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Tribe’s War on Diabetes Starts to Pay Off by Jeremy Olson In the days when they hoofed by the thousands across Nebraska, buffalo meant everything to Indian tribes: They were spiritual symbols of freedom. Their furry hides served as shelter and clothing. Moreover, their low-fat, low-cholesterol meat was the mainstay of a healthy diet. But when the buffalo all but vanished from the Great Plains, the food source that replaced them proved far less healthy - starting with the lower-grade beef and salt pork provided to the reservations by the federal government in the late 19th century and evolving into the cheap cheeseburgers and microwave burritos of the modern fast-food era. This shift coincided with some startling health problems for American Indians, who were combining poorer eating habits with inactive lifestyles on the reservations. Diabetes took a particularly devastating toll on the Indians, who consequently suffered kidney failure, blindness and amputation of feet and legs. After watching beloved tribal leaders die at age 40 or 50 because of the disorder, members of the Winnebago Tribe of northeast Nebraska declared a “war on diabetes” over the past decade. At a recent conference in Omaha, tribal leaders said it is a war they are starting to win, and they encouraged other tribes and communities to look at the physical, emotional and spiritual efforts that have helped them succeed. “It’s that warrior spirit,” said Scott Aldrich, Sr., a trainer for the Whirling Thunder Wellness Program that is central to the Winnebago Tribe’s efforts. “They say that warriors will do anything possible to survive.” The tribe’s strategies include a blend of modern health tips, such as exercising on treadmills and stationary bicycles, and old traditions. One of those is reintegrating historical American Indian staples - such 58 inMotion Volume 11, Issue 2 March/April 2001 as buffalo meat - back into the diet. “We didn’t start getting sick until that traditional food source was disrupted from our diet,” said Lorelei DeCora, a Winnebago registered nurse. “So it makes sense to renew our bodies with that traditional food source.” By the state’s numbers, Indians are the most unhealthy and the most economically disadvantaged people in Nebraska. They die on average nearly 10 years earlier than white Nebraskans. They suffer proportionally higher risks of cancer, sexually transmitted diseases, heart disease, homicides and fatal car accidents. One in four American Indian mothers in Nebraska receives inadequate prenatal care. But it is the frightening grip that diabetes has on the American Indian community that is particularly alarming. Indians are four times as likely as whites to have diabetes and to suffer diabetesrelated deaths. That is apparent when looking at the 1,280-member Winnebago Tribe. DeCora estimated that as many as two-thirds of the people older than 45 have been diagnosed with Type 2 diabetes. The Indian Health Service hospital, which is based on the Winnebago Reservation and serves Nebraska, Iowa and the Dakotas, has a list of 827 registered diabetics. Most are from the Winnebago reservation. Take the example of Cherie LaPointe, who assists DeCora in setting up “talking circles” so that Winnebago tribal members can deal with diabetes as a community. LaPointe doesn’t have diabetes and is taking preventive steps by riding a stationary bike once a day and playing volleyball at the fitness center. But her father died from complications of diabetes, and her mother, an older brother and two sisters have it. “It certainly motivates me to do my job,” she said. Diabetes is the result of the body’s inability to produce enough insulin, which regulates the body’s metabolism of glucose, or its inability to use insulin effectively. It is treatable - but so far, incurable. DeCora said that is why the community had to get involved. People needed to learn that diabetes is treatable and preventable if they make the right health choices. To that end, DeCora established talking circles at the Winnebago and three other Midwest reservations to study whether communication at the local level could encourage efforts against diabetes. She also encouraged tribal members to plant gardens for exercise, to provide a source of healthful food and to reestablish a spiritual connection with the earth - a connection she said is lost in the massproduced world of fast food. “Before we can start talking about nutrition, we have to renew the spiritual connection our people had with food as a gift from our creator,” she said. “People are getting sick because of the loss of spiritual connection with food.” It is a bit harder to reestablish a historical connection with the level of fitness of American Indian ancestors, who on average walked 10 miles a day, chased buffalo on foot and on horses, and moved hundreds of miles to relocate their camps, Aldrich said. “But we can still do the treadmills and the bikes, and we can lift weights.” The Whirling Thunder program and fitness facilities have grown in popularity. Aldrich said an outdoor track was recently added to the local school, and an indoor pool may be next. And there is the buffalo program, which Winnebago leaders said is a critical component of their war on diabetes because it creates such a strong link to the past. Louis LaRose, head of the Winnebago buffalo program, said more mainstream attempts to lower diabetes have tried and failed, partly because they didn’t have that cultural connection. The Winnebago Tribe uses the buffalo (it has 66 now) for meals that are served at powwows and community wellness programs. LaRose said it is a matter of reestablishing the “circle of wellness” that was broken when the buffalo disappeared from the Great Plains. “Part of dealing with diabetes,” he said, “is mending that broken circle.” Reprinted by permission of the Omaha World-Herald in Omaha, Nebraska Diabetes and American Indians About 1 in 8 American Indian adults has diabetes (twice the rate of Caucasians). For example: • The Pima tribe in Arizona has the highest rate of diabetes in the world. About 50 percent of Pimas between the ages of 30 and 64 have diabetes. • There are approximately 10,000 diabetes patients within the Cherokee Nation, almost three times the national average. The number of patients diagnosed with the disease has increased 128 percent from 1989 to 1997, according to Cherokee Nation Health Service statistics. • Over 16 percent of Navajo adults have been found by glucose tolerance testing to have diabetes. • About half of American Indian adults have diabetes; most have Type 2 diabetes. Rates vary markedly among tribes. • American Indians and Alaska Natives have genetic, medical and lifestyle risk factors for Type 2 diabetes, which in youth is relatively rare; however, recent reports highlight an increasing incidence of Type 2 diabetes in children and adolescents. • American Indians and Alaska Natives with diabetes have a high incidence of diabetes complications such as eye and kidney disease, cardiovascular disease, and lower-extremity amputations. • Cardiovascular disease is the leading cause of death in Ameri- can Indians, and diabetes is a major contributing risk factor for cardiovascular disease. Diabetes and Hispanic Americans • 1 in 4 Puerto Rican Americans has diabetes. • 1 in 4 Mexican Americans has diabetes. • 1 in 6 Cuban Americans has diabetes. When compared with non-Hispanic Caucasians, rates of diabetes are 50 to 60 percent higher in Cuban Americans and 110 to 120 percent higher in Mexican Americans and Puerto Rican Americans. Diabetes and Asian Americans, Pacific Island Americans • Asian Americans are twice as likely to get diabetes as Caucasians. • In Hawaii, Asian Americans and Native Hawaiians develop diabetes much more frequently than Caucasians, and Native Hawaiians have the highest diabetes rates. Diabetes and African Americans If you are African American, you have a greater chance of getting diabetes than Caucasians. Approximately 1 in 9 African Americans has diabetes (compared with 1 in 16 Caucasians). • 1 out of every 4 African American women age 55 years or older has diabetes. • 1 out of every 4 African American adults between the ages of 65 and 74 has diabetes. inMotion Volume 11, Issue 2 March/April 2001 59