All photos courtesy Sven OE Ebbesson, PhD, Alaska Siberia Medical Research Program.

BETHESDA, MD—Until about 30 years ago, diabetes was largely non-existent among Alaska’s Eskimos. So was hypertension, obesity, and coronary artery disease.

But something changed, and within 2 generations, the prevalence, morbidity and mortality of these diseases have all soared to levels comparable to the worst estimates in the Lower 48.

That “something” was a major shift from the physically-active hunting and fishing life, and its attendant diet rich in marine omega-3 fatty acids, to a sedentary lifestyle, and a processed food diet that replaced fish and whale blubber with Crisco shortening.

Sven Ebbesson, PhD, director emeritus of the Alaska Siberia Medical Research Program, who has been studying Eskimo health in Alaska and abroad for the last decade, believes that beyond a dramatic reduction in daily exercise, the deterioration of Alaskan Eskimo health reflects a sudden turn toward a diet laden with saturated, trans-fatty acids rather than the omega-3 highly unsaturated fats of the traditional diet.

In fact, if one wanted to learn how the balance between saturated and unsaturated fatty acids affects health, there’s probably no more illustrative scenario than that of the Eskimos.

	The traditional eskimo diet of whale, seal and fish, while high in cholesterol, is very rich in omega-3 fatty acids. In Alaska, many Eskimos have abandoned hunting and fishing, and the omega-3 rich diet, prompting an explosion of cardiovascular disease.

Few peoples in the world have had such a specific traditional diet that they are literally named for it: according to Webster’s dictionary, the word “Eskimo” derives from an Algonquin root, “askimowew,” which literally means, “he eats it raw.” Whale and seal blubber, that is.

Despite an extremely high-fat diet in which these two are staple foods, Eskimos who live the traditional way rarely develop the metabolic and cardiovascular diseases we typically associate with extreme fat intake.

“About 5 or 6 years ago, we did a collaborative study with the Russians to determine the prevalence of diabetes in Eskimos in Siberia versus Alaska. Among the Siberians, it was under 1%, whereas among the Alaskans, it was about 9%,” said Dr. Ebbesson at the recent International Workshop on Omega-3 Fatty Acids, Diabetes and Cardiovascular Disease.

He observed a similar disparity for hypertension and coronary heart disease, which are almost unknown to the Siberian Eskimos, but have a prevalence of roughly 25% in those over 45 years of age in some Alaskan Eskimo villages.

The Siberians still live much as their ancestors have for centuries: fishing and hunting whales and seals. Though their total cholesterols often hit 250–260 mg/dl, their omega-3 plasma levels are extremely high. Even in Alaska, those who live the traditional way have plasma omega-3 levels that are 7–8 times the norm for non-Eskimo (ie. Caucasian) Alaskans.

Muctuc, raw whale skin and blubber, is being replaced by Crisco and bacon fat as staple foods.

But with the growth of the Alaskan oil industry, many Eskimos have adopted “modern” ways, replacing sleds and hand-paddled boats with snowmobiles; fresh fish with fast food burgers and fatty pork chops; and muctuc (raw whale skin and fat) with Crisco.

The latter is eaten in staggering quantities. In the villages he has studied, Dr. Ebbesson said it is not uncommon for three or four adults to finish a pound of the stuff—eaten with a spoon right from the can—every day, especially when out hunting. “They always ate a very high fat diet,” Dr. Ebbesson explained. “It was typical for families to keep a bucket of whale or seal fat in the kitchen for general consumption. To them, Crisco, butter, and bacon fat are the same.”

Biochemically and physiologically, they could not be more different. Essentially, the Eskimos replaced all the beneficial marine omega-3’s they used to eat with palmitic and stearic acids, practically a recipe for cardiovascular and autoimmune disease. The clinical impact has been profound, particularly in postmenopausal women, since even in a traditional context, women are less physically active than men.

Dr. Ebbesson has worked closely with the inhabitants of 4 Alaskan villages, comprising 452 adults, initially screened for diabetes and CVD risk factors in 1994. At that time, roughly half of all villagers over 55 were obese, with body mass indices over 27, and 25% had evidence of coronary heart disease.

Among the women, type 2 diabetes was present in 18%; 40% had impaired glucose tolerance, as defined by World Health Organization criteria. For men over 55, prevalence of diabetes and IGT were approximately half that of the women. Both cardiac risk and prevalence of glucose intolerance correlated almost directly with reduced plasma omega-3 levels.

The sudden “epidemic” of CVD and diabetes has shocked the Eskimos. “These are people who have not seen these kinds of diseases before. Now it is common to see people who have had triple bypass surgery. They’re very frightened,” said Dr. Ebbesson, who has been able to mobilize some of that fear into a pro-active intervention.

The program involves one-on-one lifestyle counseling that stresses regular exercise and a reduction in saturated fat consumption. In some cases, he has been able to convince shop-keepers to remove the Crisco from their shelves, replacing it with olive oil. “The Eskimos don’t particularly like it, but they’re willing to eat it.”

To test the efficacy of the intervention, he re-assessed CVD risk factors and diabetes incidence in 2 villages that had participated in the counseling program, versus 2 that had not. From 1994 to 1998, the number of new IGT cases decreased from 38 to 4, and new NIDDM diagnoses decreased from 14 to 2. There were no significant changes in the villages that did not receive counseling. Those who participated often lost weight, in the range of 15–20 lb over the course of the 4 years.

Cholesterol levels also showed a marked drop in the intervention villages, with low density lipoproteins decreasing from a mean of 180 mg/dl prior to the intervention, to 155 mg/dl afterward. Some of this effect is attributable to cholesterol-lowering medications, which were given to roughly 10% of the individuals in the intervention groups.

But much of the benefit is attributed to increased exercise and decreased saturated fat. Interestingly, the plasma omega-3 levels did not change much in the intervention groups over the 4-year period. “It is not that they are going back to the fish and seal diet of the past.” What they are doing is reducing palmitic and stearic acid intake.

The Eskimo research shows clearly that dietary fat profile affects glucose metabolism and diabetes risk. It also suggests that from a cardiovascular perspective, the American obsession with cholesterol may be somewhat misguided.

The omega-3/omega-6 balance, along with genetic predisposition and exercise level, may be even more important. “The Eskimos’ cholesterol levels have been very high all along, but you saw little CVD, because they typically had very high HDLs (“good” cholesterol) and extremely low triglycerides. Even now, you rarely see high-TGLs unless they have diabetes or advanced CVD.”