samedi 19 juillet 2014

MH 017 BAD LUCK FOR MALAYSIA AND NAIL IN THE COFFIN FOR MH, AND LOTS OF MEMORIES FLYING THEM     

I am at the International Airport in Kuala Lumpur, just one day after the news arrived that MH 17 enroute from Amsterdam to Kuala Lumpur with nearly 300 passengers and crew had been shot down by Russia backed rebels in the Eastern Ukraine!
What a tragedy!
So many households affected and more importantly so many lives altered forever, with unfulfilled dreams and inconceivable difficulties. Life is the most sacred of all and its puffing out, especially under strenuous circumstances, is never acceptable.
The mood at the airport was sombre, and people checking in to various destinations, in silence and there was no laughter and the lines moved quickly enough

Malaysian Airlines holds a special place in my heart. On a visit to my parents that I could remember, I flew them from Brunei to Singapore with a stop in Kuching on my way to Perth in Australia. I even remember the aircraft, A Fokker 100 or was it called the Fokker Friendship aircraft?
Soon after qualifying as a doctor in London, I needed to get back to Melbourne to begin my first job as a Houseman, I remember, it was Malaysian Airlines that took me home: London to Kuwait to Kuala Lumpur to Melbourne
Before South East Asia became a popular destination, one could easily get Business Class seats on MH.
I remember flying them from Los Angeles to Kuala Lumpur via Tokyo and then on to Madras in India!
I liked the fact that one could get Nasi Lemak for breakfast and then Teh Tahrek made to order.
The most memorable flight on MH was certainly the one from LHR to KUL to MEL and back with a short stop over in KUL. I remember sleeping all the way back to London!
In the last couple of years, I have tried to fly them internally within Asia, as well as a DXB to KUL flight and a KUL-CDG flight. In recent months, I flew MH on KUL-RGN, KUL-SIN, KUL-REP as well as KUL-CGK in addition to flying them domestically to TGG.
I would miss MH but it may be reborn as some form of a long distance Budget Airline? Under the leadership of that aviation dynamo, Tony Fernandes?
In the local news paper, the Union Boss had insisted that whatever happens to MH, the new management must not include the top three guys, all with lots of honorific titles like Dato, Tan Sri etc. As the union boss said, they were given a chance but they have shown they cannot manage this airline.
The same rag, owned by the government, had a small story: yesterday all Cathay Pacific Flights from Hong Kong to Kuala Lumpur were full but the MH flights were carrying light loads of groups travelling on discounted fares!


I will miss MH and also their lovely lounges at the Kuala Lumpur International Airport! (photos below)






vendredi 18 juillet 2014

SHABBAT SHALOM FROM MALAYSIA A MOSLEM COUNTRY

IT is so very important to me to say my Shabbat prayers here in this Moslem Country where they chant anti Israeli songs each day and the politicians call Israel an arrogant and superior country.
The Malays here are a converted people, having converted to Islam only in the 15th century by Gujerati moslem traders who were in the court of the Hindu Prince who had fled the Hindu Kingdom in Sumatra. The enthusiasm of the converted, you may read VS Naipaul's book, Among the Believers, are staged and exaggerated and Malaysia is no exception, trying to legitimize their role as Moslems by finding a blood connection to the Arabs!
So, on this day, on this shabbat, as the sun was setting over Kuala Lumpur, I was at the 34th floor of this hotel, saying the ancient Hebrew prayers
welcoming this night
giving thanks for the fruit of the earth 
for grapes and vines..


and tonight for the families of the people lost on the Malaysian Airlines Flight 17 which was shot down one day ago..

I pray for my family and friends in France, USA and Israel!
I pray for the conflict with the Palestinians to end and them to have their own state and recognize the right of Israel to exist as a Jewish state. I pray for the anti israel mindset of many of the intellectuals in the west and let them see that it is we who are their friends and not the  radical Arabs, who would think not twice before bombing their trains, killing their children or burning their churches.
shabbat shalom from Malaysia 

lundi 14 juillet 2014

CELEBRATING BASTILLE DAY, THE FRENCH NATIONAL DAY IN MALAYSIA

IT is 14th of July 2014
Bastille Day
Fete Nacional France
Celebrations Parades Fireworks
yes in France but I am in Kuala Lumpur, Malaysia

Since I have family in France and some good friends, I decided to celebrate the Fete nacional here. I don't want to go to the French Embassy so why not celebrate it symbolically.
Pondicherry was a colony of France until quite recent times and why not celebrate with a nice meal from that part of the world!
That is not a problem here, since everywhere you look, you can find, representatives of Tamoul Culture here in KL.. so a walk through the Little India, the answer was waiting
Saravanna Bhavan, a well known restaurant catering original South Indian food..

