enough to inquire as to your well-being, while others just come long enough to poke and prod and leave with nary a word.  A person who speaks the king’s English would have a hard time navigating the health system.  A person who speaks limited or no English would drown in fear and embarrassment.  There is also the matter of inequitable access to services in the communities of color.  Are clinics within walking distance or near a bus stop? Do those who provide services understand the complexities of a person of color coming to their spaces in search for help?  Are they immediately placed at ease?  Are there people present in these spaces who can walk among the emotional minefields of their patient’s mind?

I remembered offering to take my mother to a cancer support group comprised of Haitian women.  The social worker in me thought it would be best for her to be among others who were grappling with similar issues.  She gave me a blank stare and a firm “No”.  I never brought it up again.  At times, we professionals believe we know what’s best for those who need help.   Imposing our norms and expectations lessens the opportunity for the person to establish personal ownership of their circumstances.  They’ve heard about the church member who became ill, went to the hospital and never came back home.  Walking into foreign spaces and experiencing a new normal is difficult for the average human being.  Being a woman of color compounds those feelings of helplessness.  When the strong black woman mystique had been challenged and the figurative “S” was off her chest, my mother didn’t want a support group.  Attendance at weekly church services was support enough.

There cannot be a one size fits all approach to healthcare.  My mother’s doctor knew well enough not to say the big “C” word in sessions.  She was delicate and respectful in her approach, she maintained deference in her tone and she left the hard discussions during one-on-ones with me.  At times she would practice her Creole on my mom.  This would make my mom smile.  The feeble attempts at seeking commonality met with ultimate respect.  For my mom that was enough to keep her committed to returning every month.  Even when the blood work started coming back with less than positive news, she kept her appointments without fail. Being seen by doctors and nurses who knew her name and smiled with their eyes made the trips that much bearable.  Half the battle is won when communities of color are provided with opportunities to maintain their personal dignity while seeking the help they so very much deserve and need.

This is not a mandate to learn a new language or join Doctors Without Borders.  It is however a call to action for professionals in the healing arts to take stock of how they approach their patients of color.  What works for Jane Doe may not work for Marie Pierre and Mary Johnson.  Cultural norms play a big part in how they each approach seeking help.  Knowing Jane’s cultural constructs and not Marie/Mary’s should cause one to pause and assess their effectiveness in providing service.  As the Haitian daughter of a Haitian woman I thought I knew all there was to making sure my mom received the services she needed.  My westernized approach to therapeutic intervention failed miserably.  I should have known that my mother cared less about support groups than ensuring she had a nurse aid to provide meals.  She cared less about the blood work coming back negative and more about when the bus would come to take her to her prayer service.  It didn’t take me long to stop hitting my head against the proverbial wall.  It was less of what I wanted and more about what she needed.  Once I made peace with that, it was smooth sailing.

Delphine is a licensed clinical social worker with experience in education, health, social welfare, community development, and individual/family/group intervention services. Her professional background emphasizes a special focus on community involvement and service; utilizing social networking for the purpose of bridging the gap between those with established needs and those with access to the resources to meet those needs. Read more on her blog.

Source:  American Cancer Society http://www.cancer.org/

 

Health Isn’t One-Size-Fits-All

Spinach & Sundried Tomato Stuffed Shells

Spinach & Sundried Tomato Stuffed Shells

This recipe makes 5 servings of 3 shells each.

INGREDIENTS:

10 oz fresh spinach

8 oz fresh mozzarella

32 oz part skim ricotta cheese

8 oz sundried tomatoes in olive oil, julienne cut or sliced

1/2 tsp sea salt

1/2 tsp black pepper

1/2 tsp italian seasoning blend

12 oz (1 box) jumbo shells pasta

DIRECTIONS:

1. Prepare jumbo shells according to package instructions. Once the pasta is fully cooked, drain, rinse with cold water, and set aside to cool.

2. Add 1/4 cup water to a skillet, then add the spinach, cover, and cook until completely wilted (about 2 minutes).

3. Add the sundried tomatoes, ricotta cheese, mozzarella and seasonings to the skillet and mix thoroughly. Once the mozzarella cheese has melted, remove the cheese mixture from heat and let cool for 5-10 minutes.

4.Spread 1/3 of spaghetti sauce in the bottom of a 9 x 13 inch pan (or whatever dish your heart desires). Stuff shells with a tablespoon-full of the filling and place open side up, and close together in the pan.

5. Bake at 350 degrees for 20-25 minutes, or until cheese is bubbling. Serve with a side of your favorite green vegetable or a light garlic bread. Enjoy!

