Type II Diabetes in Indigenous Populations

A Writing Space for "Bodily Subjects"

Final Thoughts

I think that what I found during my research and the topic I chose definitely relates to the topics we discussed in class. Indigenous people lived a certain way before Europeans came to this land. Their traditional diet was very different from what is considered normal today. Changes in their diet began as soon as trade started between Europeans and Indigenous peoples as they were introduced to sugar, flour and other new, possibly less nutritious food. This was emphasized during the switch to reservations and through residential schools. Their way of life and diet was forcibly altered by each of these as the traditional way of gathering food became limited. What I see in this was that Europeans believed Indigenous people did not know how to care for themselves well enough through traditional ways, which lead to enforcing a new way of life. This is looking at how Europeans claiming authority over Indigenous peoples lead to various alterations in their lifestyle. It also raises the question of how and if Indigenous peoples were viewed as citizens. I may not have addressed these questions directly in my research but they are there when looking at Canadian history.

Introduction and Conclusion

Seeing as how it would be impractical to share the entire research paper here, I thought I would include the introduction and conclusion.

When considering the long history of Diabetes Mellitus it is a fairly recent disease for Indigenous people of Canada. By starting with the general history of diabetes, I hope to establish a comparison point for the disease as it occurs in First Nations people. From there I will discuss the link between obesity and diabetes, starting with a discussion of the occurrence Caucasian women and transitioning into discussing First Nations people.  Following this, I will discuss data available on Inuit populations of the Northwest Territories. Unfortunately, there is not a substantial amount of data available for Métis people and because of that this paper will mainly focus on First Nations and Inuit people. From there, I will look at diabetes statistics that are available on all Canadians diagnosed with diabetes. Most studies on diabetes and obesity in Indigenous populations are relatively recent, having been conducted within the last fifty to sixty years. Though the focus is on Canadian First Nations, I will be doing a comparison to non-First Nations/Indigenous peoples when necessary. The colonization of Indigenous people of Canada has been detrimental to their health; enforcing a reservation system and assimilation on them has resulted in alarming rates of diabetes and obesity.

. . .

In conclusion, it seems indisputable that colonization changed Indigenous health in Canada. Lifestyles along with diet were greatly altered as Europeans forced their way onto Indigenous land and Indigenous peoples onto reservations and into Residential Schools. Type 2 Diabetes Mellitus, an old disease in the history of the world, is fairly new for Indigenous peoples. It seems most probable that the introduction of refined sugars, flour, and other processed foods, along with decreased physical activity due to an altered lifestyle, led to the high and rising rates of obesity and diabetes. Indigenous peoples were self-sufficient, active and relatively healthy compared to their lives post-colonization. Caucasians and other non-Indigenous populations have significantly lower prevalence rates of diabetes. Unfortunately, I have not found why it is First Nations women that have higher prevalence rates and not men. There is the possibility that it is tied to obesity and the type, android versus gynecoid, that First Nations women have.

Reflecting on My Research

Overall, I am happy with the results of my research even though I could not answer all of the questions that I began with. I found more sources, particularly more studies than I was originally anticipating I would find. I was particularly pleased to find studies on diabetes in Inuit populations because I was initially only going to focus on First Nations populations. Perhaps the answers I could not find exist somewhere and I just did not come across the right document.

Unanswered Questions

I knew when starting this research project that I wanted to look at how gender and diabetes were linked together. I was disappointed when I could not answer the question of “why”. The government publications state that men are at higher risk of developing diabetes than women are, but this is not true for First Nations people. I wanted to know why First Nations women are at higher risk than First Nations men. While many studies point out the higher prevalence among First Nations women, no study that I read said why this was true. My only speculation comes from a study I read on body fat distribution. The study noted that the participants with android obesity when there is more fat at the neck and there is a higher fat-to-muscle ratio in the arm than in the thigh,[1]  This observation makes me wonder if First Nations women are more likely to carry fat in this manner. This is a reasonable explanation, in my opinion, because android obesity is considered to be more common in men, which would explain why non-Indigenous men are at higher risk.[2]

[1] David S. Freedman and Alfred A. Rimm, “The Relation of Body Fat Distribution, as Assessed by Six Girth Measurements, to Diabetes Mellitus in Women,” American Journal of Public Health, 1989, vol. 79, no. 6, 715.

