The diabetes epidemic in Indian Country:

September 21, 2010

The diabetes epidemic in Indian Country:
Mark K. Tilsen, assistant director of marketing for Native American Natural Foods, sat down recently with Marcella Gilbert, a leading nutritionist at Whirling Thunder Wellness, based in Nebraska, for some straightforward talk about the ongoing health crisis in Indian Country. Here is his account:

A conversation with nutritionist Marcy Gilbert

The coffee is Dark Canyon Highlander Grog. The place is Tanka Bar Headquarters, Kyle, S.D. The smell in the air is of the Tanka Dog, our 90-gram, 100 percent all-natural, all-buffalo hotdog, and I am here visiting with Marcy Gilbert, one of the leading nutritionists for the Winnebago Tribe of Nebraska.

Marcy has generously decided to review the Tanka Dog from a nutritional perspective and to see if the product could work for the health programs and diabetes prevention initiatives she works with.

While she was here, I thought it'd be an interesting change of pace for us to do a question-and-answer session.

'Now it's the normal or skinny kids who get terrorized'

Tanka Bar: How long have you been interested in nutritional health?

Marcy Gilbert: Since, shoot... I started getting interested in vitamins, basic stuff, when I was 18.

TB: What brought that on?

MG: Well I was a runner and you know when you maintain any kind of state of health your try to expose yourself to healthful ways of living. What do vitamins do for you, what vitamins should I be taking? It started out as trying to take care of myself and learning through magazines. I used to subscribe to Muscle and Fitness (laughs) that was my main one. I was also interested in bodybuilding.

TB: You mentioned that you were a runner. Did you ever compete?

MG: I did in seventh grade as part of school, but not really competitively. I was on the pow-wow trail for most of my life and participated some of the runs that surrounds the pow-wows.

I noticed when I was running in those road races, Grace Her Many Horses, she was one of the top dancers and she has always ran. I'm gonna dance fancy (Fancy Dancing is a pow-wow style of dance.) as long as she does and I'm gonna run as long as she does.

If you were serious about your dancing, you also had to be serious about maintaining a sense of health. I took it a step further by eating right; cutting out pop, salt and this is back when next to no one around was doing that.

The motivation to stay healthy was I want to live. I want to live a long life, not just survive or be in a wheelchair, but really be healthy. The only way to have a long life worth living is to be healthy.

I started my kids out on healthy diets. I didn't put sugar in their cereal or salt on their plates. We drank juice and water, ate lean meats and lots of vegetables. They ate a whole variety of fruit and vegetables.

They'd get called names at school, believe it or not. My daughter gets called anorexic, but they are really normal weight. I have to get them motivated to move around, but at least they eat well. None of them are overweight or obese.

I remember when my mom said when people are their normal weight they are going to be abnormal. When I was a kid, it was the fat kids who got teased and now it's the normal or skinny kids who get terrorized.

'Your people have so much land; how come you don't feed yourself?'

TB: What do you feel is the most significant threat to Indian country today from a nutritional perspective?

MG: Well aside from the obvious, I think our people have reached a point of colonization where we expect to be taken care of. And it's getting worse as our generations move forward. We are taking control of our lives, but it's so hard to do to when you live with fatalistic attitudes.

People think, "Well my mom had diabetes so I'm going to get it." But that's not really the case. That's the downfall of our health; we are expecting someone else to take care of it.

A friend of mine works for a society over in Rosebud (Reservation in South Dakota), a South American, and he asks, "Your people have so much land; how come you don't feed yourself?"

Dang, that's a really intense question; if we did, we would be healthy. Everybody knows that we did gardens and had farms and fed ourselves and we were healthy. It's not like we don't know how.

TB: What hopeful signs do you see in Native communities?

MG: I see there are pockets of people among our homelands that are being proactive in starting their own schools and programs and group empowerment, whatever it might be. But working together as a collective? These pockets of people are moving forward and really trying to make a difference in their communities and even just in their own families.

Media plays such a huge role in this. I think media is going to be a big role in having these conversations, in connecting these isolated pockets of progress. Young people are going to play a big role in this change, or at least they should be. They live in media; they just need the direction and guidance.

TB: What is a great example of a trend or program that is facilitating a change in health?

MG: There are several examples. There is a whole movement of Indian Country making moves and differences and a lot of them are evolving. Gardening is a big deal. Bringing people back to the Earth that way. They don't have to make a huge decision about identity. It's simple; they plant food to eat.

Native Movement is doing great gardens down south. Anything that is going to direct young people in a direction of empowerment is good. Knowing what it feels like, what it is to make your own decisions and feel good is what creates good leaders.

It is going to take a while to see major changes in Indian Country where people are going to move toward regaining their health. No Federal agency is going to do it for Indian people. We have to do it ourselves. It's an individual choice, a family choice, and a community choice to be healthy. I think Tanka Bar is one of those examples.

We have a generation of young people who don't know who they are.

'Every reservation has a diabetes program, but our diabetes rate is still going up'

TB: What are the most significant improvements that can happen in our communities to create change?

MG: Awareness and education is key. If you become aware or educated, you can't be ignorant anymore. You have that knowledge and you can only move forward.

