Health among the Amish

Health among the Amish is characterized by higher incidences of particular genetic disorders, especially among the Old Order Amish. These disorders include dwarfism,^[1] Angelman syndrome,^[2] and various metabolic disorders, such as Tay-Sachs disease,^[3] as well as an unusual distribution of blood types.^[4]

Overview

Amish represent a collection of different demes or genetically closed communities.^[5] Since almost all Amish descend from about 500 18th-century founders,^{[citation needed]} genetic disorders that come out due to inbreeding exist in more isolated districts (an example of the founder effect). These disorders include dwarfism (Ellis–van Creveld syndrome),^[1] Angelman syndrome,^[2] and various metabolic disorders,^[6]^[3] as well as an unusual distribution of blood types.^[4] Some of these disorders are quite rare, or unique, and are serious enough to increase the mortality rate among Amish children. The majority of Amish accept these as "Gottes Wille" (God's will); they reject use of preventive genetic tests prior to marriage and genetic testing of unborn children to discover genetic disorders. However, Amish are willing to participate in studies of genetic diseases. Their extensive family histories are useful to researchers investigating diseases such as Alzheimer's, Parkinson's, and macular degeneration.

While the Amish are at an increased risk for some genetic disorders, researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) have found their tendency for clean living can lead to better health. Overall cancer rates in the Amish are 60 percent of the age-adjusted rate for Ohio and 56 percent of the national rate. Tobacco-related cancers in Amish adults are 37 percent and non-tobacco-related cancers are 72 percent of the rate for Ohio adults. The Amish are protected against many types of cancer both through their lifestyle—there is very little tobacco or alcohol use and limited sexual partners—and through genes that may reduce their susceptibility to cancer. Dr. Judith Westman, director of human genetics at OSUCCC – James, conducted the study. The findings were reported in a recent issue of the journal Cancer Causes & Control. Even skin cancer rates are lower for Amish, despite the fact many Amish make their living working outdoors where they are exposed to sunlight and UV rays. They are typically covered and dressed to work in the sun by wearing wide-brimmed hats and long sleeves which protect their skin.^[7]

The Amish are conscious of the advantages of exogamy. A common bloodline in one community will often be absent in another, and genetic disorders can be avoided by choosing spouses from unrelated communities. For example, the founding families of the Lancaster County Amish are unrelated to the founders of the Perth County, Ontario Amish community. Because of a smaller gene pool, some groups have increased incidences of certain inheritable conditions.^[8]

The Old Order Amish do not typically carry private commercial health insurance.^[9]^[10] About two-thirds of the Amish in Pennsylvania's Lancaster County participate in Church Aid, an informal self-insurance plan for helping members with catastrophic medical expenses.^[9] A handful of American hospitals, starting in the mid-1990s, created special outreach programs to assist the Amish. The first of these programs was instituted at the Susquehanna Health System in central Pennsylvania by James Huebert. This program has earned national media attention in the United States, and has spread to several surrounding hospitals.^[11]^[12] Treating genetic problems is the mission of Clinic for Special Children in Strasburg, Pennsylvania, which has developed effective treatments for such problems as maple syrup urine disease, a previously fatal disease. The clinic is embraced by most Amish, ending the need for parents to leave the community to receive proper care for their children, an action that might result in shunning.

DDC Clinic for Special Needs Children, located in Middlefield, Ohio, has been treating special-needs children with inherited or metabolic disorders since May 2002.^[13] The DDC Clinic provides treatment, research, and educational services to Amish and non-Amish children and their families.

The prevalence of asthma in the Amish of Indiana was low at 5.2% as compared to 21.3% in Hutterite schoolchildren of South Dakota; likewise the prevalence of allergic sensitization was 7.2% versus 33.3%. The lifestyles of the two groups are similar except for farming practices, where Hutterites use industrialized farming whereas Amish do not. In a study from 2016, important differences in the children's innate immune cells and in the allergy inducing nature of the dust in their homes were found, leading to the conclusion that the Amish environment had protected against asthma by shaping the innate immune response.^[14]

