Medicine Wheel Nutrition Medicine Wheel Nutrition

Medicine Wheel Nutrition

Sioux Tribes in South Dakota

Workshop Outline

• Original Indigenous Foodways

• Health Transitions

• Utilizing Indigenous Symbols/Messages

• Tribal Food Sovereignty in Action

Tribes of a common region often shared a similar foodway.

Tribes of a common region often shared a similar foodway.

Images of Wellness

Chief Red CloudBone Necklace - 1889

Images of Wellness

Images of Wellness

Wm. Denver McGaa family - 1937

Original American Foods

The Original Americans were the Greatest Agriculturalist!

Three out of every four plants we eat today were first grown by Native North

and South Americans.

Native American Food Crops

• Tomato• Beans• Peanuts• Sunflowers• Avocado• Squash• Chili Peppers

• Coffee• Corn• Cocoa• Berry Varieties• Pumpkin• Pineapple• Potatoes

Slow foods - absorption keeps pace with insulin production

Corn

• Increased the supply of meat and lard• Also, eggs, milk, butter, cheese and all domesticated animal products Population Impact in Europe: 1650 to 1950

100 million to 600 million

Lived in Balanced - Cycles

Wherever power moves, it moves in a circle.

Black Elk, Oglala, Lakota

Salmon Fishing -

Salmon – Sacred Sustenance

“Their existence is vital and linked to ours, we will not allow them to go extinct”

.

Lakota NameCanpa (Chan-paw)

Chokecherries

means bitter wood stem

Scientific name - Prunus Virginiana

A variety of nutrients

Food Variety• “Our foods are varied,

delicious and served in some of the finest eateries in the world – foods such as abalone, mussels, oysters, clams, sea urchins, sea anemones, turban snails, duck, goose, quail, venison, elk, rabbit, salmon, trout, seaweed, hazelnuts, black walnuts, watercress and berries: strawberries, raspberries, blackberries and huckleberries”.

Kathleen Rose SmithFederated Indians of Graton

Rancheria

Native Teas - California

Common• Mint• Rosehip• Raspberry• Red Clover• Manzanita Berry• Madrone Berry• Sumac Berry

Medicinal• Cedar• Sage• Bitter Root• Yurba Buena• Wormwood• Elderberry

“The Three Sisters (corn, beans and squash) are our medicine. When we eat them regularly, we stay in

good health. Our bodies are in balance. Our Spirit is renewed since

we are fulfilling our Creator’s instructions. As we drift to Western or foreign diets we are no longer in

balance and disease develops”.

Brenda La France, Mohawk

Time Spent on Food

Most Indian Cultures ate quantities of superior quality animals and seafood to maintain resistance to disease, great physical strength, and perfect, normal reproduction.

Dr. Weston Price

Removal from the Land and Food

Across North America, the U.S. Government has followed a program of systemic removal of Native people from their traditional lands, destroying long standing traditional food and agricultural systems

Introduction of European food and government Rations

Beef, Pork, and poultry, Diary, fruit, Flour – Fry bread Refined wheat bread, Salt Pork, Coffee

Despite major changes the people still hunted smalland gathered plants and were still relatively a healthy nation.

“ It is widely recognized that the replacement of indigenous foods with a diet composed primarily of modern refined foods is the center

piece of the diabetes problem.”

Kuhnlin, HV. “Culture and Ecology in Dietetics and Nutrition” in Journal of the American Dietetic Assoc. 1989, 89 (8) 1059-1060.

(Pima) Tohono O’odham

Traditionally were skilled desert farmers,

Used ditch irrigation to grow crops such as corn and beans.

Farming stopped in the 1930’s

More than half of the tribe suffers from a diet related disease.

Change in Diabetes Rate Among the Pima

Early 1950’s ……3% Diabetes 1960’s…….19% 1980’s…….50% (over age 35) 1988-93……69%(over age 45)

Diabetes Prevalence

• Native Americans have the highest age-adjusted rate of diagnosed diabetes among all racial and ethnic groups in the United States.

• Nearly 2 x the rate of the general population.

• Diabetes related mortality rate among AI/AN is 3 x that of the general population.

