Carbohydrate in the Alaskan A. Feldman,
C. Bruce Taylor,
M.D.,3’4
M.D.,7
Arthur
Lena
H. Rubenstein,
A. Lewis,
Ph.D.8
M.D.,5
and Belma
Kang-Jey
Ho, M.D.,
Ph.D.6
Mikkelson9
ABSTRACT The effect of a low total carbohydrate low sucrose diet on various parameters of hipid and carbohydrate metabolism was studied among residents of a North Slope Alaskan Eskimo village. Fr comparative purposes a group of Eskimo youths consuming a higher carbohydrate
institutional
had unusually tolbutamide
low serum triglycerides and very low density hipoproteins and normal tolerance tests. Eskimos on a higher carbohydrate diet exhibited
elevations
of
cholesterol
diet
triglycerides
intake
and
between
The who
Arctic Eskimo is a descendant migrated
3,000 been line,
to
years
ago.
20th
stuffs their
costs,
in large
Asia habitat
diet
to a variable (1). Such
an opportunity induced adaptive
which general
is
some has
Previous
studies
low confection, composition.
have
demonstrated which
unique
ecological
certain
until
recently
virtually
devoid
of
is believed
their very high sucrose (10%) glucose
be
that,
metabolic
and
the both that
incidence intolerance intolerance
TheAmerican
peoples, to
diet.
Eskimo milk
this
of lactose (2). and
diet
products may
in
the
charac-
attributable
environment
example,
mod-
indicated
Western
might
to the a rela-
of
(50%)
On diabetes
the
Journal
of
his
For was and
account
for and
other mellitus
Cl mica!
in
Eskimos
glucose
accompanied
high
levels
consuming
free
cially this
their
tolerance
testing.
changes
in serum
by of
Am.
fatty
to
the Eskimos that their
work
has
and
intake
This study was bolic characteristics
result
from
From
in
indicated
that
triglycer-
(VLDL) their
low
(4, 6). designed to investigate of Eskimos which
their
the
espe-
factor
Greenlandic Eskimos have low serum ide and very low density lipoproteins which may again be attributable to
carbohydrate
in
(3, 4), modest
be an important
Recent
in and
ketonemia 1975.
carbohydrates
may
diet
Differences
acids without 588-594,
refined
confection regard (5).
native
glucose and significant
cholesterol
J. Clin.Nutr. 28:
exposure
albeit
to identify genetic phenomena to this diet
to urbanized
teristics
to
items,
characterized, in comparison American cuisine, as being
comparison
It
continued
extent by imported an isolated people
tively low carbohydrate, erate fat and high protein
Eskimo
has
of indigenous
presents and/or
588
from as their
Those
are exceedingly rare among and it has been suggested
North
people
well north of the tree on an almost purely
their
part,
supplemented food products
hand,
Alaskan
derived from sea mammals, fowl, and land mammals until the midcentury when import of processed foodbecame possible. Nevertheless, through own inclination and because of high
importation
were
levels. Unusually were noted as well.
Mongolian
America Inasmuch
studied.
alterations
groups
diet
consist,
sugar.
the
the arid Arctic zone, they had subsisted
carnivorous fish,
of
of the
also
minor
these
low density lipoprotein the North Slope sample
Slope
was
unusual
Departments
diet.
Studies
of Pathology,
VA
metamight
were Research
Hospital and Northwestern University, Chicago, Ill. (Dr. Feldman), Department of Medicine, University of Chicago Medical School, Chicago, Ill. (Dr. Rubenstein), Department of Research, Cleveland Clinic, Cleveland, Ohio (Dr. Lewis), Department of Pathology, University of Alabama Medical School, Birmingham, Ala. (Dr.
Ho)
and
the
VA
Hospital
and
Albany
Medical
College, Albany, N.Y. (Dr. Taylor and Ms Mikkehson). 2 Supported in part by Public Health Service Grants HL 13612, HE 6835, HL 6853, AM 13941, PH 43-67-144, GM 18625-03, GM 093, general research support from the Veterans Administration Hospital, Albany and Veterans Administration Research Hospital, Chicago, Foundation
and by of Chicago.
the
Bertha
4Assistant
College of Medicine, 1200 Texas 77025. of Pathology, Northwestern of Medicine 6 Associate
Professor
University. ‘Professor Professor of Pathology. for Research and Education
Nutrition
Brownstein
address: Baylor Avenue, Houston,
Moursund
ogy.
