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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.