May 21, 1999
By Neal D. Barnard, M.D., and Martha Martin
La comida y bebida de enfermedad y muerte. Unfortunately, that's what the current federal Dietary Guidelines push heavilythe food and drink of illness and death. Ask a doctor who works in a barrio health clinic, and you will hear about many cases of diabetes, obesity, heart diseases, high blood pressure, and asthma, all diseases much-connected with what people eat.
In Mexico, even poor people usually can get fresh fruits and vegetables, such as broccoli and corn. By contrast, the poverty-stricken, inner-city U.S. neighborhoods where many Mexican immigrants live have few food coops or supermarkets with produce sections, but an abundance of fast-food joints, convenience stores stocked with canned meats, junk foods, and cigarettes, and liquor stores. Unsurprisingly, as many Hispanic immigrants assimilate, down goes their health. Without serious dietary changes, today's incidence of largely preventable health problems will only increase.
The 1995 revision of the Dietary Guidelines for Amer-icans, and their associated 1996 Food Guide Pyramid, finally put less emphasis on the old staples of meat and dairy, and more on healthy fruits, vegetables, legumes, and grains. But the changes were far too timid. With the 2000 version actively under discussion, it is vital that the special health needs of minorities be considered.
Let's start with lactose intolerance, the body's inability to break down the milk sugar lactose. Studies in the 1960s revealed that lactose intolerancewhich can bring on diarrhea, abdominal cramping, bloating, nausea, and vomitingaffects most adults in all racial groups other than whites. The two to three servings of dairy items still suggested in the Guidelines can bring on bloating, abdominal pain, and diarrhea. Lactose intolerance affects more than 50 percent of Mexican Americans, as documented in studies published in the early 1970s in the American Journal of Clinical Nutrition. It also affects more than 90 percent of Asian Americans, more than 70 percent of Native Americans and African Africans, and many people of Jewish, Arabic, Greek, and Italian heritage.
Ironically, if it dissuades dairy consumption, lactose tolerance is a plus. The fat and cholesterol in cow's milk products make them inherently unhealthy. Beans, fortified orange juice, green leafy vegetables, and calcium-set tofu provide needed calcium without dairy's baggage.
On another dietary front, with Hispanics, the diabetes risk notably exceeds that for non-Hispanics. The Centers for Disease Control and Prevention (CDC) reports that Hispanic women are 70 percent more likely to die from diabetes complications than are non-Hispanic women. Hispanic men are 60 percent more likely to succumb to diabetes.
The Hispanic Health and Nutrition Examination Survey (HHANES) of 1982 to 1984 showed that studies conducted in Texas and Colorado confirmed a prevalence of diabetes in Hispanics two to five times higher than in non-Hispanics.
Long-term implications for anyone with diabetes include higher risks for heart disease, strokes, high blood pressure, blindness, kidney disease, nerve damage, amputations, dental disease, diabetes (including during pregnancy), congenital defects in babies, and newborn deaths.
One study cited in an August 1996 issue of The Annals of Internal Medicine showed that while about 13 percent of Hispanics living in Mexico develop diabetes, the rate rises to 18 percent for those living in the United States. The study blames an Americanization of diet and lifestyle that includes consuming more calories and fat and less fiber, coupled with less exercise.
Other diet-linked chronic diseases and conditions afflict Hispanics. For example:
o The age-adjusted incidence of ischemic heart disease is double that for Hispanic women as for non-Hispanic women. Not surprisingly, heart disease kills more Hispanic than non-Hispanic women. CDC reports that Hispanic women 45- to 64-years old are more likely to have a stroke than for non-Hispanic women of the same age. The same is true for Hispanic men in an age-adjusted study.
o An American Cancer Society study shows that the incidence of all cancers among Hispanic men and women is greater than that in the Chinese, Filipinos, Koreans, and Native Americans.
o An HHANES report found that 46.7 percent of Mexican American women are overweight compared to 32.9 percent of non-Hispanic white women.
The role of diet in overall health and longevity is clear. If current trends continue, most meat-eating, milk-drinking members of the U.S. population will succumb to preventable, diet-related conditions and diseases. Roadblocks to diagnosing and treating many Hispanics and other minorities include language and dialect barriers, lack of outpatient health insurance, fatalistic attitudes, and low literacy and education levels. Let us make sure that the 2000 Dietary Guidelines do not impose another, needless roadblock for Hispanics and others.
Neal D. Barnard, M.D. author of Foods That Fight Pain and Eat Right, Live Longer, founded the Washington, D.C.-based Physicians Committee for Responsible Medicine in 1985. Martha Martin is a writer in Carrollton, Georgia.