Dustin (reading the paper): Do you know that more Native Americans are overweight than ever before? Thirty-seven percent of all Native Americans are overweight and 15% are obese. Within certain tribes, up to 90 % of the population is overweight. Grandma, what is so significant about this for Native Americans?
Grandma: Well, Dustin, this means that Indian people are heavier than ever before.
Dustin: Why is there such a problem with being heavier?
Grandma: Being heavier means having more fat on our bodies. Some fat on our bodies is good, but too much fat causes health problems.
Dustin: Like what?
Overweight- Actual body weight; the expected weight for height.
Obesity- Long term excess of body fat.
High Blood Pressure- The pressure inside the blood vessels of the body as measured by a systolic blood pressure greater than 140 mmHg and/or a diastolic blood pressure greater than 90 mmHg. The systolic pressure measures the pressure in the blood vessels when the heart contracts. The diastolic pressure measures the pressure in the blood vessels when the heart is at rest and filling with blood.
Blood Glucose- Main sugar in the blood and preferred fuel source of the body.
Cholesterol- Are used in the body to make cell and body components such as steroid hormones and vitamin D.
Malnutrition- Inadequate intake of energy and/or nutrients that increases the prevalence and/or susceptibility towards death and disease.
Overnutrition- Excessive intake of energy and/or nutrients that increases the prevalence and/or susceptibilty towards death and disease.
Refined- Removal of the outer course layers of food during food processing that contain dietary fiber and other nutrients.
The Three Sisters- Corn, beans, and squash.
Calories- Fuel or energy value of food as expressed by the amount of heat necessary to raise one gram of water one degree Celsius.
Grandma: Health problems like obesity, high blood pressure, too much blood glucose, and too much blood cholesterol.
Grandma: Health problems like obesity, high blood pressure, too much blood glucose, and too much blood cholesterol.
Dustin: Did Native Americans always have problems with having too much body fat?....with having high blood sugar?.......and all those other health problems?
Grandma: Fifty years ago, very few Native Americans were obese or had problems with high blood sugar.
Dustin: What changed? .....and why did it happen so fast?
Grandma: Until recently, our people use to live off the land. Activities for everyday living required a lot of physical work. To eat, our men would hunt for food while our women would stay around the camp to pick berries and dig roots. When the government decided to relocate us on reservations, we began to rely on the food rations they supplied rather than continue with our traditional ways of retrieving food.
Dustin: So, our people became less active and had more food available.
Grandma: No, not initially. When our people were first relocated many of our people died due to malnutrition. It was not until this later century that we became less active and ate more food and began to die of diseases of overnutrition. The food that we began to eat was different from what our people were used to eating.
Dustin: How so?
Grandma: Well, traditional foods that we ate were more natural...less refined. We ate wild berries, wild roots, nuts, vegetables such as The Three Sisters, fowl, fish, or wild game for meat, leaves, and flowers. The food rations from the government were canned meats, processed fruits and vegetables, fruit juices, powdered milk and eggs, flour, sugar, and shortening.
Dustin: Wow, that's a big difference! How did we manage to eat those new foods?
Grandma (laughs): Dustin, our people have always been creative. We learned to make new foods such as frybread from the flour, sugar, and shortening....for those Indian tacos you enjoy so much.
Dustin: Mmmm, frybread. I wish we had some right now, I could eat a couple or more!
Grandma: Ah, Dustin, that's what needs to change.
Dustin: What needs to change?
Grandma: The amount of frybread we eat. We need to learn to eat one piece at a time, not two, or three, or four.
Dustin (teasing): Ah Grandma, only one? Why does it matter if I eat just one instead of the three pieces I usually eat?
Grandma: Because it is fried. Fried foods contain lots of calories. And three is too many, you need to eat a variety of foods to stay healthy instead of just filling up on one type of food.
Dustin: Grandma, you sure have learned a lot about diabetes since you have been going to the Indian Health Service to see the lady that helps you with your diet.....what is she called again?
Grandma (laughs): She is a dietician. And we have learned a lot together. It's time for me to visit her again. Would you like to go with me?
Dustin: You bet! I want to know exactly how many of those pieces of frybread I can eat at one time.
Ms. Crystal: Hello, Grandma Josephine. How are you feeling today?
Grandma: Pretty good. My grandson, Dustin, came with me today. We have been talking about the different types of foods that Indian people have been eating over the years. He has some questions.
Ms. Crystal: No problem. Dustin, are there any particular foods that you want to discuss?
Dustin: Yeah, I want to know more about our Indian frybread. Since it is fried, is it a bad food that we should never eat?
Ms. Crystal: Dustin, that's a good question and brings up a common misconception many people have about food.
Dustin: What misconception?
Ms. Crystal: The good food, bad food syndrome.
Dustin: The good food, bad food syndrome? What is it?
Ms. Crystal: Some people believe that some foods are bad and should never be eaten when, in fact, all foods can fit into a healthy diet plan. How we nourish ourselves does not depend on the selection of any one food for one day, but what we feed ourselves over days, weeks, and years.
