Message #15:
From: AzTeC SW Archaeology SIG
To:   "'Matthias Giessler'" 
Subject: Pima Have Changed Because Of Close Proximity to the White Population
Date: Sat, 04 Jan 1997 21:52:37 -0700
Encoding: MIME-Version: 1.0

Diabetes: An Epidemic of Color  --  Type 2 ravages an ancient people 
--  For Pimas, diabetes is 'a way of life' 

GILA RIVER INDIAN RESERVATION, Ariz. - No one knows why diabetes has
attacked the People of the River so ferociously, but there is no
question it has. The Pima Indians, believed by some to be descendents of
the first humans to cross the Bering Land Bridge into North America,
have the highest known rate of diabetes of any people on Earth. More
than half of Pimas over age 30 are diabetic. The adult form of the
disease, which typically strikes those of European descent in their 60s
and 70s, reaches down and seizes Pima children as young as age 5.
"Around here, it's just a way of life," said James Tree, 52, a cook at
Hu Hu Kan Memorial Hospital. "It's funny, but people just wait for it to
happen to them. It's something they expect." Tree knows how the disease
can sweep through families. A diabetic for the past decade, his brother
and three sisters also are diabetic. Both parents died of complications
from the disease. "It's like my daughter. She's a little overweight. I
tell her, 'It's in the family. You're right in line for it. You have to
watch your diet and lose some weight.' It doesn't sink in. She says,
'I'm going to get it because you have it, Grandma has it; so what's the
use?' " That fatalistic view, say the doctors and nurses who work here,
is as destructive a complication of diabetes as the blindness, the
kidney failure, the gangrenous limbs and the heart disease that also
runs epidemic through this small desert community. "We're getting into
second, third, fourth generations with these uncontrolled sugars and
end-organ disease," said Dr. Dominick Kistler with the Indian Health
Service.  "Everybody has a relative who is on dialysis or lost his
eyesight. So it's almost a birthright in the community." Last year, one
young Pima hanged himself in despair over watching diabetes eat away at
his mother, said Mary Thomas, governor of the tribal council. "People
who go on dialysis, their color changes. Some refer to themselves as the
walking dead," said Thomas, herself a diabetic for 30 years. "That
somebody is just beginning to go into that, it's a scar they face.
That's the most terrible part about it, is the emotional scars." While
the Pimas are the best studied, American Indians as a whole have a
higher risk of diabetes - although the exact prevalence is unclear,
since those living on reservations have been excluded from national
health studies. "You go up to the Seneca (tribe) right in New York
state. They tell you the same thing: Diabetes is just the Indians'
curse," said Dr. Kenneth M. Weiss, distinguished professor of
anthropology and genetics at Pennsylvania State University. About 1.9
million U.S. residents identify themselves as American Indians. They are
a diverse group, scattered among 500 tribal organizations and more than
33 reservations. Diabetes death rates for American Indians are much
higher than for the population as a whole. One nationwide study found
the death rate was 2.7 times higher. Age- and sex-adjusted death rates
among Pimas between 1975 and 1984 was 11.9 times greater. Diabetes risk
is higher in full-blooded American Indians. Some researchers have
suggested that the degree of American Indian ancestry in
Mexican-Americans -on average, about a third of their genetic heritage -
is linked to the prevalence of diabetes in that group as well. The Pimas
are perhaps the best example of how frustrating a disease diabetes is.
They have been the best-studied of any group at high risk for diabetes.
The Indian Health Service has funded a hospital here for decades, and
the National Institutes of Health have operated a research clinic. And
still, diabetes rages on. The large number of adults disabled by
amputation and kidney disease has contributed to the impoverishment of
the Pimas. The recent arrival of gambling casinos on the reservation has
provided some jobs and income, Thomas said. The high prevalence of
diabetes among the Pimas was discovered accidently. In the 1950s,
researchers trying to learn if rheumatoid arthritis was related to
climate, undertook a health survey of the Pimas, as well as the
Blackfoot tribe in Montana. The fact that the Pimas had more arthritis
than the Blackfoot destroyed the researchers' hypothesis, but in the
process they found an incredibly large number of diabetics. The National
Institutes of Health established a diabetes study center here in 1963, a
project that continues today. The fact that years of research and
treatment have failed to make a dent in the problem has some Pimas
frustrated, said Viola Johnson, a Pima and administrator of the 20-bed
Hu Hu Kan Hospital on the reservation. "I think people understand
there's value in research. But it takes forever to get some results. So
if you talk to people who have been around a long time, they might
resent it. But there's the other group that knows it's important." The
disease has worsened since the 1950s as traditional foods and patterns
of living have been abandoned in favor of the typical American lifestyle
of fast food and inactivity, said Dr. William Knowler, a researcher with
the National Institute of Diabetes and Digestive and Kidney Diseases.
"Type 2 diabetes is due to a combination of genetics and lifestyle,''
Knowler said. ''The genetics can't change that rapidly; so the changes
in frequency almost have to be due to changes in socioeconomic factors."
"Things have changed a lot because of our close proximity to the white
population," Johnson said. "If you look at the pictures of the old
Pimas, like that one up there," she points to an old photograph on her
office wall depicting a Pima woman, "you see how thin they were. The
inactivity is a big factor." "I used to carry my sister on my back,"
Thomas recalled. "Nowadays they have a stroller. The chopping of wood,
the bringing in of water from outside. Even children were encouraged to
walk at an early age." Studies have shown that despite the lack of
fast-food restaurants on the reservation, the Pima's diet is very
similar to that of other Americans in percentages of fats, protein and
carbohydrates. In other words, not very    healthy, Knowler said. "I
don't think anyone would advocate them returning to the lifestyle they
had 100 years ago, which was an extremely harsh form of living," Knowler
said. "Everyone would like to take the best of what the modern world
offers without taking the bad things that come with it." In their search
for genes that might be responsible for the high diabetes risk among
Pimas, Knowler and his colleagues have identified three genetic regions
related to the diabetes process -such as insulin secretion. "We hope in
several years we will have identified all the important genetic
determinants, and if we can figure out how to put them all together,
we'll have an explanation for the inheritance of diabetes. That may or
may not happen." But Weiss believes that diabetes is so common among
Pimas that it will be very difficult to identify a genetic mutation
responsible, since there are too few people without the mutation to set
them apart.  Because Mexican-Americans have a lower risk than Pimas -
but still very high - some think they may have a better chance of
finding genes  applicable to both populations. When researchers at the
University of Texas Health Science Center at Houston announced earlier
this year they had a strong candidate on Chromosome 2 in Starr County
Mexican-Americans, the Arizona researchers went back quickly and checked
the region in Pimas. They announced at the American Diabetes Association
this year they did not find any link between diabetic Pimas and the
region on Chromosome 2. 

By Don Finley,
Express-News Medical Writer,
San Antonio Express-News