2010 (Oct) Alberta Diabetes Institute Research Day, poster presentation by Richard Oster (BRAID Research)

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TRADITIONAL FIRST NATIONS FOODS AND TYPE 2 DIABETES
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Richard T. Oster, Department of Medicine, University of Alberta
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ABSTRACT
The current health, in the biomedical
sense, of First Nations populations is
generally poorer in comparison with the
health of the Canadian population at
large. Type 2 diabetes in particular,
excessively impacts the Canadian First
Nations population, having reached
epidemic proportions in an accelerated
manner. Encouraging the increased
procurement and consumption of
traditional foods is gaining momentum as
a potential strategy to prevent and
manage type 2 diabetes in First Nations
communities. Through review of the
literature, our purpose was to present a
general summary of the advantages and
disadvantages of this strategy.
Specifically, studies of the possible
nutritional, fitness, and cultural benefits of
promoting traditional food consumption
were explored, as were the risks posed
by environmental toxins and food security
issues. Future research needs are
highlighted.
Keywords: Aboriginal; North American;
Type 2 Diabetes; Traditional Diet
REFERENCES
1. Oster RT et al. Alberta Diabetes Atlas
2009:189-212.
2. Willows ND. Canadian Journal of
Public Health. 2005, 96(Suppl 3):S32-
S36.
3. Hu FB et al. Diabetologia. 44:805-817,
2001.
4. Bryan SN et al. Canadian Journal of
Public Health. 2006, 97:271-276.
5. Chandler MJ and Lalonde CE: Cultural
continuity as a hedge against suicide in
Canada’s First Nations. Transcultural
Psychiatry. 35:191, 2003.
6. Power EM. Canadian Journal of Public
Health. 2008, 99:95-97.
7. Sharp D. International Journal of
Circumpolar Health. 2009, 68:316-326.
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BACKGROUND
First Nations health compares inferiorly to that of the general Canadian
population, and type 2 diabetes is no exception. Studies suggest that
type 2 diabetes and its complications occur at much higher rates (2-5
times) among First Nations peoples than the general Canadian
population1.
Before the arrival of Europeans to North America, First Nations peoples
survived for centuries by harvesting foods entirely off the land. What
was consumed varied depending on food availability, season,
geographic location, tribe in question, as well as spiritual and cultural
values2. Common foods included bison, caribou, moose, beaver, bear,
rabbit, deer, muskrat, waterfowl, grouse, pheasant, crustaceans,
shellfish, salmon, whitefish and other fish, berries, nuts, seeds, wild
greens, roots, bulbs, as well as numerous vegetables including corn,
squash and potatoes2.
There is a recent movement, in both academic and First Nations
communities, to encourage the partial return to traditional lifestyles as a
means to combat type 2 diabetes.
A literature review was performed to provide a general overview of the
potential advantages and disadvantages of encouraging the
consumption of traditional foods to prevent type 2 diabetes for First
Nations peoples.
Nutritional
A poor diet is the most common modifiable risk factor for type 2
diabetes3. While many First Nations people still consume some
traditional foods, they have been largely replaced by ‘market foods’
which are of poor nutritional content.
Table 1 Summary of the traditional and contemporary diets of First
Nations populations based on the literature available.
Physical Activity
Even independent of obesity and weight gain, physical inactivity has
been shown to increase the risk of type 2 diabetes4. With colonization
and the change to a more sedentary way of life, physical inactivity has
become extremely common in many First Nations populations4. Prior to
the 20th century, First Nations people were highly active as most
activities of daily life were physically demanding, such as hunting,
trapping, fishing, traveling and gathering.Traditional food procurement is
still a common form of activity among First Nations people.
Cultural
Traditional food is a central part of First Nations cultural identity,
providing significant social, spiritual, and psychological benefits5. Much
of First Nations culture, including traditional food practices, was
destroyed by the effects of colonialism, with attempted oppression and
assimilation. Suicides experienced by First Nations people have been
attributed to cultural disconnection5. Only recently has the idea of
culture as a protective factor begun to be extrapolated to other health
issues, such as type 2 diabetes.
PubMed and Web of Science were searched to find studies related to
the current understanding of traditional First Nations foods and type 2
diabetes. Key potential advantages/disadvantages were identified,
leading to more focused searching.
Practicality
Whether or not traditional First Nations foods can be harvested and
consumed is affected by issues of:
- Access: urban dwellers, loss of traditional lands
- Availability: industry, infrastructure, climate change
- Cost: equipment, travel, loss of paid time
- Ability to harvest: decreased cultural knowledge transfer
- Apprehension: “chemo-phobia”6
Environmental Toxins
New epidemiological research has shown an association between type
2 diabetes and exposure to organo-chlorines such as polychlorinated
biphenyls (PCBs) and dioxins7. PCBs and dioxins accumulate in the
environment and eventually in the organs and adipose tissue of
animals and humans. These toxins may be present at high levels in
many traditional First Nations foods, such as certain wild game and
fish. However, there appears to be great variability in concentrations
depending on the specific animals and species in question, and the
geographical location7.
DISCUSSION
The easing of this controversy likely hinges on two facets:
1. The closing of research gaps
- Intervention studies to examine whether collecting/consuming
more traditional foods improves nutritional status, fitness,
cultural continuity, and ultimately type 2 diabetes risk.
- The possible links between cultural continuity and type 2
diabetes.
- Mechanistic studies of PCBs/dioxins and type 2 diabetes.
- Identification of where, when and which traditional foods can
be consumed to minimize risk.
- Traditional food supply exploration, especially in urban First
Nations.
2. Collaboration
- Of First Nations organizations, academics, governments,
healthcare systems and other agencies.
METHODS
POTENTIAL ADVANTAGES POTENTIAL DISADVANTAGES
Traditional diet Contemporary diet
Very diverse, calories widely
distributed
Calorie dense
High in fiber Low in fiber
High in polyunsaturated and
monounsaturated fatty acids
High in saturated and trans fatty
acids
Rich in micronutrients and
vitamins
Low in iron, folate, calcium,
vitamin D and vitamin A
Low in simple carbohydrates High in sugar
High in lean animal protein Low in fruits and vegetables
Alberta Diabetes Atlas, 2009