[2] Janjic D, “[Android-type Obesity and Gynecoid-type Obesity,” 1997, web, accessed March 30, 2017. https://www.ncbi.nlm.nih.gov/pubmed/8992575

Diabetes History and Traditional Diets

I learned a lot more about the history of both diabetes and traditional Indigenous diets than I expected to learn through my research. One of the most interesting sources I found was on the history of diabetes. I learned that polyuria was found by Egyptians in 1500 BC in what they called the sugar disease.[1] Diabetes was named by the Greek in 164 AD, and Mellitus was added to it later when they discovered sugar in the urine.[2] This source also gave many examples of how the diet of diabetics was altered over time in attempts to treat the disease. Diets varied from being heavy in fats and pastries to being quite sparse, consisting mainly of bread, milk and barley water.[3]

Another source I found particularly interesting was in Mary-Ellen Kelm’s Colonizing Bodies. Her essay is written about the traditional diet of BC First Nations. I found it interesting that the traditional diet for them, being high in fats and proteins, was similar to some of the later recommended diets for diabetics mentioned in “History of Diabetes.”[4]

 

[1] Kathryn M. King and Greg Rubin, “History of Diabetes: From Antiquity to Discovering Insulin,” British Journal of Nursing, 2003, vol. 12, no. 13, 1091.

[2] Ibid.

[3] Ibid., 1092.

[4] Mary Ellen Kelm, “’My People Are Sick, My Young Men are Angry’: The Impact of Colonization on Aboriginal Diet and Nutrition,” Colonizing Bodies, UBC Press, 1998, 21.

Returning to a Traditional Diet

During my research, I found an interview about a First Nations woman who decided to try going back to traditional foods in order to avoid developing diabetes. I didn’t end up using the interview in my final paper, but I found it interesting nonetheless. The woman, K.C. Adams, “calls it the reclamation of well-being diet.”[1] Adams says that before starting the diet, she recognized the pre-diabetic stages “tired after eating, feeling lethargic all the time, [her] stomach was very large.”[2] Adams is of Cree, Ojibway and British ancestry, and her mother is diabetic.[3] Her diet consisted of food available in North America, sticking to Manitoban local was too difficult.[4] As diabetes was not an issue or Aboriginal people before European contact, Adams and a few of her friends decided to turn to a diet of their ancestors, pre-European contact.[5] I find it interesting that she recognized pre-Diabetes symptoms and decided to turn to more tradition Aboriginal foods to try and prevent Diabetes from developing. Looking back at the interview now, I recognize a few things that I found during my research such as the non-existence of diabetes in First Nations people before the introduction of non-traditional foods.

[1] Kim Wheeler, “First Nations artist goes back to traditional diet to beat Diabetes,” CBC News, Nov. 22, 2014, par. 1

[2] Wheeler, par. 8.

[3] Wheeler, par. 4, 6.

[4] Wheeler, par. 5.

[5] Wheeler, par. 2, 3.

Bibliography

Here is a copy of my bibliography:

Davies, L. E. C., S. Hanson, “The Eskimos of the Northwest Passage: A Survey of Dietary Composition and Various Blood and Metabolic Measurements.” The Canadian Medical Association Journal, 1965, vol. 92, no. 5, 205-216.

Dyck, Roland F., et al., “Do Discrimination, residential school attendance and cultural disruption add to individual-level diabetes risk among Aboriginal people in Canada?” BMC Public Health, 2015, 1-12.

Freedman, David S., and Alfred A. Rimm, “The Relation of Body Fat Distribution, as Assessed by Six Girth Measurements, to Diabetes Mellitus in Women.” American Journal of Public Health, 1989, vol. 79, no. 6, 715-720.

Haman, F et. al., “Obesity and Type 2 Diabetes in Northern Canada’s Remote First Nations Communities: The Dietary Dilemma.” International Journal of Obesity, 2010, vol. 34, S24-S31.

