Anchorage Daily News

Dr. Nora Nagaruk was 29 and in her second year of residency as a family practice physician when she was diagnosed with acute leukemia in 2004. The day after getting the news, she was on a plane to Seattle for treatment and eventually, a stem-cell transplant.

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TRADITIONAL FOOD GUIDE -- Distributed free to Alaska Native cancer patients; sold to others for $24.95. To buy a copy call Karen Mitchell, 729-4491, e-mail her, kmmitchell@anthc.org, or call ANTHC, 729-1900.

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With her immune system on empty for months, the foods she ate and how they were handled could have made the difference if she lived or died.

"Lots of restrictions," she said. "The rule was, if it wasn't clear or understood, don't risk it. So I had to avoid a lot of the stuff I like to eat -- dried fish, seal and berries."

For those fighting cancer, a healthy diet is critical. For Alaska Natives fighting cancer, a healthy diet means foods hunted and gathered from land and sea, foods seasoned by a sense of place and community, foods like muktuk and seagull egg pie that the non-Native medical establishment doesn't understand and, therefore, has a hard time endorsing.

That's why Nagaruk, as both a cancer survivor and a physician, is grateful for the new "Traditional Food Guide for Alaska Native Cancer Survivors." The guide gives dietary credibility to what subsistence eaters have known all along: Wild foods are not only rich in nutrients, but rich in story, culture and comfort, all part of the health and healing package.

Christine DeCourtney of the Alaska Native Tribal Health Consortium's Cancer Project spearheaded the project. She's heard stories like Nagaruk's too many times before.

With the help of Desiree Simeon, Karen Mitchell and others, DeCourtney has taken nutritional analyses from past studies on subsistence foods, presented them in an easy-to-understand format and woven in stories from Native people all over the state about why these foods matter.

Ethel Lund of Juneau put it this way:

"They told me to eat kale when I was getting cancer treatment. I don't even know what kale is. I wanted sea asparagus."

The colorful 142-page guide, primarily funded by a grant from the Lance Armstrong Foundation, provides protein analysis for everything from musk ox to muskrat. It lists the vitamin A and C content of wild celery, fiddlehead ferns, fireweed and other subsistence plants. Calories, cholesterol and carbohydrates, too.

It also explains a few things. Like, what's a "serving?" More specifically, what's a serving of moose?

"We show it in pictures so people can understand portion size," DeCourtney says. A cup, a half-cup, the amount that fits in the palm of one's hand.

A section titled "Moose & Caribou Parts" lists, beyond the obvious, what's good to eat, and what's not. Nutritionally and culturally.

Head? Yes.

Lower lips? Taboo for all except old men.

The guide also includes 30 recipes, among them caribou stew, baked moose bones, beaver pot roast, herring egg salad, sheefish chowder, baked ptarmigan and Akutaq (Eskimo ice cream).

Proportionally, Alaska Natives die of cancer way more than this country's white population does. With 400 new cases diagnosed each year, it's the leading cause of death among Natives in this state, as it is for all Alaskans.

Research indicates that a shift of diet, from subsistence foods toward processed, convenient ones, may play a role, DeCourtney says. And not just in higher rates of cancer, but diabetes, obesity and other health issues that are hitting the Native community hard.

When undergoing cancer treatment, following a healthy diet can help reduce fatigue, manage side effects and build the body's defense system, the guidebook says. But also, for Alaska Natives, traditional foods offer a significant source of comfort during and after treatment. Special meaning and memories are often associated with food.

"The tundra berries, that's what I missed the most," said Nagaruk, now 32, in remission and working for Norton Sound Health Corp. in Nome.

Among other memories, the taste of wild berries transports her to her favorite berry patch -- up the Unalakleet River, on the hilltop above her mom's cabin. The way she likes them is straight from the bush when in season, and straight from the freezer when not.

During treatment, with her immune system suppressed, she was discouraged from eating them unless they were thoroughly washed, which makes them "mooshy," or baked in something like a muffin.

Not the same.

"I have a background in microbiology," she said, "so I understood where they were coming from. I was a good patient; I stuck to the rules.

"But getting through cancer treatment, you need your comfort foods. You're struggling enough, and isolated enough with all the rules you need to follow to keep yourself alive."

Nagaruk expects the guidebook to do good things for patient-provider relationships.

"The more knowledge health care providers have about the nutritional and cultural value of Native foods, the more likely it will be encouraged and promoted, which in turn makes a patient who eats these foods feel culturally respected and may give the patient more trust in their provider.

