FINDINGS

Objective 1: The status of existing published knowledge on consumption of subsistence foods in Alaska, their nutritive value, and gaps in knowledge will be described.

Information that describes quantitative consumption of subsistence food exists from several published reports. (TABLE 1). A variety of related articles exist which describe qualitative consumption of subsistence foods. These references are cited in the Annotated Bibliography. All of these reports describe use of subsistence foods by Alaska Natives. None discussed consumption by non-Natives. This information primarily addresses adults. Thirty-six communities out of more than 200 were surveyed since 1956. Information was found for communities associated with five of twenty regional Native Health Corporations.

In most instances the information was combined and not reported by community. This is done to make results more meaningful. When there are only a few people in a study, any unusual result from even one person, may lead to misleading conclusions about the entire group. Dietary information has many variations. One person's intake varies in amount and variety from day to day. In Alaska there also are seasonal and community differences. Nonetheless, the reports show several benefits of subsistence foods.

Why eat subsistence foods?

Subsistence foods make major contributions to what Alaska Natives eat. Subsistence foods provide energy; energy is vital to life. In the 1950'#146;s Eskimos and Indians were getting almost one-half of their energy and much of their nutrient intake from subsistence foods (Heller & Scott, 1967). In the years since, transportation to the villages has improved and there is more food to choose from in grocery stores. Yet in 1992, Eskimos of Gambell were still getting one-fourth of their energy from subsistence foods (Nobmann, 1996). Subsistence foods contribute large amounts of important nutrients

The Division of Subsistence of the Alaska Department of Fish and Game reports large amounts of subsistence foods are harvested (Alaska Department of Fish and Game, 1996). Information from many communities is compiled in the Community Profile Database that reflects what is harvested. While harvest data may give an estimate of what is eaten, actual consumption will vary from what is harvested or brought into the kitchen. Harvest data is something like a food balance sheet, describing the amount of food available per person for a nation or a community. Consumption data identifies what is actually eaten by individuals.

Subsistence foods are nutritious. That Alaska Natives have survived for thousands of years is testament to the fact that subsistence foods available in Alaska were and are capable of fully nourishing people. We know that nutrients provide energy, maintain health, and build and repair the body. In addition, there are elements in food whose importance has yet to be understood. TABLE 2 describes some of the nutritional contributions of subsistence foods.

In addition to providing energy, subsistence foods are rich in many nutrients. Traditional Arctic foods are known to be rich sources of retinol (vitamin A), iron, zinc, copper and essential fats (Kuhnlein, et al, 1995). Among Yupiks of Gambell, over one-half of their protein, iron, vitamin B-12, and omega-3 fatty acids came from subsistence foods. All of the desirable fatty acid known as EPA came from subsistence foods. Protein is vital in building and repairing the body; iron helps turn food into energy; vitamin B-12 helps build blood and nerve cells; and omega-3 fatty acids, including EPA, reduce the risk of heart disease.

It is important to compare subsistence foods with the alternatives, non-subsistence foods. Fish and meat are relatively lean when compared with beef. The fats present in subsistence fish, sea mammals and meats are generally unsaturated fats that are better for heart health than saturated fats found in many non-subsistence foods. Furthermore, fish and sea mammals are the richest sources of omega-3 fatty acids. They have been associated with lower rates of heart disease and other positive health benefits. Subsistence foods do not contain concentrated amounts of carbohydrates that are associated with tooth decay. Subsistence animals are unusually high in iron. Subsistence foods are low in salt when compared to many foods from the store. Most people in the US get more salt than they need, which may contribute to high blood pressure for some. Some foods from the store are high in sugar, salt and fat, especially saturated fats. These "empty calorie foods" contain little or none of the many nutrients found in concentrated amounts in foods from the land and sea.

Recent attention has focused on lesser-known nutrients such as selenium. Selenium is a trace element found in seafoods, kidney and liver of various animals, whale, and to a lesser extent in other meats and fish. Selenium protects body cells by reducing peroxides; it prevents Keshan Disease, a form of heart disease (NRC, 1989); it is known to counteract the toxic effect of methyl mercury on nerves (Mulvad, 1996). The diet of Siberian Yupik adults in Alaska is generous in selenium, with mean intakes greater than what is recommended for people in the US (Nobmann, 1996). One fourth of their selenium comes from subsistence foods.