 

Spinach & Sundried Tomato Stuffed Shells

Spinach & Strawberry Salad w|Feta Cheese

Spinach & Strawberry Salad w|Feta Cheese

This recipe makes 6-8 servings.

INGREDIENTS:

1 15 oz bag of spinach

1 pint strawberries, sliced

1 15 oz can of chickpeas, drained and rinsed

6 oz feta cheese, crumbled

1 tsp sea salt

1 tsp black pepper

1/2 cup honey

2 lemons

1/2 cup olive oil + 2 tsp

DIRECTIONS:

1. Preheat oven to 400 degrees.

2. Drain and rinse chickpeas, then toss with olive oil and spread evenly onto a baking sheet.

3. Bake 15-20 minutes, until crisp.

4. Remove the chickpeas from the oven and let cool, then mix with spinach, strawberries, and feta cheese. Toss with the honey-lemon dressing immediately before serving.

For the Dressing:

1. Mix ½ cup extra virgin olive oil with ½ cup of raw honey and the fresh juice of 2 lemons.

2. Season with 1 teaspoon of sea salt and 1 teaspoon of black pepper. Mix vigorously. Store in the refrigerator for no more than one week.

Spinach & Strawberry Salad w|Feta Cheese

Chicken Apple Breakfast Sausage

IMG_4372

Chicken Apple Breakfast Sausage

This recipe makes 10 sausages; one sausage is one serving.

INGREDIENTS:

1 lb ground chicken

1 gala apple, diced

1/2 yellow onion, diced

1 tsp ground sage

1 tsp sea salt

1 tsp black pepper

1 tbsp honey

2 tsp olive oil

DIRECTIONS:

1. Heat 1 tsp olive oil in a small pan over medium high heat. Toss in the diced onions and coat in the oil, then spread into a single layer and cook for 2-3 minutes, then add the apples and saute again for 2-3 more minutes. Once they are done, remove from heat and set aside in a small bowl to cool.

2. In a medium bowl, mix together all of the ingredients thoroughly and form 10 patties.

3. Heat the other tsp of olive oil, then saute the burgers for 9-12 minutes, flipping once during the cooking time.

4. Serve warm with a side of honey or maple syrup.

 

Chicken Apple Breakfast Sausage

Mixed Berry Almond French Toast Bake

Its National Strawberry Day and I have an amazing brunch recipe to help you celebrate! This easy and delicious french toast bake cuts down the sugar and fat in a traditional french toast recipe, and is also easy to make in bulk in case you are in the mood to share! Before we get to the recipe.. let’s go over the health benefits in the topping.

Strawberries are packed with vitamins, minerals, fiber, and particularly high levels of antioxidants that reduce inflammation. Strawberries are sodium-free, fat-free, cholesterol-free, and low-calorie. Just one serving of strawberries (8) provides more Vitamin C than an orange!

Almonds are a great source of vitamin E, copper, magnesium, and high quality protein. Almonds also contain high levels of healthy unsaturated fatty acids, fiber, vitamins, other minerals, and antioxidants, which can help prevent cardiovascular heart diseases.

IMG_4637

This recipe makes 8 servings.

INGREDIENTS:

1 tsp olive oil

1 loaf challah bread

6 eggs

1 cup milk

1 tsp vanilla extract

1 tbsp honey

1 tsp cinnamon

1/2 tsp allspice

1 1/2 cup mixed berries, frozen

1/4 cup almonds, sliced

Additional honey or maple syrup for serving

DIRECTIONS:

1. First, cut the challah bread into one inch pieces. Whip the eggs, milk, vanilla extract, & honey together in a small bowl.

2. Grease a 9×13 inch glass baking dish with olive oil, then layer the bread across the bottom of the dish in a single layer.

3. Sprinkle the cinnamon and allspice over the bread, then pour the egg mixture into the dish and cover with plastic wrap.

4. At this point, you can either refrigerate the bake overnight in the refrigerator, or leave the bake at room temperature for 1 hour. I’ve tried both and both work, so.. your choice!

5. Either way, when you are ready to bake your french toast, preheat the oven to 350 degrees and flip the challah bread pieces over in the pan. Bake uncovered for 30 minutes.

6. Remove the dish from the oven and top the casserole with mixed berries (I prefer them frozen) and sliced almonds. Bake for an additional 10-15 minutes.

7. Serve warm with a side of honey or maple syrup.

Mixed Berry Almond French Toast Bake