(jewelry from Pondicherry region dating back to 2 BCE can be seen at Musee Guimet in Paris)

 who would not love such a lovely Vegetable Thali? I was reminded of a lovely visit to Pondicherry and Mahabalipuram in December 2008/January 2009 and the wonderful meeting with the Blind Astrologer of Madras!
Soon after that I arrived at the Hotel for the Hospitality Hour where they served MOROCCAN lamb ! Apart from White Wine, this time a Chardonnay from Australia, Perrier Water was available... in France, there would have been champagne, but never mind, we are after all in the Tropics!

The pastry chef at this hotel is exceptional in that each day he produces something different and todays Chocolate Mousse was delicious indeed!

As the night was falling over this city, built on the confluence of two rivers, in a country with no deep history before the arrival of a Hindu Prince from Majapahit Kingdom in the 14th Century, I thought of my dear friends and family, scattered over the globe
France, Belgium, Israel, Miami, Portland, La Habana, Baracoa
Felt good thinking about them, felt good about Malaysia, knowing that I will not be coming back anytime soon. I wish the Chinese and Indian Citizens of this country, peace and prosperity and most importantly Freedom and Equality in the future.
On this Fete Nacional of France, I can only hope that in the years to come Malaysia along with many other countries where there are Moslem majorities would understand what it means by the french concept of Secularism:
French secularity (or Laicism) in Frenchlaïcité (pronounced [la.isiˈte]) is a concept denoting the absence of religious involvement in government affairs as well as absence of government involvement in religious affairs. French secularism has a long history but the current regime is based on the 1905 French law on the Separation of the Churches and the State.


dimanche 13 juillet 2014

TOURIST NOT AN ANTHROPOLOGIST IN MALAYSIA: LAZY DAYS IN KUALA LUMPUR

This is the first time, in a very long while, that I have spent any time as a tourist in the capital of Malaysia.
First of all, I have to shut off all my observant eyes of an anthropologist and just enjoy the train rides, food and conversations with people. 
So obviously when I approach anyone there is a change in my demeanor or the tone of voice and I am rewarded for that.

I have to hide my sorrow at the indentured laborers by the thousands and the ridiculousness of the Malay politicians (hail hitler, said one of them, when Germany won, racist sentiments prevalent in the country, such as Indians drink Toddy and they are all Gang members etc)

Once that stage is over, it has become a very pleasant experience.
All Malaysians that I come in contact with, including some of the immigrants, have  uniformly been friendly.
(searching for remnants of colonial architecture has been rewarding)
I am staying at a very nice hotel and the room at 32nd stood affords  a panoramic view and can see the Twin Towers of Petronas very easily from this floor. The Executive Lounge at 34th floor is staffed by people, who I have become friends with, so breakfast at 9 AM and the afternoon wine and cheese and canapés are long drawn out affairs. The pastry chef is very good and there is a good combination of food offered during the day, complimentary, at the Lounge: 

Hummous and arab salads, samosas, various Chinese tapas like dishes, and wonderful cakes and snacks, and wine served by lovely people who are attentive to your needs.
Each day, I plan to do one touristy thing: Botanical Gardens, Batu Caves, taking the Commuter train to nearby towns, a day trip to Malacca
Shopping is not an option as I have to travel to Bogor from here and then on to Miami and I have become used to traveling with just hand luggage.
 (I am surprised that the entire populace is not obese only about half of them, as there is good food, bad food at cheaper prices and thousands of opportunities to eat them)
(Can you be a health conscious Moslem and break your Ramadan Fast at Pizza Hut? Look what they are offering!)
Along with Indonesia, Malaysia is very tolerant to non moslems enjoying their food during their Ramadan month of fasting/ In fact Ramadan is hardly evident in the air!

