Mitchell Bush, Onondaga/Mohawk, was diagnosed with diabetes in 1986 but wasn't told by his doctor until five years later. He lives just outside of Richmond and is extremely active in the Virginia Native community, attending and participating in numerous pow wows throughout the year, as well as with the Virginia Council of Indians.
His mother lost both her legs from diabetes, and he knows all too well the dangers Native people face with this disease.
Indian Country Today's Vincent Schilling sat down with Bush to learn more about living with Type 2 diabetes in today's Native culture.
Vincent Schilling: Can you tell us something about yourself, Mr. Bush?
Mitchell Bush: I am Onondaga and Mohawk - I am enrolled as both. My father is Mohawk from Akwesasne on the Canadian side.
Schilling: At what point in your life did you realize you might have diabetes?
Bush: In 1987, I had had a minor heart attack. I was under a doctor's care. In my last meeting with him in 1991 as I was walking out, he asked, ''What are you doing about your diabetes?'' I said, ''What do you mean, diabetes?'' I began taking a pill because I was not that bad then. I took the pill until October 2006.
I had a major heart attack and ''died'' on October 5, 2006, and my organs shut down; they had to get them restarted again [and] apparently that's something that triggers full-blown diabetes. I've been taking insulin from then until now.
Schilling: Did having diabetes change your lifestyle at all?
Bush: I had to change my lifestyle a great deal getting out of the hospital. I began to pay more attention to my sugar level. They told me if I could keep my sugar down, I may forego my need for insulin and be able to go back to the pill. I've been watching my sugar level the best that I can, and I've been learning in the meantime what foods that I ate that contained a lot of sugar. I'm a big spaghetti fan, and the sauce that you put on spaghetti has a lot of sugar.
So now, I still eat spaghetti, but I have a lot less sauce on it. When I order it in a restaurant, I ask for the sauce on the side; that way, I can control how much goes on to it. I don't eat meatballs that often. Maybe once every 10 days with dinner. Of course, that's another issue with my doctor; he's concerned about my cholesterol.
Schilling: Do you manage to get exercise?
Bush: Unfortunately, I also have arthritis, so I'm not too nimble. More recently, I have been doing a lot of traveling to pow wows and I man a booth all weekend, so I'm fairly active. I tell my doctor, ''If you want to know if I'm doing jumping jacks, the answer is no. But I am very active.''
Schilling: How do you feel diabetes has affected you?
Bush: It's made me more alert to sugar. Fortunately I quit drinking about 10 or 12 years ago, so I don't get sugar that way. This has all been a part of becoming aware of what is not good for you. I call alcohol and diabetes the twin devils that bother Native Americans. I say this because the Native American body systems are not able to properly absorb sugar.
Schilling: Our Native ancestors didn't have access to processed sugar that we do today.
Bush: That's right. And now, in today's world, a lot of Native people don't have a lot of money. Mothers are fixing their kids foods with macaroni in it. Macaroni isn't all that good for you.
Schilling: Whole wheat pasta is a whole lot better for you than processed white pasta.
Bush: Right. The one funny thing that I should be watching, but I don't eat that often, is frybread. Frybread is bad for you. But it's good, so I have frybread maybe once or twice a month. Some of the Indian women who make frybread are becoming aware of the health benefits of whole wheat frybread. They are experimenting on different ways of getting away from white flour.
My sister lives on the Onondaga reservation, and my family up there still gathers wild plants out in the woods that our people have eaten for forever. We still gather leeks, cowslips and wild onions. These are the foods that we had eaten before we got the white man's white flour and sugar.
Schilling: What would you suggest to someone who finds out they have diabetes?
Bush: You can tell somebody something, but it doesn't necessarily mean they're going to absorb it. There are numerous books out there that tell people with diabetes what they can eat. They need to start familiarizing themselves with cookbooks. I stay away from cereals that have sugar added, like Froot Loops. I try to stay more with the bran cereals. You just need to have an awareness of what you're eating.
I've also learned with diabetes that you can have the opposite of a sugar high. When I have low blood sugar, I've also learned that you can have things like a glass of orange juice to bring your blood sugar back to normal.
Out of the more than 20 million adults and children with diabetes in America, one out of three does not know it. Fifty-four million people have pre-diabetes.
Bush's story is not uncommon; many American Indians today suffer from the effects of Type 2 diabetes. Type 2 diabetes is different from Type 1 in that Type 2 is brought on by environmental influences such as poor diet and lack of exercise.
But Natives today are becoming more empowered and are fighting the disease with better diet, more exercise and education. Programs are constantly being created to assist them with diabetes-related health issues, and more Native people are taking advantage of these programs.
A Native-Friendly Diabetes Prevention Program
Jan Chacon is the diabetes prevention program coordinator at the Indian Health Center of Santa Clara Valley in San Jose, Calif. She coordinates the prevention sector of the Special Diabetes Program for Indians. It is one of two urban grant programs in the United States; 31 other grant programs are run by individual tribes.