& Henry
‘Staff
28: JUNE
researcher.
1975,
pp.
‘
Associate Chief of Staff and Professor of PatholResearch associate.
588-594.
Printed
in U.S.A.
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/6/588/4716349 by University of Glasgow user on 14 February 2019
Sheldon
and lipid metabolism Arctic Eskimo” 2
CARBOHYDRATE
performed Eskimo
with village
AND
volunteers
at the
of
Hope,
Point
North
METABOLISM
Slope
Chemical
Alaska.
In
Slope diet
and methods
Subjects All subjects participating in the several facets of this study were Eskimos indigenous to the North Slope coastal region of Alaska. One group were current
residents located
of the village of Point on a sandbar extending
Hope, Alaska, which is into the Chukchi Sea. The second group consisted of individuals who were native to North Slope villages, but who were resident students School region school
at the Bureau of Indian Affairs Boarding High at Mt. Edgecumbe in the southern coastal of Alaska. This latter group had resided at for 8 months preceding the tests. Blood samples from all volunteers of the population of Point Hope over the age of 6 (60% of the population) were assayed for cholesterol, triglycerides, free fatty acids and lipoproteins. These persons were not identified as to the degree of outmarriage, although less than 10% were categorized by the Bureau of Indian Affiars census as being hess than 50% Eskimo. Samples were not taken from persons with acute illnesses. This Point Hope group consisted of 76 males and 88 females, 37% of whom were aged 6-12, 16% 13-17, 18% 18-35 years, 20% 36-60 years, and 9% over 60 years of age. Blood specimens were obtained at various intervals following a meal, but
only one sample was taken from each individual. In addition, blood was taken in the fasting state from a smaller number of subjects for measurements of circulating glucose, serum insulin, lipids and hipoproteins. This sample consisted of 41 youths, aged 16-20 years, who were age-matched to those persons
similarly
tested
at Mt. Edgecumbe.
From
this subset of
10 persons were recruited to and tolbutamide tolerance tests. samples were obtained from 32
ide, and
hipoprotein
Edgecumbe. tests.
Each
concentrations. of
these
samples
Dietary
evaluation
The dietary composition at Point Hope was estimated by analyzing dietary logs maintained by eight adults over a 3-week period and from interviews with the adolescents undergoing the tolerance tests. Cholesterol intake was calculated from published tables and supplemented by chemical analysis of indigenous dietary items (14). The carbohydrate, fat, and protein contents of the diet were calculated from published tables of food composition. The Mt. Edgecumbe diet was determined from schedules of the food offered and the quantities supplied. Adjustments were made for deviations from this diet in interviews with the tested subjects. Mathematical
analysis
The serum lipid and lipoprotein data from the Point Hope subjects were submitted to an analysis of variance, testing associations with age, sex, and time interval following the last meal. Both linear and polynomial correlation analyses were performed. Comparisons between Point Hope and Mt. Edgecumbe
serum out
lipid
using
glucose
tolerance
of variance
data
and
were
Student’s
carried
t-test.
Results Lipid and The
lipoproteins
mean
resident Table
lipid
chylomicra intervals.
of these
Mt.
postprandial
for
erate
and
This
are The
intervals extended
may fasting
population fasted
a range
values
of
for
the
be considered
17.0
a
mod-
strikingly
triglyceride
state
time 26-hour
states.
shows
of serum
26-hour
with
lipoprotemn
at Point Hope are shown in free fatty acids, and
listed for four postprandial 11- to 14- and 16- to
concentration to
at Point Hope
and
population 1. Triglycerides,
analyzed
test consisted of 100 g glucose in water taken over a 3to 5-mm period following a 12-hour fast. Blood samples for insulin and glucose were obtained at 0, 60, and 120 mm.