All in all it has Visit Malaysia Year 2014 for me!
The rest of the year my academic responsibilities will keep me in the western hemisphere, so let me savor this lovely visit to Malaysia 

jeudi 3 juillet 2014

MEDICAL CARE IN AN UNDERDEVELOPED COUNTRY: STORY OF IGNORANCE, GREED AND SUFFERING

MEDICAL CARE IN AN UNDERDEVELOPED COUNTRY
STORY OF IGNORANCE, GREED AND SUFFERING
Let us call this South East Asian country, Srivijaya. Charming people, wonderful smiles, tolerant of others, they had suffered greatly through colonial and postcolonial brutalities.
In the last 10 years, there has been unbridled, uncontrolled, ill charted growth and development, mired in corruption and non-transparency.
Infrastructure that allows the bourgeoisie and politicians to increase their wealth, in tandem with the total, wanton neglect of the welfare of the poor, who constitute the majority of the population.
Health care was totally neglected, and those who had a little income (average wages are below 100 USD per month) could see a doctor in private practice who may give injections or fluid therapy, at proportionately tremendous costs. Among those with access to money, they fly off to KL, Singapore or Bangkok for their medical care, without realizing that these places offer better technical medical care than is available in Srivijaya but not better humanitarian care. I am told of many stories of those who went off to Singapore or Bangkok, only to return with a slew of new medications and investigations that the local doctors couldn't follow through.
I give a case history of suffering but of successful outcome of a Srivijaya resident, thanks to my friends, Drs W and H, in Miami.
This 42-year-old man, who has been in perfect health, began noticing increasing fatigue and weight loss, towards the end of 2013. The city where he lived, which is very popular with western tourists, lacks easy access to medical care, except for a private hospital staffed by Australian doctors with a very bad reputation. He decided to go to the capital city where he was advised to see a Gastroenterologist, since his complaints were weight loss, vague abdominal pains and fatigue.
The Specialist physician carried out an Upper GI (stomach) and a lower GI (colon). As is the case with many people who are leading lives peppered with low fibre, high sugar food, the specialist found Gastritis and Diverticulosis. As he had noticed a high White Cell count, the specialist prescribed in addition to Proton Pump Inhibitors (Prevacid is the name of the medication in the USA) and also triple antibiotics for presumed Diverticulitis! My friend took these medications faithfully but found that at the end of the month, his symptoms had not improved. The specialist had requested some blood tests and once again it was noticed that the White Blood Cell counts were inappropriately elevated (close to ten times the normal). At that time, he got in touch with me through email and I talked to him on the telephone and I suspected that this did not sound like Diverticulitis but something more sinister in which faulty production of the White Blood Cells were involved. I encouraged him to go Bangkok for further investigations. He referred himself to a doctor in Bangkok (I do not have any medical contacts in Bangkok), who turned out to be a GI specialist, since my friend was thinking that the problems lay in his Gut, who repeated the endoscopic studies done in the capital city of Srivijaya, and proudly confirmed the diagnosis. But the concerned doctor noticed that the White Blood Cell count now exceeded over 100,000, abnormally high and referred the patient to a Haematologist, who admitted the patient to a hospital and within a day had the correct diagnosis, after a bone marrow biopsy.
My friend waited out the results in a hotel in Bangkok, only to be told that his condition was,
Chronic Myelogenous Leukaemia, with Ph+ positive, with BCR-CHL divergence of 90% (these are extremely sophisticated studies).
The haematologist prescribed Hydroxyurea as a stopgap measure to bring down the white blood cell count while waiting for the definitive treatment with expensive medications that were available in all the countries in South East Asia with the exception of Srivijaya. The doctor did give hope that if he were to take these medications on a regular basis, there is a high chance he would be cured.
I was in touch with him through this period on email and telephone. Surprise was in store for my friend when he enquired at the pharmacy about the medication prescribed for him, back in Srivijaya. He was told that they could procure the medication for him for $175 per pill! And the payment has to be in cash!
The price of the medication was similar in Singapore, Kuala Lumpur or Bangkok!
Like many busy administrators, he was not aware of the seriousness of his condition and once again we talked. He wondered whether he could just take Hydroxyurea and not worry about the new medication prescribed for him. He has been feeling better since he began taking it.
Right about this time, I had read about a court case in India, where a western pharmaceutical company had given up suing the government for breach of patent. The lifesaving medication, the name I couldn't remember was being distributed as a generic in India.
Once I had all the investigations, scanned to me, on hand, I contacted two good friends of mine in Miami, Drs W and H, one of whom is a professor of Haematology at the University of Miami.
Where could we get the life saving medication for our Srivijaya friend? A telephone call to a pharmacist in Bangalore in India gave us the breath of life, I clearly remember the relief I felt when the pharmacist told me that this medication is available in blisters of 10 for 1523 INR (about 25 dollars, i.e. $2.5 dollars each!), a fraction of the price in the pharmacies of the south east Asian nations! Thank you, India!
The name of the medication is Imatinib, 400 mg in strength, marketed as Gleevac in the USA.
Imatinib was invented in the late 1990s by scientists at Ciba-Geigy (which merged with Sandoz in 1996 to become Novartis), in a team led by biochemist Nicholas Lydon and that included Elisabeth Buchdunger and Jürg Zimmerman and its use to treat CML was driven by oncologist Brian Druker of Oregon Health & Science University (OHSU). Other major contributions to imatinib development were made by Carlo Gambacorti-Passerini, a physician scientist and hematologist at University of Milano Bicocca, Italy, John Goldman at Hammersmith Hospital in London, UK, and later on by Charles Sawyers of Memorial Sloan-Kettering Cancer Center. Druker led the clinical trials confirming its efficacy in CML

