Waging war against diabetes with education

Farmington, New Mexico (AP) 4-07

Evangeline Sam patrols her meals. Instead of cooking the fried potatoes she ate growing up, the 43yearold diabetic woman stocks her cabinets with whole wheat spaghetti, ``lite'' Spam and sugarfree lemonade mix. In her neat kitchen on the Navajo Nation in northwestern New Mexico, she serves her family smaller portions whether they like it or not. She also records her blood sugar twice a day in a special notebook.

``I'm scared,'' Sam said. ``I want to live longer.''

Diabetics wage a daily battle against the disease, examining every bite of food, every step of exercise, every shift in blood sugar.

``It's an insidious disease,'' said Robert Nakai, a program manager for the tribe's Special Diabetes Project.

It also tends to sneak up on its victims.


``It doesn't hurt like a headache ... it's slow, insidious, sneaky,'' said registered nurse Jill Cashon, a certified diabetes educator for San Juan Regional Health Center.

Diabetes is a problem across the country, but American Indian and Alaska Natives are about 2.6 times more likely to get it than the nation as a whole, according to the National Indian Health Board.

And the numbers are highest in Indian communities in the Southwest, where about 27 percent of the population has it, according to the National Diabetes Education Program. In certain communities, the Indian Health Board said the prevalence is up to 60 percent of the population.

Experts are mystified by the disparity, but what they do know is the disease is uniquely suited to do the most damage among Indians who have a traditional diet rich in fat and carbohydrates, tend to live rurally and sometimes face medical culture shock.

Nearly 20 years ago, doctors removed Fannie Collins' gall bladder. As she recuperated, doctors noticed her approximately 7inch incision wasn't healing properly. They suspected diabetes.

``I hadn't heard of it before,'' said Collins, now 79. ``Nobody was talking about it then.''

The doctors, she said, gave her a prescription but didn't tell her about the disease or how to deal with it.

``I didn't care what I ate, I just ate anything - potatoes, fry bread, tortillas, mutton stew, good stuff,'' she said. ``It's hard to say not to eat that.''

Doctors eventually diagnosed her four brothers and one sister with the disease. Looking back, they think their father may have died of diabetes complications without ever knowing he had it.

Health educators can't explain why diabetes is so much more common among Indians and Alaska Natives.

One explanation is the ``thrifty gene'' theory, said Marlene Betonie, a registered nurse who does diabetes outreach in the Navajo community for San Juan Regional Medical Center.

Ancient men and women were hunter gathers, often unsure how they'd get their next meal. In that scenario, it would be handy to have the kind of metabolism that used food energy very slowly, allowing the person to go longer without food, Cashon said. The ``thrifty gene'' was an evolutionary advantage and it became part of the human genetic makeup.

Now, move ahead hundreds of years and countless McDonalds' meals.

``In a land of plenty, guess what? It's not a blessing anymore,'' Cashon said.

All humans developed this way. But the theory goes, Anglo bodies have had longer to adjust. Native people in the Southwest, on the other hand, were still living a huntergatherer lifestyle 150 years ago.

And they didn't exactly end that lifestyle by choice, said Nakai.

He traces the origins of the disease back to 1864, during the infamous Long Walk. Until then, the Navajo diet consisted of corn, wild berries, carrots, onions, deer, bison, prairie dogs, wild rice and fish. Exercise was a fact of life.

But then American soldiers forcibly removed nearly all the Navajos from the land and marched them to Fort Sumner to become farmers.

``What were the foods they gave the Navajos? Lard, white flour, sugar, coffee and beef,'' he said.

Those ingredients sound familiar for a reason: some are used to make the sinfully delicious fry bread.

Over the years, as cars and technology began to take hold, lifestyles changed, Betonie said.

Whatever the causes, the reality of life on the Navajo Nation bedevils diabetes educators.

When Sam was diagnosed about four months ago doctors gave her a prescription and sent her on her way. But she wasn't sure how to eat properly.

About two weeks ago, she ran into diabetes educator Lena Guerito at the Counselor chapter house southeast of Farmington. Guerito invited her to a diabetic cooking class.

Sam lives about 30 minutes down dirt roads by car, in the center of a vast stretch of mesas and scrub trees.

The higher price of healthy food, however, isn't the only purely economic barrier to eating healthy. Her husband, an oil field worker, commutes to Farmington. Sam does her grocery shopping here, but the 70 mile trip isn't easy to make, especially when gas hits $3 a gallon and the fruits and vegetables Guerito recommends go bad quickly.

And then there's the language barrier. Though Sam speaks fluent English, she seems more comfortable speaking Navajo, especially when it comes to some of the more complex nutritional concepts she's learned to handle with the disease.

Is there a Navajo word for calorie?

``It isn't just one word; you have to describe it,'' said Marlene Thomas, community health representative for the Counselor Chapter.

That's not to say traditional ideas don't always conflict with modern concepts of nutrition.

``We tell them, if it comes from Mother Earth, it is good for you,'' Guerito said.

Guerito and Thomas teach serving sizes using their hands. One finger is about an ounce, a palm is about the right size for a tortilla.

``What we explain is, you can eat anything you want, just don't eat it all,'' Nakai said. ``Have one piece of chicken, or eat a smaller piece. Have a Navajo taco, but cut it in half and save the rest.''