Health Equity and Longevity

We have a lot of choices to make about our diet. Add to that – doing the right thing when it comes to treating a chronic illness, fighting a virus, or losing weight, and suddenly, our nutrition choices can seem almost overwhelming.  

Well, I’m here to help. Welcome to the Nutrition Facts podcast. I’m your host – Dr. Michael Greger.

Does it ever seem to you that some of us are kept from living longer, healthier lives – because of our skin color? In our first story, we look at health equity – and why black Americans are sicker and die younger than their white counterparts, on average.

During the COVID-19 pandemic, the death rate for African Americans was as much as six times higher than white Americans. The higher Black pandemic deaths placed a harsh spotlight on their longstanding higher mortality and diminished longevity in general. Unfortunately, diminished African American life expectancy predates the COVID-19 pandemic by decades. The Black-white death gap for women is about three years, and for men, closer to five years.

The COVID-19 death disparities may have to do with limited access to healthy food in predominantly Black communities, the housing density, the need to work or else, the inability to practice social distancing, but also the underlying burden of ill health. Increased COVID-19 mortality and complications occur more often in individuals with pre-existing conditions like hypertension, obesity, diabetes, and cardiovascular disease––comorbidities that are more prevalent in African Americans. More high blood pressure, more diabetes, more strokes, more likely to die at early ages from all causes put together. The question is why. Why do Black Americans live sicker and die younger than their white counterparts?

Well, one big factor is socioeconomic status. In the United States, race is closely tied to class, with African Americans about twice as likely to be living in poverty. On average, education levels are lower as well; however, even among African Americans whose socioeconomic status is comparable to that of whites, despite the higher education and more socioeconomic resources, health outcomes are still poorer. Part of that has to do with lifestyle behaviors. For example, fewer than 5 percent of African American adults met physical activity guidelines. Smoking rates are actually comparable, though African Americans tend to be exposed to more second-hand smoke and have lower quit rates. This may be because they’re more likely to use menthol cigarettes, which enhance the addictive potential of nicotine. Why menthols? Because tobacco companies target the marketing of mentholated products to African Americans. Black lives…Black lung.

Similarly, if you look at food messages on African American television shows, not only does Black prime time contain a greater number of food commercials, African American audiences may be receiving nearly three times as many advertisements for low-nutrient junk such as candy and soda. That may be one reason why African Americans tend to consume fewer fresh fruits and vegetables, and are more likely to eat junkier foods.

Of course, where are you going to get those fresh fruits and vegetables? There are fewer supermarkets located in Black neighborhoods compared with white neighborhoods––as in four times fewer supermarkets. What Black neighborhoods do excel in, though, is fast food. Predominantly Black neighborhoods have 60 percent more fast food restaurants per square mile compared to predominantly white neighborhoods.

Now, of course, dietary behaviors alone do not fully explain the significant differences in diet-related disease patterns between racial groups. There are differences in employment and poverty and home ownership and healthcare access, all of which can affect outcomes. But while there are certainly many social and economic factors, such as racism and income inequality, that contribute to health disparities, there is good evidence that simply eating a more plant-based diet could help eliminate disparities in cardiovascular disease and diabetes.

Here’s the diabetes data. Even after controlling for education, income, physical activity, and even BMI, non-Blacks eating strictly plant-based diets had 57 percent lower odds of diabetes, and among Black vegans, it was even more striking—70 percent lower odds. And that was after taking BMI into account. So, even at the same weight, Black vegans have 70 percent lower odds of diabetes than Black omnivores. And the racial disparity is only about half that: 36 percent. So, the increased risk of diabetes among Black participants was on the order of one-third, while the protection afforded by vegan diets in this subgroup was about 70 percent. Even just a vegetarian diet that includes still eating dairy and eggs may more than counteract the racial disparity in diabetes risk.

And they’re not the same weight. African Americans have higher obesity rates, cutting their lifespans by six years, but Black vegetarian and vegans have less than half the risk of obesity compared to those who eat meat. And this is after adjusting for differences in physical activity. So, even at the same exercise levels, those eating more plant-based had but a fraction of the obesity risk.

High blood pressure. In African Americans, hypertension is the most significant contributor to their increased cardiovascular disease burden and mortality but…Black vegetarians and vegans combined had 44 percent lower odds of hypertension, an important finding for Black individuals where hypertension is so prevalent, with no benefit found for those who cut out all other meat, but continued to eat fish. And the same thing found for total cholesterol and LDL cholesterol: cutting odds in half among Black vegetarians and vegans. As with non-Blacks, the researchers conclude, these results suggest that there are sizeable advantages to a vegetarian diet in Black individuals. What about vegetarians versus vegans? The title gives it all away. “Cardiovascular Disease Risk Factors are [even] Lower in African American Vegans.”

