Reservation holds shocks in diabetes' prevalance


In May of 1983 my wife and I arrived at a small mission hospital at Monument Valley in southern Utah in the Navajo Nation. We had been told it was the most traditional of any place on the res.

Also it was said that if it wasn't the end of the world, you could see the end from there. But that is not really what this is all about.

When I graduated from medical school in 1953 and for a number of years after that I didn't see very many diabetic patients. The great majority of the ones I did see had Type 2 diabetes and were in their 50s or older.

It was a different story on the res, even at Monument Valley. I learned that 75 years before that diabetes was almost unheard of on the res. In 1988, I joined the staff at the Shiprock, N.M., Indian Health Service Hospital in the northwestern corner of New Mexico and discovered diabetes was four times as common among the Navajo as in Anglos. By that time it had largely become clear that sugar was not the culprit as far as causing diabetes, but rather fat.

Several years ago I heard Dr. Dean Ornish lecture and his lament was that Americans have a love affair with fat. It is important to note that in both Anglos and Native Americans, thin folks do occasionally get diabetes type 2 but in the majority of cases it is related to being overweight.

I also learned that the Kentucky Fried Chicken in Shiprock had the No. 1 sales in the nation and that the KFC in Chinle, Ariz., also on the res, was No. 2. Unfortunately, in too many instances the food in fast food places is high in fat, sugar and salt. It appears the white man's diet is killing the Indians.

Another sad problem was that in general it was significantly more difficult for the Navajo to maintain good control of their diabetes. Consequently too many of these folks end up on dialysis. There are many dialysis centers on the res.

In 1972, Congress granted comprehensive coverage under Medicare to virtually anyone with kidney failure regardless of age or income. It costs about $70,000 per year per patient for dialysis, which means that the government now spends about $20 billion yearly for this treatment.

The Pima Indians in southern Arizona are generally considered to have the highest rates of diabetes in the U.S. with roughly 50 percent of all adults afflicted.

Nowadays even children are developing type 2 diabetes. Before I retired from the Indian Health Service in 2007, I had learned that the youngest person in the U.S. to have Type 2 diabetes was a 5-year-old Pima boy.

The August 1997 issue of the journal The American Family Physician reported that the Pima Indians over the border in Mexico had only one-sixth the prevalence of diabetes compared to the Pimas in Arizona. The traditional lifestyle of the Mexico Pimas was that of considerable physical labor and a diet rich in vegetables, fruits and grains. The mean body mass index of the Pima in Mexico was 24.9 and the Pima in Arizona was 34.2, significantly heavier than their Mexican cousins.

I don't want anyone to think that I am taking potshots at Indians in general or Navajos in particular. Reservation living has many problems, and it is not only Indians who are showing up more and more with diabetes.

It appears that the observation made years ago in the Peanuts comic strip, as I recall by Charlie Brown, "We have met the enemy and they is us," is all too true when it comes to the health status of many Americans.

Dr. Don Casebolt of College Place is a retired physician who is passionate about preventive medicine. He spent four years as a medical officer in the U.S. Navy, the last 21/2 years as a flight surgeon. He also worked on the Navajo Reservation for 22 years.


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