The trouble all started when their irrigation waters were diverted upstream in the late 19th century. Their traditional diet of corn, beans, squash, fish, game meats and gathered plant foods became impossible. They became dependent on government food programs, which provided them with white flour, sugar, lard and canned goods. Now they are the subjects of scientific research because of their staggering health problems.
I'm happy to report that after more than 30 years of activism, lawsuits and negotiation, the Pima and neighboring tribes have reached an agreement with the federal government that will restore a portion of their original water. Of the 2 million acre-feet of water the Pima were estimated to have used since before the 16th century, the settlement will restore 653,500. An acre-foot is approximately the personal water use of one household. The settlement also provides federal funds for reconstructing old irrigation canals.
Now we will see how the Pima will use it. Will they return to an agricultural lifestyle, perhaps with the advantages of modern technology? Or will they lease the water rights for money and continue to live off Western foods? Perhaps some of both. They are definitely aware that Western food is causing their health problems, and that they could regain their health by eating traditional foods. However, white flour "fry bread", sugar and canned meat have been around for so long they are also a cultural tradition at this point. Only time will tell which path they choose.
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That's why Tuesday, Sept. 16, is Get Ready Day. Sponsored by APHA, Get Ready Day is raising awareness about community preparedness.
No matter where you live, there is always a possibility of a public health emergency, from earthquakes and hurricanes to infectious disease or terrorism. Unfortunately, Americans just aren't prepared for a public health crisis, according to a 2007 poll from APHA.
A whopping 87 percent of Americans would not be prepared if a public health crisis such as an infectious disease outbreak or disaster struck their communities the next day, the poll found. While disasters such as Hurricane Katrina have made us all more aware of what could go wrong, only 14 percent of people said they had an adequate emergency supply of water, food and medication.
So what can you do? First, assess how prepared you and your family are (Do you have an emergency plan? A three-day supply of food and water? Where would your family meet during a disaster if they could not go home? How would you leave town if you had to evacuate?) Check out these planning tips and information on emergency stockpiling for help in getting yourself and your family prepared.
Once you are up to date, bring the Get Ready message to your community during Get Ready Day. Need ideas? Here's a few:
* Sponsor a preparedness talk at your local senior center or hold a community meeting. Invite someone from your local health department or American Red Cross to be a speaker.
* Insert preparedness planning materials into your church or religious organization’s bulletin, and post information at your library.
* Work with a local grocery store to promote preparedness and stockpiling to shoppers through displays or fliers. Pass out shopping lists of what people should have to be prepared.
You'll find plenty of helpful free preparedness planning materials on the Get Ready fact sheet page or via the Red Cross. September is also National Preparedness Month, so check out this great information from Uncle Sam as well.
Thanks to your help and Get Ready events held around the country, we'll all be a bit more prepared for the worst!
They recommend keeping LDL below 100 mg/dL, which would place tens of millions of Americans on statins.
I was reading Dr. John Briffa's blog today and he linked to a government web page disclosing NCEP panel members' conflicts of interest. It's fairly common in academic circles to require conflict of interest statements, so a skeptical audience can decide whether or not they think someone is biased. The 9-member NECP panel was happy to indulge us:
Every company in bold is a statin manufacturer. This is outrageous! These are the people setting official government blood cholesterol target values for the entire country! Eight out of nine of them should be dismissed immediately, and replaced by people who can do a better job of pretending to be impartial!
Dr. Grundy has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline.
Dr. Cleeman has no financial relationships to disclose.
Dr. Bairey Merz has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.
Dr. Brewer has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.
Dr. Clark has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.
Dr. Hunninghake has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.
Dr. Pasternak has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.
Dr. Smith has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.
Dr. Stone has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.
There has been a lot of discussion lately about the role of public health in the upcoming heating and energy crisis. Clearly, when people cannot heat their homes their health may be affected directly, such as suffering from hypothermia. Or, their health may be indirectly affected, such as by the need to take on a second job in order to pay for heating bills. And, with two papermills just this week in Maine laying off people, those second jobs and even first jobs may not even be available.
We also realize that our public health system may be stretched by the crisis. Already, WIC (Women Infants and Children Program) is seeing a record number of clients ever served in Maine, and about 14% higher than the number of clients served just over 2 years ago.
I thought it would be helpful to review some of the activities of the Maine CDC to address the upcoming winter heating crisis, and invite others to use this blog to share ideas about the current and potential role of public health at the state and local level in this crisis.
Thus far, at Maine CDC our current and planned work includes:
· We are funding and helping to develop a telephone poll that the American Lung Association of Maine is conducting to help determine geographical and population variations in heating, transportation, and carbon monoxide issues. It is hoped this survey will help policymakers and community members address specific heating and energy-related issues. Results are expected by early October. (Essential Public Health Services=EPHS #1 and 2)
· Some of our epidemiologists (Dr. Eric Tongren) and others (Dr. Andy Smith, our State Toxicologist and Dr. Andy Pelletier, a medical epidemiologist) are designing and implementing a system to track health issues such as carbon monoxide poisoning, hypothermia, asthma, and other respiratory illnesses through this upcoming winter. We hope these data will help us monitor the direct health effects of the crisis, and help us to modify our interventions to improve effectiveness. (EPHS # 1 and 2)
· We are developing public education materials, including written speaking points and radio/tv PSAs, regarding preventing the health-related issues of carbon monoxide poisoning, hypothermia, and asthma and other respiratory illnesses. These materials are being and will be shared with media outlets as well as public health, health care, and social services professionals. (EPHS # 3)
· Some of our district staff, such as our public health nurses, are participating on regional community collaboratives that have been convened mostly by United Way agencies, to address the heating crisis in their area. (EPHS # 4 and 7)
· Maine CDC is conducting a survey of its own staff and has met with energy experts to implement changes in the way it conducts business in order to save energy costs for the agency as well as for our employees. Examples include: turning many of our lights off during office hours and putting the rest of them on a timer, working on flex time alternatives, and increasingly offering meetings with teleconferencing capabilities. (EPHS #5)
What other ideas are there at the state or local level? Thank you! Dora
Governor's Stay Safe and Warm Website
Governor's Energy Website with Energy Task Force Report and Short Term Strategies
Ten Essential Public Health Services:
EPHS #1 Monitor health status to identify community health problems.