Most Amish clearly seem to use some form of birth control, a fact that generally is not discussed among the Amish, but indicated by the fact that the number of children systematically increases in correlation with the conservatism of a congregation, the more conservative, the more children. The large number of children is due to the fact that many children are appreciated by the community and not because there is no birth control.^[15] Some communities openly allow access to birth control to women whose health would be compromised by childbirth.^[16] The Amish are against abortion and also find "artificial insemination, genetics, eugenics, and stem cell research" to be "inconsistent with Amish values and beliefs".^[17]

People's Helpers is an Amish-organized network of mental health caregivers who help families dealing with mental illness and recommend professional counselors.^[18] Suicide rates for the Amish of Lancaster County were 5.5 per 100,000 in 1980, about half that of the general population.^[a]

Notes

^ The overall suicide rate in 1980 in the US was 12.5 per 100,000.^[19]

References

^ ^a ^b McKusick, Victor A. (2000). "Ellis-van Creveld syndrome and the Amish". Nature Genetics. 24 (3): 203–204. doi:10.1038/73389. PMID 10700162. S2CID 1418080.
^ ^a ^b Harlalka, G.V. (2013). "Mutation of HERC2 causes developmental delay with Angelman-like features". Journal of Medical Genetics. 50 (2): 65–73. doi:10.1136/jmedgenet-2012-101367. PMID 23243086. S2CID 206997462. Retrieved November 3, 2014.
^ ^a ^b "Tay-Sachs Disease". United Brain Association. Retrieved February 13, 2023.
^ ^a ^b Hostetler 1993, p. 330.
^ Hostetler 1993, p. 328.
^ Morton, D. Holmes; Morton, Caroline S.; Strauss, Kevin A.; Robinson, Donna L.; Puffenberger, Erik G.; Hendrickson, Christine; Kelley, Richard I. (June 27, 2003). "Pediatric medicine and the genetic disorders of the Amish and Mennonite people of Pennsylvania". American Journal of Medical Genetics. 121C (1): 5–17. doi:10.1002/ajmg.c.20002. PMID 12888982. S2CID 25532297. Archived from the original on January 5, 2013. Retrieved July 2, 2008. Regional hospitals and midwives routinely send whole-blood filter paper neonatal screens for tandem mass spectrometry and other modern analytical methods to detect 14 of the metabolic disorders found in these populations…
^ "Amish Have Lower Rates of Cancer, Ohio State Study Shows". Columbus, OH: Ohio State University Medical Center. January 1, 2010. Archived from the original on June 16, 2010. Retrieved January 6, 2010.
^ Ruder, Katherine (July 23, 2004). "Genomics in Amish Country". Genome News Network.
^ ^a ^b Rubinkam, Michael (October 5, 2006). "Amish Reluctantly Accept Donations". The Washington Post. Retrieved March 25, 2008.
^ "Amish Studies – Beliefs". Young Center for Anabaptist & Pietist Studies, Elizabethtown College. Retrieved February 2, 2013.
^ Milavsky, Bevin (June 18, 2004). "Doctors make house calls in barn". The Daily Item. Archived from the original on June 19, 2004. Retrieved March 4, 2012.
^ "A culture vastly different from the rest of America". The Irish Medical Times. August 3, 2007. Archived from the original on October 6, 2008.
^ "DDC Clinic for Special Needs Children". October 7, 2011. Retrieved November 25, 2011.
^ Stein., Michelle M.; Hrusch, Cara L.; Gozdz, Justyna; et al. (2016). "Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children". New England Journal of Medicine. 375 (5): 411–421. doi:10.1056/NEJMoa1508749. PMC 5137793. PMID 27518660.
^ Kraybill, Donald B.; Johnson-Weiner, Karen M.; Nolt, Steven M. (2013). The Amish. Baltimore: Johns Hopkins University Press. pp. 157–158.
^ Showalter, Anita (2000). "Birthing among the Amish". International Journal of Childbirth Education. 15: 10.
^ Andrews, Margaret M.; Boyle, Joyceen S. (2002). Transcultural concepts in nursing care. Vol. 13. Lippincott. pp. 178–180. doi:10.1177/10459602013003002. ISBN 978-0781736800. PMID 12113145. S2CID 201377433. Retrieved January 19, 2008 – via Google Books. {{cite book}}: |journal= ignored (help)
^ Kraybill 2001, p. 105.
^ Kraybill, Donald (Autumn 1986). "Suicide Patterns in a Religious Subculture: The Old Order Amish". International Journal of Moral and Social Studies. 1. et al.

