Ka Wai Ola - Office of Hawaiian Affairs, Volume 1, Number 1, 1 February 1984 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D. V

This seventh eolumn of He Mau Ninau Ola responds to a reader's ninau on mea'ai (nutrition). It also covers ninau raised by other readers, for whieh we mahalo ia oukou apau. Q. I am 52, height 5 feet 10 inches, weight 237 pounds; my kauka (doctor) tells me my diabetes and high blood pressure will go away if I lose down to an ideal weight of 150 pounds; but my husband tells me he doesn't want me so wiwi ("skinny"). What shall I do? A: You might try to arrange for your kane (husband) to join you at your next appointment with your kauka when you ask him to explain the reasons for his advice, and to tell both of you of workable ways to achieve your health goals. Let me cite seven background items that may be helpful to you and your kane as you ho'omakaukau (prepare) to talk with your kauka. Item 1: Tables of "ideal"or "desirable" body weight, related to height, gender and age, are often found on the wall in phvsicians' offices. They are distributed by the life insurance industry, with ranges of body weights, not single values. These ranges are associated with longest lifeexpectancy of insured Mainland East Coast insured persons dating back to 1888. Thus, they may not be wholly applicable to us po'e Hawai'i today. We should also realize that such "actuarial" data do not take into account other crueial factors, such as co-existing ma'i (illnesses), puhi paka (cigarette-smoking), and 'oihana (occupation), whieh also affect longevity. Further, the ranges of "ideal" weights vary up to 10%depending on "body build." For example, one table I have would allow a wahine of your age and tallness to weigh up to 163 pounds if you are of "large frame." So, I suggest that you not become pa'a (fixed) on any single weight number as your goal, and consider the following additional items. Item 2: Mimi-ko (diabetes mellitus), with onset in adulthood, is seven times more eommon in po'e Hawai'i piha (pure Hawaiians) than in po'e haole, and five times more frequent in momona (fat) adults than in momona'ole (non-fat) persons. Regardless of race, however, loss of excess body fat results in lessening of the severity of diabetes in over half of patients. Sometimes, but not always, the mimi-ko may appear to go away; however, this favorable result from fat-loss has no constant relationship to a particular "ideal" weight. Thus, you are probably one of the two to five percent of us po'e Hawai'i who inherits a predisposition to diabetes. But if you are careful about your mea'ai and rid yourself of too mueh kino momona (body fat), probability favors your mimi-ko coming under control. We will focus on physiologic meehanisms to explain the relationship of mea'ai to the metabolism of diabetes in a future eolumn. Item 3: A suitable and safe way to attain the goal of loss of kino momona and amelioration of mimi-ko, such as in your case, is the newiy-proposed high-starch, high-fibre, low-fat, no-sugar diet, sometimes called an "alternate diet." Contrary to previous teaching, starch (complex) carbohydrate is "good," not "bad" for diabetes, whereas sugar (simple) carbohydrate) is still "bad." Starches include taro, ulu (breadfruit), 'uala (sweet potato), and uhi (yam), whieh were the staples of our kupuna kahiko (ancestors of old), as well as rice. palaoa (bread), potato, and noodles of modern times. These mea'ai relieve pololi (hunger) because of their bulk. Yet, they

contain fewer calories by weight than fatty and or sugared foods, such as meats, butter, cheese, pastry, iee cream, candy and soda pop, whieh ycu should avoid. High-fibre me'ai include unprocessed vegetables, such as lu'au taro and carrots; fruit, such as mai'a (banana) and he'i (papaya); and unrefined grains, such as whole-wheat bread and cereals, whieh also provide bulk to satisfy pololi with minimal calories. By emphasizing these starches and fibre mea'ai and adding i'a (fish) and lean moa (ehieken), this new diet simulates that of our kupuna maka'ainana of old. With this fare, you ean eat well without hunger, and gradually lose about two pound per week until you have reached an optimal body weight with better control of your diabetes and high blood pressure. This diet is ample in protein, minerals and vitamins so that no supplements are required. This program does not mean that you ean "never" enjoy pua'a kalua (roast pig) whieh was usual mea'ai for na ali'i in ancient times, or haole-introduced pipikaula (beef jerky), salamona lomilomi and coconut eake. Rather, these pa'ina nui (feast) foods should be reserved for infrequent, special occasions, and then in moderation, when you ean treat yourself. They should not be your regular, daily, meahime fare. Item 4: Becuase you also have high blood pressure, you also need to restrict pa'akia (sodium) in your mea'ai, as discussed in my eolumn last year. Both bodyfat loss and limitation of sodium intake, independently, ean result in alleviation of arterial hypertension. Physical exercise and anti-stress measures ean also contribute to control of mimi-ko and high blood pressure. Item 5: Atherosclerosis (thickening of the arterial vessel walls) is the most serious complication of diabetes, obesity and high blood pressure. In the heart, atherosclerosis leads to "heart attack"(infarction), with the highest incidence in us po'e Hawai'i; in the brain, the vesselthickening leads to stroke, also with highest rates in us po'e Hawai'i; in the legs, it leads to gangrene; in the kidneys, mimiko, hypertension and atherosclerosis often lead to end-stage renal failure, with the greatest occurrence in us po'e Hawai'i. We will discuss the details of mechanisms involved in future columns. In any case, because diabetes increases the risk of these complications, prevention should be the major approach before it is too late. Item 6: Your kane needs to be reassured that loss of too mueh body fat does not mean that you will be nani'ole (without beauty) and without poli palupalu for him to enjoy. Since reduction of adverse risks means longer life for you, with less likelihood of disabilities of heart attack, and the worry and expense of heart bypass surgery, amputation of a limb, kidney dialysis and renal transplantation, you both need to decide in advance on your "priorities" — what in life are most important to you two — harmful food with sickness or proper diet with less risk of major illness? Moreover, you might consider that a meaningful life is not merely the absence of illness, but the enjoyment of doing what you really want to do, regardless of body weight and handicaps. While the simple diet proposed may seem initially unappetizing, ingenious new tasty recipes have been developed, and the basic features of this new diet have been endorsed by the American Diabetes" Association, the American Heart Association, and recently by the American Cancer Society for reduction of cancer risk as well.