High Rates of Type 2 Diabetes: The Native American Epidemic

To give us a better understanding of the type 2 diabetes epidemic, I feel it’s important to know more about the different ethnic groups that are more profoundly affected by the disease. The Native American communities have without a doubt experienced the greatest impact.

native american diabetesAccording to the CDC, 16.1% of the total adult population served by Indian Health Services (HIS) had diagnosed diabetes – almost twice the national average, with rates varying by region, and as high as 33.5% among Native American adults in southern Arizona (arguably the highest percentage in the world).[i] 

Rates of diagnosed type 2 diabetes among Native Americans younger than 35 doubled from 1994-2004.[ii]

“We are the sickest racial, ethnic population in the United States,” said Irene Vernon, a professor at Colorado State University who specializes in Native American health.[iii]

This is in large part, an issue of poverty, and limited access to healthy food. But the bigger issue is the near extinction of the Native American food culture due to the loss of most of their lands followed by the dependence on fatty federal western diet rations that defined reservation life. 

“We were a healthy people, generally, pre-contact. We had to hunt for our food, fish for our food, plant our own garden” Vernon said.[iv]

In his book, The Case Against Sugar, Gary Taubes holds that the Pima tribe had practically no diabetes until they were subjected to a western-style diet and lifestyle. Their sugar intake skyrocketed, and hence, so did their rates of diabetes and obesity. 

The Thrifty Gene Theory

According to the National Institute for Diabetes and Digestive and Kidney Diseases, the “thrifty gene” theory suggests that Native Americans – as well as African Americans, Hispanic Americans, and Asian Americans – inherited a gene from their ancestors, which enabled them to use food more efficiently during “feast and famine” cycles. Today there are fewer such cycles; this causes certain populations to be more susceptible to obesity and to developing type 2 diabetes.[v] 

More than the feast and famine aspect, the thrifty gene theory can be easily explained by the thousands of years in which the Pima and other First Nations communities in Southern Arizona lived on an extremely low-calorie, high fiber diet.

In her 2012 article, “Feces Fossil Sheds Light on Native Americans’ High Diabetes Risk,” LiveScience writer Stephanie Pappas reports that the southwest diet consisting of prickly pear, yucca and flour ground from plant seeds was 20-30 times more fibrous than today’s typical diet.  This centuries-old diet had a very low impact on blood sugar level, thus making this group more susceptible to type 2 once the “richer Anglo foods made their way to North America.”[vi]

In her article Pappas shared the findings of forensic sciences Professor Karl Reinhard of the University of Nebraska, who discovered the indigenous “southwest diet” by analyzing fossilized feces. According to Reinhard, once the ancient nutritional regimen was replaced by Americanized foods with a super-high glycemic index, the Native American body could not produce enough insulin to break down sugar from food, or worse yet, the cells failed to recognize the insulin it was producing. In other words, a digestive system that was a model of efficiency shaped by centuries of low-calorie, high-fiber foods could not adapt quickly enough to the new American diet.

Genetics notwithstanding, Caucasian Americans of European ancestry also had a food culture that – before the industrial revolution – consisted of virtually no added sugars; while the rare craving for sweet tastes were fulfilled with the occasional fruit or bit of honey. And while there may be a genetic predisposition that is not as susceptible to developing type 2, the predominance of added sugars in the western diet puts us all at risk. 

Reservations as "Food Deserts"food deserts

Perhaps the biggest point to the Native American phenomenon is that reservations are essentially “food deserts” for healthy dietary options. Food deserts are more familiar terms for lower-income urban neighborhoods in which residents have to travel a long way for groceries, but can easily be applied to reservation life, especially given the exceedingly higher rates of diabetes and obesity there.

When comparing reservation life to mainstream supermarkets and other food shopping outlets in metropolitan America, the availability of fruits and vegetables, as well as healthier options seem to give way to the interior aisles (and frozen food sections) of processed goods that are filled with added sugars, high sodium, bad carbohydrates and artificial ingredients.

Since 1998, a federally-funded Special Diabetes Program for Native Americans has made significant gains in improving the health of the many diabetics. There is a growing sovereign food movement to recover old agricultural practices and Native American cuisine. However, the incidence of diabetes, especially among children, continues to rise.[vii]

The prevalence of type 2 diabetes among Native American youth should be the most alarming element of this examination. Consider the food and beverages and “faux healthy snacks” that are marketed and peddled to all American youth, and it is not a stretch to say that we are moving toward a self-imposed reservation diet for our children as well as for adults.

And the only consolation for us non-Native American adults is that we will die slower. 

But like our First Nation's contemporaries, we will watch our youth suffer from the same dubious struggles and health risks of the same disease at a much earlier age. 

This is what defines a pandemic.

 View More  Diabetes Resources

[i] https://www.cdc.gov/media/matte/2011/11_diabetes_Native_American.pdf

[ii] https://www.cdc.gov/media/matte/2011/11_diabetes_Native_American.pdf

[iii] http://america.aljazeera.com/watch/shows/america-tonight/america-tonight-blog/2013/8/28/5-huge-native-americanhealthissuesyoudontknowabout.html

[iv] http://america.aljazeera.com/watch/shows/america-tonight/america-tonight-blog/2013/8/28/5-huge-native-americanhealthissuesyoudontknowabout.html

[v] http://vltakaliseji.tripod.com/Vtlakaliseji/id2.html

[vi] http://www.huffingtonpost.com/2012/07/27/feces-fossil-native-americans-diabetes-epidemic_n_1701404.html

[vii] http://america.aljazeera.com/watch/shows/america-tonight/america-tonight-blog/2013/8/28/5-huge-native-americanhealthissuesyoudontknowabout.html

Sean Browne

Sean Browne

Former Chief Revenue Officer, CCS Medical

Subscribe to Blog Updates