EPHS #2 Diagnose and investigate health problems and health hazards in the community.
EPHS #3 Inform, educate, and empower people about health issues.
EPHS #4 Mobilize community partnerships to identify and solve health problems.
EPHS #5 Develop policies and plans that support individual and community health efforts.
EPHS #6 Enforce laws and regulations that protect health and ensure safety.
EPHS #7 Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
EPHS #8 Assure a competent public health and personal health care workforce.
EPHS #9 Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
EPHS #10 Research for new insights and innovative solutions to health problems.
America was also home to a number of huge and unusual animals: mammoths, dire wolves, lions, giant sloths and others.
The same goes for Australia, where giant kangaroos, huge wombats and marsupial 'lions' once roamed.
What do these extinctions have in common? They all occurred around when humans arrived. The idea that humans caused them is hotly debated, because they also sometimes coincided with climactic and vegetation changes. However, I believe the fact that these extinctions occurred on several different continents about when humans arrived points to an anthropogenic explanation.
A recent archaeological study from the island of Tasmania off the coast of Australia supports the idea that humans were behind the Australian extinctions. Many large animals went extinct around the time when humans arrived in Australia, but that time also coincided with a change in climate. What the new study shows is that the same large animals survived for another 5,000 years in Tasmania... until humans arrived there from the mainland. Then they promptly went extinct. That time period didn't correspond to a major climate change, so it's hard to explain it away.
It's a harsh reality that our big brains and remarkable adaptability give us the power to be exceptionally destructive to the environment. We're good at finding the most productive niches available, and exploiting them until they implode. Jared Diamond wrote an excellent book on the subject called Collapse, which details how nearly every major civilization collapse throughout history was caused at least in part by environmental damage. It's been a hallmark of human history since the beginning.
I don't think it will take much to convince you that the trend has accelerated in modern times. Ocean life, our major source of nutrient-rich wild food, has already been severely depleted. The current extinction rate is estimated to be over 1,000 times the baseline, pre-modern level, and rising.
Humans have always been top-level predators. We kill and eat nutrient-dense prey that is often much larger than we are. But today, the extinction of such walking meat lockers has caused us to eat down the food chain. We're turning to jellyfish and sea cucumbers and... gasp... lobsters!
While it's true that we've probably always eaten things like shellfish and insects, I find it disturbing that we've depleted the oceans to the point where we can no longer sustainably eat formerly abundant carnivorous fish like tuna. We need to make a concerted effort to preserve these species because extinction is permanent.
I don't want to live in a future where the only thing on the menu is bacteria patties, the other other other other white meat.
There were two groups: the Kiffian, who were powerful hunters and fishermen, and the Tenerian, who were smaller pastoralists (herders) and fishermen.
Individuals at the Kiffian sites averaged over 6 feet tall, with some reaching 6' 8". They were powerfully muscled, and found with the remains of elephants, giraffes, pythons, giant perch and other large game.
Not that you have to be Conan the Barbarian to kill an elephant. Forest pygmies traditionally hunt elephants, and there's a picutre in Nutrition and Physical Degeneration to prove it. They use stealth, agility and an intimate knowledge of their prey to make up for their small size and primitive weapons.
Both the Kiffians and the Tenerians had excellent dental development and health. Take a look at some of the pictures. Those are the teeth of a wild Homo sapiens. Straight, free of decay and with plenty of room for the wisdom teeth. They must have had good dentists.
Both cultures also showed a high level of intelligence and empathy. They were found with decorated pottery shards and their bodies were arranged in imaginative and empathetic ways. A man was buried sitting on a tortoise shell. A mother was buried with her two children. Here's the picture. I can't say it better than the LA Times:
Among the Tenerian graves was a heart-rending burial tableaux [SIC!!]: A young woman was lying on her side. Pollen under her body suggested that she was placed on a bed of flowers. Lying on their sides facing her were two young children, their fingers interlocked with hers, leaving a tangle of bones.Haha, I couldn't let the spelling error slide, it should be 'tableau'. Hey, I'm half French, give me a break.
Leaving the county, I felt a wide mixture of emotions. On one hand I felt shaken by seeing the dozens of graves of young people. On the other hand, I also felt inspired by the many people we met and the beauty of Washington County.
I also kept thinking of the eagles we witnessed on Big Lake. The eagle needs our respect and trust. Without these, the eagle can tragically dwindle to endangerment. With them, the eagle can flourish and give us strength and inspiration.
As the sun set, we drove home through Routes 1 and 6, across the northern part of Washington County. I could see the changes in the landscape from the rocky granite and blueberry barrens along the coast, to the heavy woods along the county’s mid-section, to now the more rolling hills and lakes, very reminiscent of adjacent Aroostook County to the north, the home area of my mother.
