Traditional Foods as Medicine: What the Native American Experience Teaches the Rest of Us
Thomas Lee Abshier, ND | 13 September 2026
Every physician learns, somewhere in the first year of training, that the body is built out of what it eats. Then most of them spend the next forty years of practice never mentioning it to a patient. This is not a personal failing of individual doctors. It is a structural feature of the system that trains, pays, and schedules them. I want to examine that structure through a case that makes it unusually visible: the health of American Indian and Alaska Native communities, and the movement within those communities to recover their ancestral foods as medicine.
I was prompted to write this by a continuing-education webinar published in August 2026 by the National Council of Urban Indian Health, presented by Nahla Holland of the Eastern Pequot Tribal Nation and her colleague Lyz Best. Their audience was clinicians and community health workers serving Native people in cities. Their argument, though, deserves a wider hearing, because the Native experience is a concentrated version of what has happened, more slowly and less visibly, to everyone in the industrialized world.
A natural experiment nobody consented to
Consider what happened to the Plains nations when the bison were destroyed. Within a few decades — in some regions, within a single one — a food source that had anchored diet, clothing, shelter, and trade for centuries was gone. What replaced it was not a comparable food. It was rations: refined flour, lard, canned meat, sugar, and later the processed cheese that became a grim joke in Native households. The same pattern repeated in different forms across the continent. In the Pacific Northwest during the 1960s and 1970s, Native fishermen were arrested for taking salmon in the very places their treaties guaranteed them. Boarding schools removed children from the households where they would have learned to gather, hunt, plant, and cook. Whole nations were relocated from coastlines to interior plains, or from forests to deserts, where the foods they knew simply did not grow.
The result was a diet imposed rather than chosen, imposed on a population whose metabolism had spent thousands of years adapting to something else entirely. If a scientist proposed this as an experiment — take a population, remove its ancestral foods within one or two generations, substitute refined carbohydrate and processed fat, and observe the outcome — no ethics board on earth would approve it. It was done anyway, and we have the data.
The data are what one would predict. Diabetes and heart disease sit at the top of the mortality tables for Native Americans, at rates well above the general population. According to a 2024 report from the United States Department of Agriculture covering 2016 through 2021, American Indian and Alaska Native households reported the highest food insecurity of any group in the country, at roughly 23 percent — nearly one household in four. Local studies in urban settings have found figures far higher than that.
Why the city makes it worse
One might expect that moving to a city, with its grocery stores and restaurants, would relieve food insecurity. For urban Native people, the opposite is often true, and the reasons are instructive.
The federal food distribution program for reservations does not follow a person to the city. The informal economy of a tribal community — the cousin who invites you to dinner, the ceremony that feeds everyone who attends, the neighbor who notices you are struggling — does not follow either. And the foods themselves are not on the shelves. A person from a coastal nation living in the Great Plains cannot buy the shellfish his grandmother cooked at any price he can afford; a person from the interior cannot find chokecherries at any supermarket. Someone in this position has lost his food, his food distribution system, and his social support system at the same stroke, and has been given nothing in exchange but the same processed calories available to everyone else.
This is worth pausing on, because it defines food insecurity as more than a shortage of calories. It is a shortage of the right calories, embedded in the right social structure. The cheapest food in America is refined flour, sugar, and seed oil, and a person can be both overweight and malnourished on a diet of nothing else.
What “traditional food” actually means
The presenters were careful to define their terms, and the definition works well for any clinician. A traditional food is one eaten in a given place before European contact—indigenous to that land and the people who lived on it. For a Pequot from the Connecticut shore, that means quahogs, blue crab, bluefish, squash, strawberries, and maple. For a Lakota, it means bison, chokecherries, prairie turnips, and wild plums. For a Diné, it means corn, beans, squash, and the mutton that came later but has been fully absorbed. There is no single “Native diet,” and the presenters were emphatic that an urban Native community drawn from many nations will find itself sharing and learning one another’s foods rather than reconstructing a single tradition.
What these diets have in common is not any particular food but a set of properties. They are built from whole foods harvested close to where they are eaten. They are low in refined carbohydrate and industrial fat. The plant foods — squash, beans, corn, wild rice, tubers, berries — carry fiber, minerals, and polyphenols in the proportions a body expects. The animal foods are lean, wild or pastured, and eaten with their organs and fat rather than as isolated muscle. And they are eaten communally, which matters more than most physicians appreciate.
Physiologically, none of this is mysterious. A diet built from foods like these has a lower glycemic load, which means smaller insulin excursions, less lipogenesis, and less chronic hyperinsulinemia that drives fatty liver, dyslipidemia, and eventually beta-cell exhaustion. It supplies the fiber that feeds a diverse gut flora, which in turn produces the short-chain fatty acids that regulate inflammation and intestinal barrier function. It provides omega-3 fats in the omega-6 ratio a human inflammatory system was tuned for. Programs that have moved Native patients back toward these foods report improvements in hemoglobin A1c, blood pressure, and lipid profiles — exactly the markers one would expect to move when the biochemical insults are removed.
Why your doctor never brought it up
Here the essay turns from the Native case to the general one, because the obstacle is the same for every patient.
Surveys of American medical schools have found for decades that most physicians graduate with fewer than twenty hours of nutrition instruction across their entire training. Twenty hours is a long weekend. That is less time than a medical student spends learning to read an electrocardiogram, and the ECG, for all its importance, addresses a problem that diet helped create. The predictable result is that physicians report low confidence in counseling patients about food, and low confidence produces silence.