and
analysis
was
After drawing a fasting blood sample, 1 g of sodium tolbutamide was injected intravenously over 2 mm followed by sequential sampling at 2, 5, 10, and 15 mm. The test was terminated by infusing 25 g glucose at 15 mm since there were inadequate facilities for the treatment of hypoglycemia. The oral glucose tolerance
589
analysis
Five
Tolerance testing
ESKIMO
Plasma glucose was measured using glucose oxidase (7). Cholesterol, free fatty acids and triglycerides were assayed by a quantitative thin-layer chromatography technique (8) and checked by accepted reference methods (9, 10). Insulin was determined by a modification of the double antibody method (11). Lipoproteins were assayed by both paper electrophoresis and analytical ultracentrifugation (12, 13). Serum ketones were tested by the sodium nitroprusside reaction utilizing a method sensitive to 1 mg/dl acetoacetic acid or 5 mg/dl acetone (12).
Point Hope residents, participate in glucose
Fasting blood North Slope Eskimos aged 16-20 years at the Bureau of Indian Affairs Boarding High School at Mt. Edgecumbe. Each of these samples were analyzed for plasma glucose, serum insulin, cholesterol, triglycer-
IN THE
(61.0
to 72.1
low
in the ±
mg/dl.
17.0 Neither
11-
mg/dl) sex
nor age influenced this result. An initial rise of triglycerides at the 1- to 4-hour postprandial interval
was
noted
chylomicronemia 10-hour
triglyceride low VLDL
and
which
period.
In
concentration, level with
was
associated
persisted addition
to
with
to the
6- to
their
low
these people have a a mean fasting value of
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/6/588/4716349 by University of Glasgow user on 14 February 2019
addition, a group of youthful North Eskimos on a typical Western institutional were investigated for comparative purposes. Materials
LIPID
590
FELDMAN
TABLE Mean
ET
1 values of serum
of point
lipid moieties
At postprandial N164
1-5
91
6-10
± 7.6
11-14
56±
16-26
65
a Values
±
39.0±
18.1
49.0
31.1 0.20,
P
C. Bruce Taylor,
M.D.,3’4
M.D.,7
Arthur
Lena
H. Rubenstein,
A. Lewis,
Ph.D.8
M.D.,5
and Belma
Kang-Jey
Ho, M.D.,
Ph.D.6
Mikkelson9
ABSTRACT The effect of a low total carbohydrate low sucrose diet on various parameters of hipid and carbohydrate metabolism was studied among residents of a North Slope Alaskan Eskimo village. Fr comparative purposes a group of Eskimo youths consuming a higher carbohydrate
institutional
had unusually tolbutamide
low serum triglycerides and very low density hipoproteins and normal tolerance tests. Eskimos on a higher carbohydrate diet exhibited
elevations
of
cholesterol
diet
triglycerides
intake
and
between
The who
Arctic Eskimo is a descendant migrated
3,000 been line,
to
years
ago.
20th
stuffs their
costs,
in large
Asia habitat
diet
to a variable (1). Such
an opportunity induced adaptive
which general
is
some has
Previous
studies
low confection, composition.
have
demonstrated which
unique
ecological
certain
until
recently
virtually
devoid
of
is believed
their very high sucrose (10%) glucose
be
that,
metabolic
and
the both that
incidence intolerance intolerance
TheAmerican
peoples, to
diet.
Eskimo milk
this
of lactose (2). and
diet
products may
in
the
charac-
attributable
environment
example,
mod-
indicated
Western
might
to the a rela-
of
(50%)
On diabetes
the
Journal
of
his
For was and
account
for and
other mellitus
Cl mica!
in
Eskimos
glucose
accompanied
high
levels
consuming
free
cially this
their
tolerance
testing.
changes
in serum
by of
Am.
fatty
to
the Eskimos that their
work
has
and
intake
This study was bolic characteristics
result
from
From
in
indicated
that
triglycer-
(VLDL) their
low
(4, 6). designed to investigate of Eskimos which
their
the
espe-
factor
Greenlandic Eskimos have low serum ide and very low density lipoproteins which may again be attributable to
carbohydrate
in
(3, 4), modest
be an important
Recent
in and
ketonemia 1975.