After passing through Lincoln, Interstate 95 whisked us southbound. As we drove home I asked my children what they liked best about their visit of Washington County. One replied they were delighted my Blackberry and cell phone, because of poor reception, did not interrupt their time with me and the friends we made. The other said combing the beaches and the boat ride on the lake with Mr. Sockabasin was what they liked best. It seems that both children tapped into what made the trip special to me as well – the beauty of spending time with each other and our Downeast friends as well as the natural beauty of the area.
Indeed, Downeast Maine is extremely precious, and I am grateful for our short trip there and the many gifts we were blessed with. Thank you – Woliwon!
After spending a relaxing morning hanging out in our cabin by Grand Lake Stream, getting some work done on the laptop, my son voraciously reading a book (and with his dyslexia, that’s always a blessing), and visiting with Kathy and Kurt at the store, we drove down the road and met Lisa at Peter Dana Point, also known as Indian Township, the other Washington County Passamaquoddy Reservation.
Lisa’s father, Allen Sockabasin, was our host for the afternoon. Sitting by the shore of Big Lake, we spent a relaxing time talking while the children explored the woods and waterfront. His stories are full of struggles as well as inspiration – about his growing up on the Reservation, his years as Passamaquoddy Governor, his efforts to preserve Passamaquoddy language, history, and culture, and his dedication to working with today’s youth through his books, his many guest appearances in Maine schools, and his work with Native youth.
Although I would have enjoyed sitting and talking with Allen all afternoon, after a while he took us for a boat ride. For over two hours we skimmed over Big Lake, and except for Peter Dana Point, we encountered no other motorized boats, no houses, and no people - just lake, woods, and bald eagles. Allen pointed out his favorite hunting and fishing grounds. I imagined that over the past 12,000 years many have hunted and fished here and shared the exact same views that we enjoyed today.
From a distance across the water, Alan easily pointed out several bald eagles atop trees. Realizing how important these rare birds are to Native American history and culture, I was even more touched by their appearances. In Native American culture, it is an eagle’s wings that flap and make snow, and an eagle’s wings that likewise make wind. The bald eagles looked like they had been peering over life on Big Lake for thousands of years.
As I left Peter Dana Point, I made one last stop - the cemetery. On one hand, it is a place of beauty, blanketing the slopes overlooking the peaceful lake. On the other hand, there is striking evidence of struggles and tragedy. The graves were primarily of young Native Americans – people in their 20s, 30s, and 40s. Only occasionally was a grave for someone in their 60s or older. Clearly, this cemetery told a story of too many people dying too young. The cemetery gave a grim picture of what we have been told – life expectancy is decreasing in this corner of Maine.
As we drove away, I explained this to my children, and they asked, “It’s so beautiful here, why are young people dying?” I told them the answers are complex and perhaps not fully known right now. I told them that poverty, lack of educational opportunities, and isolation all contribute to health risks such as smoking, substance abuse, poor nutrition, and physical inactivity. And, these risks in turn contribute to causes of death such as cancer, heart disease and stroke, diabetes, and suicide.
But, the data can only tell us so much. The people of Washington County probably know more about the reasons and more of the solutions than the data alone can tell us. I told them that it is part of our job as state officials to gather and analyze the data, but it is also part of our job to listen to and learn from what those in Washington County have to say.
The first graph showed the average cardiorespiratory endurance of Americans at different ages. It peaks around 30 and goes downhill from there. But the author of this chapter was very intelligent; he knew that averages sometimes conceal meaningful information. The second graph showed two lines: one representing a man who was sedentary, and the other representing a man who exercised regularly for his entire life. The data were from real individuals. The endurance of the first man basically tracked the national average as he aged. The endurance of the second man remained relatively stable from early adulthood until the age of 70, after which it declined noticeably.
We aren't taking care of ourselves for nothing, ladies and gentlemen. We're doing it because the stakes are high. Just look at Jack LaLanne, the fitness buff. He's been working out regularly and eating a whole foods diet since before I was born, and he's still pumping iron every day at 93.
¿Hablas Español? If so, you may find a new set of materials from APHA's Get Ready campaign of interest.
In August, the Get Ready campaign debuted Spanish-language versions of its popular Helping Handouts series. The free handouts address preparedness issues such as handwashing, vaccinations, food safety, healthy travel and pandemic flu.
The colorful handouts -- which are also available in English -- are aimed at educating the public and are presented in a fun, easy-to-read style. They can be used at health fairs, passed out on campus, posted at work or handed out at health clinics -- it's up to you!
The new Spanish-language materials are just the latest offerings from APHA's Get Ready campaign, which works to help Americans prepare themselves, their families and their communities for all hazards, including pandemic flu, infectious diseases and other health emergencies.
Other free Get Ready materials include a stockpiling checklist, fact sheets on infectious disease, preparedness tips and games for kids. Many of the resources can be customized with your organization's logo, so be sure and check them out.
The first thing we can say is that a high intake of carbohydrate is not enough, by itself, to cause overweight or the diseases of civilization. It's also not enough to cause insulin resistance. I sent an e-mail to Dr. Lindeberg asking if his group had measured Kitavans' glucose tolerance. He told me they had not. However, I can only guess they had good glucose control since they suffered from none of the complications of unmanaged diabetes.
