Sunday, May 3, 2015

African Americans, Diabetes and Thinking Like a Freak

Last week I was listening to Think Like a Freak: The Authors of Freakonomics Offer to Retrain Your Brain . The whole premise of the book is looking at problems from different angles. In it the authors shared the story of an economist who was interested in why is it that African Americans have such higher rates of diabetes and heart disease compared to other parts of the population. This is so even if you account for things like stress, education and income level. If you look at European Africans or Native Africans, their incidence of diabetes and heart disease is far less than African Americans. This isn't racism, it's just statistics. Then why is it that African Americans are prone to have these problems? The economist's theory (which he is still researching) is that those who survived the slave trade had a genetic propensity to be able to withstand extreme dehydration, because they held more salt in their sweat and bodily fluids, they retained more water.  This leads to a higher oncotic pressure in the blood and more cardiovascular damage. These people who had this characteristic  would have more tendency towards heart disease and would pass this on to their descendants, modern African Americans. Slave- traders actually selected for this characteristic by licking potential slave purchases and selecting people who tasted more salty.
An Englishman tasting an African

Now this is all well and interesting, (and the history of the slave trade is very tragic) but so what? What can we do with this information right now? This morning I had an 'ah-ha' moment while listening to my pharmacology lecture. There is a newer group of diabetic medications known as SGLT2 inhibitors (Invokana) which inhibit sodium & glucose transport in the kidney which leads to less sodium and glucose in the blood, and is essentially an osmotic diuretic. One of the side effects is weight loss and patients are more likely to experience DEHYDRATION. This is a the perfect medication to give to patients who are genetically resistant to dehydration. Of course has a pediatric nurse practitioner it is not likely that I will be treating African American patients with Type 2 diabetes, and I'm sure that someone else out there has already made this connection, but I was excited about it and am so grateful for science and people who think outside the box to try to find solutions to problems and improve healthcare.

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