Dustin: So, I can eat Indian tacos with frybread?
Ms. Crystal (laughing): Yes, as long as you eat them along with a variety of other foods in moderation.
Dustin: That's it!
Diet Planning Principles
Adequacy- Provision of sufficient energy and nutrients that meet the needs of a healthy person. Too many or too few calories or nutrients may cause a person to develop symptoms of deficiency or excess, respectively.
Balance- To eat a variety of foods from the different foods groups.
Calorie Control- To control body weight by matching the energy contained in the food consumed with energy used in the activities of daily living.
Nutrient Density- A food is nutrient dense if it supplies many nutrients per calorie. For example, a can of cola and a bowl of watermelon both provide ~150 calories. The watermelon provides vitamins, minerals, fiber, and carbohydrates besides calories. The cola only supplies calories.
Moderation- To eat not too many or too few of a variety of foods.
Variety- To eat foods from the different food groups. Foods from the different food groups provide different nutrients and add excitement to a meal plan.
Ms. Crystal: Not quite, Dustin. There are a few simple diet-planning principles that people need to keep in mind when they are selecting and eating food.
Dustin: Like what?
Ms. Crystal: Well, besides eating a variety of foods, we need to eat to satisfy our hunger. Sometimes we eat because we are bored or because we do not feel good about something. We end up eating way too many calories, exercising too little, and gaining too much weight. Too much weight, especially too much fat, leads to the development of different chronic diseases such as diabetes.
Dustin: My Grandmother and I were talking about that... just before she had to come in to see you. So, what we choose to eat over the years affects our health?
Ms. Crystal: Yes, and it starts with one meal, one day at a time.
Dustin: Is it impossible for a person to change their food habits?
Ms. Crystal: Impossible, No! A challenge, yes! For a person to change their food habits, they need to believe in the change and have people support them while they are making the changes. That is why your grandmother comes to see me. Each time she visits, we talk about her diet and the activity changes that she has made since her last visit. Then, we talk about other changes that she will try to make before her next visit with me.
Dustin: What if she or someone else that you see forgets the stuff that was discussed during the visit?
Ms. Crystal: Everyone forgets things. That is why we hand out information sheets to people. For people with diabetes, we have information sheets specific for diabetes.
Dustin: Is the diet information that you give to someone with diabetes very different than the information that you give to someone who does not have diabetes?
Ms. Crystal: It really depends on the person. It depends on how well they control their blood sugar levels and if they have other health problems. The basic diet plan for someone with diabetes is built on the same nutrition principles outlined in the choices. Food Guide Pyramid and the Dietary Guidelines. Would you like a copy of them?
Dustin: Yes, I would. Thanks.
Ms. Crystal: Any more questions?
Dustin: Yes, my Grandmother was telling me about how the food that Indian people have been eating over the years has changed. How are the foods different? And have the changes affected our health?
Ms. Crystal: Some more very good questions. The food habits of Native Americans have changed considerably over the last few generations. Before we were uprooted from our traditional lands, our food habits were influenced mainly by geography and climate. Each Native American nation developed a way of life that maximized local resources. For some nations, their way of life was based on agriculture, while others were predominately hunters and gatherers. Some nations lived predominately on fish. For the most part, the majority of each day was spent obtaining food.
Dietary Guidelines for Americans*
Eat a variety of foods. Balance the foods you eat with physical activity; maintain or improve your weight. Choose a diet with plenty of grain products, vegetables, and fruits. Choose a diet low in fat, saturated fat, and cholesterol. Choose a diet moderate in sugars. Choose a diet moderate in salt and sodium. If you drink alcoholic beverages, do so in moderation.
* For healthy people over two years old.
Dustin: Soooo, we used a lot of calories every day to find the food that we needed to eat?
Ms. Crystal: Yes.
Dustin: My family makes some traditional foods for the holidays such as frybread, chokecherry preserves, and June berry soup.
Ms. Crystal: Many people take pride in preparing traditional foods but make them only when it is convenient or for special occasions.
Dustin: What were the traditional foods of Native Americans?
Ms. Crystal: The foods of most Native Americans were plant-based. However, some Native American diets like the Alaska Natives were meat-based. These diets were very high in protein and were very low in carbohydrate. These diets were also high in fat but contained different types of fat.
Dustin: So, Native Americans ate a variety of foods?
Ms. Crystal: Yes, most Native American groups ate a variety of foods in moderation. The diets contained all different types of fruits, nuts, seeds, meat, roots, tubers, vegetables, grains, legumes, flowers, and leaves. Depending on the region and time of year, the fruits that were eaten included berries, grapes, crab apples, currants, persimmons, and plums. There were all different types of nuts from acorns to pinon nuts. Meat was wild game, birds, small animals, fish, and even insects in some tribes. The most common tubers and roots were cassava, groundnut, arrowroot, potatoes, and sweet potatoes. Vegetables included such things as bell peppers, cactus, pumpkins and tomatoes. The most common vegetables among all Native Americans were corn, beans, and squash.