The antioxidant effects of selenium and vitamin E may reinforce each other in protecting cell membranes from oxidative damage. They may also enhance metabolism and synthesis of immunoglobulin, or antibodies, and ubiquinone, a part of the energy producing system (Mahan and Arlin, 1992).

Vitamin E, acting as an antioxidant, inhibits the peroxidation of polyunsaturated fatty acids in the low-density lipoprotein (LDL) fats in the blood and blood vessel walls. Peroxidation is thought to be a common step in the development of harmful fatty streaks in atherosclerosis.

Plant oils are the richest sources of vitamin E in the US diet in general as well as in the diet of Siberian Yupiks. Fried bread, pilot bread, and berry agutuk (Eskimo ice cream often made from berries, sugar, and vegetable shortening) were their major sources of Vitamin E. However, subsistence foods also contribute significant vitamin E to the diet. Seal, whale, walrus and caribou tissues were analyzed and found to contain vitamin E in its most active form (Wei Wo and Draper, 1975). The blood of Eskimos, who were eating 45% of their energy from Native foods, was tested in the early 1970's (Wei Wo and Draper, 1975). They had vitamin E levels that were comparable to those in other US adults who consumed a mixed diet.

Subsistence foods are associated with good health. Few studies have been done among Alaskans that compare intake of subsistence foods with physical outcomes (TABLE 3). But among those studies done, eating subsistence foods was related to better health. Eating more subsistence foods was associated with less glucose intolerance. Glucose intolerance is associated with Type II diabetes (Murphy, et al, 1995). In other words subsistence food eaters handled blood sugar better than those who ate less subsistence foods. More specifically, eating seal oil daily and salmon daily was associated with less glucose intolerance (Adler, et al. 1994). In another study, eating fresh bird and foods with alpha-tocopherol (vitamin E) was associated with lower LDL-HDL ratios (Nobmann, 1996). If a person has a high ratio of LDL-HDL in the blood, it is a strong risk factor for coronary heart disease, so having a low LDL-HDL ratio is good.

Cancer is one of the leading causes of death among both Native and non-Native Alaskans (Alaska Department of Health and Social Services, 1997). Low rates of some cancers among Alaskan Inuit may be associated with diet (TABLE 3).

Another important nutritional aspect of subsistence foods is the energy people expend while harvesting them. Maintaining a healthy weight requires burning as much energy as the body takes in. The activities surrounding hunting, fishing, gathering and preserving subsistence foods contribute to an active lifestyle. Physical activity is important in preventing obesity. Obesity is associated with increased risk of heart disease, diabetes, and other medical conditions.

Subsistence foods provide more than nutrients. The process of nourishing involves the body, the mind and the spirit. Perhaps those who live close to the land retain a more integrated sense of nourishment in the broadest sense. At an Alaska-Russia Native People's Health and Social Issues Conference in 1992, 39 attendees called for models that addressed social, emotional, spiritual and cultural issues as well as physical health (Marshall and Soule, 1993). The former factors are not measured as easily as is physical health, but they are just as important.

The 1989 oil spill from the supertanker, Exxon Valdez, illustrates the relationship of food and psychosocial health (Palankas, et al, 1993). The impact of the Exxon Valdez oil spill on social, cultural and psychological well being of people in affected communities was evaluated by asking people six questions. One of the questions was "Has the oil spill directly affected the hunting, fishing, or gathering activities of any member of this household?" The investigators concluded that there was a significant impact on the psychosocial environment. The more people were exposed to the oil spill through its effects on their food gathering activities (as well as 5 other indicators), the greater the psychosocial impact they experienced.

Subsistence foods make substantial economic contributions to the community (Wolfe and Walker, 1987, Wolfe and Bosworth, 1994). Among other contributions is reducing the monetary cost to feed a family, which takes on greater importance when cash income is low and paying jobs are scarce. When comparing the same foods, the cost of feeding a family with purchased foods in some rural communities is almost twice the cost in Anchorage (Cooperative Extension, June, 1997). People in more remote villages pay even greater amounts.

Subsistence foods make other contributions that are harder to measure but very important. The practice of obtaining subsistence foods gives a person tasty food, exercise, fresh air, a chance to be with family members, and something to share (Mary Gregory, personal communication). These contributions are tangible examples of important cultural and social values.

Plants also are used for medicinal purpose, but a review of literature on medicinal uses is beyond the scope of this paper (For further information, see Fortuine, 1988).

