Doctor's Review: Medicine on the Move

December 15, 2017

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Food for thought

Cultural assassination and its effect on the aboriginal diet

An epidemic is wreaking havoc on Canada’s Aboriginal Peoples. First Nations, Inuit and Metis on reserve have a rate of Type 2 diabetes that is three to five times higher than that of non-aboriginal Canadians. As many as 40 percent of adults on First Nations reserves have Type 2 diabetes, compared with seven percent of the general population. Aboriginal people are also diagnosed with diabetes when they are 10 to 20 years younger. Nearly a third are morbidly obese and fully one in twenty have had a diabetes-related amputation.

These ever-rising statistics are only a few of many that reveal the health crisis currently experienced by Canadian Aboriginal Peoples and one that affects many indigenous people globally. Obesity and its attendant chronic illnesses are on the rise with many people all over the world, but why is indigenous health deteriorating more quickly than that of other populations?

One popular theory suggests that a rapid change in the nutritional environment can be blamed for the high rates of diabetes among aboriginals. The sudden move from a traditional diet of foods low in fats and sugars and high in micronutrients like vitamin A and omega-3 fatty acids to a diet of white flour, sugar and other processed foods brought about by the introduction to European culture was bound to cause a decline in health. The larger question is whether aboriginal populations are genetically predisposed to diabetes?

“Thrifty” genes?

A nature/nurture debate is at play here. Some researchers, such as Dr Stewart Harris, Professor of Family Medicine at the University of Western Ontario, believe genetics are a factor.

“Aboriginal people have a genetic make-up that was ideal in their ancestors’ feast-famine environment, which made energy storage a priority,” he asserts.

Critics disagree. They contend theories like those of Dr Harris veer dangerously close to promoting a racist discourse and question the science behind them. The idea stems from the “thrifty gene hypothesis,” proposed in 1962 by Dr James Neel, a prominent US geneticist. He asserts that indigenous people share a susceptibility gene as a result of evolving as hunter-gatherers, a so-called “thrifty” gene which acts to conserve energy by quickly converting it to glucose. A release of insulin causes the body to store the excess glucose for later use, saving it for a time when food is scarce. This ability to survive long food shortages would offer a selective advantage and spread the genes throughout the larger population. When a people becomes less active, the suggestion is the thrifty genes are still active. They promote an excessive amount of insulin and result in obesity and Type 2 diabetes. People of European descent ostensibly lost such a gene long ago after leaving the hunter-gatherer lifestyle to pursue agriculture.

This theory has been widely questioned and is generally considered less significant than the effects of environmental and cultural changes, poor diet and a sedentary lifestyle brought on by contact with the European population.

In the realm of genetics, another factor is perhaps more relevant: aboriginal women, who have greater rates of gestational diabetes related to obesity, have an increased likelihood of passing diabetes on to their offspring, who are more likely to pass on the trait in turn. This could be a factor accounting for the sudden increases in diabetes in the youngest aboriginal Canadians.

The federal government has thrown a fair bit of money at the aboriginal diabetes epidemic, yet the statistics don’t indicate much success. In 1999, the Canadian Diabetes Strategy (CDS) was funded $115 million over five years. The Aboriginal Diabetes Initiative (ADI) was included as a key component. The direness of the situation inspired the ADI to direct $58 million of the total to address aboriginal diabetes with the focus on screening and treatment and several studies to determine the quality of diabetes healthcare in 19 First Nations communities.

Culture then diet

Meanwhile, in Montreal, an independent, multidisciplinary research and education centre created by Canada’s aboriginal leaders took a different approach. The Centre for Indigenous Peoples’ Nutrition and Environment (CINE) opened its doors on McGill University’s campus in 1993, led by Chief Bill Erasmus and Dr Harriet Kuhnlein. The centre, heavily supported by McGill University, was designed to work with indigenous people globally on topics related to food systems, independent of the government. Anecdotal evidence of the program’s success praises its culturally holistic approach to health. Instead of discussing diet and nutrients, CINE focuses first on supporting the rich culture that surrounds traditional diets.

A return to a traditional way of eating brings with it a host of health benefits, not the least of which is the physical activity required to harvest traditional foods. Cultural cohesion is, perhaps, of even greater significance. CINE has worked extensively with the Nuxalk, who live along the fjords on the central west coast of British Columbia, both to document elders’ knowledge of traditional foods as well as to promote community harvesting of salmon, berries and other foods. CINE has also helped document the change in diet between older and younger generations in Inuit populations.

Root causes

Dr Mark Aquash, a member of the Walpole Island First Nation reserve located in the mouth of Ontario’s St Claire River, is Dean of the School of Indigenous and Community Relations at Winnipeg’s Red River College, and former Professor of Education at UBC. He has written extensively on indigenous issues and believes that at the root of the health crisis lie the psychological effects of colonization and forced assimilation, an idea that has at last been accepted by Canada’s government.

This concept was of central focus to those who wrote the final, 94-page report of the Truth and Reconciliation Committee, released last December 15. The report included a request that the Canadian government, “Acknowledge that the current state of aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal Peoples as identified in international law, constitutional law, and under the Treaties.”

Prime Minister Trudeau told an overflowing crowd present for the report’s release that Canada fully accepted its “failing” with regard to the century-long abuse of aboriginal children in residential schools, and received hoots, hollers and a standing ovation from those in the room, many of whom had been residential school students themselves.

Trudeau went on to promise that the government would take action on all proposals in the report that come under federal jurisdiction, including the endorsement of the UN Declaration on the Rights of Indigenous Peoples, which the previous government refused to do. Trudeau summarized this hopeful change of relationship in his statement: “Today, we find ourselves on a new path, working together toward a nation-to-nation relationship based on recognition, rights, respect, co-operation and partnership.”

Let’s eat

Assuming that the new government is sincere and the changes are implemented, the real work can begin. According to Dr Aquash, a process of decolonization through self-determination at an individual level is necessary in order to undo history’s deleterious effects. The process, he says, is fourfold.

First comes a rediscovery and recovery stage, which brings an individual into contact with lost culture as well as with the atrocities experienced by that culture through forced assimilation. Second comes a period of anger and grief. Third comes visioning in which the individual discovers new purpose in life and community. A commitment to action which reinforces the vision is the fourth and final stage.

One such vision is at play at Salmon n’ Bannock, a Vancouver bistro that offers First Nations food cooked in a modern way. The restaurant is staffed entirely by First Nations people and has won accolades on the hotly competitive Vancouver restaurant scene. Co-owner Inez Cook, Nuxalk Nation, is a buoyant spokesperson for a return to traditional foods. “I’m very proud of First Nations food,” she says. “It’s great. I want to shout out: try it! Eat it!”

The menu brims with treats like barbecued salmon mousse on bannock and blueberry chutney on bison carpaccio. And while this may seem a far cry from a meal plan on an isolated reserve where pizza and soda prevail, this broad cultural recognition of “country foods” is one step on the path towards health — both physical and spiritual.

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