carbohydrates
may
diet
Differences
acids without 588-594,
refined
confection regard (5).
native
glucose and significant
cholesterol
J. Clin.Nutr. 28:
exposure
albeit
to identify genetic phenomena to this diet
to urbanized
teristics
to
items,
characterized, in comparison American cuisine, as being
comparison
It
continued
extent by imported an isolated people
tively low carbohydrate, erate fat and high protein
Eskimo
has
of indigenous
presents and/or
588
from as their
Those
are exceedingly rare among and it has been suggested
North
people
well north of the tree on an almost purely
their
part,
supplemented food products
hand,
Alaskan
derived from sea mammals, fowl, and land mammals until the midcentury when import of processed foodbecame possible. Nevertheless, through own inclination and because of high
importation
were
levels. Unusually were noted as well.
Mongolian
America Inasmuch
studied.
alterations
groups
diet
consist,
sugar.
the
the arid Arctic zone, they had subsisted
carnivorous fish,
of
of the
also
minor
these
low density lipoprotein the North Slope sample
Slope
was
unusual
Departments
diet.
Studies
of Pathology,
VA
metamight
were Research
Hospital and Northwestern University, Chicago, Ill. (Dr. Feldman), Department of Medicine, University of Chicago Medical School, Chicago, Ill. (Dr. Rubenstein), Department of Research, Cleveland Clinic, Cleveland, Ohio (Dr. Lewis), Department of Pathology, University of Alabama Medical School, Birmingham, Ala. (Dr.
Ho)
and
the
VA
Hospital
and
Albany
Medical
College, Albany, N.Y. (Dr. Taylor and Ms Mikkehson). 2 Supported in part by Public Health Service Grants HL 13612, HE 6835, HL 6853, AM 13941, PH 43-67-144, GM 18625-03, GM 093, general research support from the Veterans Administration Hospital, Albany and Veterans Administration Research Hospital, Chicago, Foundation
and by of Chicago.
the
Bertha
4Assistant
College of Medicine, 1200 Texas 77025. of Pathology, Northwestern of Medicine 6 Associate
Professor
University. ‘Professor Professor of Pathology. for Research and Education
Nutrition
Brownstein
address: Baylor Avenue, Houston,
Moursund
ogy.
& Henry
‘Staff
28: JUNE
researcher.
1975,
pp.
‘
Associate Chief of Staff and Professor of PatholResearch associate.
588-594.
Printed
in U.S.A.
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/6/588/4716349 by University of Glasgow user on 14 February 2019
Sheldon
and lipid metabolism Arctic Eskimo” 2
CARBOHYDRATE
performed Eskimo
with village
AND
volunteers
at the
of
Hope,
Point
North
METABOLISM
Slope
Chemical
Alaska.
In
Slope diet
and methods
Subjects All subjects participating in the several facets of this study were Eskimos indigenous to the North Slope coastal region of Alaska. One group were current
residents located
of the village of Point on a sandbar extending
Hope, Alaska, which is into the Chukchi Sea. The second group consisted of individuals who were native to North Slope villages, but who were resident students School region school
at the Bureau of Indian Affairs Boarding High at Mt. Edgecumbe in the southern coastal of Alaska. This latter group had resided at for 8 months preceding the tests. Blood samples from all volunteers of the population of Point Hope over the age of 6 (60% of the population) were assayed for cholesterol, triglycerides, free fatty acids and lipoproteins. These persons were not identified as to the degree of outmarriage, although less than 10% were categorized by the Bureau of Indian Affiars census as being hess than 50% Eskimo. Samples were not taken from persons with acute illnesses. This Point Hope group consisted of 76 males and 88 females, 37% of whom were aged 6-12, 16% 13-17, 18% 18-35 years, 20% 36-60 years, and 9% over 60 years of age. Blood specimens were obtained at various intervals following a meal, but
only one sample was taken from each individual. In addition, blood was taken in the fasting state from a smaller number of subjects for measurements of circulating glucose, serum insulin, lipids and hipoproteins. This sample consisted of 41 youths, aged 16-20 years, who were age-matched to those persons
similarly
tested
at Mt. Edgecumbe.