The Kitavan diet is low in fat, and most of the fat they eat is saturated because it comes from coconuts. Compared to Americans and Swedes, they have a high intake of saturated fat. So much for the theory that saturated fat causes CVD... They also have a relatively high intake of fish fat, at 4g per day. This gives them a high ratio of omega-3 to omega-6 fatty acids, with plenty of DHA and EPA.
Their blood lipid profile is not what a mainstream cardiologist would expect. In fact, it's "worse" than the Swedish profile in many ways, despite the fact that Swedes are highly prone to CVD. This raises the possibility that blood lipids are not causing CVD, but are simply markers of diet and lifestyle factors. That's very easy for me to swallow because it never made sense to me that our livers would try to kill us by secreting triglycerides and withholding HDL. The blood lipid profile that associates best with CVD and metabolic syndrome in the West (but has no relation to them on Kitava) is one that's consistent with a high carbohydrate intake. Where does carbohydrate come from in the West? White flour and sugar maybe?
Kitavans also have very low serum leptin. This may be a keystone to their leanness and health. It suggests that their diet is not interfering with the body's metabolic feedback loops that maintain leanness.
The Kitavan diet is one path to vibrant health. Like many other non-industrial groups, Kitavans eat whole, natural foods that are broadly consistent with what our hunter-gatherer ancestors would have eaten. It amazes me that as humans, we can live well on diets that range from near-complete carnivory to plant-rich omnivory. We are possibly the most adaptable species on the planet.
The ideal diet for humans includes a lot of possibilities. I believe the focus on macronutrients is misguided. There are examples of cultures that were/are healthy eating high-fat diets, high-carbohydrate diets and everything in between. What they do not eat is processed grains, particularly wheat, refined sugar, industrially processed seed oils and other modern foods. I believe these are unhealthy, and this is visible in the trail of destruction they have left around the globe. Its traces can be found in the Pacific islands, where close genetic relatives of the Kitavans have become morbidly obese and unhealthy on a processed-food diet.
Caloric intake and expenditure vary from day to day and week to week in humans, yet most people maintain a relatively stable weight without consciously adjusting food intake. For example, I become hungry after a long fast, whereas I won't be very hungry if I've stuffed myself for two meals in a row. This suggests a homeostatic mechanism, or feedback loop, which keeps weight in the body's preferred range. Leptin is the major feedback signal.
Here's how it works. Leptin is secreted by adipose (fat) tissue, and its blood levels are proportional to fat mass. The more fat, the more leptin. It acts in the brain to increase the metabolic rate, decrease eating behaviors, and inhibit the deposition of fat. Thus, if fat mass increases, hunger diminishes and the body tries to burn calories to regain its preferred equilibrium.
The next logical question is "how could anyone become obese if this feedback loop inhibits energy storage in response to fat gain?" The answer is a problem called leptin resistance. In people who are obese, the brain no longer responds to the leptin signal. In fact, the brain believes leptin levels are low, implying stored energy is low, so it thinks it's starving. This explains the low metabolic rate, increased tendency for fat storage and hyperphagia (increased eating) seen in many obese people. Leptin resistance has reset the body's preferred weight 'set-point' to a higher level.
Incidentally, some reaserchers have claimed that obese people gain fat because they don't fidget as much as others. This is based on the observation that thin people fidget more than overweight people. Leptin also influences activity levels, so it's possible that obese people fidget less than thin people due to their leptin resistance. In other words, they fidget less because they're fat, rather than the other way around.
The problem of leptin resistance is well illustrated by a rat model called the Zucker fatty strain. The Zucker rat has a mutation in the leptin receptor gene, making its brain unresponsive to leptin signals. The rat's fat tissue pumps out leptin, but its brain is deaf to it. This is basically a model of severe leptin resistance, the same thing we see in obese humans. What happens to these rats? They become hyperphagic, hypometabolic, obese, develop insulin resistance, impaired glucose tolerance, dyslipidemia, diabetes, and cardiovascular disease. Basically, severe metabolic syndrome.
This shows that leptin resistance is sufficient to cause many of the common metabolic problems that plague modern societies. In humans, it's a little known fact that leptin resistance precedes the development of obesity, insulin resistance, and impaired glucose tolerance! Furthermore, humans with leptin receptor mutations or impaired leptin production become hyperphagic and severely obese. This puts leptin at the top of my list of suspects.
So here we have the Kitavans, who are thin and healthy. How's their leptin? Incredibly low. Even in young individuals, Kitavan leptin levels average less than half of Swedish levels. Beyond age 60, Kitavans have 1/4 the leptin level of Swedish people. The difference is so great, the standard deviations don't even overlap.
This isn't surprising, since leptin levels track with fat mass and the Kitavans are very lean (average male BMI = 20, female BMI = 18). Now we are faced with a chicken and egg question. Are Kitavans thin because they're leptin-sensitive, or are they leptin-sensitive because they're thin?
There's no way to answer this question conclusively using the data I'm familiar with. However, in mice and humans, leptin resistance by itself can initiate a spectrum of metabolic problems very reminiscent of what we see so frequently in modern societies. This leads me to believe that there's something about the modern lifestyle that causes leptin resistance. As usual, my microscope is pointed directly at industrial food.
After a morning walk around Eastport, which reminded me of my hometown of Farmington, and a couple of hours of combing the beaches at Prince Cove, we drove to the annual Indian Days celebration at the Passamaquoddy Reservation in nearby Pleasant Point.