In 2013, more than 100 cancer specialists published a letter in Blood saying that the prices of many new cancer drugs, including imatinib, are so high that U.S. patients couldn't afford them, and that the level of prices, and profits, was so high as to be immoral. [They stated that in 2001, imatinib was priced at $30,000 a year, which was based on the price of interferon, then the standard treatment, and that at this price Novartis would have recouped its initial development costs in two years. They stated that after unexpectedly becoming a blockbuster, Novartis increased the price to $92,000 per year in 2012, with annual revenues of $4.7 billion. Other doctors have complained about the cost.
We were able to arrange the delivery of medications on a regular basis to Srivijaya at $40 per blister pack of 10 tablets. He gets 50 tablets at a time, delivered to him by air, he has never ran out of medications.
I made arrangements to visit him at Srivijaya in March 2014, adding a side trip to my visit to SE Asia. I reviewed his laboratory tests and was very pleased to see that the white cell count has steadily decreased and now hovered around 6000! 
Two months later (May 2014) the patient from Srivijaya got in touch with me again with a slew of questions.
How long do I have to take Imatinib?
When do I need another Bone Marrow Biopsy?
Should I go back to the doctor in Bangkok who did the bone marrow biopsy?
During the last week of May 2014, I had scheduled a visit to my good friend in Indonesia, the humble man of Bogor. American Indians say that things happen for a reason, and that we are not smart enough to decipher why most of the time! Few days before my appointed travel towards Singapore and Jakarta, my friend was summoned by the Ministry of Agriculture to be present at the meetings of visiting specialists, that would take him away from his home and work. Visiting him and his family and staff is one of my highlights of a visit to South East Asia. As I had already booked my tickets to Singapore, I decided to go to Srivijaya instead to visit and counsel my friend with CML who was taking Imatinib! I tried to visit a project I was involved in another country but the coordinator was out of the country during that period.
I had an uneventful flight from Havana. Havana-Miami-Newark-Hong Kong-Singapore. After arriving in Singapore at 12 30 AM, I was able to book a ticket to his city that very same morning.
It was as if I was supposed to be here, I had been there two months before. I spent time visiting friends, old and new. This visit was more than a social visit.
With the help of my friends in Miami, we were able to chart a course of treatment for him, with follow up tests to be carried out at regular intervals. Since there were no adult haematologists in all of Srivijaya, and the country does not have infrastructure to do the sophisticated blood tests (called FISH), we found out that it is possible to get the tests done in Ho Chi Minh City in Vietnam! His Family Practitioner in Srivijaya was a retired French doctor who confessed that he knew nothing about his illness. I left Srivijaya leaving detailed instructions for him for follow up (as given by my friend in Miami). And to find a concerned and interested Family Practitioner in his town!
Dr H was head of Haematology as well as Internal Medicine at the University of Miami/Jackson Memorial Hospital when I was a student there. His dedication to International medicine was exemplary, and I was influenced by it. I had a chance to work with him a little, organizing a connection to Jamaica.
The doctor friend who helped me in Miami was none other than the son of the above professor!
I sat down on banks of the river not too far from the river and offered a prayer of gratitude. I felt so humble and elevated in spirit, that I had to hold back my tears!
A Kaddish for all my illustrious teachers: Dr H, Haematology, Dr L, Oncology, Dr R, Endocrinology all from University of Miami and Dr H, Medical Anthropology from London

