Canada’s Food Guide and Native Women

This is a paper I wrote a few years ago and there have been slight changes to the Food Guide since then but my observations are still relevant.  I’d love to hear any latest research or personal stories.   All rights reserved.

The Canada Food Guide for First Nations, Inuit and Metis: Helping or Harming First Nations Women?

Many health conditions that aboriginal women in Canada suffer are diet related.  Not only do aboriginal women have less access to health care and are more vulnerable to discrimination, abuse and poverty than other demographics, they also suffer disproportionately from diet related conditions. The government is aware of this and Canada’s Food Guide has recently (2007) made some effort to address the dietary needs of First Nations people with instructions for pregnant women.  It claims that by following it you will “lower your risk of obesity, type 2 diabetes, heart disease, certain types of cancer and osteoporosis” (Canada Food Guide).  However, some of their solutions are part of the problem.   Diabetes, celiac, lactose intolerance, IBS, and nutrient deficiencies are actually promoted by a Canada Food Guide that does not take into account the unique physiology of Native women.

Diabetes is a life-threatening disease.  Complications range from increased chance of heart disease, to loss of limbs, vision, and ultimately death (Brown, 2004).  In Canada, diabetes disproportionately affects First Nations people with numbers as high as 20% of adults which is 3-5 times higher than other Canadians (NAHO, 2009).  First Nations women are more likely to have diabetes than their men (NAHO, 2009).  If she is pregnant and on a reserve, a Native woman may have more than 9 times the risk of other Canadians to develop Gestational Diabetes (Canadian Diabetes Association, 2005-2009a, Dyck et al., 2002).   Not only is she more likely to have the condition, but she and her children suffer more health consequences from it (NAHO, 2009).

High glucose levels in the blood are teratogenic; it adversely affects the development of the fetus including impaired intellectual development (Brown, 2004).  A child whose mother had gestational diabetes (GDM) is more likely to struggle with obesity and diabetes later in life (CDA, 2005-2009a; Harris et al., 1997, p. 1422; Dyck et al., 2002, p. 487) .  Immediately after birth the child is more likely to have dangerously low blood sugar levels and jaundice which may require extra care (CDA, 2005-2009a; Harris et al., 1997, p. 1422).  The birth itself is more likely to have complications since the infants of women with diabetes are usually larger (Harris et al., 1997, p. 1422) .  This can lead to higher incidences of shoulder distocia of the infant during birth with temporary or permanent nerve damage and increased need of cesareans (Berger, Crane, & Farine, 2002, p. 4, Brown, 2004) .  A First Nations mother who has GDM increases her risk of developing type 2 diabetes by 70% while a non-First Nations woman has only a 40% chance of developing type 2 diabetes later on (Berger, Crane, & Farine, 2002, p. 4).  Aboriginal mothers with GDM are also at increased risk of high blood pressure during pregnancy which has detrimental effects for both mother and child including higher risk of stroke later in life and increased infant and mother mortality rate (Dyck et al., 2002, p. 491, Brown, 2004 p 121).  

There are many factors contributing to why Native women are more at risk for diabetes.  Native women often have limited access to resources, quality food, education and health care.   The loss of traditional lifestyle is a key factor and studies show that those people who retain or reclaim a more traditional lifestyle have lower rates of diabetes (Wortman, n.d.).  But even without the poverty and resource based reasons, simply being aboriginal is a risk factor (NAHO, 2007).  Their physiology is different from that of those of agrarian background whom the Canada Food Guide is based on.   While Canada’s Food Guide has made an effort to include traditional foods and be available in several different First Nations languages, it has not taken into account the metabolism differences between the First Nations and the European or Mediterranean peoples.  If a First Nations woman follows the suggestions of the Canada Food Guide, she may be eating bannock instead of bread, or wild game instead of domestic meat, but the proportions of nutrients suggested are the same as a person of solely European descent.  This is very important because the proportion of nutrients affects her blood sugar levels in different ways than someone of only European descent.

It is normal for a pregnant woman to become slightly carbohydrate intolerant, especially in her third trimester (Brown, 2004).  This impacts a First Nations woman even more because, according to researcher Dr. J. Wortman, who is currently running studies on this and blogging about it, she may not metabolize carbohydrates well even when not pregnant.  Native people have a physiology adapted to a diet higher in fibre, protein, and fats and lower in carbohydrates and the addition of extra carbohydrates has shown to be detrimental (Shephard & Rode, 1996).

If one follows the Canada Food Guide’s suggested servings, she will find approximately 60% of her caloric intake from carbohydrates, 25% from protein, and 15% from fat.  This is fine for someone of agrarian background.  The traditional Native diet is much higher in protein and fat and lower in carbohydrates.  From someone of Inuit background this is even more pronounced as their traditional diet was on average 70% fat and 30% protein with minimal carbohydrates (Gadsby, 2004).  Most traditional First Nations diets ranged from 30-40% protein, and that does seem to be human’s upper limit of protein before ketonuria or protein poisoning (Gadsby, 2004).  To metabolize such a diet, Native peoples often have larger livers and urine output, and a much lower tolerance for glucose.  Several studies have shown that reducing diabetes and hyperglycemia is as simple as following a diet low in carbohydrates and higher in good fats (Allick G., et al., 2004) .

