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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.
.
Newest Federal Indian Health Medical Center
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