The program began research approximately 10 years ago. The results were a success and the Special Diabetes Program for Indians began its inception at the center five years ago.
''In the lifestyle balance program, it has been shown that if you lose 7 percent of your body weight and combine this with 30 minutes of exercise five times a week, your chance of diabetes declines by 58 percent for adults that have been diagnosed with pre-diabetes,'' according to Chacon.
The lifestyle balance program is a 16-week curriculum that teaches pre-diabetic Native adults improved lifestyle choices.
''We are taking people who have not had the tools to even know where to begin,'' Chacon explained. ''If we can change just their thinking and habits to make small adjustments with a big outcome, they'll stick to it.''
''Sodas are raising our blood sugar levels,'' Ramin Naderi, community wellness and outreach director at the center, added. ''One 20-ounce soda has 240 calories, which is equal to 17 sugar cubes. In our classes, we provide alternatives to sweetened beverages. Participants report they start to drink more water instead of drinks that contain a lot of sugar.''
The average person eats almost 175 pounds of sugar a year - about half a pound of sugar in one day. The single largest source is sugary drinks. Extra calories lead to weight gain, putting people at risk for lifelong problems that include diabetes and heart disease.
More than just pills and lab tests, the program consists of walking groups, classes on movement and motivation, all the while maintaining a sense of Native tradition. Participants often take part in smudging and Sweatlodge ceremonies. The program even teaches participants how to shop in grocery stores.
''They should not be shopping in the middle aisles,'' asserted Chacon, who explained that the middle of a grocery store contains all the processed foods, while the perimeter contains the healthy produce. She also stressed the importance of organic and non-processed foods as part of a healthy diet.
''Native Americans were once the healthiest people. Frybread came out of processed commodities that are not your Native food.''
The program has continued to show success across the country, according to Chacon.
''National results on the average, people lose 4 percent of their body weight, which is not the standard 7 percent. It's the average, which is still great. One person in our program lost 30 pounds in the 16 weeks.''
For more information, call the Indian Health Center at (408) 445-3400, ext. 271, e-mail Chacon at firstname.lastname@example.org or visit www.indianhealthcenter.org.
Making Healthy Choices Can Reverse Some Types of Diabetes
Dr. Amy Lanou holds a doctorate in human nutrition and is currently an assistant professor at the University of North Carolina - Asheville in the Department of Health and Wellness. She is also the senior nutrition scientist for the Physicians Committee for Responsible Medicine and has worked closely with Dr. Neal Bernard, author of ''Dr. Neal Barnard's Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs'' (Rodale, January 2007).
In an interview with Indian Country Today, she spoke of some of the early warning signs of diabetes and commonly held myths, as well as healthy eating tips.
Those that have Type 2 diabetes, approximately 90 - 95 percent of diabetes cases, it is still reversible for many people as long as their pancreas is able to produce insulin. Shifting the way of eating, body weight and lifestyle in terms of movement, can often reverse diabetes.
There are a lot of indications to the onset of diabetes, such as frequent urination and extreme thirst; sometimes people may notice problems with their feet, such as swelling, pain or wounds that won't heal. When you have more sugar in your blood, it is harder for your immune system to fight bacteria.
People may also notice problems with tooth decay and gum issues. Because there's so much sugar in the blood, it keeps bacteria happy that fight against the immune system's ability to thwart infection.
Even walking to the mailbox or walking around the garden a few times is great. A swimming pool can be really helpful, especially if the person has arthritis. If a person is sedentary, they can start slow, but figure out something. If they are chair-bound, lift the legs, lift the arms and put them down.
When moving, the cells that are being resistant to insulin become less resistant. This allows the cells to take up sugar.
Sugar is a racecar, Fiber are the brakes
Fiber is incredibly important for diabetics. Plant foods are where people get fiber: there is no fiber in food from animal sources - not in meat, milk, eggs or fish. None of them has any fiber.
Fiber is extremely important in achieving proper glycemic control. Fiber is what slows down sugar's release into the blood.
Whole food diets
When I think of traditional diets around the world, most of them are built using whole foods. How many kids in school are eating these highly processed meats and chicken nuggets that are so far away from traditional diets? There is research linking processed meats to cases of Type 2 diabetes risk. It is also very strongly linked with cancer risks.
'I can't have fruit'
That is a myth. Fiber-dense fruit such as cherries, peaches or apples are fantastic for diabetics. Vegetables like carrots and tomatoes are also very high in soluble fiber.
There are also lots of alternatives for good healthy starches such as potatoes, sweet potatoes and corn. One of my favorite grains is quinoa, which is a protein-dense grain with a low glycemic index. One really good grain for people with diabetes is oats. It is a grain with a lot of soluble fiber.
Fat is the real enemy
The cause of Type 2 diabetes is generally sedentariness and overeating in general. The main way people overeat is too many foods high in fat or low in nutrients or highly processed foods such as meats and cheeses. One of the easiest ways to bring calorie levels to a healthy range is to limit or avoid high-calorie, high-fat or high-sugar foods.