The Canada Food Guide does not take into consideration the traditional diet proportions.  It has simply taken the Food Guide created for an agrarian society and added a few ‘traditional’ foods, some of which are not even traditional.  Of the grain products shown, only wild rice was used before the Europeans came.  Including bannock as a traditional meal is like saying horseback was a traditional mode of transportation although it was used for a short period of time after the Europeans introduced it and both have cultural importance.  Such a high emphasis on grains in the Canada Food Guide is a recipe for increased risk of diabetes and obesity for a woman of First Nations ancestry (Gadsby, 2004).

While the aboriginal peoples did get a majority of their calories from fat, the Canada Food Guide calls for restricted fat.  This is because the most of the calories in the Guide come from grains.  Not all fats are beneficial for humans and most saturated fats can be damaging (Brown, 2004).  Animals which are grain-fed have high levels of saturated fats and this should be minimized (Gadsby, 2004).  Monounsaturated fats (MUFAS) are anti-inflammatory and protective against heart disease, depression, arthritis, and stroke (Brown, 2004).  These are found in plant sources, marine animals, and wild or grass fed animals (Gadsby, 2004).   By severely restricting all fats to their recommended few tablespoons, the Food Guide promotes a diet which leaves First Nations women more vulnerable to inflammatory conditions, such as heart disease, and forces them to get the majority of their calories from grains.

Some studies show a link between diabetes and other chronic illnesses and low vitamin D levels (Vitamin D, 2010).  Northern Canada does not have enough sunlight to support adequate vitamin D production (Brown, 2004).  Low vitamin D is related to higher rates of depression, cancer and osteoporosis as well as rickets in children (Weiler, Fitzpatrick-Wong,  Veitch, Kovacs,  Schellenberg, McCloy, & Yuen, 2005).  Aboriginal women have much higher rates of vitamin D deficiency, 32% compared to 18.6% of non-aboriginal white women (Weiler, Leslie, Krahn, Steiman and Metge, 2007).  One study found deficiency rates as high as 76% in Aboriginal women of Northern Manitoba (Weiler et al., 2005).

The Food Guide’s recommendation for Aboriginal women to consume vitamin D fortified milk is not helpful since 95% of First Nations adults are lactose intolerant, second only to people of Asian ancestry (McCracken, 1971) .  Only one of seven options under “Milk and Milk Alternatives” does not contain dairy. The side effects of consuming lactose for someone who is lactose intolerant include gas, bloating, diarrhea, and in severe cases, vomiting (O’Neil, 2001). Women are encouraged to consume a larger percentage of their diet from dairy than men by the Food Guide.   Recommending a woman to get her vitamin D through sources that will most likely cause her abdominal pain and diarrhea is not appropriate.

Instead of addressing the nutritional profile that dairy products can provide, the Food Guide simply recommends dairy.  Traditionally First Nations people obtained the macrominerals such as calcium through bones boiled in stews or the smaller softer bones from fish.  There is no mention of this is in the Food Guide.  Instead, the women are given the option of eating dairy products or an expensive dairy substitute.  First Nations women who have food security and have trouble affording milk will not be able to buy the much pricier almond or hazelnut milk.

At least the Food Guide mentioned lactose intolerance and gave an alternative source.  It did not mention celiac, or wheat intolerance, at all.  According to a presentation by Dr. Green of Columbia University, rates of diagnosis of celiac are rising.  In North America celiac affects approximately 1 % (Green, n.d.).  Celiac disease leads to higher risk of anemia, osteoporosis, cancer, depression and mental fog, and difficulty in maintaining healthy weight (Green, n.d.).  A study of 4633 people in Germany found that women who have undiagnosed celiac have mortality rates from cancer 2.7x higher than men, and overall mortality was 2.1x higher (Eur J Epidemiol, 2008; as cited in Green, n.d.).

There are several risk factors for celiac that are much higher for First Nations people.  Lactose intolerance has been linked with undiagnosed celiac disease and the Canadian Digestive Health Foundation states that “25% of patients who have been clinically identified as lactose intolerant, have celiac disease” (Lactose Intolerance, n.d.)  GI infections are also a risk factor in developing celiac disease and First Nations people have an H-pylori rate of 75% (Statistics, n.d.)- the highest in the country.

Aboriginal women have less access to medical care and less chance of diagnosis and therefore a higher probability of living with undiagnosed celiac.  While I could not find specific numbers for rates of celiac in aboriginal women, several First Nations women I have talked to mentioned specific bowel pain when eating breads and the relief they have found when going off wheat.  We still do not have the data to understand how this impacts the health of aboriginal women, but when the studies do come in I predict they will not be favourable.  All of the grains except for the one picture of rice in the Food Guide are wheat based.