This is something we’ve known about when Caucasian vegans have been compared to vegetarians. However, it was not known whether African Americans vegans exhibit a more favorable cholesterol profile, until now. Significantly lower LDL cholesterol in vegans. Now, of course, the vegans were also significantly slimmer, on average normal weight as opposed to the overweight vegetarians. But even after taking that into account, those eating more plant-based had significantly lower cholesterol.

So, there’s a tremendous “Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States.” In fact, they may have an even greater benefit. For example, African Americans have an excess burden of chronic kidney disease, not only because they have more high blood pressure and diabetes, but there are genetic factors. Eight percent to 12 percent of African Americans are carriers of the sickle cell trait, which places them at significantly higher risk of kidney disease; so, while Blacks represent a relatively small fraction of the U.S. population, they account for more than a third of all patients on dialysis, due to chronic kidney disease. And that’s where plant-based diets can come in, shown to protect against both chronic kidney disease development as well as progression.

Three quarters of Blacks are lactose-intolerant too; so, would again stand to benefit even more from eating plant-based. It is unacceptable that for decades, the American healthcare system has failed African Americans and other minority communities in terms of helping to prevent some of our leading killers, but that just makes it all the more important for them to take their reigns of their own health destiny.

In our next story, we look at what role diet and baby powder play in the development of fibroids and ovarian cancer.

If you randomly select a group of women and ultrasound their uterus, the majority of them have fibroid tumors by age 50. And by most, I mean, more than 80% of black women, and about nearly 70% of white women. Half of white women already have fibroids by their early 40s, and the same could be said for African-American women in their mid-30s.

After getting over the shock of how widespread fibroids are, the next question becomes, why the racial disparity? Is it “diet, stress,…environmental exposures”? Maybe, whatever it is could offer a clue as to what causes fibroids. For example, African Americans tend to have a “lower intake…of fruits [and] vegetables,” and fruits and vegetables appear protective against fibroids—particularly citrus; though not, apparently, just citrus juice.

It’s interesting; if you measure the levels of beta-carotene in fresh surgical tissue samples of uterine fibroids, and “adjacent normal [uterus tissue] obtained” during hysterectomies, you find “significantly…lower” concentrations in the fibroids. In fact, beta-carotene was not even detectable in half the fibroid specimens. The same thing is actually found in cancer. Most cancerous tissues tested had undetectable levels of beta carotene, compared to the normal tissue right next to the tumor. So, maybe “decreased levels of [beta]-carotene” somehow play a role in causing these conditions? Sounds like a bit of a stretch, but you don’t know until you put it to the test. But, there had never been a randomized, controlled, clinical trial of fruits and vegetables for fibroids, until… never! They did do a randomized, controlled trial of kind-of-a-fruit-and-vegetable-at-the-same-time—tomatoes—but for the prevention of fibroids in Japanese quail, and most of my patients are not Japanese, nor quail.

The action of lycopene, the red pigment in tomatoes, “in an animal model may not accurately represent lycopene action in humans.” And indeed, the Harvard Nurses’ study found no apparent link between lycopene consumption and fibroids. So, yeah, fruits and at least green vegetables may have a “protective effect.” But we won’t know for sure, until they’re properly put to the test.

Vitamin D is another possibility as to why African-Americans disproportionately suffer from fibroids. “Women with darker skin are…more likely to be Vitamin D-deficient;” as many as 80% of black women may have “inadequate levels of Vitamin D,” compared to only one in five white women.

Vitamin D does inhibit fibroid cell proliferation—in a petri dish. It may be able to shrink tumors in your pet rat; but what about people? A population study did find that “[w]omen with sufficient vitamin D” levels in their blood had about a third “lower odds of fibroids”—consistent with the finding that women who report lots of sun exposure also appear to be protected. But, until there’s an interventional trial where women are randomized to vitamin D or placebo, we won’t know for sure if vitamin D plays a role in fibroid prevention or treatment, or not.

African American women are also more likely to sprinkle baby powder on their genitals, which may not only double the odds of fibroids, but may increase the risk of ovarian cancer—the deadliest gynecological cancer. Internal memos show Johnson & Johnson knew about the cancer risk, but still decided to target African-Americans. “Think of us”, Johnson & Johnson said, “as a lifetime friend of the family”—a lifetime cut short, perhaps, by its baby powder, or at least so said a jury, which recently awarded a family $110 million in damages—on top of the $200 million in verdicts from last year, with thousands of lawsuits pending after internal memos revealed that decades ago, their own contracted toxicologists were warning the company that there are multiple studies showing a cancer link, and anyone who denies this risk “will be perceived by the public” in the same light as those who denied a link between smoking cigarettes and cancer: “denying the obvious in the face of all evidence to the contrary.”

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To see any graphs, charts, graphics, other images, or studies mentioned here, please go to the NutritionFacts podcast landing page. There you’ll find all the detailed information you need – plus links to all of the sources we cite for each of these topics.

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