Just this morning, I received eCopy of NEJM for July 3, 2014
There is an article on Putting quality on the Global Health Agenda
from Harvard University. An Interesting article. I would just quote one line from it.
In a study involving standardized patients in INDIA, nearly 7 out of 10 medical providers failed to ascertain the basic pertinent history for common ailments such as angina, asthma, and childhood diarrhea and incorrectly diagnosed a large majority of cases!

mercredi 2 juillet 2014

THE BARBER POET OF LA HABANA

THE BARBER POET OF LA HABANA
EL ULTIMO ROMANTICO
It was a balmy evening in La Habana, Cuba. As usual people were milling about, this being a Friday, more than ever. I was slowly walking along La Rampa, away from Yara theatre towards a neo-Mexican restaurant recommended to me. When I got there it turned out to be very popular and there were many people waiting in line.
I carried on walking down the street and before long came across the Barber Poet of La Habana.

 There is a famous photograph by American photographer Walker Evans of a barbershop in La Habana in 1933. Fascinated by that photograph, I never fail to stop by barbershops in countries that I visit, and this barbershop was no exception. But the Barber turned out to be exceptional!
Do you mind if I take a photo of you with your client? I asked
Not at all, chirped in the Barber, and in the typical Cuban fashion, neither did the client.

Then he added here is a pair of scissors, why don't you join us in the picture. We got someone to take a picture the three of us.
With an elegant move of his hands, he presented me with his card. I love writing poetry, he said, most of which I dedicate to my wife, whom I adore. He had a large portrait of a plump lady on the sill in front of the large mirror that reflected him and his clients. And of course, I adore our national hero, Jose Marti. Permit me to recite the poem I have written in honour of our illustrious hero, and began reciting a poem, with scissors in hand, while the client looked on with amusement, patiently. A small crowd had gathered, mainly young revellers, waiting to get into a Pizzeria near by and all of us enjoyed this Barber Poet of La Habana.
Miguel Barnet once called me the Last Romantic, he continued. 
Miguel Barnet is a leading intellectual of Cuba, historian and ethnologist and director of the museum of Fernando Ortiz; I had met him on several occasions
Coming back to more mundane things, I made an appointment to have a haircut by the Last Romantic Barber poet of La Habana, Cuba, just a few blocks away from where I stay.
See you soon, Companero!
Yet another famous photo by Walker Evans. I think Fernando Ortiz called it or compared this to  Los Negros Curros?



mardi 1 juillet 2014

CHRONOLOGY OF DISEASES AMONG INDIGENOUS PEOPLE OF THE NEW WORLD

CHRONOLOGY OF METABOLIC DETERIORATION WITH INCREASING OVERWEIGHT AND OBESITY AMONG AMERICAN INDIANS 



When I began working with the American Indians, I was shown a copy of a painting by Seth Eastman, which I liked to call, The Last Year of Freedom 1862, even though it was painted earlier,
What was amazing about the painting, showing the Lakota in their dignity and bearing, cheery and active, was that all those depicted were sinewy, and athletic and LEAN.
What if we were to paint that scene now? After 100 years of “Freedom”? Gone are the dignity, the good bearing and activity and more importantly, every one in the picture would be overweight or obese!
Even as late as 1964, one could find lean adolescents and adults among American Indians, but alas, it is seldom the case now, in 2014.
When a proportion of a population becomes overweight or obese, we tend to blame the individual (excessive, cheap food made available to a weak willed people, the Food Companies might argue), it becomes a shallow argument when an entire culture or tribe becomes overweight or obese, as is the case of many Native American cultural groups.
Here the definition of who is Native? Arises. There are two million Indians in America and nearly half of them, are of so much mixed ancestry that a racial grouping would be meaningless in that half. More traditionally living Indians, such as the UmonHon in Nebraska tend to have less mixed ancestry (European, Black or Mexican).
It is also worth noting that the less racially mixed Indians are heavier than the Indians who are racially mixed (such as those in Oklahoma).

