Chronic illnesses have puzzled scientists, physicians and investigators since the early years of medicine. Researchers have looked into the different facets of these diseases in the hope of finding the ultimate cure. Chronic diseases such as diabetes, hypertension, chronic depression, asthma and heart disease have been mainstays in the diagnostic world that one just accepts his or her diagnosis with a shrug or even uses it as a way to get special treatment, Puzzling as they are, physicians have long found out that these diseases have racial or ethnic predilection.
Some races are just so susceptible while others simply won’t contract the diseases. Some scientists have blames the genetic make-up of individuals while others blame lifestyle patterns and eating habits. In University of Regina, an assistant professor even went through the history of Canada to trace the occurrence of chronic diseases and their possible relationship with the Colonization era in the country. Professor Carrie Bourassa of University of Regina in her talk entitled, “Does History Matter?
Health and Healing in Aboriginal Communities”, explored on the possibility of a link existing between the occurrence of chronic diseases with the history of colonization of Canada. According to her, Aboriginal people experience higher rates of infectious and chronic disease, higher rates of poverty and unemployment, lower levels of education, lower incomes, higher rates of domestic violence and higher incarceration rates than non-Aboriginal people in Canada (www. uregina. ca). The professor also linked the pat to the present condition of the society of Canada and their state of health.
According to her, the people today are still struggling , subconsciously,, to establish a sense of identity and to attain personal freedom. As such, they are still under a great deal of stress, A chronic disease, however comprehensively explained in books, are multifactorial in nature. One of the more popular and well-researched chronic diseases is Diabetes Mellitus. The disease is linked to the American race. In the past, researchers attributed the occurrence of the disease to the diet of Americans. They blames the high calorie content of American food .
However, in the last ten years, with the advent of advances in molecular biology and genetics, scientists have found out that the disease is not solely due to the diet of Americans. They, instead, found errors in the genes of affected individuals. This pushed the “diet theory” on the backseat. They have not dismissed the fact that lifestyle contributes to the development and progression of the disease. However, the focus of researches today have shifted to the genetic mutations in genes of individuals.
This theory will be explained further in the next parts of the paper. The Filipino race will be given focus in the paper. In various studies conducted in the Philippines and in the United States, researchers have found a high prevalence of Diabetes among Filipinos. This came in as a puzzle in the beginning because Filipinos have small frames as compared to Westerners. The diet of Filipinos also consists of mostly grains and vegetables because it is an agricultural country. Findings of various studies will be presented in subsequent parts o f the paper.
Traditional beliefs and traditional medicine in the field of Diabetes will also be explored in the paper. The author hopes to explore the link between the Filipino culture and the incidence of Diabetes in the said race. II. Diabetes Mellitus- The fusion of Lifestyle and Genetics Diabetes mellitus (DM) comprises a group of common metabolic disorders that share the phenotype of hyperglycemia. Several distinct types of DM exist and are caused by a complex interaction of genetics, environmental factors, and life-style choices.
Depending on the cause of the DM, factors contributing to hyperglycemia may include reduced insulin secretion, decreased glucose utilization, and increased glucose production (Powers, 2005) The metabolic dysregulation associated with DM causes secondary pathologic changes in different organ systems that impose a tremendous burden on the individual with diabetes and on the health care system. In the Philippines, DM is one of the leading causes of end-stage renal disease (ESRD), nontraumatic lower extremity amputations, and adult blindness. Insulin resistance and abnormal insulin secretion are central to the development of type 2 DM.
Although controversy remains regarding the primary defect, most studies support the view that insulin resistance precedes insulin secretory defects and that diabetes develops only if insulin secretion becomes inadequate (Dans,et. al. , 2006). A. The Genetics of Diabetes Mellitus Diabetes Mellitus has a strong genetic component. Major genes that predispose to this disorder have yet to be identified, but it is clear that the disease involves many genes and is multifactorial. Individuals with a parent with type 2 DM have an increased risk of diabetes; if both parents have type 2 DM, the risk approaches 40%.