We spent a picturesque and delightful afternoon with Lisa Sockabasin and some friends. With views of and breezes from the water and islands on both sides of a large field, the setting was perfect for such a gathering. While enjoying some Indian tacos and Tom Francis bread, we chatted with various friends, including Representative Donald Soctomah, who represents the Passamaquoddy Tribe in the Maine Legislature, and sits on the Health and Human Services Committee. Rep Soctomah is well recognized for his many efforts to preserve Passamaquoddy history, which is especially important because of the oral history tradition that is easily lost in these days of reliance on technology.
We also chatted with Sandra Yarmal and some others from the Pleasant Point Health Center, one of five Indian Health Centers in Maine (the others being a Passamaquoddy health center at Indian Township, a Penobscot health center at Indian Island, a Maliseet health center in Houlton, and a Mic Mac health center in Presque Isle).
The Passamaquoddy have lived in the watershed area of the St. Croix (formerly the Passamaquoddy River) for over 12,000 years. Those living on the Canadian side of the river are know as the St. Croix or Schoodic Band. Those living on the US side of the river have two reservations – one at Pleasant Point (the Sipayik members of the Passamaquoddy Tribe) and one at Indian Township (Peter Dana Point) near Princeton, Maine.
According to the Passamaquoddy website, a total of 3,369 tribal members are listed on the tribal census rolls in Maine with about two-thirds listed at Pleasant Point, and one-third at Indian Township. The US Census data for 2006 only lists 1,629 Native Americans in Washington County. This kind of discrepancy in data unfortunately is too common when trying to track health issues among our racial and ethnic minority populations. For instance, a 2005 study conducted by the then Bureau of Health (now Maine CDC) and Indian health centers in Maine showed multiple types of data quality errors apparently contributing to underestimates of death rates for certain diseases among American Indians in Maine. These errors not only included incorrect recording of race on death certificates but also errors in data coding, data entry and analysis. Complicating these errors is a lack of standardized data quality procedures (such as double data entry and automatic edit checking) in our Vital Records office because of a lack of staff and funds. These quality processes were in place until the early 1990s when Vital Records was depleted of much of its resources. Unfortunately, we are now seeing more of the effects of this depletion, including the undercounting of a number minority populations and the inability to accurately track health issues confronting them.
An afternoon visit to the nearby Waponahki Museum was very worthwhile. With Passamaquoddy history and art on display, there are exhibits that interest any age.
Coincidently and delightfully, we ran into a friend Ben Levine and his partner, Julia Schulz, at the museum. Hailing from Rockland, Ben is a filmmaker and Julia a cultural anthropologist and linguist, who are working with the Passamaquoddy Tribe and fluent Passamaquoddy speakers on a project to document and preserve this endangered language.
While at the museum we also ran into Fredda Paul a practitioner of traditional Passamaquoddy medicine, including the use of herbs, hands-on healing, and other methods he learned as a child from his grandmother. Having had a long-standing interest in multiple healing methods, especially sparked from living and traveling in Africa and Asia and observing a number of successful non-western healings, I wished I had more lifetimes to fully study them. I am humbled by the dimensions of healing, and how western medicine teaches one of a number of paradigms. Fredda is a well-respected healer, including having received an honorary degree from Unity College last year. I greatly appreciate the time he spent with me sharing some of his life’s story.
After a wonderful afternoon at Pleasant Point, the children and I drove north to Grand Lake Stream. While approaching Calais, I saw Representative Anne Perry driving south, and figured she was probably heading to Pleasant Point for Indian Days as well. We stopped briefly at the St. Croix Island International Historic Site, which is the site of the first French attempt to settle in North America in 1604, and included the famous explorer, Samuel Champlain. During the first winter, nearly half of the 79 members of the expedition died (mostly due to scurvy, from insufficient vitamin C). Thanks to trading with nearby Native Americans in the spring, the survivors were able to gain strength, and eventually moved on to permanently settle in Nova Scotia.
We arrived in Grand Lake Stream just in time to watch a glorious sunset over the lake. My childhood friend Kurt Cressey and his wife Kathy own and run the Pine Tree Store there, so we spent much of the evening catching up on news of family and friends. We finally settled into a nearby cabin and sleep after a wonderful Washington County day!
Passamaquoddy Pleasant Point
Passamaquoddy Indian Township
Houlton Band of Maliseets
Aroostook Band of Micmacs
Penobscot Indian Nation
Underestimation of Cardiovascular Disease Mortality Among Maine American Indians: The Role of Procedural and Data Errors
Abbe Museum of Maine's Native American Heritage
The Wabanaki Center at the University of Maine — http://www.nap.umaine.edu/Wab_Home.html
St. Croix Island National Historic Site
In their next study, the researchers examined Kitavans' insulin levels compared to Swedish controls. This paper is short but very sweet. Young Kitavan men and women have a fasting serum insulin level considerably lower than their Swedish counterparts (KM 3.9 IU/mL; SM 5.7; KW 3.5; SW 6.2). Kitavan insulin is relatively stable with age, whereas Swedish insulin increases. In the 60-74 year old group, Kitavans have approximately half the fasting serum insulin of Swedes. One thing to keep in mind is that these are average numbers. There is some overlap between the Kitavan and Swedish numbers, with a few Kitavans above the Swedish mean.
In figure 2, they address the possibility that exercise is the reason for Kitavans' low insulin levels. Kitavans have an activity level comparable to a moderately active Swedish person. They divided the Swedes into three categories: low, medium, and high amounts of physical activity at work. The people in the "low" category had the highest insulin, followed by the "high" group and then the "medium" group. The differences were small, however, and Kitavans had far lower serum insulin, on average, than any of the three Swedish groups. These data show that exercise can not explain Kitavans' low insulin levels.
