Ka Wai Ola - Office of Hawaiian Affairs, Volume 5, Number 8, 1 August 1988 — He Mau Nīnau Ola [ARTICLE]
He Mau Nīnau Ola
» Some Health Questions by Kekuni Blaisdell, M.D.
Ka Ho'oke 'Ai: Mokuna 'Ekolu
Ninau: E ke Kauka, we Hawaiians today are too spoiled by easy, fastfood haole lifestyle. How did you get those Moloka'i kānaka to give up Big Macs, Spam, Portagee sausage, pastry, deep fries, bacon and eggs, mayonnaise, shoyu, ketchup, soda and iee cream for plain
fish and poi? Pane: Many of you po'e heluhelu (readers) have sent me similar nīnau about how Ka Ho'okē 'Ai (The Moloka'i Diet Study) originated, how the participants were recruited, what motivated them to comply, what were nā hua (the results), and what significance does the study have for us kekahi (other) kānaka maoli. According to Kauka Emmett Aluli and Coordinator Helen Kanawaliwali of Nā Pu'uwai, the Native Hawaiian health organization that eonducted Ka Ho'oke 'Ai, the 10 participants in the 1987 experiment were adults who were recruited from the 257 homesteaders (i.e., those with 50 percent or more Hawaiian ancestry) surveyed in the 1985 Moloka'i Heart Study. That initial survey was also conducted by Na Pu'uwai with Kauka David Curb and his colleagues at the University of Hawai'i School of Public Health. That Heart Study, the first such systematic health survey of that many rural po'e Hawai'i, revealed a ki'eki'e (high) prevalence of cardiovascular risk factors, as previously reported in He Mau Ninau Ola. Among the quantitative findings was a frequency of 46 percent of those age 50 or older with ki'eki'e (high) koko (blood) cholesterol and triglyceride levels, predisposing them to myocardial infarction (heart attack), as described i kēlā mahina aku nei (last month).
When this startling result became known in academic circles, Kauka William Connor, professor of nutrition and medicine at Portland, Oregon, suggested to Kauka Aluli and Kanawaliwali that a suitable number of these po'e ho'oku'ono'ono (homesteaders) be tested to see if their ki'eki'e koko cholesterol and triglyceride values would ho'oemi (decline) if they consumed a traditional pre-Westem Hawaiian mea 'ai (diet). Such a lalo-(low) saturated fat, lalo-cholesterol, lalo-pa'akai, ki'eki'e-starch-fibre mea 'ai, as previously detailed in this eolumn, would be expected to ho'oemi (decrease) their koko lipid (cholesterol and triglyceride) levels and ho'oemi their risk of heart attack. When the previously surveyed po'e ho'oku'ono'ono were informed of this opportunity, 10 readily agreed to participate: three men and seven women, ages 29 to 57 years. All of them told of 'ohana or hoapili (close friends) who had died of heart attack. Pēlā, these volunteers were eager to escape the same fate for a variety of personal reasons. Akā, they also wanted to leam more about nutrition, fitness and health and sickness, and how to procure and prepare healthful food for themselves and their 'ohana. Soon the project became "theirs." They insisted on being called participants, and not subjects. Finally in late 1986, adequate kālā (funds)
became available from the Hawai'i Heart Association, the Oregon Heart Association (ma Kauka Connor), and the Office of Hawaiian Affairs to launeh the study. The feeding portion of the project was eonducted during a 7-week period from September to November 1987. Eaeh participant was carefully interviewed and examined. Daily calorie (energy unit) food intake was estimated by a research nutritionist from Kauka Connor's Portland laboratory, so that the participants would neither gain nor lose body weight, since weight-loss itself ean lower koko cholesterol and triglyceride values. Claire Ku'uleilani Hughes, Department of Health nutritionist, advised on locally available food items and their nutritional composition. A research eook, also from Oregon, with Aunty May Helm as a consultant, prepared three daily individualized meals for eaeh participant at the Ho'olehua Recreation Center of the Department of Hawaiian Home Lands. Kauka Helen Petrovitch of the University of Hawai'i Department of Medicine, supervised blood pressure, weight and skin-thickness measurements, and the handling of blood and urine specimens. After a three-week period of a "transition diet" period, and eight days of the traditional Hawaiian mea 'ai, with low saturated fat (10 percent), low cholesterol (200 mg per day), low pa'akai (2 grams), and high starch (78 percent), high fibre, and high omega-3-fatty unsaturated fatty acid fish oil (6.4 grams), the ki'eki'e koko cholesterol and triglyceride values of all the participants ho'oemi 'ia (declined) to normal or near-normal levels, with the average values for all as shown in Table 1. When the 10 participants returned to their previous ki'eki'e saturated fat, ki'eki'e cholesterol, ki'eki'e-pa'akai, lalo-starch-fibre, lalo-unsaturated fat diet, also carefully prepared, measured and served at the Center three times daily for three weeks, the participants' blood lipid levels rose,
with average values for all as also shown in T able 1. While consuming the pre-Westem Hawaiian diet, the participants said they felt more energetic. After three weeks, when it was time to return to the modem usual haole diet, they were reluctant to do so. When they did comply, they complained that the mea'ai was too greasy and too salty, and they felt lethargic, as reported in the Honolulu Advertiser Dec. 21, 1987. The measurement data are now being carefully analyzed in detail for official scientific journal publication. Meanwhile, Coordinator Kanawaliwali and Kauka Aluli, at the request of the participants, have started monthly diet counseling for eaeh of the mea ho'oku'ono'ono and their 'ohana by Claire Hughes, incorporating modem, readily-available and inexpensive food items to add variety to the prehaole Hawaiian diet, with weight-control adjustments. Some of the participants are now growing their own kalo, 'uala (sweet potato), ulu, and other vegetables, such as eom, beans and hua (fruit), such as mikana (papaya), mai'a (banana) and ipu (watermelon), and more are fishing for themselves. They plan to sponsor a demonstration "healthful lu'au" to share their "bom-again" traditional wholesome ways with the entire Moloka'i eommunity. They have begun talking with Kaunakakai market managers about promoting healthful food
sales, and they are trying to mobilize community action on improving the nutrition quality of public school lunches for their kamali'i a me na mo'opuna. Other Native Hawaiian communities have invited these participants to give workshops on their experiences. Pela, what began as a research study proposed by a non-Hawai'i non-Hawaiian, with non-Ha-waiians working with and for Hawaiians, has become a wholly "owned" and self-perpetuating, long-range, self-service program by Hawaiians, now extending to other mokupuni in our homeland. E ho'omaika'i i nā kānaka maoli o Moloka'i nui a Hina.
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Table 1. AVERAGE CHOLESTEROL AND TRIGLYCERIDE VALUES FOR 10 PARTICIPANTS IN KA HO'OKE AI Haole Diet Hawaiian Diet Haole Diet Blood Cholesterol *227 mg/dl 206 mg/dl 234 mg/dl Blood Triglyceride *331 174 200 *"Normal" blood cholesterol is less than 200 mg/dl and "normal" blood triglyceride less than 150 mg/dl.