CAUSAL THEORIES CONCERNING DIABETES AMONG NATIVE AMERICANS A review of research and progress by Elizabeth (Liz) Pollard Copyright 1995. All rights Reserved. One of the more interesting areas for study in diabetes research is that of epidemiology, or study of the prevalence of the disease in populations of various areas of the world or ethnic origins. Epidemiologists in the first half of this century, around 1940, began to notice a huge jump in the incidence of diabetes in Native Americans. Up to this time, there had been little or no diabetes reported in this population, but it had begun to appear sometime after reservations were established for many of them and they were fed mostly on government rations. Present day records show the highest incidence of diabetes worldwide among Native American groups, especially those in certain parts of the United States and Mexico. While it is very common among all Native Americans, the incidence of diabetes varies from 1 case among 25 people in the Alaskan tribes to 1 in 3 in the desert Southwest! The heaviest concentration is among the Pima and their relatives the O'Odham (formerly called Papago) near Tucson, Arizona. Among the Pima over 35 years of age, the incidence of Type II diabetes is 40%! It is not the first time a "White Man's" disease has struck among these people. In the nineteenth century, whole populations of them were wiped out by infectious diseases they contracted from the early settlers. Diseases like measles, smallpox, influenza, and tuberculosis were brought from Europe by the early explorers and colonists. The Native Americans had never been exposed to any of them, and had built up no immunities to them. When first exposed, these plagues killed them faster and more viciously than they would have killed people who had developed immunities and antibodies to them for centuries. Diabetes, however, is not infectious, but genetic in origin. What has caused it to appear in such great numbers in a population previously free of it? Researchers have come up with many theories, none of which has yet been proven, but recent studies show promise of remedying that. The most prevalent theory for decades for the cause of diabetes in Native American groups holds that the change from traditional foods, high in fiber and low in fat, to modern "White Man's Diet", high in processed carbohydrates and sugar, high in fat, and low in fiber, is the reason diabetes began to appear in this group. Since the appearance of diabetes in time also coincides with the change in diet in most tribes, this appears to make elegant sense. However, it is well known there is a strong genetic link in Type II diabetes (NIDDM), the most prevalent type among Native Americans, so this theory doesn't take into account the absence of diabetes among Native Americans during all those centuries before this one. Another theory is that they always had diabetes among them, but that it was never diagnosed as disease before. It was probably seen as a curse or witchcraft and treated with medicine men's "magic" cures. If the patient died, the witch's power was simply greater, as with any other such disease they couldn't cure. Of course, if there were cases of diabetes before contact with whites, there were no records kept of it, so no one really knows or can determine if this is what happened. Modern medical record keeping has remedied this situation and revealed the distressingly high rates of diabetes among Native Americans. This theory, however, assumes the genetics were always there, and active, but the disease wasn't recognized as such. Some research of the last few years suggests this may be correct in some ways. Several researchers at NIH in recent years have suggested that Native Americans, and other indigenous peoples around the world, may have developed a special gene in response to the conditions under which they lived. Their lifestyles all included alternating periods of famine and plenty, due to their habit of hunting and gathering for food. Hunting and a nomadic way of life also provided them with a lot of activity which called for fuel in the body to accommodate it. These researchers theorize a "thrifty" gene which fostered high insulin levels in the body, enabling these people to extract energy efficiently from the foods they ate, to gain weight during times of plenty, and store it to be drawn upon when food was not plentiful. The foods they ate include high levels of a starchy substance called amylose, which was more slowly digested than other starches, as well as plenty of soluble fibers, known as gums and mucilages. Many of these same foods, when tested on diabetic and non diabetic populations by modern researchers, appear to slow the rise of blood glucose, while providing high levels of energy. Once these people settled on reservations, assuming a more sedentary lifestyle, and began eating white flour and other refined carbohydrate foods, provided in their government rations, the "thrifty" gene became a hazard to their survival. No longer were there long periods of famine during which their bodies drew on stored food for energy. The weight continued to accumulate instead, and they took in more fat than before in their diets. As time went by, and many of them began to eat fast foods, also high in fat and low in fibers, the situation worsened. They also consumed less of the traditional foods, like mescal, mesquite pods, acorns, tepary or lima beans, and prickly pear cactus, which contained the soluble fibers and amylose which had protected them from rapidly rising blood sugar. As a result, diabetes began to appear among them, mostly the non-insulin dependent type. The situation has become desperate now, and several organizations have sprung up around the country which are trying to preserve the seeds of native foods and encourage their use in the diets of Native Americans, as well as other diabetics. Their efforts show promise and are being monitored closely by scientists for their effect on the situation. One such organization is Native Seeds/SEARCH, which has developed a project including education on desert foods in the Native American diet. More information on their program may be obtained from them at 2509 N. Campbell Ave., #325, Tucson, AZ 85719, or by phone, (602) 327-9123