My associations have been with traditionally living or maintaining, groups of American Indians and according to the local surveys, 90 to 95 % of them are overweight or obese. What a change from zero per cent overweight or obese just a few years ago!
One curious aspect not mentioned often is that among Indians Obesity is more common than Overweight!
American Indian 2011 European American
30.8% Overweight but not Obese   33.9%
40-8% Obese   26.2%

What did happen?
An Elder from the first tribe I worked with had said: They poisoned us.
I was baffled, as my explanatory models were all from the American/British/Australian Universities where I had been educated: How can Food be poisonous?
Many years later, I was to fully understand that wisdom of the American Indians.

First they poisoned us, the elder had told me, now they are beginning to poison themselves.
While at medical school, we were taught that the macro vascular complications of Type 2 Diabetes (heart for example) begin long before the person has been diagnosed with Type 2 Diabetes. Metabolic changes that would later manifest as Diabetes, had already been at work, high blood sugars are absent at this stage but the detrimental effects of metabolic changes are active. So some other hormonal, immunologic or inflammatory factor is at work, rather than the high blood sugar of Diabetes. In contrast, micro vascular complications (eye, kidney) occur well after the high blood sugar (hyperglycaemia) has become established.
It is well documented that indigenous people are remarkably free of cardiovascular diseases. This was the case with the American Indians as well. Studies from early part of the 20th century documented the low levels of cardiovascular diseases among the southwestern Indians.
The high prevalence of overweight, obesity, cardiovascular diseases, diabetes among the Indians may be due to genetic predisposition, or due to insults by outside chemical agents or metabolic changes that causes both heart diseases and Diabetes but unrelated to each other.
Laboratory determinations as markers are well demonstrated by the rapid rise in cholesterol in this population as well as the general American population and in other countries grappling with the epidemic of overweight and obesity.
The metabolism of Cholesterol was fully worked out only in the 1970s, coinciding with the arrival of Statin medications that chemically would stop the production of cholesterol. Even in those early days when high LDL (low density cholesterol, the bad one) was uncommon among American population, the researchers had noted that LDL may be related to a dietary change that is high in Carbohydrates (which came with the Low Fat Diet Fad) and obesity per se many not be responsible for it.
No other cultural group, perhaps with the exception of Australian Aboriginal population had to grow throw as dramatic changes in the way they lived as the American Indians. These “lifestyle” changes were not their choice but imposed upon them, now they are being blamed for having “lifestyle diseases”.
An Indian elder once said: The white people are always exhorting us to pull ourselves by the socks but it is they who cut off our feet!
At a recent International Conference in Endocrinology in Chicago, one of the speakers commented: in the future, we would look back at horror at the barbaric ways we treated patients with Diabetes!
It is because we have thought about these metabolic diseases, not in terms of their natural aetiology but in terms of our own concepts that are limited by our culture and our education.
One such good example is this:
Even in those early days it had been established that it is Obesity that caused High Insulin Levels, caused by Insulin Resistance, the mechanisms at the level of the receptors had been worked out
: Decreased number of Receptors
: Decreased affinity of the Receptors, presumably due to food excess (carbohydrates) and Inactivity.
At that time the researchers working with the PIMA Indians had noted that the LEAN PIMA  (they were lean then!) had unexplained Hyperinsulinaemia!
When I became a consultant to the Hocank and UmonHon tribes of Nebraska, it coincided with our collaboration with Prof C Stuart and with five long years of fieldwork, we were able to demonstrate that all Indians have hyper responses to food (European food) of the Insulin. In over 500 measurements of Insulin (an ingenious method devised by Dr Stuart, impregnating a blotting paper with insulin antibodies and then dropping one drop of blood into a predetermined area, pulp it up and measure the insulin!) in school age children we found that:
All Indian children were “hyperinsuiinaemic” and that the dark markings around the neck, called Acanthosis Nigricans had a direct correlation with the Insulin levels.
I am happy, along with colleagues Michele S, Tonia K and Julie B, to have made this small contribution to the medical knowledge.
There is a tireless worker in the field of Nutrition in Sydney, Australia, Professor Brand-Miller who has clarified some of these conundrums about food and insulin and glucose responses in the human.
Indigenous people, mainly in Canada, USA, Australia and New Zealand had to make dramatic changes in their diet and were subjected to the same rules and regulations which were measured and calibrated to the European bodies and nutrition or malnutrition. Thus they suffered twice: deprived of their own good food and being subjected to a inferior product imported to their midst.
At the recent meeting in Chicago, Prof Brand Miller had introduced a concept, Food Insulin Index that made a lot of sense to those of us interested in this field and struggling to help our patients loose weight or not put on weight. It may explain how a group of people who were very insulin sensitive went on to become Insulin resistant and then obese.
Why did or do the indigenous people need such a sensitive response of Insulin? Here the time-tested theory of Dr Neel, Feast and Famine comes in handy.
Those of us who have been lucky to have experienced bits and pieces of hunter-gatherer lifestyles (what is remaining of it) in various parts of the world, would note the physical stamina of the Indigenous people (mainly American Indians, Australian Aboriginals, Kalahari Bushmen/San, some smaller tribes in Africa but not Black Africans, some tribes (Negrito) in Malay Archipelago, Siberian tribes).
They are the only group that I know of, who historically could go to fight, after a bout of fasting! 
They can go without food or water for four days when they go on vision quests or sun dances. 
To this day, they prefer to eat a large meal before sunset, rather than the prescribed three meals and snacks.
A long chat with a visiting Endocrinologist from Yale at a beach in the north coast of Jamaica, many moons ago, gave us a clue.
He had done research and published in NEJM about exercise and source of energy in the body. He had postulated that the European when beginning the exercise resorts to circulating glucose and then soon switches over to lipolysis, breaking down of stored energy in muscle and fat. 
In the Indian, he postulated, this does not happen in the fed state, but it does happen in the fasting state!
It was a Eureka moment for me! I had wondered why the Indians, post prandially could bring down their blood sugar by few minutes of exercise whereas in the fasting state, exercise only increased their blood sugar!