Task 1.3 Gaps in current knowledge will be defined which will lead to development of a comprehensive program which assists individuals and agency personnel in understanding the nutritional aspects of subsistence foods so that they can make informed decisions about consumption of subsistence foods.

Although some information exists (TABLE 1, TABLE 2, TABLE 3), there is great need for additional information in order to better understand the complex relationships of food and health. Several authors call for better information. Data on the health of Alaska Natives is needed, including investigations into the influence of traditional as well as modern diet (Jackson, 1986). In the ten years since Jackson described these needs, there has been progress in describing nutritional benefits. Yet there is a need for more definitive information. For example, further information about the effects of traditional cooking practices on the pattern of cancer in the Inuit of all circumpolar countries is needed (Nielsen, et al, 1996). Health and risk effects of traditional food need further investigation (Mulvad, et al, 1996), as they relate to ischemic heart disease as well as to other conditions.

Recently the Alaska Department of Health and Social Services released Eat Smart Alaska! Nutrition Related Chronic Disease in Alaska, 1997 Needs Assessment. This baseline needs assessment calls for continuing analyses of and access to nutritional values of traditional/subsistence foods. It calls for collection and analysis of food consumption patterns among adults (average adult daily intake of fat and total calories). Information on nutrition knowledge and behaviors is needed. Surveys such as the Behavioral Risk Factor Surveillance System and Youth Risk Behavior Survey or nutrition-related survey questions to allow for trend analysis should be repeated (Alaska Department of Health and Social Services, 1997). The needs assessment also describes an educational need for increased efforts to promote the identification, gathering, and preparation of traditional and subsistence foods.

People want to know what is in their food. There are numerous needs in order to have a comprehensive source of information about the nutritive value of subsistence foods in Alaska. The Nutrient Value of Alaska Native Foods (Nobmann, 1993) is the most comprehensive table of nutrient values of foods consumed in Alaska. It was compiled from 40 sources. However, numerous nutrient values are missing from the table because the foods haven't been analyzed or existing data have not been evaluated for applicability to Alaska (TABLE 4). For example, only 3% of vitamin E content of subsistence foods are listed.

A compilation of nutrient composition of foods harvested and consumed in Alaska is needed. It should be readily available, accurate, comprehensive, and updated periodically. Updating the Nutrient Value of Alaska Native Foods could be a starting point. It should include other nutrients such as selenium, omega-3 and omega-6 fatty acids, and beta-carotene. It should include foods that people eat.

Information from other databases and other countries should be considered but only if foods and preparation methods are similar. Values for 40 Alaska Native foods have been incorporated into The Minnesota Nutrition Data System (NDS, Nutrition Coordinating Center, 1993, University of Minnesota, Minneapolis, MN). This was completed to evaluate food intakes as they relate to heart disease and diabetes among Alaska Natives in four Northwest Alaska communities (SOE Ebbesson, Principal Investigator, University of Alaska). An additional 26 foods were identified during data analysis that were not in the NDS food database (Risica, 1997). Appropriate foods had to be substituted.

The Centre for Nutrition and the Environment of Indigenous Peoples (CINE, McGill Univerity, Ste. Anne de Bellevue, Quebec H9X 3V9) conducts extensive analyses of indigenous foods for both nutrient and contaminant levels. However the developers advise their published nutrient values should be used only in specific arctic regions, as values vary with regions (H.V. Kuhnlein, personal communication). Collaboration on the common problems in developing nutrient databases in circumpolar regions would be beneficial.

Laboratory analyses are needed to measure important nutrients in foods where data is lacking. Nutritive values of different organs or portions of animals are needed.

The impact of preparation methods needs to be better understood. For example, Canadian investigators found traditional ooligan grease was ten times richer in omega-3 fatty acids after it was prepared than was the fat of the ooligan fish from which it was prepared (Kuhnlein et al, 1996).

The risks and benefits of specific foods and the interactions of nutrients are important to investigate. The works of Kuhnlein et al (1996) and Chan et al (1996) on ooligan grease offer a good example of this type of investigation. The nutritional contributions of ooligan grease are numerous; it is a rich source of omega-3 fatty acids and vitamin A, and a good source of calcium, iron, and zinc. At the same time the contaminant levels are below guidelines established by Health Canada and Agriculture Canada for arsenic, cadmium, mercury, and lead. The level of persistent organic pollutants also is below Health Canada regulation limits

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