Food Sovereignty

The rights of all peoples to decide how they will hunt, grow, gather, sell or give away their food.

www.treatycouncil.org

Many consider the restoration of traditional foods and practices as essential in order to regain their health, traditional economy and culture for generations to come.

Strengthening our Traditional Food Systems

Inter-tribal Bison Cooperative

• With 53 member tribes, ITBC has succeeded in restoring bison to Indian Nations in a manner that is compatible with their spiritual an cultural beliefs and practices.

Winona La Duke

White Earth Land Recovery Project

Recovering Traditional Foods to heal the People

www.honorearth.org

Importance of culturally appropriate materials

“Teaching nutrition in a way that supports tribal food sovereignty and the use of traditional foods with a message that is consistent with historical food practices is needed”.

Kibbe Conti MS, RD, CDE Oglala.

The Medicine Wheel, representing the four dietary components of the traditional Northern Plains Indian hunter/gatherer food pattern

Native American Natural Foods Based in Kyle, SD on the Pine Ridge Reservation

Made from all-natural buffalo and cranberries, two indigenous foods from Native America.

Comparison of Meats (3.5 oz Portion)

Hot Dog• Fat - 25 grams• Protein - 12 grams• Saturated Fat 10 g• Contain

Nitrates/Salt

Salmon Essential Fatty acids Protein Rich Saturated Fat – 1 gr.

Traditional Cooking Methods

• Boiling Stones/baskets

• Roasting Hot Coals

• Baking Earthen Pit

• Drying

Frying is not Traditional

Copyright 2001, Licensed to Northern Plains Nutrition Consulting

How to reconstruct a healthy food system?

Tohono O’odham Community Action (TOCA)www.toca.org

• Cultivated several acres of traditional crops; corn, tepary beans, squash, melon and sorghum.

• Organized trips to collect desert foods.• Gives out seeds and tools to those O’odham who

want to grow things.

“Reversing generations of high-fat, high-sugar diets”. TOCA

The Medicine Wheel Nutrition Intervention: A Diabetes Education Study with the Cheyenne River Sioux Tribe

Kendra K. Kattelmann, PhD, RD: South Dakota State University (SDSU)Kibbe Conti, MS, RD

Cuirong Ren, PhD: SDSU

Kattelman, K, et al.J Am Diet Assoc. 2009; 109 (September)

JOURNAL OF THEACADEMY OF NUTRITION AND DIETETICS

Four Bands History

Epidemiology• American Indian populations experience significant

nutrition-related health disparities compared to other racial and ethnic groups within the US.

• American Indian adults have the highest age-adjusted rates for cardiovascular disease, diabetes and obesity of any racial or ethnic group.

• Age-adjusted rates of diabetes among Native people vary from 14% to 72%, which are 2.4 to more than 6 times the rate of the general US population.

Pre-reservation dietary patterns

• Hunted Foods : Buffalo, Deer, Elk• Fish Small game birds/animals

• Gathered Plants : Leafy plants, Shoots• Roots, Berries, Seeds, Nuts, Bulbs

Trade Crops: Corn varieties, Beans, Squash

• Teas/Water

Diet Composition Change – Plains Indians

Protein

Carbo's

Fat 48%

37%

15%

47%

28% 25%

40%

40%20%

Hunter/Gatherer Diet Early Reservation Era Modern Diet

Source: The Strong Heart Study, 1993 Welty, Zephier.

Source: Yvonne Jackson, 1994, Diabetes: A Disease of

Civilization. Mouton de Gruyter.

Study Objective

Background• The Northern Plains

Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity.

To determine if Northern Plains Indians with type 2 diabetes who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Nutrition guide in addition to their usual dietary education will have better control of their type 2 diabetes than nonintervention participants.

Methods

When: 2005 – Six month period Who: Persons with Diabetes from Cheyenne River Sioux Reservation What: Randomized Trial

Participants assigned to education intervention or usual care control group.

Methods• Education group –

Six nutrition lessons based on the Medicine Wheel Guide, a diet patterned after the traditional consumption of macronutrients for Northern Plains Indians; protein (25% of energy), moderate in carbohydrate (45% to 50% of energy), and low in fat (25% to 30% of

energy). • Usual care group - usual dietary education from

their personal providers.