Even a physician who wants to talk about food runs into the clock and the ledger. The fifteen-minute visit has no room for a conversation about what a patient actually eats, and the billing codes that pay for that visit do not reward the conversation if it happens. Dietitians exist, but in most clinics they are a referral to somewhere else rather than a member of the team in the room. And when nutrition guidance is finally offered, it arrives as a standardized handout — the food pyramid, the plate diagram, the diabetic exchange list — designed for a hypothetical average patient who eats a hypothetical average American diet. For a Native patient, or an immigrant, or anyone whose grandmother cooked differently from the handout, the guidance is not merely unhelpful; it carries the implicit message that his own food is the problem and the clinic’s food is the solution.
This is where the political dimension enters, and I will not pretend it is absent. A medical system built around pharmaceutical and procedural reimbursement has no economic reason to develop competence in the one intervention that would reduce demand for both. Nobody conspired to keep nutrition out of medical school. The incentives simply never pointed toward including it. One of the clinic directors quoted in the NCUIH report made the point plainly: teaching people to live differently saves the payer enormous sums in medication and hospitalization. That is true, and it is also the reason the payer’s system will not do it on its own.
Cultural humility as a clinical method
The most practically useful part of the webinar was how a clinician should open the conversation, and the method it described is one I would commend to any practitioner, regardless of who is sitting across the desk.
The conventional nutrition encounter is a lecture. The clinician has a list of foods to avoid and a plan to follow, and the patient’s job is to comply. The alternative the presenters called cultural humility begins with the opposite posture: the clinician assumes he does not know what the patient eats, why he eats it, what it means to him, or what constraints of money, time, and geography govern his kitchen—and asks.
The questions are simple. What did you eat growing up? What foods matter to your family? What are you cooking at home now? How much time do you have to cook? What does the store near you actually sell? The clinician listens before he advises, and when he advises, he builds on what the patient already has rather than replacing it. If the patient’s family has always eaten beans and squash, the plan starts with beans and squash. If the patient’s grandmother made a stew from wild game, the plan asks whether any of that game is still reachable. The clinician offers options and asks which feel realistic. The patient, having been treated as the authority on his own life, is far more likely to follow a plan he helped make.
I have practiced this way for a long time without having a name for it, and I can report that it works for reasons that go beyond compliance. When a patient is asked about the food of his childhood, something in him relaxes. Food carries memory, identity, and belonging. A clinician who honors that is treating the whole person, and the whole person heals faster than the isolated pancreas.
What the programs look like
The NCUIH surveyed urban Indian health organizations about the food programs they run, and four models recurred. I describe them here because each is transferable to any community clinic.
Food prescriptions. The clinician writes an order not for a drug but for food: produce delivered directly, prepared meals matched to a diagnosis, or vouchers redeemable at a farmers’ market. Eligibility is sometimes tied to a diagnosis such as prediabetes or documented food insecurity, and sometimes open to anyone who asks. Every organization surveyed wanted to offer this; the obstacle was funding, since many grants forbid paying for food.
Diabetes programs with cultural content. The federal Special Diabetes Program for Indians has run for decades and is unusually flexible in what it will fund. Because it permits cultural activity and food as legitimate diabetes interventions, it has become the vehicle for much traditional-food work—cooking classes, gardening, community meals—that other funders would not cover.
Nutritional counseling. This ranges from one-on-one sessions to group cooking classes led by Native chefs who demonstrate how to make appealing meals from unfamiliar traditional ingredients. One organization ran a competition modeled on a television cooking show, handing participants a basket of traditional ingredients and challenging them to make dinner. The point is not the recipe; it is discovering that the food is good and that one can make it.
Community gardens. In a city, green space is scarce, and a garden run by a clinic gives people a place to grow foods that cannot be bought — the chokecherries, the heirloom squash, the medicinal plants. The garden also delivers exercise, sunlight, social contact, and the particular psychological benefit of putting one’s hands in soil. Research on gardening and mental health is consistent enough that I would prescribe it independent of what is grown.
None of these programs is run by a clinic alone. They draw on local tribes for access to traditional foods, on universities for research, on food banks and housing programs for logistics. Food, as the presenters kept returning to, is communal by nature, and the programs succeed because they are communal too.
The lesson for everyone else
The Native experience is extreme, but it is not exotic. Every population in the industrialized world has undergone a slower version of the same displacement. My own ancestors ate fermented vegetables, organ meats, sourdough bread, whole milk from grass-fed animals, and cold-water fish. Within three generations, that diet was replaced by the same refined flour, sugar, and seed oil that were shipped to the reservations, and my people acquired the same diseases at only a slightly slower rate. The mechanism was economics rather than force, but biochemistry doesn’t care about the mechanism.
The remedy is the same too. Eat the foods your body was built for — whole, local, unprocessed, prepared in a kitchen rather than a factory — and eat them with other people. Find a physician who will ask what you eat before telling you what to eat. And recognize that a medical system which cannot afford to talk about food has told you something important about what it is for.
The presenters closed by speaking of the next seven generations, a phrase from the Haudenosaunee that asks every decision to be weighed by its effect on descendants a century and more away. It is the right frame for nutrition. What a person eats today shapes not only his own arteries but the habits, the palate, and the epigenetic inheritance of the children at his table. The Native communities working to recover their foods understand this. The rest of us would do well to learn it from them.
Source acknowledgment: This essay draws on ideas presented in “Rethinking Nutrition: Why Traditional Foods Matter in Wellness and Beyond,” a continuing-education webinar from the National Council of Urban Indian Health (published August 11, 2026; presenters Nahla Holland and Lyz Best), and on the NCUIH’s 2024 report on traditional food programs at Urban Indian Organizations. All prose is original; readers wanting the presenters’ own words and the underlying data should consult the webinar directly.