An ancient treatment for a modern disease

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Elder Minnie Awashish never imagined that she would have a key medication compound for diabetes treatment named for her.

After nearly 15 years of working with scientists from universities in southern Quebec and Ontario, the Mistissini Elder was surprised to learn that scientists had named a chemical compound, Awashishinic Acid, after her and her late husband, Sam Awashish.

It was in honour of their work on a project to determine what traditional plant medicines could be effective to treat diabetes.

That story began nearly 20 years ago, with a flight to Morocco in 1998.

Pierre Haddad got off the plane to attend a conference on medicines and plants. Haddad, born in Egypt but who moved to Canada at the age of four, was a professor at the Université de Montréal. He had been studying medicine, especially for diabetes, and came across a session on traditional medicine that fascinated him.

Haddad was then restructuring his work around diabetes, and decided he wanted to focus on looking at diabetes and the impact of traditional plant medicine.

They formed a team. They brought together a botanist and a phytochemist – someone who specializes in plant chemistry – and consulted with a member of the Cree Board of Health and Social Services committee.

It came at a fortuitous time for the Cree communities. In 1999, Mistissini Elders had spoken of the need to preserve and promote traditional medicines at a local annual general assembly.

Minnie Awashish says it’s crucial to continue to pass along this knowledge to the youth. Even though she can no longer make the medicine herself, she’s taught her daughter, Francis Awashish, how to prepare these traditional remedies.

“It’s very important to continue with the medicines, to practice it,” Minnie Awashish emphasized. “I encourage people to practice more using the medicines. There are a lot of Elders who have the knowledge, and to the youth, I encourage them to ask your Elders questions about the traditional medicine.”

Haddad’s team organized a number of meetings, at first with Elders, then with band councils. More and more people came on board, swelling to dozens of representatives of scientists, local Elders, chiefs and councils, and local health authorities. By 2002, they were ready to begin the work and obtained funding to proceed.

There were several questions to address.

Diabetes had been relatively unknown before the 1970s, maybe 1980s, in northern Quebec. Some felt that there was likely something about the traditional diet that prevented it.

Talking to over 150 Elders in six communities, they managed to narrow down 17 plants that were repeatedly mentioned as dealing with the symptoms of diabetes. Would any of them prove promising to either preventing type 2 diabetes (previously called adult-onset diabetes) in the first place, or treating its symptoms?

The project had more than just one goal. Beyond identifying traditional ways of treating a modern disease, these scientists also wanted to see traditional knowledge taken more seriously by academics, by doctors and nurses, and by the public health administrators who decide on policies at a higher level.

It was essentially an effort of translation and verification. Translating – often literally, from Cree to English – the traditional knowledge that many Elders had into words that other academics anywhere in the world could understand.

The verification would take longer.

When asked, Haddad laughed at the comparisons with the science in fictional TV shows like CSI.

There, a forensic scientist inserts a vial in a machine. Whizz. Bang. Beep. Methyl-mercury was the murder weapon. Easy.

In real life, an undertaking like this wouldn’t be over in seconds, or minutes. It would take years. Twelve, to be exact.

Starting in 2003, Alain Cuerrier, a botanist with the Université de Montréal and the Montreal Botanical Garden, began his journeys to Eeyou Istchee along with his students. Haddad recounts that Cuerrier was instantly liked by many of the Elders for the simple reason that he knew his plants.

Later they would trek into the bush, accompanied by Elders, searching out the candidate plants that had been identified as traditional remedies. This happened multiple times over the years as they talked to more and more Elders.

After obtaining plant samples, they would return south, where the phytochemist would clean, dry and isolate the parts of the plants that Elders said were useful.

This was a trial-and-error process, one informed by feedback from community members, who might suggest that a certain plant or tree bark had to be boiled for a certain amount of time. Other potential medicinal compounds were extracted with alcohol, similar to the herbal tinctures available in stores, explained Haddad.

These extractions needed to be tested, first in petri dishes – cultures of live cells. There, they could study what the compounds did to the cells, and eliminate those that were toxic to living cells.

Eventually, this narrowed the process down to 10 plants and trees.

The testing was rigorous. They tested different compounds found in each plant again and again, trying slightly different compounds. It took six months to isolate just one compound that could prove most likely to work.

Once they had these plant compounds isolated, they began testing them, along with the whole plant preparation, on live mice.

“When we told the Elders we were going to use mice, they were happy because they said mice are man’s helpers,” Haddad added.

Mice share a lot of genetic makeup with humans, and allowed scientists to see how those that are both pre-diabetic and diabetic react to the different traditional medicines.

Each mouse had to be raised for between two to four months before testing different potential medicines and recording the impacts. Up to 78 animals were used in a single test – with examinations of up to 20 animal part samples – for a total of nearly 1,600 tests with just one plant compound.

After the animals were anesthetized, Haddad and his students removed their body tissues and organs to determine if the results were successful or not.

In the end, they determined just what effect these 10 plants had. Many were very common species: balsam fir (innasht), Labrador tea (kachichpukw), mountain cranberry (wishichimna), and tamarack (watnagan), which had the new chemical that was named after Elder Minnie Awashish and her family.

The results showed that many traditional medicines have the power to prevent diabetes, treat symptoms, or sometimes both. Some had effects similar to existing drugs, which meant they could be used to limit the prescription of expensive pharmaceutical drugs. But they needed to be used with caution and under a doctor’s guidance.

Haddad is hopeful this research will help raise the credibility of traditional medicines in the medical establishment. He noted that it’s already helped traditional knowledge practitioners be more confident in their own knowledge.

However, Haddad is disappointed that his research findings didn’t make the impact he had hoped for. “We did our research, our reports and our summaries, but it didn’t quite reach the desks of doctors and other health professionals,” he said.

This is the next challenge – advancing traditional medicine within the strict constraints of the current health system – one that Haddad and other health professionals are already working on.

They’ve begun a project to bring together community members, Elders, health professionals and health administrators to identify the barriers to using traditional medicine. When it’s done, sometimes this year, they intend to host workshops in different communities to present their findings. They will discuss short, medium and long-term action plans to improving traditional medicine access.

For diabetes prevention, they’ve also put together a team of researchers and health professionals to look at creating programs focusing on physical activity and healthy eating, which will also encourage medicinal plants as part of a healthy diet. The goal is to identify the impacts that lifestyle changes and traditional medicines can have in improving blood sugar, by involving both pre-diabetics and people who already have diabetes.

Haddad acknowledges that none of these projects could have started in the first place if they didn’t work hard to develop good relationships.

“My colleagues who had experience working with communities said, ‘You’re crazy, this will never work!’ But we trusted the process, had like-minded people, and had some bumps along the way. There were some tensions, some mistakes along the way, but we built a great relationship,” Haddad noted.

Elder Awashish agrees. “Some people were afraid at first. But then they were willing to work with the scientists. They accepted them. Working with [community members] they learned other things, so they were both learning from each other.”

To this day, there are a number of people who began taking the traditional medicines that the Awashishes began to make during this study, which they continue to do. Passing on traditional knowledge is paramount, she says, and not only for the Cree.

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