Dustin: The Three Sisters!
Ms. Crystal: Yes, the important Three Sisters that were the foundation of most diets. Corn was the principle grain before wheat and rye were introduced to us by Europeans. Cornmeal was used to make baked or steamed bread, hominy, grits, gruels, and tortillas. Wild rice was eaten by some Indians living in the North.
Dustin: Hominy and grits? Those are Southern foods?
Ms. Crystal: Yes, many foods and flavors that are typically associated with particular regions of the country such as Boston baked beans, succotash, clambakes, and grits are based on traditional Native American foods and recipes.
Dustin: I didn't know that.
Ms. Crystal: Most people don't. I have learned a lot about our traditional lifestyle habits and history by exploring our previous food practices.
Dustin: Did we eat sweets like candy?
Ms. Crystal: All people like sweets including Native Americans but the types of sweets that we ate were different from candy. Fruits such as blackberries, blueberries, cranberries, huckleberries, raspberries, and gooseberries provided sweetness to our diets. Other foods were sweetened with maple syrup, honey, or other indigenous sweeteners. However, these sweeteners were not found or used in the same amounts as today's sweeteners. It takes about 40 gallons of tree sap, which is the entire production of sap for one year from one mature tree, to make one gallon of maple syrup.
Dustin: So, we did not drink sugared sodas?
Ms. Crystal: Not really. Our people did drink honey with water but they mainly drank water or teas made from mint, sassafras, spicebrush, buffalo berries, rose hip and other berries. And we did have a type of lemonade during the summer months that was made from the citrus-flavored sumac berries.
Dustin: Was fat used in our diets?
Ms. Crystal: Fat was available and was used to make foods. However, the amounts and types of fats used were different. Nuts, seeds, whole grains, and meats naturally contain fat besides other key vitamins and minerals. These foods were very nutrient dense. Fat that was obtained from buffalo, caribou, moose, elk, and other land mammals was also used in food preparation.
Dustin: How was fat used to prepare foods?.....did they fry foods?
Ms. Crystal: Fat was used as it has always been used to hold on to the flavors of spices and seasonings contained in a food dish. It was also used to make energy dense foods such as pemmican that was consumed by our people during long journeys. But, to answer your question, fat was not used to fry foods until recently. Traditional methods of food preparation included roasting, baking, stewing, steaming, and boiling. Some foods were also dried or smoked so that they could be consumed later in the year. An important point about the traditional ways that were used to prepare foods is that all of them were low-fat methods of food preparation. So, this means that foods prepared by these methods had fewer calories than if the same foods had been fried.
Dustin: So, the amount of time that was used to obtain food was not the only thing that had changed in the food habits among Native Americans? The types of foods, the amount and variety of foods consumed, and the methods used to cook food have all changed?
Ms. Crystal: Yes, food rations provided on reservations usually offered less variety and were very different from traditional foods. The current diets of most Native Americans are higher in refined carbohydrates, sugars, and fat and low in meat, fruits, and vegetables. Fresh or dried foods have been replaced with processed, canned, packaged, and fried foods that are low in nutrients and usually high in calories. The frequency of food consumption has also changed. Most Native American groups ate two meals per day. Now, three meals per day with frequent snacking have become the norm.
Dustin: So, have the changes in the diets of our people from a traditional diet to a more westernized diet affected our health?
Ms. Crystal: The changes that have occurred in both our dietary AND physical activity habits have adversely affected our health. Higher rates of Type II diabetes have been found among Alaskan Natives who consumed less traditional foods like salmon, caribou, berries, and seal oil and ate more non-native foods such as white bread, rice, soft drinks, beef, chicken, butter, and shortening. Diabetes is thought to be so high among us because we are less active, eat more fat, and have changed the type of carbohydrate we eat.
Dustin: So, the type of carbohydrate is different?
Ms. Crystal: Yes, the kind of carbohydrate or starch present in traditional foods such as corn, beans, and other plants, roots, and tubers are different than the type found in refined flours and sugars. The starches present in traditional foods are much harder to digest and absorb which causes the levels of glucose and insulin in the blood to rise more slowly after a meal. A slower rise may be protective against diabetes.
Dustin: Can we do anything about this or are we stuck with diabetes?
Ms. Crystal: No, we are not "stuck" with diabetes. Studies with Native Hawaiians and other Native people have demonstrated that if Native people return to former food habits, their problems with obesity, diabetes, high blood pressure, and heart disease decrease.
Dustin: Does this mean I need to start digging up roots and picking berries?
Ms. Crystal (laughing): Only if you want to. Otherwise, you could shop at your local grocery store..and "hunt" more wisely down the different food aisles. You could also plant a garden?
Dustin: Gardening? Who? Me?
Grandma: Yes, you, Dustin. We could make it a family project. Oh, your aunties and uncles loved to garden when they were children. And your grandfather did enjoy eating fresh corn and beans.