Janjic, D. “[Android-type Obesity and Gynecoid-type Obesity,” 1997, web, accessed March 30, 2017. https://www.ncbi.nlm.nih.gov/pubmed/8992575

Kelm, Mary-Ellen. “’My People Are Sick, My Young Men are Angry’: The Impact of Colonization on Aboriginal Diet and Nutrition.” Colonizing Bodies, UBC Press, 1998, 19-37.

King, Kathryn M., and Greg Rubin. “History of Diabetes: From Antiquity to Discovering Insulin.” British Journal of Nursing, 2003, vol. 12, no. 13, 1091-1095.

Korpal, Daniel and Anne Wong. “Education and the Health of the First Nations People of Canada.” Alternative, 2015, vol. 11, no. 2, 133-146.

Kue Young T., et al., “Determinants of Plasma Glucose Level and Diabetic Status in a Northern Canadian Indian Population.” Canadian Medical Association Journal, 1990, vol. 142, no. 8, 821-830.

Kue Young T., et al., “Epidemiologic Features of Diabetes Mellitus Among Indians in Northwestern Ontario and Northeastern Manitoba.” Canadian Medical Association Journal, 1985, vol. 132, no. 7, 793-797.

Public Health Agency of Canada. Diabetes in Canada: Facts and Figures From a Public Health Perspective. 2011.

Schaefer, Otto. “Glycosuria and Diabetes Mellitus in Canadian Eskimos.” Canadian Medical Association Journal, 1968, vol. 99, 201-206.

Skarfors, Einar T., et al., “Risk Factors for Developing Non-Insulin Dependent Diabetes: A 10 Year Follow Up of Men in Uppsala.” BMJ: British Medical Journal, vol. 3 no. 68, 1991, 755-760.

Turin, Tanvir Chowdhury, et al., “Lifetime Risk of Diabetes Among First Nations and Non-First Nations people.” Canadian Medical Association Journal, 2016, vol. 188, no. 16, 1147-1153.

Wright, Jane. “A History of Opium, From Medical to Recreational Use.” British Journal of School Nursing, 2011, vol. 6, no. 10, 512-513.

 

On Choosing Sources

During the span of my research, I looked at government pamphlets, studies, articles, interviews, and books. In the end, the most useful sources ended up being studies. Taking a look at my Bibliography for the paper, most of my sources were, in fact, studies. I found the government pamphlets useful for providing statistics on the general population. I wanted to try and find books on the subject but it proved to be difficult. With so many of my sources having been published in the last seven years, I tried to make it more focused on the history aspect through looking at dietary changes and also studies conducted on non-Indigenous populations. I came across only a few books specifically on Diabetes in Indigenous people and therefore had to pull my information mostly from other sources.

The sources I used vary in time when looking at publication dates. Most of the sources on First Nations and diabetes were published in 2010 or later. The studies on Inuit populations were actually published in 1965 and 1968. While a few sources were published in the 1980’s and 1990’s, most of the sources were actually published after 2000. I found studies that looked at obesity and diabetes prevalence in Caucasian women, and multiple studies that looked at diabetes in Inuit or First Nations populations. I was surprised to find any studies on the disease in Inuit populations because I understood that data for Inuit and Métis is limited.

 

Residential Schools and Diabetes

During the beginning of my research, I came across one study that tried to determine if there is a connection between residential school attendance and diabetes among Indigenous peoples. I was both hopeful and worried that the study would answer all of the questions I was looking to answer. I was hopeful because the topic is so interesting and the possible connection between the subjects would be interesting to see. I was worried because if the study could answer all, or most, of my questions, there would be no reason to continue my research. The study showed that those who attended residential school did have a slightly higher prevalence of diabetes, but the difference was not significant [1]. At the end of the study, the researchers state that “it is possible that the detrimental impact of residential schools on the health of individuals within First Nations communities is so pervasive that it is difficult to find a truly unexposed comparison group.”[2]. Their results ultimately mean that we will most likely never know exactly what long-term effects on health residential schools had on the attendees and the subsequent generations.

[1] Roland F Dyck et al. “Do discrimination, residential school attendance and cultural disruption add to individual-level diabetes risk among Aboriginal people in Canada?” BMC Public Health. 2015: 4.

[2] Ibid., 10.

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