A review of features of polymorphism of lipid and carbohydrate metabolism genes in aboriginal populations of Siberia is presented. The most significant genetic changes in aboriginal populations of Northeast Asia (Eskimos, Chukchi and Koryaks) are described, related to long-term adaptation to extreme conditions of the natural environment and dietary characteristics. Part of the genetic variability of aboriginal populations of this region is represented by polymorphisms associated with metabolic disorders (deficiency of carnitine palmitoyltransferase 1A, pancreatic amylase, sucrase-isomaltase, trehalase) caused by the change of the traditional protein-lipid diet to “European” carbohydrate one. In modern conditions, it is extremely important to perform large-scale genetic testing of aboriginal populations of the Far North.