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Nobody has a greater battle to fight with diabetes than Native Americans. Even with combined government, tribal, and private industry effort, type 2 diabetes on Indian reservations is nothing less than an epidemic.
Statistics from National Institutes of Diabetes, Digestive and Kidney Disorders from October 1995 show that up to 50 percent of Native Americans have diabetes, compared to 6.2 percent of White Americans, a roughly nine percent of African and Mexican Americans.
And things are getting worse.
Since 1995 federal resources for Native Americans have decreased by over 15 percent with more cuts expected in the next few years.
Lorrain Kerley, a diabetes educator who works with the Navajo and Hopi reservations says conditions for people with diabetes are so bad that most people on her reservation have never even tasted a piece of fruit-let alone get the five recommended servings a day.
"It's like a third world country right here in Arizona," says Kerley, who grew up on a reservation herself.
Hospitals on the reservation have become so impacted people have to wait up to four hours just to get their blood sugar tested, according to Kerley.
"Most end up in the emergency room before their diabetes is diagnosed," she says.
With these and other problems-ranging from a lack of educational materials printed in Native American languages to difficulties acquiring blood glucose meters-some form of proactive program is desperately needed.
But no program has proved effective at curving rates of diabetes for Native Americans, and most don't even try.
"The majority of studies focus on characterizing the presence (of diabetes) and identifying the risk factors," says Tim Gilbert, an Alaskan native who has worked with various Native American tribes and diabetes for years.
This lack of prevention shows.
Take the example of one of the most watched and affected tribes, the Pima Indians of Arizona. The National Institutes of Health, as well as a private research group called Native Seeds/SEARCH (Southwest Endangered Arid Lands Resources Clearinghouse) have been working to curb the rate of diabetes in the Pima tribe for a decade, but still around half of all adult Pima Indians are diagnosed with type 2 diabetes-the highest rate in the world.
According to the National Institutes of Health publication Diabetes in America,"the age- and sex- adjusted death rate (for Pima Indians) from diabetes was 11.9 times greater than the 1980 death rate for all races in the United States."
The "Thrifty Gene"
The prime suspect for such pronounced rates of type 2 diabetes in Native Americans is an elusive "thrifty gene." According to Bill Knowler of the NIH, such a gene has been suspected since the 1960s, but so far attempts to isolate it have proved futile.
The "thrifty gene" is a particular gene favored in Native Americans through natural selection because it allowes them to live in the "feast or famine" environment.
The gene presumably allows the body to store fat from food more efficiently, allowing people to survive when food is scarce.
Even after industrialization swept America, most Native Americans still lived on the diets which were created by their ancestors. But during World War II Native Americans started leaving the reservations to either fight or work in the booming economy. When they returned to the reservations many brought back the "new" American high-fat diet. This was disastrous to a people whose genetic makeup was designed to store fats.
Gilbert agrees a "thrifty gene" may exist, but he doesn't feel it holds the key to curing diabetes.
"In my mind it (studying the thrifty gene) takes away from a public health position," Gilbert says. "When it comes right down to it, diets have changed a lot and the amount of physical activity is a lot less."
One program which uses both the "thrifty gene" philosophy and a public health approach is Native Seeds/SEARCH. Native Seeds is trying to implement a logical approach to tackling diabetes-have tribes return to traditional foods which they feel have significant blood sugar control qualities.
"Today we are learning that the same gooey substances which keep cactus from drying up and dying during drought also slows down the digestion and absorption of foods," reads a Native Seeds booklet.
Native Seeds offers recipes for cooking with prickly pear cactus, cholla cactus buds, saguaro, chia, and native beans. The booklet also offers resources for those who wish to grow these foods in their gardens.
It seems a natural and logical choice-foods native to a region are healthy for people who lived and evolved in that region. But some feel that successfully battling diabetes in this way is unrealistic.
"The traditional diet was much better, but realistically I don't see that going back to the old ways will ever happen," says Nora Bashian, a diabetes educator who works with tribes near Fresno, California.
The tribes Bashian works with used to pick acorns and hunt for deer and fish. Today none of these things are in enough abundance for people to rely on as food.
"We can't go back," agrees Kathy Kobes of the California Indian Health Service.
Kobes and Bashian are concentrating their efforts in what they see as more realistic goals, mostly improving education and the quality of government-offered food subsidies programs.
One of the tribes Bashian works with is experiencing one of two pilot programs in the United States to improve food commodity packages by bringing fresh fruit to reservations.
This is the newest approach at trying to make the food packages better. A previous pilot program offered frozen (as opposed to canned) ground beef. The beef met with an overwhelming response, according to Madelin Mullen, a nutritionist who works with the subsidy program for the United States Department of Agriculture.
"They're trying," says Gilbert.
But changing the food packages may also have limited ability to turn the tides of diabetes.
Mullen says she constantly wants to increase the nutritional value of the food in the package, but such measures are often seen as threats to sovereignty.
"People don't want to be told what they can and can't eat by do-gooder nutritionists," says Mullen.
In addition, better food only addresses half the problem. Knowler points out that eating nutritious foods is not enough; decreased levels of physical activity also contribute to obesity and diabetes on the reservations.
The only effective way of lowering rates of diabetes on the reservation that Tim Gilbert sees is education-especially of the young.
"You've got to blast the younger generation," he said.
Gilbert is currently working with a program funded by the USDA called the Nutrition Assistance Program.
In this program, Gilbert and other nutritionists go to rural Native American communities and select one person to be a Nutritional Assistant. This person is trained in Nutrition and fitness and then is sent to teach other tribal members.
"They're already familiar with traditional habits and customs" and have an easier time teaching, says Gilbert.
It is still too early to know what effects the Nutritional Assistant program is having.
Native Seeds says their plan is also well rounded and includes returning people to traditional farming of foods, which will increase activity and improve diet.
One of Native Seeds' biggest success stories is that of Pima Indian Earl Ray.
While DIABETES HEALTH did not have a chance to talk to Ray, his story has been documented in the magazine Eating Well, The New York Times and The Phoenix Gazette.
At one point Ray's high-fat diet had him weighing in at over 230 pounds-he is 5-feet 6-inches. He started eating traditional foods such as tepary beans, cholla buds and charparral tea. Today Ray maintains a healthy 150 pounds.
As with all other current programs, whether the Native Seeds approach is truly plausible remains to be seen. The only thing that is clear is that the "epidemic" is not going to be tamed any time soon.
An overview of the state of Native American diabetes appearing in the January 1993 Diabetes Care is still accurate today: "Better strategies to prevent the complications and ultimately prevent the disease are urgently needed."
0 comments - Jul 1, 1996
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