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From Canwest News Service 

Sandy Lake First Nation -- epicentre of diabetes epidemic

By Margaret Munro, Canwest News Service

Anne Meekis checks out her receipt from the Sandy Lake store, where she's just paid $6.75 for two litres of milk.Photograph by: Margaret Munro, Canwest News ServiceSANDY LAKE, Ont. -- Anne Meekis knows feeding her grandkids healthy food is one of the keys to halting the diabetic scourge here in the northern spruce forest.

But it's not easy. "Look at how much milk costs," says Meekis, who's just paid $6.75 for a two-litre carton at Sandy Lake's store.

Fresh fruits and veggies are also more than double what most Canadians pay -- green grapes $13.49 a kilogram, McIntosh apples $8.49, tomatoes $10.29 and bananas $5.69. "Way too expensive," says Lucy Day, shopping with her four-year-old grandniece.

High prices are common in fly-in communities. But they are particularly hard to swallow here in Sandy Lake, where a quarter of the people have diabetes, the highest rate in Canada and third highest in the world.

Diabetes -- triggered by a combination of genetic risk, lifestyle and diet -- hits hard here and it hits young. And it is robbing many people of their limbs, their kidneys and their sight.

This story is part of a Canwest News Service series that has been funded in part by a journalism award from the Canadian Institutes of Health Research.

Diabetes is also taking a huge toll in the nearby communities of Bearskin Lake, Red Sucker Lake and Island Lake straddling the northern Ontario-Manitoba border. But Sandy Lake First Nation, roughly 300 kilometres northeast of Winnipeg, stands out because the problem here has been so well-documented.

The community made international headlines in 1996 when a study revealed 26 per cent of Sandy Lake residents had diabetes -- five times the Canadian average -- and another 14 per cent were at high risk.

Despite a concerted decade-long effort to slow the epidemic, people in Sandy Lake are still developing the incurable disease at an extraordinary rate, according to a study published this spring. It looked at 492 residents and found 10.5 per cent of children ages 10 to 19 developed diabetes over the 10-year study period and 43.3 per cent of people in their 40s.

"The rates are alarmingly high," says co-author Dr. Stewart Harris at the University of Western Ontario in London, who has worked with the community for almost 20 years.

The disease has cut a wide swath through Rod Fiddler's family, one of Sandy Lake's big clans. His father had to relocate to Thunder Bay, Ont., for dialysis after the disease knocked out his kidneys. His mother learned to operate a home dialysis machine so his father could return home before his death last year. Several of his older siblings have diabetes and some are already experiencing complications.

"Nowadays, people are becoming diabetic in their 30s and 40s," says Fiddler, 34, who, as director of Sandy Lake's diabetes-prevention program, is determined to stop the epidemic.

He and his team organize sports leagues, run children's diabetes camps, build outdoor skating rinks and cajole people to adopt healthier lifestyles with everything from cooking classes to weight-loss competitions.

The prevention program receives $115,000 a year from Health Canada, but Fiddler says money to offset the high cost of wholesome food or to build the kind of fitness facilities most Canadians take for granted remains elusive.

So do sophisticated and much-needed medical services, such as a dialysis unit, which community leaders have been requesting for years.

"We have so many people who have had to leave for dialysis," said Chief Adam Fiddler, pointing to the "enormous" financial and human costs of relocating people to Thunder Bay and Winnipeg. "When you're plucked out of your home community and forced to live in a city where you've never lived, with no family, it makes your situation worse."

There is also an urgent need for better diabetes treatment and followup, says Harris, who says far too many people are losing their kidneys, limbs and eyesight because of complications that could be prevented.

The Oji-Cree people in this region are more vulnerable to diabetes -- and to the ill effects of today's sedentary lifestyles and smorgasbord of sweet, fatty foods -- than almost any people on earth. Only the South Pacific's Naura people and Arizona's Puma Indians have higher diabetes rates.

Genetics and geography help explain why.

Until the 1950s, Oji-Cree lived a harsh and strenuous traditional life in the region's forests and maze of lakes and rivers. Fish, duck, rabbit and moose were mainstays. Blueberries and cranberries were picked by the basketful. They ran trap lines on snowshoes and dog sleds, often covering tens of kilometres a day.

