September Article Summary

The Medicine Wheel Nutrition Intervention: A Diabetes Education Study with the Cheyenne River Sioux Tribe



The Northern Plains Indians, in particular the Indians of the Cheyenne River Sioux Tribe, like the rest of the United States, have experienced an increased prevalence of obesity and Type 2 Diabetes. This is due to the various dietary and lifestyle changes that they have encountered in the past seven generations. Before they were interrupted by American habits, these Indians consumed a wide variety of wild plants and animals that were rich in protein, moderate in carbohydrate, low in fat, and rich in antioxidants. Important to take note of are the wild plants, which included things such as wild turnips, potatoes, roots, onions, mushrooms, nuts and seeds. All of these items were slowly digested and facilitated a healthy balance between blood sugars and insulin levels. It was after World War II that these Native Americans began to participate in the modern economy, and they began to consume higher carbohydrate loads in their diets. As a result, these individuals are experiencing rates of Diabetes that are 3 times higher than the overall US population. Similarly, American Indians experience higher rates of Cardiovascular Disease and related risk factors than the US population as a whole (2).

A 6-month, randomized, controlled trial was conducted in an effort to determine who would obtain better control of their Diabetes. The participants consisted of 104 American Indians aged 18-65, all of which had Type 2 Diabetes. There was an education intervention group that received their usual dietary education along with the Medicine Wheel Model for Nutrition; a series of culturally adapted educational lessons. It encouraged participants to consume a diet patterned after their traditional consumption of macronutrients; protein (25%), carbohydrate (45-50%), fat (25-30%). The second group was the control group, whom only received their usual dietary education.

The results showed that the education intervention group had a significant mean weight loss and a decreased in BMI from baseline to completion. The control group did not experience any changes in weight or BMI. Interestingly, there were no significant differences in physical activity level or dietary intake for either of the groups. The education intervention group and the control group had macronutrient intakes similar to that of the U.S. population at the end of the study. Therefore, the hypothesis that the educational program would empower the subjects to choose diets that patterned their native diet was wrong. However, although the participants did not reach the goal of 20-25% protein, there was an upward trend in protein consumption (14% -18%), and a downward trend in fat intake in the intervention group, though not significant.

In summary, the results of the study are inconclusive. Professionals should not be discouraged however, as this trial is one of the first studies reported that attempts to measure the influence of the traditional Northern Plains Indians diet on control of type 2 diabetes. Additionally, while not Type 2 Diabetes specifically, it was found that dietary intake estimates of several vitamins known to modify CVD risk were below national recommendations and intake estimates of several macronutrients and dietary cholesterol were higher than recommended among many Strong Heart Dietary Study, Phase II, participants (2). It is likely that these vitamins that modify CVD risk would also aid in better control of Type 2 Diabetes. In order to determine whether or not the traditional dietary habits of the Native Americans will result in better control of Type 2 Diabetes, future studies are needed.



(1) Continuing Education Article:

http://download.journals.elsevierhealth.com/pdfs/journals/0002-8223/PIIS0002822309007627.pdf


(2) Additional Article:

http://download.journals.elsevierhealth.com/pdfs/journals/0002-8223/PIIS0002822305015506.pdf