Edelweiss Ramal, associate professor of nursing at Loma Linda University, remembers a Latino patient who eagerly agreed to become a subject in a study of whether a more plant-based diet could reduce A1C levels. The man had been treated with medication for diabetes, but stopped getting medical care because he’d lost his health insurance, and was no longer able to afford his usual treatment. “His A1C had skyrocketed” into dangerous zones,” Ramal recalls. “He was very determined to do everything that I was teaching.”
His wife learned how to prepare healthier meals, and starting cooking those for the whole family. By the end of the study, “he lowered his A1C to normal levels,” she said.
Ramal specializes in looking for ways to reduce the high rate of diabetes among the Latino population, for whom the threat is particularly high.
The estimated rate of diabetes, both diagnosed and not diagnosed, is 86 percent higher in the adult Latino population than it is for non-Hispanic whites, according to a 2014 report by the U.S. Centers for Disease Control and Prevention. Why include an estimate for undiagnosed cases? Because poverty levels are higher among Latinos, which means less access to medical care and diabetes that goes undiagnosed for too long. The report didn’t break those numbers down by how many were Type 1 and Type 2, but it’s believed that most of them were the latter.
Even more disturbing is a chart of Type 2 diabetes rates among preteens and teenagers. The rate among Latino youngsters was more than three times higher than in non-Hispanic whites of the same age. When it came to Type 1 diabetes, the situation was reversed – Latino youth were considerably less likely to have the disease.
In fact, these troubling rates of diabetes were included in a recent report by the University of Southern California Department of Nursing that raised alarms about rising levels of Alzheimer’s disease in the U.S. Latino population. Latinos are 50 percent more likely to develop this form of dementia. And one underlying reason is the high diabetes rate. A growing body of research has found diabetes to be a major risk factor for Alzheimer’s disease.
Ramal, who has worked with patients in Mexico as well as with the Latino population in the Loma Linda area of eastern San Bernardino County, California, sees culture as a major contributor to the increased diabetes risk.
“Food and family are important parts of Mexican culture,” she said. “And food is big, it’s a way that they show love and caring for each other.” It’s even considered offensive, she said, when people don’t partake of all the food at a family celebration because they’re trying to control their eating.
And though diabetes is a problem for in Mexico, the situation is worsened in the United States, where highly processed junk food is cheap and quick, Ramal said. In this country, many parents work two or three jobs; they don’t have time to prepare many meals from scratch, using fresh vegetables.
Dr. Ruchi Mathur, director of clinical diabetes at Cedars Sinai Medical Center in Los Angeles, said the low price of junk food is another part of the picture.
“Economics certainly plays a role, especially when food with little nutritional value is much cheaper than healthier options like fish, fruits and vegetables,” Mathur said. “In addition, cultural and societal patterns influence a variety of behaviors such as when to see a physician and what is a considered a normal meal pattern.”
The growing threat to Latino health has drawn attention in part because of the population growth among that group. A 2017 Pew Research Center report put the number of Latinos in the nation at close to 58 million. Latinos account for half of the nation’s total population growth since 2000 and is expected to comprise a third of the U.S. population by 2050.
Mortality rates among Latino patients with diabetes also are worse.
“When we look at death rates in Latino and non-Latino diabetics, the rate is 30% higher, in Latinos and 50% higher in Latinas compared to non-Latino whites,” Mathur said.
Not all groups of Latino Americans have very elevated rates of diabetes; there are significant differences among groups. For example, according to a 2014 study by the National Heart, Lung and Blood Institute, the diabetes rate is highest among Mexican Americans, at 18.3 percent, and lowest among people of South American descent, at 10.2 percent—which is about the same as for non-Hispanic whites in the United States.
Getting to the bottom of why these differences exist is more complicated than it might seem. Certainly, poverty has been closely linked to higher risk of developing Type 2 diabetes, and people of Mexican descent are more likely to be low-income, the Pew Research Center has reported. They are more likely to live in so-called “food deserts” where fresh fruits and vegetables are not readily available; cheap, highly-processed fast food often dominates the local food scene. Perhaps, some experts theorize, that has led to worsening obesity. Finances and language barriers create obstacles to medical care that could catch an impending health problem early and perhaps turn it around.
In addition, obesity, a major risk factor for diabetes, is significantly higher in the Latino population, according to a report by The State of Obesity, a project of the Trust for America’s Health.
“Forty-two percent of Latino adults are obese compared with 32.6 percent of whites,” the report says. “More than 77 percent of Latino adults are overweight or obese, compared with 67.2 percent of whites.”
But there might be more to the picture than that. Genetics also appear to play a role.
In 2013, a team of international scientists reported in the journal Nature that they had identified genetic mutations that occurred thousands of years ago that appeared to raise the risk for Latinos, including a gene that appears to be involved in fat metabolism. Mutations in the gene can increase risk of Type 2 diabetes by 20 to 40 percent, the team found, depending on whether one parent or both carry the mutation.
That provides all the more reason for providing the nation’s Latino population with the education, medical care and other resources to stave off diabetes, experts said.
“Access to healthcare certainly factors in,” Mathur said, “since delays in care can result in worsening of disease and its complications. The prevalence rate for eye, kidney, nerve, and limb involvement are all higher in this group.
“Having dealt with hundreds of patients, I know there is always a certain fear that comes with the diagnosis of diabetes. Many people feel if they don’t know, they don’t have to do anything about it, and that is much easier, isn’t it? I’ve always said that If diabetes caused an itch or an ache every time blood sugar went up, people would run to their doctors to get treated. But diabetes often goes for years without diagnosis precisely because there is no itch or pain – it is easy to avoid.”
Ramal finds hope for the future in the kind of eating program that was taught to patients and their families in the Loma Linda study, which found significantly lowered A1C levels among patients who followed the diet. Remembering the man who lost weight and lowered his levels to normal, she sees not only one saved patient, but now an entire family, including children, who have learned about new ways of cooking and eating to improve their health.