1. Medicine Wheel Nutrition Medicine Wheel Nutrition

2. Sioux Tribes in South Dakota

3. Workshop Outline Original Indigenous Foodways Health Transitions Utilizing Indigenous Symbols/Messages Tribal Food Sovereignty in Action

4. Tribes of a common region often shared a similar foodway. Tribes of a common region often shared a similar foodway.

5. Images of Wellness Chief Red Cloud Bone Necklace - 1889

6. Images of Wellness

7. Wm. Denver McGaa family - 1937

8. Original American Foods

9. 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.

10. Native American Food Crops Tomato Beans Peanuts Sunflowers Avocado Squash Chili Peppers Coffee Corn Cocoa Berry Varieties Pumpkin Pineapple Potatoes

11. Slow foods - absorption keeps pace with insulin production

12. Corn Increased the supply of meat and lard Also, eggs, milk, butter, cheese all and all domesticated animal products Population Impact in Europe: 1650 to 1950 100 million to 600 million

13. Lived in Balanced - Cycles Wherever power moves,it moves in a circle. Black Elk, Oglala, Lakota

14. Salmon Fishing -

15. Salmon – Sacred Sustenance “Their existence is vital and linked to ours, we will not allow them to go extinct”

16. . Lakota Name Canpa (Chan-paw ) Chokecherries  means bitter wood stem Scientific name - Prunus Virginiana

17. A variety of nutrients

18. 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

19. Native Teas - California Common Mint Rosehip Raspberry Red Clover Manzanita Berry Madrone Berry Sumac Berry Medicinal Cedar Sage Bitter Root Yurba Buena Wormwood Elderberry

20. “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

21. Time Spent on Food

22. 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

23. 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

26. 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.

27. “ 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.

28. (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.

29. 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)

30. Diabetes Prevalence Native Americans have the highest age- adjusted 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.

31. Food Sovereignty The rights of all peoples to decide how they will hunt, grow, gather, sell or give away their food. www.treatycouncil.org

32. 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. Strengthening our Traditional Food Systems

33. 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.

34. Winona La Duke White Earth Land Recovery Project

35. Recovering Traditional Foods to heal the People www.honorearth.org

36. 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.

37. The Medicine Wheel, representing the four dietary components of the traditional Northern Plains Indian hunter/gatherer food pattern

40. 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.

41. Comparison of Meats (3.5 oz Portion) Hot Dog Fat - 25 grams Protein - 12 grams Saturated Fat 10 g Contain Nitrates/Salt Salmon  Essential Fatty acids  Protein Rich  Saturated Fat – 1 gr.

43. Traditional Cooking Methods Boiling Stones/baskets Roasting Hot Coals Baking E arthen Pit Drying Frying is not Traditional Copyright 2001, Licensed to Northern Plains Nutrition Consulting

47. 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

48. 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 Kattelman, K, et al. J Am Diet Assoc. 2009; 109 (September) JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

50. Four Bands History

51. 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.

52. 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

53. Diet Composition Change – Plains Indians 48% 37% 15% 47% 28%25% 40% 20% Hunter/Gatherer DietEarly Reservation EraModern Diet Source: The Strong Heart Study, 1993 Welty, Zephier. Source: Yvonne Jackson, 1994, Diabetes: A Disease of Civilization. Mouton de Gruyter.

54. 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.

55. 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.

56. 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.