The researchers also found that they could accurately predict average Swedish and Kitavan insulin levels using an equation that factored in age, BMI and waist circumference. This shows that there is a strong correlation between body composition and insulin levels, which applies across cultures.
Now it's time to take a step back and do some interpreting. First of all, this paper is consistent with the idea (but does not prove) that elevated insulin is a central element of overweight, vascular disease and possibly the other diseases of civilization. While we saw previously that mainstream blood lipid markers do not correlate well with CVD or stroke on Kitava, insulin has withstood the cross-cultural test.
In my opinion, the most important finding in this paper is that a high-carbohydrate diet does not necessarily lead to elevated fasting insulin. This is why I think the statement "carbohydrate drives insulin drives fat" is an oversimplification. With a properly-functioning pancreas and insulin-sensitive tissues (which many people in industrial societies do not have), a healthy person can eat a high-carbohydrate meal and keep blood glucose under control. Insulin definitely spikes, but it's temporary. The rest of the day, insulin is at basal levels. The Kitavans show that insulin spikes per se do not cause hyperinsulinemia.
So this leads to the Big Question: what causes hyperinsulinemia?? The best I can give you is informed speculation. Who has hyperinsulinemia? Industrial populations, especially the U.S. and native populations that have adopted Western foods. Who doesn't? Non-industrial populations that have not been affected by Western food habits, including the traditional Inuit, the Kuna, the traditional Masai and the Kitavans.
We can guess that total fat, saturated fat and carbohydrate do not cause hyperinsulinemia, based on data from the Inuit, the Masai and the Kitavans, respectively. We can also guess that there's not some specific food that protects these populations, since they eat completely different things. Exercise also can not completely account for these findings. What does that leave us with? Western food habits. In my opinion, the trail of metabolic destruction that has followed Westerners throughout the world is probably due in large part to industrial foods, including refined wheat flour, sugar and seed oils.
I'm not the first person to come up with this idea, far from it. The idea that specific types of carbohydrate foods, rather than carbohydrate in general, are responsible for the diseases of civilization, has been around for at least a century. It was an inescapable conclusion in the time of Weston Price, when anthropologists and field physicians could observe the transitions of native people to Western diets all over the world. This information has gradually faded from our collective consciousness as native cultures have become increasingly rare. The Kitava study is a helpful modern-day reminder.
Doctors commonly refer to total cholesterol over 200 mg/dL (5.2 mmol/L) as "high", so Kitavan men are in the clear. On the other hand, Kitavan women should be dying of heart disease left and right with their high middle-age cholesterol of 247 mg/dL (6.4 mmol/L)! That's actually higher than the value for Swedish women of the same age, who are far more prone to heart disease than Kitavans.
The fun doesn't stop there. Total cholesterol isn't a good predictor of heart attack risk, but there are better measures. LDL on Kitava is lower in males than in Sweden, but for females it's about the same until old age. HDL is slightly lower than Swedes' at middle and old age, and triglycerides are higher on average. Judging by these numbers, Kitavans should have cardiovascular disease (CVD) comparable to Swedes, who suffer from a high rate of cardiovascular mortality.
Kitavan smokers had a lower HDL than nonsmokers, yet still did not develop CVD. Smoking is considered one of the most powerful risk factors for cardiovascular disease in Western populations. I think it's worth noting, however, that Kitavans tend to be light smokers.
These data are difficult to reconcile with the hypothesis that certain patterns of blood lipids cause CVD. Kitavans, particularly the women, have a blood lipid profile that should have them clutching their chests, yet they remain healthy.
There is a theory of the relationship between blood lipids and CVD that can explain these data. Perhaps blood lipids, rather than causing CVD, simply reflect diet composition and other lifestyle factors. Both on Kitava and in the West, low HDL and elevated triglycerides imply a high carbohydrate intake. Low-carbohydrate diets consistently raise HDL and lower triglycerides. On Kitava, carbohydrate comes mostly from root crops. In the West, it comes mostly from processed grains (typically wheat) and sugar. So the blood lipid pattern that associates best with CVD and the metabolic syndrome in the West is simply a marker of industrial food intake.
The site is focused on collaboration and communication. It's full of great links to important policies, publications, training materials, translated documents and more - everything to help prepare diverse communities for emergencies.
"There's not a one-size-fits-all plan," says Jonathan Purtle, a health policy analyst with the Drexel University School of Public Health's Center for Health Equality, which developed the site with support from the U.S. Department of Health and Human Services' Office of Minority Health. In an emergency, national organizations must rely on local expertise when planning a relief effort - which is where residents and community leaders come in.
Web visitors can access articles on emergency situations such as bioterrorism, natural disasters and disease outbreaks. Articles are posted in a range of languages - from Albanian to Laotian to Yupik.
To stay informed, sign up for the Diversity Preparedness E-Newsletter, which will be issued monthly.
The National Resource Center is a needed site and a great resource, Purtle told APHA's Get Ready campaign, but it's too early to know the benefits. The main goal is to ensure that everyone in our communities is accounted for in our emergency preparedness plans, including those created in our local communities and hometowns. So it's up to all of us to use these resources and work with leaders to make sure we're all prepared.
Naturally, when Dr. Lindeberg's group discovered that Kitavans don't suffer from heart disease or stroke, they investigated further. In the second paper of the series, they analyzed the Kitavans' "cardiovascular risk factors" that sometimes associate with heart disease in Western populations, such as overweight, hypertension, elevated total cholesterol and other blood lipid markers.
