Illustration by Tim Cook
In 1996, hip-hop trio A Tribe Called Quest released “Stressed Out,” the tale of a black man looking to remain optimistic while dealing with the repercussions of his criminal record, trying to provide for his family and doing his best to not be a victim of neighborhood violence. For many African-American men, this narrative — whether in part or in full — is gospel. Environmental concerns keep African-American men in a perpetual state of fight-or-flight, and studies show that this chronic stress has led to health disparities, with diabetes being one of the most insidious.
“There’s substantial evidence to demonstrate the environment we live in has direct impacts on our health,” says Rebecca Hasson, an exercise physiologist and director of the Childhood Disparities Research Laboratory at the University of Michigan.
About 13 percent of African-Americans age 20 and older have been diagnosed with diabetes, according to the American Diabetes Association. About 9 percent of all Americans are diabetic, according to the Centers for Disease Control and Prevention. African-American men are 1.7 times more likely than white non-Hispanic men to have diabetes.
When Protective Hormones Harm
Hasson’s findings point to cortisol, a steroid hormone produced by the adrenal glands, as a contributing factor in stress-related onsets of diabetes. Cortisol temporarily increases energy production required for immediate survival — like running from a bear, or escaping a house fire. For the average person, cortisol levels begin high in the morning and taper off as the day progresses, fluctuating appropriately. In African-American men living in socioeconomically depressed communities, cortisol levels start and remain high — the bear is always chasing; the smoke alarm’s always screeching.
Debra J. Barksdale, professor and associate dean of academic programs at Virginia Commonwealth University’s School of Nursing, has been examining stress in African-American men for three decades. Like Hasson, she cites cortisol and its role in chronic stress, stating that it’s like “having your stressors turned on all the time.”
“The fight-or-flight response is more of an acute reaction,” she says. “Whether it’s related to the pressures from society, increased chances of being stopped by the authorities, trying to provide for their families or trying to find a job or sustain a job, when a stressor occurs, there are physiological processes that occur in the brain that trigger the release of cortisol. What we have found was in certain people who are constantly stressed, cortisol levels do not go down throughout the day. It will remain high.”
The Broken Thermostat
When cortisol levels remain high without the presence of imminent danger or without some physical activity to offset the effects of chronic stress, Type 2 diabetes may be the consequence. According to the American Diabetes Association, higher cortisol results in higher insulin resistance, forcing the pancreas to produce more insulin to get a response. With ongoing insulin resistance, the insulin-producing beta cells wear out, causing Type 2 diabetes.
Briana Mezuk is an associate professor in the division of epidemiology at VCU who has studied the relationship between stress and blood sugar. She explains it this way:
“Think of stress like a hot summer day. Your thermostat has to keep working harder and harder to keep your house cool. Eventually, it can’t get the temperature back down to where you want it anymore; it can’t get back down to 68 degrees. It can only get down to 69 degrees, (because) the system is worn out. Sixty-nine degrees is not bad, but then it keeps creeping up and eventually the body isn’t able to respond because it’s chronically activated. Those are the folks who are going to be more likely to progress to diabetes,” she says.
Mezuk partners with the YMCA of Greater Richmond’s diabetes control and diabetes prevention programs. The diabetes control program helps adults living with Type 2 by providing education, support and care management. The diabetes prevention program is for those at risk for Type 2 diabetes. They learn how to make lifestyle changes to reduce their chances of developing the disease.
Know Your Status
Learning to identify and manage stress positively is the first step to a healthier outcome. That can be exercise, playing in men’s sports leagues, practicing yoga, or seeking talk therapy. If no change occurs, African-American men run the risk of epidemic levels of diabetes diagnoses — 1 in 2 — by 2050, according to the diabetes association.
Caroline Fornshell, a registered dietitian and diabetes fitness and nutrition expert in Williamsburg, calls those who catch the disease before its onset “the lucky ones.”
“They are the ones that got the warning. So often, people are walking around with undiagnosed full-fledged diabetes, and so it is really an exciting opportunity for individuals who find out they have pre-diabetes to take control,” she says.
Pre-diabetics can exercise more and evaluate their diet. They also should reduce stress, get the proper amounts of sleep and seek out supports, whether it’s through a program or even some sort of wellness buddy, says Fornshell.
Mezuk encourages African-Americans who think they’re at risk due to family history or who live with chronic stress to consult a physician. Many men don’t know that they have the disease and when left untreated, it can lead to a host of other health problems, including hypertension, heart disease and kidney failure — three more conditions that African-American men suffer at higher rates than their white and Latino counterparts.
“It’s really scary to go to the doctor [and find out that you have] diabetes. People call it ‘denialabetes’ for a reason. People don’t want to believe that they’re sick,” says Mezuk. “But there is good news. We can take what we are learning about how stress and depression affect the body and actually turn that into improved health for people in terms of managing this condition better and hopefully being able to prevent this condition better.”