What do we do with this knowledge? If we don't have the funds to go to college, start a business, or farm, where do we find these opportunities?

And. of course. culture is a big part because we are getting so far removed from our (traditional) culture. We are so far removed -- we see pictures and hear stories, but that's it.

Again, there are pockets of people who hunt, have the horse culture, speak the language and have that knowledge. As we move further and further away from that old culture, we have a generation of young people who don't know who they are. They have an idea, but it doesn't mean they understand.

I ask youth, "Are Native people related to the land?" and I get a lot of blanks stares. On one of my camps we hold, I had all traditional food; chiyaka, choke cherries. The kids, ages 8-14, most never tried the food. They were afraid to try them. I had to explain that this is the real food we ate before there were grocery stores and asked, "What do you think we ate before reservations?"

Young people have screens in their faces since day one. We have little screens in their cribs at day one and it never stops. They get their knowledge from media. If we are busy parents we put them in front of cartoons, which is just promotion of food products, sugar.

They are being taught that what they see on the screen is real. What you see, you can buy, and this is a huge disservice to our way of life. We need to change that or use it to our advantage or we are going to see Indian people eating themselves to death.

On the pow-wow trail, I see little kids, babies almost, drinking 20 ounces of pop and that education has to get through.

Every reservation has a diabetes program, but our diabetes rate is still going up. What is going on?

We need to put value in our culture; we need have a cultural base as a foundation. Each generation now only has a few families that have horses. When I was young, everyone had horses, and that's how kids who got around, actually travelled from place to place on reservations.

Being entertained, we have to be entertained at all times other wise we don't know how to be or how to act.

People no longer even have to have conversations; we are checking our texts and being bored with reality [Ironically, my phone began ringing with an incoming text]. We don't know how to modify our environment. We are just letting the world happen to us and people wonder why we have diabetes.

This culture is not everywhere. The majority of Indian people are removed from their culture.

I went to a pow-wow and it's noticeable how heavy people are. By the fourth day of the pow-wow, my son sighed and said he's just tired of seeing fat people. We didn't laugh then, but it's true. We looked at who was healthy and it was the dancers, and they are going to be the survivors here and carry on the culture, as deluded as it is.

This is much more serious than people realize. Our people are being consumed by obesity. People are reacting out of fear. You can't start with teen-agers; you need to start with the children. Food addictions start so young. Oftentimes, even, it begins with formula.

This is a battle and it can be losing battle. You love your children, so you try to give your kids whatever they want. I fight with my family to keep from giving them pop and fast food. And I've even gone so far to say, "You can't take my kids if you are going to feed them that crap." Of course, they got it once in a while, but we have to do something.

It's not about waiting. We have to do something. We have reached a point where only the strong are going to survive. It's an epidemic and the question is not what change to make, but who is going to survive.

We have identified two very young people, who are Type 2 diabetics under 10 years old, something almost unheard before now. Is this the next step of the disease?

We see a lot of gestational diabetes and that means your baby's blood sugar is high a lot of the time. It has an effect on formation of organs of the fetus; your blood sugar damages your organs when it's too high. Imagine what that is doing the baby you are carrying for nine months. You are already having organ damage and blood vessels, and, when they baby is born, their pancreas is already fatigued.

By the time they are pre-school their pancreas gives out and they are already Type 1 diabetics. When we found these two young people, this was something beyond our training. We were trained to deal with Type 2 Diabetes ,we were not set up to deal with Type 2 Diabetes in children so young.

I work in prevention and this work has got to start before the girls get pregnant. Otherwise, this gestational diabetes leads to full onset diabetes.

You can't make people healthy or be active.

TB: Well we haven't tried at gunpoint yet.

MG: Ha, ha, that's true.

'Whenever you hit the point of needing dialysis, it's already too late'

TB: How do you think we make behavior changes?

MG: Unfortunately, we wait until the last minute. We wait until our lives are in danger. When you are overweight, everything in your body is under stress. Nowadays, it's normal to be heavy. People are accepting that everyone is fat.

Whenever you hit the point of needing dialysis, it's already too late. You can only prolong your life.

A barrier: People expect to be paid to do anything nowadays. You don't have people who are willing to going go out and create an athletic program. What's the incentive? And it's still the hand-out mentality. Few people take pride in being the definition of a citizen, taking care of your family, your community and doing it without compensation.

We have removed ourselves in taking pride in that. We don't recognize people who do things without being paid. The whole mentality, "I'm only worth as much as they pay me," needs to die. Something needs to change.

One change a young person could make to impact their health: Move around, that simple. Yeah, we may have to buy crummy food, but physical activity is the key to health. In Winnebago, we have a community garden that's all vegetables and it's like pulling teeth to get people to help maintain.

Activity has so many benefits. Being active works better than medication for mild depression. It's not just about what you eat but you need to get out and move around. Walking, running, playing, whatever it takes. Hauling wood, water and whatever else.

Marcella Gilbert: Biographical information:
Current employer: Winnebago Tribe of Nebraska, Whirling Thunder Wellness Program
Education: Masters of science in nutrition from SDSU.
Tribal affiliation: Cheyenne River Sioux Tribe

For more information: The Winnebago Tribe of Nebraska

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