Bibliography

Hostetler, John A. (1993). Amish Society (4 ed.). Johns Hopkins University Press. ISBN 978-0801844423.
Kraybill, Donald B. (2001). The Riddle of Amish Culture. Johns Hopkins University Press.

Kelsoe, J. R.; Ginns, E. I.; Egeland, J. A.; Gerhard, D. S.; Goldstein, A. M.; Bale, S. J.; Pauls, D. L.; Long, R. T.; Kidd, K. K.; Conte, G.; Housman, D. E.; Paul, S. M. (1989). "Re-evaluation of the linkage relationship between chromosome 11p loci and the gene for bipolar affective disorder in the Old Order Amish". Nature. 342 (6247): 238–243. Bibcode:1989Natur.342..238K. doi:10.1038/342238a0. PMID 2682265. S2CID 4331268.
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Ginns, E. I.; St Jean, P.; Philibert, R. A.; Galdzicka, M.; Damschroder-Williams, P.; Thiel, B.; Long, R. T.; Ingraham, L. J.; et al. (1998). "A genome-wide search for chromosomal loci linked to mental health wellness in relatives at high risk for bipolar affective disorder among the Old Order Amish". Proceedings of the National Academy of Sciences of the United States of America. 95 (26): 15531–15536. Bibcode:1998PNAS...9515531G. doi:10.1073/pnas.95.26.15531. PMC 28077. PMID 9861003.
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Cystic fibrosis

Wood Klinger, K. (1983). "Cystic fibrosis in the Ohio Amish: Gene frequency and founder effect". Human Genetics. 65 (2): 94–98. doi:10.1007/BF00286641. PMID 6654341. S2CID 189889167.
Knowles, M. R.; Barnett, T. B.; McConkie-Rosell, A.; Sawyer, C.; Kahler, S. G. (1989). "Mild cystic fibrosis in a consanguineous family". Annals of Internal Medicine. 110 (8): 599–605. doi:10.7326/0003-4819-110-8-599. PMID 2930093.
Henderson, J. F.; Anbar, R. D. (2009). "Care for Amish and Mennonite children with cystic fibrosis: A case series". BMC Pediatrics. 9: 4. doi:10.1186/1471-2431-9-4. PMC 2637265. PMID 19146658.
McCrae, I. S.; Hickman, A. J. (1990). "Air pollution from traffic in topographically complex locations". Science of the Total Environment. 93: 331–338. Bibcode:1990ScTEn..93..331M. doi:10.1016/0048-9697(90)90124-D. PMID 1694304.

Diabetes

Hsueh, W. C.; Mitchell, B. D.; Aburomia, R.; Pollin, T.; Sakul, H.; Gelder Ehm, M.; Michelsen, B. K.; Wagner, M. J.; St Jean, P. L.; Knowler, W. C.; Burns, D. K.; Bell, C. J.; Shuldiner, A. R. (2000). "Diabetes in the Old Order Amish: Characterization and heritability analysis of the Amish Family Diabetes Study". Diabetes Care. 23 (5): 595–601. doi:10.2337/diacare.23.5.595. PMID 10834415.
Hsueh, W. C.; St Jean, P. L.; Mitchell, B. D.; Pollin, T. I.; Knowler, W. C.; Ehm, M. G.; Bell, C. J.; Sakul, H.; Wagner, M. J.; Burns, D. K.; Shuldiner, A. R. (2003). "Genome-wide and fine-mapping linkage studies of type 2 diabetes and glucose traits in the Old Order Amish: Evidence for a new diabetes locus on chromosome 14q11 and confirmation of a locus on chromosome 1q21-q24". Diabetes. 52 (2): 550–557. doi:10.2337/diabetes.52.2.550. PMID 12540634.
Rampersaud, E.; Damcott, C. M.; Fu, M.; Shen, H.; McArdle, P.; Shi, X.; Shelton, J.; Yin, J.; Chang, Y. -P. C.; Ott, S. H.; Zhang, L.; Zhao, Y.; Mitchell, B. D.; O'Connell, J.; Shuldiner, A. R. (2007). "Identification of Novel Candidate Genes for Type 2 Diabetes from a Genome-Wide Association Scan in the Old Order Amish: Evidence for Replication from Diabetes-Related Quantitative Traits and from Independent Populations". Diabetes. 56 (12): 3053–3062. doi:10.2337/db07-0457. PMID 17846126.