Kitavans are lean. Adult male body mass index (BMI) starts out at 22, and diminishes with age. For comparison, Swedes begin at a BMI of 25 and stay that way. Both populations lose muscle mass with age, so Kitavans are staying lean while Swedes are gaining fat. The average American has a BMI of about 28, which is considered overweight and 2 points away from being obese.
Kitavans also have a low blood pressure that rises modestly with age. This is actually a bit surprising to me, since other non-industrial groups like the Kuna do not experience a rise in blood pressure with age. Compared with Swedes, Kitavans' blood pressure is considerably lower at all ages.
In the next post, I'll discuss the Kitavans' blood lipid numbers ("cholesterol"), which challenge current thinking about heart disease risk factors.
After spending the morning exploring picturesque Lubec, West Quoddy Lighthouse, and some of Campobello – the Roosevelt Cottage and a couple of hours beachcombing on Herring Cove Beach – we drove the 45 minutes around the bay to Eastport.
This afternoon’s tour of Raye’s Mustard Mill, the last remaining traditional stone-ground mustard mill, was one of the highlights of the trip for the children. Big fans of mustard, they were intrigued to see the equipment and process for making it as well as to taste several of the 24 varieties. I was interested to learn of the connection with the sardine industry. Raye’s Mustard was started over 100 years ago to provide mustard for canned sardines. With the decline in that industry, Raye’s has adjusted to focus more on table mustard. And, wow, do they do that! They’ve won a number of awards and recognition, including from Martha Stewart. Needless to say, we left loaded down with future Christmas gifs from the pantry store. We also enjoyed a nice visit with Karen Raye, one of the owners, along with her husband, Senator Kevin Raye, who was out of town on business.
By early evening I realized that we had been two days with only intermittent and weak cell phone and internet service. As we ate dinner on Eastport’s waterfront, my cell phone caught a signal from Canada across the bay, and suddenly several messages appeared – some from my husband, frantic to make sure we were okay, and some from staff alerting me to flooding in southern Maine (although partially overcast in Downeast, there was little or no rain). On one hand, not being tied so much to the phone or email was a welcomed relief. On the other hand, it made me realize how challenging it must be for people living in many areas of Downeast to not have that connectivity that many of us take for granted.
Speaking of connectivity, tonight we gathered in a common living area around the one tv in an Eastport bed and breakfast and watched the opening ceremonies of the Olympics. Squeezed onto couches and carpeting with strangers from a variety of states and Canada, we shared a special enthusiasm and awe in the ceremonies as well as pride in both our countries and the athletes. This was a connection no internet or phone can provide!
Quoddy Head State Park
After I made a comment about something being a red herring, my son asked me what the term meant and its connection to herring. I told him that the term refers to a false lead, but I didn’t know the connection to actual herring. I later looked it up and learned that “red” means smoked, and smoked herring can have such strong smells that they can be used to create a false scent that causes hunting animals (such as dogs) to lose their track. Interesting!
By mid-morning, we had driven to Milbridge and met up with Anais Tomezsko, the Director of the Mano en Mano (Hand in Hand) Program, Barbara Ginley, the Director of the Maine Migrant Health Program, and Lisa Sockabasin, Maine CDC’s Director of Minority Health. Anais generously gave us a tour of Mano en Mano’s facilities and an overview of their history and programs. The program was started a few years ago after an influx of Latino migrant workers who decided to settle in the area. There is an estimated 300 such residents in Washington County, mostly originally from Mexico and Honduras.
Although Mano en Mano has its roots in literacy – teaching preschoolers, school-aged children, and adults English – it includes some needed bridging between people living in the area. For instance, the program offers Spanish classes for area businesses and others as well as brings youth together to help each other with homework. They also have a health education program that focuses on immigrant women.
Barbara, Lisa, the children, and I then drove several miles through some thick woods and blueberry barrens outside of Milbridge. I totally lost my sense of direction after a while, the curvy road wound its way through scenery that was solely woods interrupted by blueberry barrens. Finally, after a number of miles without any signs of houses or towns, we came across a migrant camp, maintained by one of the blueberry companies for their migrant workers to live while working for them.
Although the camp houses about 300 workers, most were raking in the fields, so it was relatively quiet there. Rows of dozens of small blue camps framed a large central area that contained a soccer field, food vendors (all serving Mexican food), and bath houses. Ordering lunch from one of the vendors, I was surprised at how good the food was – tacos, burritos, and nachos, and all in the middle of woods and blueberry fields!
Although there are other camps that also house mostly Hispanic migrant workers, there are also those that mostly house Native Americans. Northeastern Blueberry Company is owned by the Passamaquoddy Tribe, and employs many rakers who are Passamaquoddy and Mic Mac, including a number from Canada.
We were fortunate that coincidently, Juan Perez-Febles arrived at the camp and joined us at lunchtime. As the Director of the Maine Department of Labor’s Migrant and Immigrant Services Division, Juan helps both employers and foreign workers. Since there are so many migrant workers this time of year in Washington County, he spends most of the month of the blueberry harvest here. Some of the workers who were having lunch greeted him, so it was evident he is well known.
After lunch we drove across more winding roads through woods and blueberry barrens to the Rakers’ Center, held in and around the town hall of Columbia Falls. This central location to many of the blueberry barrens provides one-stop shopping for migrant workers for access to a number of services. For instance, in the parking lot was a large truck that serves as a food pantry, using surplus federal foods. Inside the town hall were several tables set up by various services, such as WIC, legal aid, and employment services.
