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.
Images of Wellness
Chief Red Cloud
Bone 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
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•
•
Tomato
Beans
Peanuts
Sunflowers
Avocado
Squash
Chili Peppers
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•
•
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”
Chokecherries
.
Scientific name - Prunus Virginiana
Lakota Name
Canpa (Chan-paw)
means bitter wood stem
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 Smith
Federated Indians of Graton
Rancheria
Native Teas - California
Common
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•
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•
Mint
Rosehip
Raspberry
Red Clover
Manzanita Berry
Madrone Berry
Sumac Berry
Medicinal
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•
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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 small
and 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 ageadjusted 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
Strengthening our Traditional
Food Systems
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.
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.
White Earth Land Recovery Project
Winona La Duke
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)
Salmon
 Essential Fatty acids
 Protein Rich
 Saturated Fat – 1 gr.
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•
•
•
Hot Dog
Fat - 25 grams
Protein - 12 grams
Saturated Fat 10 g
Contain Nitrates/Salt
Traditional Cooking Methods
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Boiling
Roasting
Baking
Drying
Stones/baskets
Hot Coals
Earthen Pit
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
JOURNAL OF THE
ACADEMY OF NUTRITION
AND DIETETICS
Kattelman, K, et al.
J Am Diet Assoc. 2009; 109 (September)
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
Hunter/Gatherer Diet
20%
40%
40%
Early Reservation Era
Protein
Carbo's
Fat
Source: Yvonne Jackson,
1994, Diabetes: A Disease of
Civilization. Mouton de
Gruyter.
28%
25%
47%
Modern Diet
15%
37%
48%
Source: The Strong Heart
Study, 1993 Welty,
Zephier.
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
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
Baseline
Usual Care Groupa
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
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
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
Weight (kg)
Triglycerides
(mg/dl) g h
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/m2
e 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 hemoglobin
f To convert glucose values from conventional to SI units multiply mg/dL by 0.0555 to get mmol/L
g 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/L
iTo convert total cholesterol values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
j HDL-C= high density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
k LDL-C= low density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
l VLDL-C= very low density lipoprotein cholesterol
m To convert insulin values from conventional to SI units multiply uIU/mL 6.945 to get pmol/L
JOURNAL OF THE
ACADEMY 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
Baseline
Usual Care Groupa
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)
37±2
37±2
↓ 0.5±2
41±2
40±2
↓ 2±2
P=.3464
42 (22, 62)
↑ 12±9
32 (27, 37)
32 (26, 38)
0±3
P=.1480
l
Insulin (uIU/mL)
g
31 (25, 36)
m
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/m2
e 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 hemoglobin
f To convert glucose values from conventional to SI units multiply mg/dL by 0.0555 to get mmol/L
g 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/L
iTo convert total cholesterol values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
j HDL-C= high density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
k LDL-C= low density lipoprotein cholesterol. To convert values from conventional to SI units multiply mg/dL by 0.0259 to get mmol/L
l VLDL-C= very low density lipoprotein cholesterol
m To convert insulin values from conventional to SI units multiply uIU/dL 6.945 to get pmol/L
JOURNAL OF THE
ACADEMY OF NUTRITION
AND DIETETICS
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
Educationa
Month 1
Month 2
Month 3
Usual Care a
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 THE
ACADEMY 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 (cont’d)
Educationa
Month 1
Month 2
Month 3
Usual Care a
Month 4
Month 5
Month 6
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
15 ± 2
15 ± 1
Minutes per day of physical activity
Mean ± 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
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
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
eg
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.
JOURNAL OF THE
AMERICAN DIETETIC
ASSOCIATION
Kattelmann, K, et al.
J Am Diet Assoc. 2009; 109 (September)
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
Mitakuye Oyasin
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