Medicine Wheel Symbol

A symbol used by Native American to represent wholeness and balance

JOURNAL OF THEACADEMY OF NUTRITION AND DIETETICS

Kattelmann K, et al.J Am Diet Assoc. 2009; 109 (September)

Comparison of physiological outcome measurements of participants from the Medicine Wheel Nutrition Intervention: A diabetes education study with the Cheyenne River Sioux Tribe

Education Groupa Usual Care Groupa

Baseline Completion Within group change from baseline to

completion b

Baseline Completion Within group change from baseline to

completion b

Comparison of between group

change c

Weight (kg) 95.9±3.6 94.1±3.6 ↓ 1.4±0.4 * 96.4±3.2 94.1±3.2 ↓ 0.5±0.5 P=.1219

BMId 35.0±8 34.3±8 ↓ 1.0±0.1 ** 34.3±1.1 33.7±1.1 ↓ 0.5±0.2 P=.2375

HgA1C (%.) e 8.9±0.4 8.4±0.3 ↓ 0.3±0.3 8.6±0.3 8.5±0.3 ↓ 0.2±0.2 P=.5563

Glucose (mg/dl) f 206±12 197±12 ↓ 9±11 201±10 183±10 ↓ 18±10 P=.4849

Triglycerides (mg/dl) g h

202 (170, 238) 227 (192, 262) ↑ 30±17 232 (199, 265) 222 (189, 257) ↓ 17±12 P=.0215

Total cholesterol (mg/dl) i

204±6 199±8 ↓ 5±5 203±6 187±6 ↓ 14±5** P=.2619

HDL – C (mg/dl) j 47±2 45±2 ↓ 3±1 50±2 42±2 ↓ 6±2 ** P=.1199

a Participants were recruited from Cheyenne River Indian Reservation, South Dakota. Education group = intervention group, n=51, participants received monthly educational intervention on traditional diet using the Medicine Wheel Model for Native Nutrition. Usual Care group = control group, n=53, participants were non-intervention control and received usual dietary education provided by personal providers at Indian Health Services Hospital. Mean ± standard error or 95% Confidence Interval.bWithin group change from baseline to completion, * = P ≤ .05, ** = P ≤ .01.c Comparison of the baseline to completion changes between Education and Usual Care group. d BMI=body mass index; calculated as kg/m2e HgA1C (%) = Hemoglobin A1C, measure of long-term glucose control. To convert values from conventional to SI units multiply % total hemoglobin by 0.01 to get proportion of total hemoglobinf To convert glucose values from conventional to SI units multiply mg/dL by 0.0555 to get mmol/Lg Data was tested for normality, triglyceride and Insulin were non-normal. Data were transformed for statistical analyses. Mathematical means and 95% CI reported for non-normal data.hTo convert triglyceride values from conventional to SI units multiply mg/dL by 0.0113 to get mmol/LiTo convert total cholesterol values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Lj HDL-C= high density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Lk LDL-C= low density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Ll VLDL-C= very low density lipoprotein cholesterolm To convert insulin values from conventional to SI units multiply uIU/mL 6.945 to get pmol/L

JOURNAL OF THEACADEMY OF NUTRITION AND DIETETICS

Kattelmann, K, et al.J Am Diet Assoc. 2009; 109 (September)

Comparison of physiological outcome measurements of participants from the Medicine Wheel Nutrition Intervention: A diabetes education study with the

Cheyenne River Sioux Tribe (con’td)Education Groupa Usual Care Groupa

Baseline Completion Within group change from baseline to

completion b

Baseline Completion Within group change from baseline to

completion b

Comparison of between group

change c

LDL – C (mg/dl) k 115±5 107±4 ↓ 7±4 109±2 102±5 ↓ 5±5 P=.6634

VLDL –C (mg/dl)

l

37±2 37±2 ↓ 0.5±2 41±2 40±2 ↓ 2±2 P=.3464

Insulin (uIU/mL) g

m31 (25, 36) 42 (22, 62) ↑ 12±9 32 (27, 37) 32 (26, 38) 0±3 P=.1480

Systolic blood pressure(mm Hg)