Insulin resistance, as demonstrated by reduced glucose utilization in skeletal muscle, is present in many nondiabetic, first-degree relatives of individuals with type 2 DM However, definition of the genetic susceptibility remains a challenge because the genetic defect in insulin secretion or action may not manifest itself unless an environmental event or another genetic defect, such as obesity, is superimposed. (Cuasay,et. al. , 2003). B. Pathophysiology of Diabetes Mellitus Type 2 DM1 is characterized by three pathophysiologic abnormalities: impaired insulin secretion, peripheral insulin resistance, and excessive hepatic glucose production.
Obesity, particularly visceral or central (as evidenced by the hip-waist ratio – obtained by getting th ratio of the hip circumference to waist circumference. ), is very common in type 2 DM (Fran,2000) Fat cells secrete a number of biologic products that control insulin secretion, insulin action, and body weight and may contribute to the insulin resistance. The decreased ability of insulin to act effectively on peripheral target tissues (especially muscle and liver) is a prominent feature of type 2 DM1 and results from a combination of genetic susceptibility and obesity (Hales, 2001).
In type 2 DM1, insulin secretion initially increases in response to insulin resistance to maintain normal glucose tolerance. Initially, the insulin secretory defect is mild and selectively involves glucose-stimulated insulin secretion. The response to other nonglucose secretagogues, such as arginine, is preserved. Eventually, the insulin secretory defect progresses to a state of grossly inadequate insulin secretion (Powers, 2005). Insulin resistance in the liver reflects the failure of hyperinsulinemia to suppress production of new glucose.
Even immediately after a meal. hich results in fasting hyperglycemia and decreased glycogen storage by the liver in the postprandial state. Increased glucose production in the liver occurs early in the course of diabetes, though likely after the onset of insulin secretory abnormalities and insulin resistance in skeletal muscle. Polycystic ovary syndrome (PCOS) is a common disorder that affects premenopausal women and is characterized by chronic inability to ovulate and hyperandrogenism Insulin resistance is seen in a significant subset of women with PCOS, thus increasing their risk for having Diabetes (Powers, 2005).
III. Diabetes in Filipinos The prevalence of type 2 diabetes mellitus has tremendously increased among Filipinos in recent years. Of greater concern is the fact that “adult-onset” type 2 diabetes has emerged as a critical health issue among younger individuals (Obrero, et. al. 2006). The 2003 National Nutrition and Health Survey (NNHeS) reported the prevalence of diabetes mellitus among 30 – 39 year-old male and female Filipinos at 2. 4 and 2. 7 respectively (Dans, et. al. , 2003) The prevalence of type 2 diabetes mellitus is indeed increasing rapidly, even among young adults.
But what could be causing the increase in Diabetes among Filipinos? The race is composed of relatively thin, small-framed individuals. The diet consists of grains and fish. Hales , in his study in 2001, noted that the birth weight of individuals can greatly affect the risk of developing Diabetes as adults. He noted that children who were born thin had higher plasma glucose concentration later in life. Hales , further elucidated his point by applying the “Thrifty Phenotype Hypothesis. which proposes that infant malnutrition may contribute to adult insulin resistance (Hales, 2001). Filipinos are born small.
In fact, the health officials of the country have revised Western standsrds in birthweight to cater to Filipino infants. However, a high number of small for age babies are still being born everyday. This can be traced to the mother’s state during pregnancy. Malnutrition and chronic illnesses are common culprits. Obrero, and colleagues (2006) , in their study further showed these relationship. The current changes in lifestyle of Filipinos can also be causing the increase in incidence of Diabetes Mellitus in the country. The country is getting Westernized with the appearance of fastfood chains in various areas of the countries.