The main focus of our visit to the Rakers’ Center was the Maine Migrant Health Program’s mobile health clinic, also located in the parking lot. The visit was also a reunion of sorts with some wonderful friends. Mike Rowland, MD and Sara Roberts, PA were on duty. Mike was an emergency department physician when I practiced in Farmington, and Sara and I grew up in the same neighborhood in Farmington, and our families have been close for decades. Mike and Sara are some of a variety of medical personnel from across Maine who generously volunteer their services here.
Their days are fairly long. The clinic is held at the Rakers’ Center during most days, then travels to different migrant camps most evenings. With two exam rooms, equipment squeezed into the small space, and a generator that provides some power, moving the unit around is no easy task. But, the effort appears to be well worth it. Last year they saw almost 1,200 migrant and seasonal workers. Although most blueberry rakers they see here are from Mexico and Honduras, most are young and otherwise healthy men. However, the work is quite hard, requiring long hours of being bent over and raking the wild blueberries. As a result, there are frequent back problems. The health clinic is able to provide some relief in the form of medicines (non-narcotic), physical therapy, and exercises. This treatment is crucial to keeping workers healthy and on the job.
While I was visiting the health clinic, Lisa met with some summer interns who are working at the clinic. They are four minority students – Native American and Hispanic – who are getting an important introduction to the health field. During my brief meeting with them, I shared how much I hope they consider a health career, since minority students often serve minority populations more effectively than others. And, health careers are rewarding. I’m grateful that Lisa has helped provide such opportunities for minority students – an important investment in our future.
During several stops today my children enjoyed trying out some of their elementary school Spanish with some of the workers we met. They were greeted with pleasant smiles and enthusiastic greetings.
After spending most of the day with Barbara Ginley, Lisa Sockabasin, and in the morning Anais Tomezsko, the children and I drove eastward in the late day sun across miles of more blueberry barrens, many dotted with bent over rakers. I can see why migrant workers are considered so invisible – it took a day’s drive and travels on many back roads to even find some, and even then, most whom we saw were bent over, faces to the ground raking blueberries. How grateful I am to put a face on some of them, and for all the hard labor they provide in order to provide us healthy foods for our plates!
Mano en Mano, Milbridge, Maine
Maine Migrant Health Program
August 2008 “Invisible Mainers” - Article from Down East Magazine on Migrant Workers in Maine
The Kitava study, a series of papers produced primarily by Dr. Staffan Lindeberg and his collaborators, offers a glimpse into the nutrition and health of an ancient society, using modern scientific methods. This study is one of the most complete and useful characterizations of the diet and health of a non-industrial society I have come across. It's also the study that created, and ultimately resolved, my cognitive dissonance over the health effects of carbohydrate.
From the photos I've seen, the Kitavans are beautiful people. They have the broad, attractive faces, smooth skin and excellent teeth typical of healthy non-industrial peoples.
Like the Kuna, Kitavans straddle the line between agricultural and hunter-gatherer lifestyles. They eat a diet primarily composed of tubers (yam, sweet potato, taro and cassava), fruit, vegetables, coconut and fish, in order of calories. This is typical of traditional Pacific island cultures, although the relative amounts differ.
Grains, refined sugar, vegetable oils and other processed foods are virtually nonexistent on Kitava. They get an estimated 69% of their calories from carbohydrate, 21% from fat, 17% from saturated fat and 10% from protein. Most of their fat intake is saturated because it comes from coconuts. They have an omega-6 : omega-3 ratio of approximately 1:2. Average caloric intake is 2,200 calories per day (9,200 kJ). By Western standards, their diet is high in carbohydrate, high in saturated fat, low in total fat, a bit low in protein and high in calories.
Now for a few relevant facts before we really start diving in:
- Kitavans are moderately active. They have an activity level comparable to a moderately active Swede, the population to which Dr. Lindeberg draws frequent comparisons.
- They have abundant food, and shortage is uncommon.
- Their good health is probably not related to genetics, since genetically similar groups in the same region are exquisitely sensitive to the ravages of industrial food. Furthermore, the only Kitavan who moved away from the island to live a modern life is also the only fat Kitavan.
- Their life expectancy at birth is estimated at 45 years (includes infant mortality), and life expectancy at age 50 is an additional 25 years. This is remarkable for a culture with limited access to modern medicine.
- Over 75% of Kitavans smoke cigarettes, although in small amounts. Even the most isolated societies have their modern vices.
For the whole of PNG, no case of IHD or atherothrombotic stroke has been reported in clinical investigations and autopsy studies among traditionally living Melanesians for more than seven decades, though an increasing number of myocardial infarctions [heart attacks] and angina pectoris in urbanized populations have been reported since the 1960s.Dementia was not found except in in two young Kitavans, who were born handicapped. The elderly remained sharp until death, including one man who reached 100 years of age. Kitavans are also unfamiliar with external cancers, with the exception of one possible case of breast cancer in an elderly woman.
Overall, Kitavans possess a resistance to degenerative diseases that is baffling to industrialized societies. Not only is this typical of non-industrial cultures, I believe it represents the natural state of existence for Homo sapiens. Like all other animals, humans are healthy and robust when occupying their preferred ecological niche. Our niche happens to be a particularly broad one, ranging from near-complete carnivory to plant-rich omnivory. But it does not include large amounts of industrial foods.
In the next few posts, I'll discuss more specific data about the health of the Kitavans.