The “Latino Paradox”: Why Latinos Are More Likely to Have Diabetes

It’s called the “Latino paradox,” and it applies to many chronic conditions, including diabetes: Central and South American immigrants to the U.S. and their children are at a greater risk for diabetes than their neighbors who stayed in their home countries, and greater risk than the average U.S. population. But Latinos also have a longer life expectancy than Caucasian Americans by about 2 years.

What gives?

Genes and Lifestyle

According to a recent report, 9.5 percent of Mexican Americans aged 20 and older have diabetes. Mexican-Americans (the largest group of Hispanics in the U.S.) are 1.7 times as likely to have diabetes as whites. Puerto Ricans are 1.8 times as likely as whites to have diabetes. Some researchers hypothesize this can be explained by the “thrifty gene hypothesis.”

“People whose ancestors came from areas where there were periodic famines became more efficient at storing calories,” said Dr. Gregory Juckett, Director of the West Virginia University International Travel Clinic. “People who didn’t have the thrifty gene died out.”

“Moved to a calorie rich environment [like the typical U.S. diet], they tend to gain weight more easily and gain more weight,” he said.

Latinos might retain a longer life expectancy because of some other cardiovascular protective factor in their genes or because they tend to have tight-knit communities, connected to families and other individuals, which seems to be a stress reducer, he said.

Despite this boost, diabetes still takes a heavy toll on the Latino population.

A Heavy Toll

According to a joint NPR/Robert Wood Johnson Foundation/Harvard poll earlier this year, Latinos see diabetes as the biggest health problem for their own families.

In many Latino families, the question of diabetes is not “if,” but “when.”

“Mexicans in Mexico are at a much lower risk for diabetes and hypertension,” said Diana Naranjo, Ph.D., an assistant professor at the UCSF School of Medicine in San Francisco.

“ The immigrant group ends up faring better than their children and children’s children,” she said.

This could be due to lifestyle changes over time and the high-calorie diet, but it’s been difficult to prove exactly what is going on, Naranjo said.

“When we looked at the undiagnosed numbers, it was extremely high,” said Dr. Helene Clayton-Jeter, co-manager of the Cardiovascular and Endocrine Liaison Program (CELP), at FDA’s Office of Special Health Issues, who has studied rates of diabetes in minority populations in the U.S.

“Somehow, the diagnosis of the Latino population is just not happening,” she said.

Solutions and Barriers

Beyond genes and lifestyle, Latinos deal with specific psychosocial stressors in managing their diabetes, and doctors don’t always grasp that, Naranjo said.

Many Latinos are diagnosed with diabetes at a young age, when they aren’t prepared to make long-term health care a priority, she said.

“It’s a lot more challenging being young, Latino and having diabetes. At age 30, they may have children and be working multiple jobs,” she said. “There’s a cognitive difference between feeling young and having a chronic lifetime disease.”

Doctors should try to understand how to appeal to the whole patient, considering their lives generally, she said.

“If your kids are starving and you don’t have a job and you don’t have a license, you are not likely to take care of your diabetes,” she said. “Especially Latina women feel like they don’t have a lot of social support for managing it.”

She has seen many Latino patients who are worried more about their children’s health than their own health, and if frame the conversation around how diabetes will affect their ability to parent, that can have better results, she said.

But that brings up another potential barrier to care: conversation. For Latinos, language can sometimes come between patients and doctors.

“Just at the basic level, there are very few diabetes education classes in Spanish, but they are very accessible for English,” Naranjo said. “I can’t find a diabetes education class in Spanish in San Francisco.”

Another barrier to managed care is nutrition. Often, meal plans tailored to diabetes do not take into account the cultural background of the patient.

“We need to make our diet plans more ethnically acceptable to different groups, not just toward the Anglo groups,” Juckett said. “Especially first generation immigrants are going to want to eat certain foods,” like tortillas, he said.

Diabetic nutrition plans can include traditional Latino foods, like prickly pear cactus ‘nopales,’ while keeping blood sugar down and maintaining a healthy weight, he said.

As for medication, many Latino patients try to strike a balance between the remedies they know traditionally and Western medicine, and will end up taking less insulin than they need, supplementing it with teas or tinctures. Doctors should simply remember to ask ’what else are you doing to treat your diabetes’ Naranjo said: that’s always her first question to patients.

Resources to Help

“The key is really to look at the things that are modifiable,” like diet, attitude and communication strategies rather than genetics, Naranjo said.

Education can make an impact.

“A lot of Latinos fear insulin, because when people they have known have gone on insulin they have had more complications, hospitalizations, amputations, blindness,” Naranjo said. But targeted education efforts can reverse these beliefs, as long as providers are aware they might exist.

Cultural awareness goes hand-in-hand with tending to the “whole patient,” Clayton-Jeter said. The FDA offers resources for Latinas and others managing their diabetes.

“It comes down to understanding enough about the culture to know what to ask,” Naranjo said.

As for anyone at risk of diabetes, eating right, exercising and talking to your doctor are the first steps to a better you.

“We all have to work with the deck of cards that we’re dealt,” Juckett said.

“The onus is on both provider and patient,” he said. “We need to make sure that the medical system is available and ready. A lot of people need this.”