Canada’s Food Guide has an opportunity to bring the latest scientific knowledge to the average First Nations woman.  They have not done so.  Instead, they have redwashed a Guide based on European origin diets.  Despite findings that many First Nations and Inuit people may have adverse health impacts from the diet they promote, despite studies showing health benefits for First Nations people who follow a more traditional diet, they only changed the graphics.  This action shows an unconscious disregard for the struggles of Native women across this country.  Those women who are most vulnerable to poverty, abuse and discrimination should not have to endure yet more attacks on their health.

I wish for Canada’s Food Guide to apologize to the First Nations women.  I wish for them to acknowledge the wisdom of their traditional diet without co-opting certain foods from it and tacking them onto something harmful.  If diet can be addressed, many of the diseases and conditions that First Nations women face can be reversed.  It is time that food become once more a source of life and empowerment instead of another form of violence.

Cited
Allick, G., Bisschop, P. H., Ackermans, M. T., et al. (2004). A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis. Journal of  Clinical Endocrinology Metabolism. 89:6193–7.

Berger, H., Crane, J., & Farine, D. (2002) SOGC Clinical Practice Guideline: Screening for
gestational Diabetes mellitus. Journal of Obstetrics and Gynaecology Canada. 121, 1-10.

Brown, J., Isaacs, J., Krinke, U., Murtaugh, M., Sharbaugh, C., Stang, J., & Wooldridge, N. (2004) Nutrition Through the Life Cycle.  (2nd Ed.)  Brown, J. (Ed.) Toronto, ON: Nelson.

Canadian Diabetes Association. (2005-2009a). Gestational diabetes: preventing
complications in pregnancy. Retrieved from: http://www.diabetes.ca/aboutdiabetes/what/gestational/

Dyck, R., Klomp, H., Tan, L.K., Turnell, R.W., Boctor, M.A. (2002). A comparison of rates,
risk factors, and outcomes of gestational diabetes between Aboriginal and nonAboriginal women in the Saskatoon Health District. Diabetes Care. 25(3), 487-493.

Eating Well with Canada’s Food Guide First Nations, Inuit and Métis.  Health Canada.  Retrieved from http://www.hc-sc.gc.ca/fn-an/pubs/fnim-pnim/index-eng.php#a_6

Gadsby, P. (2004, Oct.). The Inuit Paradox.  Discover Magazine. Retrieved from http://discovermagazine.com/2004/oct/inuit-paradox/article_view?b_start:int=3&-C=

Green, P. Celiac Disease: Why the Underdiagnosis? [Power Point Slides] Retrieved from http://www.beyondprinting.com/harvard/ny11/pdf/S6B-415-Green-Celiac-NYP11.pdf

Harris, S.B., Caulfield, L.E., Sugamori, M.E., Whalen, E.A., Henning, B. (1997). The
epidemiology of diabetes in pregnant Native Canadians. Diabetes Care. 20 (9), 1422-
1425.

Lactose Intolerance.  Canadian Digestive Health Foundation.  Retrieved from http://www.cdhf.ca/digestive-disorders/statistics.shtml

McCracken, R. D., (1971). Lactase Deficiency: An Example of Dietary Evolution.
Current Anthropology 12:. 479-517.  (As cited from O’Neil in Nutritional Adaptation Retrieved from http://anthro.palomar.edu/adapt/adapt_5.htm)

NAHO. (2009). Gestational Diabetes and First Nations Women: A literature review. First Nations Centre, National Aboriginal Health Organization.  Retrieved from http://www.naho.ca/documents/fnc/english/gestational_diabetes_first_nations_women.pdf

O’Neil. (2001). Nutritional Adaptation.  Retrieved from http://anthro.palomar.edu/adapt/adapt_5.htm

Shephard, R.J. & Rode, A. (1996) The health consequences of “modernization”: evidence from circumpolar peoples. Cambridge, United Kingdom: Cambridge University Press, 1996.

Statistics.  Canadian Digestive Health Foundation.  Retrieved from http://www.cdhf.ca/digestive-disorders/statistics.shtml

Weiler, H., Leslie W, Krahn, J., Steiman, P.W., & Metge, C. (2007, Feb). Canadian Aboriginal Women Have a Higher Prevalence of Vitamin D Deficiency than Non-Aboriginal Women Despite Similar Dietary Vitamin D Intakes. The American Society for Nutrition Journal, 137:461-465. Retreived from http://www.ajcn.org/content/86/2/276.full#R22

Weiler, H., Fitzpatrick-Wong, S., Veitch, R., Kovacs, H., Schellenberg, J., McCloy, U., & Kin Yuen C. (2005). Vitamin D deficiency and whole-body and femur bone mass relative to weight in healthy newborns.  Canadian Medical Association Journal, 172(6):757-61. Retrieved from http://www.cmaj.ca/content/172/6/757.full.pdf

Wortman, J. The Story So Far…  Dr. Jay’s Blog.  Retrieved from http://www.drjaywortman.com/blog/wordpress/about/

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