57. Medicine Wheel Symbol A symbol used by Native American to represent wholeness and balance

59. 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 Education Group a Usual Care Group a BaselineCompletionWithin group change from baseline to completion b BaselineCompletionWithin group change from baseline to completion b Comparison of between group change c Weight (kg)95.9±3.694.1±3.6↓ 1.4±0.4 * 96.4±3.294.1±3.2↓ 0.5±0.5P=.1219 BMI d 35.0±834.3±8↓ 1.0±0.1 ** 34.3±1.133.7±1.1↓ 0.5±0.2P=.2375 HgA1C (%.) e 8.9±0.48.4±0.3↓ 0.3±0.38.6±0.38.5±0.3↓ 0.2±0.2P=.5563 Glucose (mg/dl) f 206±12197±12↓ 9±11201±10183±10↓ 18±10P=.4849 Triglycerides (mg/dl) g h 202 (170, 238)227 (192, 262)↑ 30±17232 (199, 265)222 (189, 257)↓ 17±12P=.0215 Total cholesterol (mg/dl) i 204±6199±8↓ 5±5203±6187±6↓ 14±5 ** P=.2619 HDL – C (mg/dl) j 47±245±2↓ 3±150±242±2↓ 6±2 ** P=.1199 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

60. 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 Group a Usual Care Group a BaselineCompletionWithin group change from baseline to completion b BaselineCompletionWithin group change from baseline to completion b Comparison of between group change c LDL – C (mg/dl) k 115±5107±4↓ 7±4109±2102±5↓ 5±5P=.6634 VLDL –C (mg/dl) l 37±2 ↓ 0.5±241±240±2↓ 2±2P=.3464 Insulin (uIU/mL) g m 31 (25, 36)42 (22, 62)↑ 12±932 (27, 37)32 (26, 38) 0±3P=.1480 Systolic blood pressure(mm Hg) 129±2128±2↓ 1±2129±2126±3↓ 2±2P=.6522 Diastolic blood pressure(mm Hg) 73±1 ↓ 1±172±169±1↓ 3±1P=.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

61. 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 Education a Usual Care a Month 1Month 2Month 3Month 4Month 5Month 6Month 1Month 2Month 3Month 4Month 5Month 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 ± 13185 ± 11203 ± 15190 ± 18188 ± 16 195 ± 14 Prot (g)57 ± 457 ± 566 ± 567 ± 469 ± 473 ± 9Prot (g)68 ± 763 ± 467 ± 758 ± 462 ± 570 ± 5 Fat (g)75 ± 566 ± 772 ± 766 ± 668 ± 565 ± 5Fat (g)73 ± 665 ± 571 ± 858 ± 566 ± 769 ± 5 % Carb b 47 ± 248 ± 2 46 ± 248 ± 2 % Carb b 47 ± 249 ± 2 50 ± 248 ± 247 ± 2 % Prot c 14 ± 116 ± 1 18 ± 1 16 ± 1% Prot c 16 ± 1 17 ± 1 % Fat d 41 ± 239 ± 237 ± 2 36 ± 235 ± 2% Fat d 39 ± 136 ± 137 ± 235 ± 238 ± 237 ± 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.

62. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 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 (cont’d) Education a Usual Care a Month 1Month 2Month 3Month 4Month 5Month 6Month 1Month 2Month 3Month 4Month 5Month 6 Minutes per day of physical activity Mean ± standard error Light activity ef 21 ± 2 x 19 ± 2 x 17 ± 1 xz 17 ± 2 19 ± 1Light activity ef 24 ± 221 ± 225 ± 816 ± 115 ± 215 ± 1 Moderate activity eg 6 ± 15 ± 1 6 ± 1 7 ± 1Moderate activity eg 7 ± 28 ± 18 ± 26 ± 112 ± 65 ± 1 Vigorous Activity eg 0.6 ± 0.3 0.2 ± 0.1 0.4 ± 0.2 0.4 ± 0.1 Vigorous Activity eg 0.5 ± 0.2 0.3 ± 0.1 0.2 ± 0.2.1 ±.030.2 ± 0.1 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 ± 1 yz 16 ± 1 yz 17 ± 1 yz 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.

63. 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.

64. Increasing the access to healthy foods US Nutrition Assistance Programs – WIC, Food Distribution Program (Commodities)  Food Stamps Strengthen Community Food Systems Reduce Food Insecurity

65. 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.

66. 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..

67. Newest Federal Indian Health Medical Center

68. Mitakuye Oyasin All my relations