"And, the guide could help physicians and other health care providers -- who have no idea what these foods are -- connect with their patients."

Find Debra McKinney online at adn.com/contact/dmckinney or call 257-4465

Food from the land

Excerpts from "Traditional Food Guide for Alaska Native Cancer Survivors."

Bird eggs

Gull, Tern, Goose, Duck, Murre

NATIVE NAMES: Kayangu (Yup'ik), K'eghaya (Dena'ina), K'wat' (Tlingit)

Gull eggs are gray with spots and are among the most popular eggs to gather. Gulls lay more eggs when some are taken from their nests. Goose, duck and tern eggs are also gathered, yet are smaller and harder to find. Eggs are usually harvested from the last week in May until the second week in June. Murre eggs are also popular in the Northwest regions of the state and are harvested in July.

PREPARATION: Bird eggs can be prepared and used like chicken eggs. For example, gull and goose eggs are great in cake mixes. Use one gull egg to replace one chicken egg. Boil eggs in water for at least 20 minutes for hard-boiled eggs.

To test if an egg is good to eat, Alaska Natives put it in water. If it sinks, it is good to eat. If it floats, it is about to hatch and is not good to eat.

Fireweed

Wild Asparagus, Wild Herb

NATIVE NAMES: Chiilqaaq (Yup'ik), Lool (Tlingit), Cillqaqtaq (Alutiiq), Pamiqtaq (Inupiaq) Chikayaasix (Unangam Tunuu-Atka dialect)

Fireweed is common throughout Alaska, from the Arctic to the Kenai Peninsula. Traditionally, all parts of this plant have been eaten in a variety of different ways. Fireweed grows best on burned-over land or disturbed soil, along river banks and where people live. Fireweed is ready to pick when the stem is violet colored, the leaves are dark purple, and they are 2 to 4 inches tall. The best time to pick fireweed is in the spring. The plant becomes tough and bitter tasting as it ages.

PREPARATION: Fireweed flowers and leaves are used in salads, soups, casseroles, teas, jams and honey. Stems and shoots can be boiled, steamed and covered with a cream sauce like asparagus. Fireweed shoots can be bundled and hung to dry for a few days. Wilted fireweed can be preserved in seal oil.

Seal

NATIVE NAMES: Keviq (Yup'ik), Qutsaghil'iy (Dena'ina), X'oon (Tlingit) Isux (Unangam Tunuu)

Seal is a delicacy among Alaska Natives who harvest it year round. Some prefer to hunt seal in the early spring when they are fattest and will render the most seal oil.

PREPARATION: The meat is a dark red-black color. Seal meat can be cooked in any regular meat dish, stewed, fried or eaten plain. Almost every part of the seal is eaten.

Mouse Food (Roots)

NATIVE NAMES: Anlleq (Yup'ik), Nivi (Inupiaq)

Mouse caches provide an easy way to gather roots such as Eskimo potato, or masru. The mouse caches are located by searching for soft spots in the tundra. Once found, the top layer of the ground is gently lifted, and using gloves, the mouse cache is felt out for roots. Only the larger roots are taken, leaving the smaller pieces for the mouse to survive.

PREPARATION: The roots taken from the mouse cache are first cleaned by removing any non-edible roots. They can be eaten raw, boiled, baked, or fried. TRADITIONAL FOOD GUIDE

Distributed free to Alaska Native cancer patients; sold for $24.95 to others. To buy a copy, call Karen Mitchell, 729-4491, e-mail her, kmmitchell@anthc.org, or call ANTHC, 729-1900.

Pay attention to food preparation and storage

DO

• Use only clean utensils for eating and transferring cooked foods to serving dishes.

• Use two separate cutting boards: one for breads, fruit and vegetables, and another for raw meat, poultry and seafood.

• Clean the tops of cans before using a can opener.

• Boil fermented foods before eating them. Although it may change the taste, boiling for 10 minutes can destroy the botulism toxins. This is important because you cannot see, taste or smell the botulism toxin.

DO NOT

• Refreeze foods once they've thawed.

• Reuse marinating sauce on cooked foods, unless you boil it before using it again.

• Use utensils or plates that have come into contact with raw food.

• Use garbage bags for food storage; they are chemically treated for garbage use only.

Online: For more information about the Alaska Native Tribal Health Consortium's cancer projects and other health research, go to anthc.org/cs/chs/oanhr/index.cfm

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