Happiness

Biswas-Diener, R.; Vittersø, J.; Diener, E. (2005). "Most People are Pretty Happy, but There is Cultural Variation: The Inughuit, the Amish, and the Maasai". Journal of Happiness Studies. 6 (3): 205–226. doi:10.1007/s10902-005-5683-8. S2CID 143987250.

Healthcare

Adams, C. E.; Leverland, M. B. (1986). "The Effects of Religious Beliefs on the Health Care Practices of the Amish". The Nurse Practitioner. 11 (3): 58, 63, 67. doi:10.1097/00006205-198603000-00008. PMID 3446212.

Inbreeding

Khoury, M. J.; Cohen, B. H.; Diamond, E. L.; Chase, G. A.; McKusick, V. A. (1987). "Inbreeding and prereproductive mortality in the Old Order Amish. I. Genealogic epidemiology of inbreeding". American Journal of Epidemiology. 125 (3): 453–461. doi:10.1093/oxfordjournals.aje.a114551. PMID 3812451.
Khoury, M. J.; Cohen, B. H.; Newill, C. A.; Bias, W.; McKusick, V. A. (1987). "Inbreeding and prereproductive mortality in the Old Order Amish. II. Genealogic epidemiology of prereproductive mortality". American Journal of Epidemiology. 125 (3): 462–472. doi:10.1093/oxfordjournals.aje.a114552. PMID 3812452.
Khoury, M. J.; Cohen, B. H.; Diamond, E. L.; Chase, G. A.; McKusick, V. A. (1987). "Inbreeding and prereproductive mortality in the Old Order Amish. III. Direct and indirect effects of inbreeding". American Journal of Epidemiology. 125 (3): 473–483. doi:10.1093/oxfordjournals.aje.a114553. PMID 3812453.
Puffenberger, E. G. (2003). "Genetic heritage of the Old Order Mennonites of southeastern Pennsylvania". American Journal of Medical Genetics. 121C (1): 18–31. doi:10.1002/ajmg.c.20003. PMID 12888983. S2CID 25317649.
Agarwala, R.; Schäffer, A. A.; Tomlin, J. F. (2001). "Towards a complete North American Anabaptist Genealogy II: Analysis of inbreeding". Human Biology. 73 (4): 533–545. doi:10.1353/hub.2001.0045. PMID 11512680. S2CID 42236600.
Jackson, C. E.; Symon, W. E.; Pruden, E. L.; Kaehr, I. M.; Mann, J. D. (1968). "Consanguinity and blood group distribution in an Amish Isolate". American Journal of Human Genetics. 20 (6): 522–527. PMC 1706380. PMID 5714527.
Dorsten, L. E.; Hotchkiss, L.; King, T. M. (1996). "Consanguineous Marriage and Early Childhood Mortality in an Amish Settlement". Sociological Focus. 29 (2): 179–185. doi:10.1080/00380237.1996.10570639.

Obesity

Hsueh, W. C.; Mitchell, B. D.; Schneider, J. L.; St Jean, P. L.; Pollin, T. I.; Ehm, M. G.; Wagner, M. J.; Burns, D. K.; Sakul, H.; Bell, C. J.; Shuldiner, A. R. (2001). "Genome-wide scan of obesity in the Old Order Amish". The Journal of Clinical Endocrinology and Metabolism. 86 (3): 1199–1205. doi:10.1210/JCEM.86.3.7358. PMID 11238509.
Bassett, D. R.; Schneider, P. L.; Huntington, G. E. (2004). "Physical Activity in an Old Order Amish Community". Medicine & Science in Sports & Exercise. 36 (1): 79–85. doi:10.1249/01.MSS.0000106184.71258.32. PMID 14707772. S2CID 17875860.
Bassett, D. R.; Tremblay, M. S.; Esliger, D. W.; Copeland, J. L.; Barnes, J. D.; Huntington, G. E. (2007). "Physical Activity and Body Mass Index of Children in an Old Order Amish Community". Medicine & Science in Sports & Exercise. 39 (3): 410–415. doi:10.1249/mss.0b013e31802d3aa7. PMID 17473766.