These fast food chains are serving high-calorie meals suited for the bodyweight of Westerners, but not for the small frame of Filipinos. Higher incidence of cigarette-smoking and alcoholism is also observed in the country. IV. Alternative Filipino Treatment With the noted increase in the incidence of Diabetes in the Philippines, vis-à-vis the economic crisis in the country, Filipinos have developed alternative treatments for Diabetes. Apart from the conventional sugar-lowering medications, local drug companies have developed commercialized versions of the country’s medicinal plants.
These are Pito-pito (a concoction of 7 different leaves) boiled and drank as tea and Charantia (Bittermelon) which is very potent in lowering sugar levels, especially when the leaves are eaten. Ampalaya or bitter melon is found throughout the Philippines, It is one of the common plants grown in backyards or vegetable gardens. It is a rich source of vitamin B, iron, phosphorus and calcium, and it appears to lower blood sugar level when ingested by diabetics. In Cuba and Puerto Rico, ampalaya has been used by the natives to treat diabetes.
The mechanism of action is not clear. While a herbal company in the Philippines has already come out with an ampalaya capsule, the medical community still awaits further and more definitive scientific studies to support this encouraging observation. Right now, the ampalaya pill is not effective and not reliable in itself to control blood sugar level, and it is NOT a substitute for prescription drugs for diabetes. The health sector in the Philippines, further stated that eating the actual leaves or fruits of the bitter melon is more beneficial, and cheaper, than taking supplements.
Patients, however, claim that they actually had good sugar level control with the better melon. The amplaya is just one of the Filipino medicinal plants advocated for curing Diabetes. Other herbs such as Banaba, and native teas are also used as alternatives for treatment of Diabetes Mellitus. V. Diabetes in the Midst of Filipino beliefs and values, and the Social and cultural influences in the country. Given the fact that Diabetes involves a great deal of genetics, one cannot change his or her genetic make-up. However, he can change controllable variables affecting his health.
Researchers still stress that t he cornerstone of treatment of Diabetes still involves exercise, diet , avoidance of vices and the use of medications. These are greatly influenced by personal beliefs, values and social and cultural influences operating in the society. The happy disposition of Filipinos poses a two-edged sword for diabetes. In one face, this disposition helps keep the Filipino optimistic and hopeful This attitude motivates the diabetic patient to seek ways of curious himself or at least, maintaining an acceptable sugar level.
On the othet hand, this happy disposition maybe causing a toll on the health of Filipinos. With the drinking sprees and family and neighborhood outings, come high calorie, carbohydrate-rich foods which, in turn, elevates blood sugar lvels. Filipinos also have high regard for health care professionals. They believe what doctors say and exert their best to follow the physician’s instructions. Sadly, the country is also facing a difficult time in their economy. High cost of medications makes it hard for the Filipinos to comply with their health regimen.
As a result, they skip medications, or worse, do not take them at all. The Filipinos’ belief in herbal and traditional medicines have also led to the use of herbal medications. The Filipinos, especially those living in rural areas, resort to herbal medicines to cure diabetes. Some local drug companies have also developed commercialized versions of these herbal concoctions. The exodus of Filipino health care workers to other Western countries have also opened the country to various treatment modalities and to advancing knowledge.
Relatives working abroad correct misconceptions of relatives left in the country. This is one of the great advantages of Filipinos working abroad. Filipinos have also been made aware of the latest available treatments for Diabetes Mellitus. The increasing influence of Western culture in the country and the recent focus given to wellness and fitness in the country have advocated proper diet and exercise as cure for Diabetes. Exercising and eating proper diet have become the focus of experts and celebrities.
In turn, the trend in wellness and fitness have been spreading like brushfire even in far-flung rural communities through community doctors. The toll of Diabetes Mellitus is recognized not only in the Philippines but around the world. With the researches and findings mentioned, it is clear that the management of Diabetes Mellitus entails multiple areas and fields. One cannot just resign to the fact that it is a genetic or racial misfortune. Integration of personal beliefs and social and cultural influences are still cornerstones of the management of Diabetes Mellitus.