From
this subset of
10 persons were recruited to and tolbutamide tolerance tests. samples were obtained from 32
ide, and
hipoprotein
Edgecumbe. tests.
Each
concentrations. of
these
samples
Dietary
evaluation
The dietary composition at Point Hope was estimated by analyzing dietary logs maintained by eight adults over a 3-week period and from interviews with the adolescents undergoing the tolerance tests. Cholesterol intake was calculated from published tables and supplemented by chemical analysis of indigenous dietary items (14). The carbohydrate, fat, and protein contents of the diet were calculated from published tables of food composition. The Mt. Edgecumbe diet was determined from schedules of the food offered and the quantities supplied. Adjustments were made for deviations from this diet in interviews with the tested subjects. Mathematical
analysis
The serum lipid and lipoprotein data from the Point Hope subjects were submitted to an analysis of variance, testing associations with age, sex, and time interval following the last meal. Both linear and polynomial correlation analyses were performed. Comparisons between Point Hope and Mt. Edgecumbe
serum out
lipid
using
glucose
tolerance
of variance
data
and
were
Student’s
carried
t-test.
Results Lipid and The
lipoproteins
mean
resident Table
lipid
chylomicra intervals.
of these
Mt.
postprandial
for
erate
and
This
are The
intervals extended
may fasting
population fasted
a range
values
of
for
the
be considered
17.0
a
mod-
strikingly
triglyceride
state
time 26-hour
states.
shows
of serum
26-hour
with
lipoprotemn
at Point Hope are shown in free fatty acids, and
listed for four postprandial 11- to 14- and 16- to
concentration to
at Point Hope
and
population 1. Triglycerides,
analyzed
test consisted of 100 g glucose in water taken over a 3to 5-mm period following a 12-hour fast. Blood samples for insulin and glucose were obtained at 0, 60, and 120 mm.
and
analysis
was
After drawing a fasting blood sample, 1 g of sodium tolbutamide was injected intravenously over 2 mm followed by sequential sampling at 2, 5, 10, and 15 mm. The test was terminated by infusing 25 g glucose at 15 mm since there were inadequate facilities for the treatment of hypoglycemia. The oral glucose tolerance
589
analysis
Five
Tolerance testing
ESKIMO
Plasma glucose was measured using glucose oxidase (7). Cholesterol, free fatty acids and triglycerides were assayed by a quantitative thin-layer chromatography technique (8) and checked by accepted reference methods (9, 10). Insulin was determined by a modification of the double antibody method (11). Lipoproteins were assayed by both paper electrophoresis and analytical ultracentrifugation (12, 13). Serum ketones were tested by the sodium nitroprusside reaction utilizing a method sensitive to 1 mg/dl acetoacetic acid or 5 mg/dl acetone (12).
Point Hope residents, participate in glucose
Fasting blood North Slope Eskimos aged 16-20 years at the Bureau of Indian Affairs Boarding High School at Mt. Edgecumbe. Each of these samples were analyzed for plasma glucose, serum insulin, cholesterol, triglycer-
IN THE
(61.0
to 72.1
low
in the ±
mg/dl.
17.0 Neither
11-
mg/dl) sex
nor age influenced this result. An initial rise of triglycerides at the 1- to 4-hour postprandial interval
was
noted
chylomicronemia 10-hour
triglyceride low VLDL
and
which
period.
In
concentration, level with
was
associated
persisted addition
to
with
to the
6- to
their
low
these people have a a mean fasting value of
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/6/588/4716349 by University of Glasgow user on 14 February 2019
addition, a group of youthful North Eskimos on a typical Western institutional were investigated for comparative purposes. Materials
LIPID
590
FELDMAN
TABLE Mean
ET
1 values of serum
of point
lipid moieties
At postprandial N164
1-5
91
6-10
± 7.6
11-14
56±
16-26
65
a Values
±
39.0±
18.1
49.0
31.1 0.20,
P