129±2 128±2 ↓ 1±2 129±2 126±3 ↓ 2±2 P=.6522

Diastolic blood pressure(mm Hg)

73±1 73±1 ↓ 1±1 72±1 69±1 ↓ 3±1 P=.1234

a Participants were recruited from Cheyenne River Indian Reservation, South Dakota. Education group = intervention group, n=51, participants received monthly educational intervention on traditional diet using the Medicine Wheel Model for Native Nutrition. Usual Care group = control group, n=53, participants were non-intervention control and received usual dietary education provided by personal providers at Indian Health Services Hospital. Mean ± standard error or 95% Confidence Interval.bWithin group change from baseline to completion, * = P ≤ .05, ** = P ≤ .01.c Comparison of the baseline to completion changes between Education and Usual Care group. d BMI=body mass index; calculated as kg/m2e HgA1C (%) = Hemoglobin A1C, measure of long-term glucose control. To convert values from conventional to SI units multiply % total hemoglobin by 0.01 to get proportion of total hemoglobinf To convert glucose values from conventional to SI units multiply mg/dL by 0.0555 to get mmol/Lg Data was tested for normality, triglyceride and Insulin were non-normal. Data were transformed for statistical analyses. Mathematical means and 95% CI reported for non-normal data.hTo convert triglyceride values from conventional to SI units multiply mg/dL by 0.0113 to get mmol/LiTo convert total cholesterol values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Lj HDL-C= high density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Lk LDL-C= low density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/Ll VLDL-C= very low density lipoprotein cholesterolm To convert insulin values from conventional to SI units multiply uIU/dL 6.945 to get pmol/L

JOURNAL OF THEACADEMY OF NUTRITION AND DIETETICS

Kattelman,n K, et al.J Am Diet Assoc. 2009; 109 (September)

Comparison of dietary intake and physical activity of participants from the Medicine Wheel Nutrition Intervention: A diabetes education study with the Cheyenne River

Sioux Tribe Educationa Usual Care a

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6

Dietary intake of macronutrients Mean ± standard error

Energy (kcal/d)

1639 ± 104

1461 ± 755

1681 ±118

1563± 97

1681 ± 114

1663 ± 124

Energy (kcal/d)

1699 ± 120

1560 ± 89

1688 ±133

1487± 96

1568 ± 119

1666 ± 103

Carb (g) 191 ± 13

166 ± 12

203 ± 16

178 ± 12

209 ± 22

190 ± 14

Carb (g) 191 ± 13

185 ± 11 203 ± 15

190 ± 18

188 ± 16

195 ± 14

Prot (g) 57 ± 4 57 ± 5 66 ± 5 67 ± 4 69 ± 4 73 ± 9 Prot (g) 68 ± 7 63 ± 4 67 ± 7 58 ± 4 62 ± 5 70 ± 5

Fat (g) 75 ± 5 66 ± 7 72 ± 7 66 ± 6 68 ± 5 65 ± 5 Fat (g) 73 ± 6 65 ± 5 71 ± 8 58 ± 5 66 ± 7 69 ± 5

% Carbb 47 ± 2 48 ± 2 48 ± 2 46 ± 2 48 ± 2 48 ± 2 % Carbb

47 ± 2 49 ± 2 49 ± 2 50 ± 2 48 ± 2 47 ± 2

% Prot c 14 ± 1 16 ± 1 16 ± 1 18 ± 1 18 ± 1 16 ± 1 % Prot c 16 ± 1 16 ± 1 16 ± 1 17 ± 1 17 ± 1 17 ± 1