Winters could be brutal. Game was so scarce in 1899-1900 that about 30 Oji Cree in the Sandy Lake area were reported to have starved. Elders' oral histories recount people trying to survive on leather, bark and lichens.

Researchers suspect the survivors of such "merciless" food scarcity were genetically and metabolically tuned to make the most of food. It was a distinct advantage to have a metabolism good at packing away extra calories as fat reserves that could be used as energy when food ran scarce.

Then life for the Oji-Cree changed radically. Canoes gave way to motorboats and tents to reserve housing. Children were shipped off to residential schools. Canned meat, sweet drinks and white bread were shipped in along with cars, snowmobiles and televisions.

Their lifestyles were transformed but their genes and metabolism were not. "The body still thinks it's got to save and store energy," says Harris, "except you've gone from a feast-famine scenario to feast, feast, feast all the time."

Making the situation even worse is a gene, uncovered by Robert Hegele at the University of Western Ontario a decade ago, that is carried in many families. Individuals with one copy of the gene have twice the normal risk of getting diabetes, while individuals carrying two copies face 15 times the risk.

It was hoped the discovery might lead to new treatments, perhaps even profits that would help lift Sandy Lake out of poverty. Cures and money haven't materialized, but the discovery shed light on why so many people here are getting sick.

Dr. Lloyd Bartlett practised in the area from 1942 to 1949 and reports seeing only two cases of diabetes then. By the 1990s "sugar disease" was so common that the community asked Harris and his colleagues in to help.

Today, there are several hundred diabetics in Sandy Lake, where 2,700 people now live in modest homes and cabins.

The disease and blood-sugar testing kits are so common it's not unusual for people to self-diagnose.

"I was at a friend's and decided to test my blood sugar," says Anne Meekis, 46, recalling how she found out she was diabetic two years ago. "It was so high I ran right to the nursing station."

Meekis, a mother of six and grandmother of seven, is now on medications that help keep her blood sugar under control and has dropped 36 kilograms.

But bad habits and simple pleasures die hard. Like many in Sandy Lake, Meekis still smokes cigarettes, which aggravate the ill effects of diabetes. And she is not a fan of the artificial sweetener she has been advised to use in tea and coffee.

"I still take regular sugar," Meekis confides with a smile, as two of her grandchildren run circles around her.

But small victories in Sandy Lake's fight against diabetes are starting to add up.

"We are becoming a healthier people," says Chief Fiddler, noting the positive effects of Sandy Lake's aggressive prevention programs will take time to show up in the diabetes rates.

There are ball and hockey leagues, taekwondo classes, walking trails through the forest and four outdoor rinks on the lake every winter. Weekly diabetes radio broadcasts urge people to join fitness and weight loss contests and win iPods or trips to Winnipeg. "We keep it fun," says Rod Fiddler, in the prevention office.

Diabetes and healthy living is taught as part of the grades 3 and 4 curriculum and a summer children's camp slips in messages about diabetes between swimming and campfires. Gary Manoakeesic, Fiddler's cheerful assistant, never misses a chance to remind kids they swallow about 10 teaspoons of sugar with every can of pop.

Pop and chips have been banned from school lunches. Banning them from the entire community would be going "too far," says Rod Fiddler, who is trying to win over, not alienate people. But he says there's been a shift to healthier eating. Diet drinks and bottled water are now prominently displayed in the local store and consumption of lard is down, and the store now stocks a "lite" version of the popular Klik luncheon meat.

Almost everyone agrees there is plenty more to be done.

Pickup trucks and cars that came up the winter ice road far outnumber walkers and cyclists on the dusty roads snaking around the sprawling community. Boardwalks built to encourage walking are missing planks and littered with pop cans and chip bags.

All suitcases and boxes that pass through Sandy Lake's tiny airport are searched to keep alcohol out of the community, which has long been dry. But sugary, fatty foods and sweet drinks helping fuel the diabetes epidemic continue to flow into town, along with the mouth-watering selection of fresh fruit and vegetables, priced beyond reach of most people here, who live on social assistance.

"Everyone tells us to eat better, but look at how much everything costs," says Meekis, waving her receipt from the store.

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