(at no service unit in the Plains states of the USA were the Indigenous people lean: over 90 per cent were either overweight or obese)
Thus indigenous people who have had contact with the Conquistadores and other Europeans to a greater degree have suffered most, because:
Their metabolism that was very different, had to adopt, 
Due to changes in food
Due to changes in religious practices
Due to changes in activity from an active life style to a sedentary lifestyle confined to reserves and locations that was outside their natural territory.
The poisoning of America continued, first it was the Indians (Commodity foods), then poor people and now the majority of Americans are being poisoned without their knowledge.
The state of knowledge about nutrition among the ordinary Americans have reached an all time low.
I have a question, when people answer, rather proudly, that they use vegetable oil.
Which vegetable produces oil?
Then I ask Where does Canola oil come from? (There is no Canola plant, and what does Canola stand for?)
If the nutritionist is of any value, can she or he explain what is Maltodextrin?
Metabolic changes brought on by fatal contact was augmented by chemical insults
These chemical insults have an acceptable scientific name now: Endocrine Disrupting Chemicals
EDCs have been implicated in a slew of diseases, including 
Precocious Puberty
Hyperthyroidism
ADHD in children 
? Autism 
And not to forget Overweight and Obesity!
The list is long enough!
This list of chemicals include some artificial sugars such as High Fructose Corn Syrup, Acesulfame and Aspartame (the kind found in fizzy soft drinks, parading as Diet drinks!)
Now you see why it is a crime to give an Indian a piece of paper with a “diet plan” and tell him to exercise 150 minutes a week!
Who is non compliant with the science of Medicine here, the MD? The NP? The PA? 
It is certainly not the patient! It is out duty to inform him, what has happened to him, to his family, to his tribe, to his people since the Fatal Contact, perhaps then we can get some results!

These are my thoughts when I began writing about the chronology of Overweight and Obesity among the Indigenous peoples.