[20] The overall suicide rate in 1980 in the US was 12.5 per 100,000.^[19]

[McKusick-1] McKusick, Victor A. (2000). "Ellis-van Creveld syndrome and the Amish". Nature Genetics. 24 (3): 203–204. doi:10.1038/73389. PMID 10700162. S2CID 1418080.

[Harlalka-2] Harlalka, G.V. (2013). "Mutation of HERC2 causes developmental delay with Angelman-like features". Journal of Medical Genetics. 50 (2): 65–73. doi:10.1136/jmedgenet-2012-101367. PMID 23243086. S2CID 206997462. Retrieved November 3, 2014.

[UBA-3] "Tay-Sachs Disease". United Brain Association. Retrieved February 13, 2023.

[FOOTNOTEHostetler1993330-4] Hostetler 1993, p. 330.

[FOOTNOTEHostetler1993328-5] Hostetler 1993, p. 328.

[6] Morton, D. Holmes; Morton, Caroline S.; Strauss, Kevin A.; Robinson, Donna L.; Puffenberger, Erik G.; Hendrickson, Christine; Kelley, Richard I. (June 27, 2003). "Pediatric medicine and the genetic disorders of the Amish and Mennonite people of Pennsylvania". American Journal of Medical Genetics. 121C (1): 5–17. doi:10.1002/ajmg.c.20002. PMID 12888982. S2CID 25532297. Archived from the original on January 5, 2013. Retrieved July 2, 2008. Regional hospitals and midwives routinely send whole-blood filter paper neonatal screens for tandem mass spectrometry and other modern analytical methods to detect 14 of the metabolic disorders found in these populations…

[7] "Amish Have Lower Rates of Cancer, Ohio State Study Shows". Columbus, OH: Ohio State University Medical Center. January 1, 2010. Archived from the original on June 16, 2010. Retrieved January 6, 2010.

[8] Ruder, Katherine (July 23, 2004). "Genomics in Amish Country". Genome News Network.

[Post-9] Rubinkam, Michael (October 5, 2006). "Amish Reluctantly Accept Donations". The Washington Post. Retrieved March 25, 2008.

[10] "Amish Studies – Beliefs". Young Center for Anabaptist & Pietist Studies, Elizabethtown College. Retrieved February 2, 2013.

[11] Milavsky, Bevin (June 18, 2004). "Doctors make house calls in barn". The Daily Item. Archived from the original on June 19, 2004. Retrieved March 4, 2012.

[12] "A culture vastly different from the rest of America". The Irish Medical Times. August 3, 2007. Archived from the original on October 6, 2008.

[13] "DDC Clinic for Special Needs Children". October 7, 2011. Retrieved November 25, 2011.

[nejm-14] Stein., Michelle M.; Hrusch, Cara L.; Gozdz, Justyna; et al. (2016). "Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children". New England Journal of Medicine. 375 (5): 411–421. doi:10.1056/NEJMoa1508749. PMC 5137793. PMID 27518660.

[15] Kraybill, Donald B.; Johnson-Weiner, Karen M.; Nolt, Steven M. (2013). The Amish. Baltimore: Johns Hopkins University Press. pp. 157–158.

[16] Showalter, Anita (2000). "Birthing among the Amish". International Journal of Childbirth Education. 15: 10.

[17] Andrews, Margaret M.; Boyle, Joyceen S. (2002). Transcultural concepts in nursing care. Vol. 13. Lippincott. pp. 178–180. doi:10.1177/10459602013003002. ISBN 978-0781736800. PMID 12113145. S2CID 201377433. Retrieved January 19, 2008 – via Google Books. {{cite book}}: |journal= ignored (help)

[FOOTNOTEKraybill2001105-18] Kraybill 2001, p. 105.

[19] Kraybill, Donald (Autumn 1986). "Suicide Patterns in a Religious Subculture: The Old Order Amish". International Journal of Moral and Social Studies. 1. et al.

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Health among the Amish

Overview

Notes

References

Bibliography

Further reading

Bipolar affective disorder

Cystic fibrosis

Diabetes

Happiness

Healthcare

Inbreeding

Obesity

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