% Fat d 41 ± 2 39 ± 2 37 ± 2 37 ± 2 36 ± 2 35 ± 2 % Fat d 39 ± 1 36 ± 1 37 ± 2 35 ± 2 38 ± 2 37 ± 1

a Participants were recruited from Cheyenne River Indian Reservation, South Dakota. Education group = intervention group, n=51, participants received monthly educational intervention on traditional diet using the Medicine Wheel Model for Native Nutrition. Usual Care group = control group, n=53, participants were non-intervention control and received usual dietary education provided by personal providers at Indian Health Services Hospital. Dietary data obtained from monthly from 24-hour recalls. No significant difference in dietary data due to the intervention or time.b Percent of total calories from carbohydrate. c Percent of total calories from protein.d Percent of total calories from fat.e Light, moderate and vigorous activity; measured as minutes/day calculated from the CAPS physical activity survey.f Significant differences determined by analysis of variance for intervention and time using Mixed Procedure, SAS. There are no significant differences due intervention (Education vs. Usual Care). There were significant differences due to time. g Significant differences determined by analysis of variance for intervention and time using Mixed Procedure, SAS. h Means from groups for light activity were summed and differences between means determined by Least Square Means. Means with different superscripts (x, y, z) are significantly different at P ≤ 0.5 due to time.

JOURNAL OF THEAMERICAN DIETETICASSOCIATION

Kattelmann, K, et al.J Am Diet Assoc. 2009; 109 (September)

Comparison of dietary intake and physical activity of participants from the Medicine Wheel Nutrition Intervention: A diabetes education study with the Cheyenne River

Sioux Tribe (cont’d)Educationa Usual Care a

Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6

Minutes per day of physical activityMean ± standard error

Light activity ef

21 ± 2x 19 ± 2x 17 ± 1xz 17 ± 2 17 ± 2 19 ± 1 Light activity ef

24 ± 2 21 ± 2 25 ± 8 16 ± 1 15 ± 2 15 ± 1

Moderate activity eg

6 ± 1 5 ± 1 5 ± 1 6 ± 1 6 ± 1 7 ± 1 Moderate activity eg

7 ± 2 8 ± 1 8 ± 2 6 ± 1 12 ± 6 5 ± 1

Vigorous Activity eg

0.6 ± 0.3

0.2 ± 0.1

0.2 ± 0.1

0.2 ± 0.1

0.4 ± 0.2

0.4 ± 0.1

Vigorous Activity eg

0.5 ± 0.2

0.5 ± 0.2

0.3 ± 0.1

0.2 ± 0.2

.1 ± .03 0.2 ± 0.1

Minutes ± standard error of summed ED and UC minutes of light activity per day

Total light minutes h

22 ± 1 x 20 ± 1 x 22 ± 4 xz 17 ± 1yz 16 ± 1yz 17 ± 1yz

a Participants were recruited from Cheyenne River Indian Reservation, South Dakota. Education group = intervention group, n=51, participants received monthly educational intervention on traditional diet using the Medicine Wheel Model for Native Nutrition. Usual Care group = control group, n=53, participants were non-intervention control and received usual dietary education provided by personal providers at Indian Health Services Hospital. Dietary data obtained from monthly from 24-hour recalls. No significant difference in dietary data due to the intervention or time.b Percent of total calories from carbohydrate. c Percent of total calories from protein.d Percent of total calories from fat.e Light, moderate and vigorous activity; measured as minutes/day calculated from the CAPS physical activity survey.f Significant differences determined by analysis of variance for intervention and time using Mixed Procedure, SAS. There are no significant differences due intervention (Education vs. Usual Care). There were significant differences due to time. g Significant differences determined by analysis of variance for intervention and time using Mixed Procedure, SAS. h Means from groups for light activity were summed and differences between means determined by Least Square Means. Means with different superscripts (x, y, z) are significantly different at P ≤ 0.5 due to time.

Built environment and health

• Renalds, A., Smith, T. & Hale, P. A systematic review of built environment and health. Family & Community Health. 2010;33:68-78.

Increasing the access to healthy foods

• US Nutrition Assistance Programs– WIC, Food Distribution Program (Commodities) Food Stamps

Strengthen Community Food Systems

Reduce Food Insecurity

Community Food System Needs

• Improved access to high quality, affordable food among low income households.

• Support for local food systems; farmers, ranchers and traditional harvesters.

• Expanded economic opportunities for tribal residents through local business or other economic development.

Study Conclusions

The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of education support may be needed to influence blood glucose and lipid parameters.

.

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