Eating Rich, Living Sick—U.S. Bangladeshi Elders Hit Hard by Diabetes

Eating Rich, Living Sick—U.S. Bangladeshi Elders Hit Hard by Diabetes

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Middle-age and older Bangladeshis in the United States are finding their lives dragged down by the diabetes epidemic, but research on this immigrant population is scarce, experts say, and is usually lumped together with data on other South Asians.

In a study conducted at New York’s Bellevue Hospital and presented this past spring at the Society for Public Health Education conference in Atlanta, researchers found that 28 percent of Bangladeshi health-survey participants had been diagnosed with type 2—also known as adult-onset—diabetes.

That is more than double the rate of diabetes among the U.S. population as a whole. In a 2009 Gallup health care survey, 11.3 percent of American adults said they had been diagnosed with the disease, though experts expect that figure to rise dramatically in the next few decades.

“Diabetes is a significant issue in the Bangladeshi community,” said Nadia Islam, deputy director of research of New York University Medical Center’s DREAM Project (Diabetes Research Education and Action for Minorities), which conducted the study. “This community experiences numerous barriers to linguistically and culturally competent care.”

Adult-onset diabetes is a preventable condition that can have serious long-term complications if not controlled, including heart attacks, kidney disease and vascular problems leading to blindness and amputation. Key risk factors include older age, obesity, higher income, family history of diabetes and reduced physical activity.

Symptoms include frequent infections and urination, blurred vision, cuts and bruises that are slow to heal, and tingling or numbness in the hands and feet. But people with type 2 diabetes may not have any warning signs or they may ignore the symptoms because they seem so minor.

Noting that a significant portion of Bangladeshis afflicted with diabetes do not receive a diagnosis until they seek emergency medical care, Islam called for local bilingual community leaders to get more involved in promoting ways to prevent the disease as well as helping those with the condition to manage it better.

Strokes. Heart Disease, and Multiple Medications

Most diabetes patients interviewed for this article declined to use their real names, but they spoke openly about their conditions.

New Jersey resident Mohammed Nurul Islam, 61, had been very active in community activities until he suffered a stroke in 2001. Like almost all the diabetes patients in the NYU study, he also suffers from high blood pressure and heart disease.

With an edge of anger, Nurul Islam said his life now consists of taking medications—so many that they seem equivalent to an entire meal—and managing his illness.

Abudul Quadir, a resident of Astoria, in the New York City borough of Queens, used to participate in sports regularly when he was in Bangladesh. Now 55, he immigrated seven years ago and eventually felt himself growing weak. He, too, was diagnosed with diabetes, high blood pressure, and heart disease.

Another Bangladeshi expatriate, Fakhrul Islam, 59, of Jamaica, also in Queens, was discovered to have diabetes when he underwent heart-bypass surgery in April 2005.

Depression and Diabetes

Experts say the diabetes epidemic among Bangladeshis is not just limited to the New York area or to older immigrants. One survey, by researchers at the Coney Island Medical Center (CIMC) in Brooklyn, connected the unusually high levels of diabetes, high blood pressure, heart disease and high cholesterol that it found to lifestyle factors— especially eating habits and reluctance to exercise among South Asians.

In addition to Bangladeshi-specific studies, NYU’s Islam and other experts recommend widespread adoption of lifestyle changes as well as attention to underlying depression among older immigrants, who may overindulge in rich foods when they are feeling isolated and low. The disease drains them of the energy they need to keep pace with their family members, which adds to their sense of isolation and depression.

Bangladeshi physician Masudul Hasan of the Northshore Medical Center in the Forest Hills area of Queens, said that many Bangladeshis come to this country with unrealistic dreams. They may become anxious or depressed after years of disappointments. As they age, they may lose touch with relatives and friends back home. Mental distress often results from years of tedious work and social isolation due to language and cultural barriers.

Another challenge to mental health, Hasan said, is that many older Bangladeshis become victims of social discrimination. This may not be manifested in disease symptoms, he said, but it can aggravate underlying conditions.

Kazi M. Rahman, a prominent physician in the Bangladeshi community in the Astoria section of Queens, said he is concerned that many Bangladeshis are reluctant to see a doctor for regular check-ups. And when they do see a physician, they frequently do not follow up on prescribed care.

What is considered normal blood pressure for most people might be too high for those with diabetes, Rahman noted. A doctor can provide guidance in lowering blood pressure to a safe level.

Rahman said the community’s high-fat diet—including spicy meats, pollao (buttered rice), sweets and condensed milk—and its culture of generously entertaining guests also contribute to the high incidence of disease.

The sleep connection

Abdul Ahad, assistant director of the Emergency Department of Lincoln Medical and Mental Health Center in the Bronx, noted a key to good health often overlooked—a good night’s sleep. As people in the Bangladeshi community get older, he said, they often lose sleep because of the habit of eating close to bedtime.

Indeed, studies have found that inadequate sleep actually increases the risk for type 2 diabetes. Ahad said that older Bangladeshis should take meals at least two hours before bedtime. He also recommended taking a stroll after evening meals.

Abu Taher, editor of Bangla Patrika, wrote this article as part of New America Media’s Ethnic Elders Fellowship program, funded by The Atlantic Philanthropies.