In many ways we live amazing lives in the developed world today. Wars are fewer and shorter, violence is actually decreasing, infant mortality rates are close to zero and modern health care helps us live long productive lives. Backbreaking labor on fields and in mines and factories is mostly a thing of the past. All in all, technology has given us possibilities we could not even dream about a mere 30 years ago.
Yet something is on the rise, something wrecking us from within. Depression, autoimmune disease, diabetes, obesity and other diseases of modernity are all up dramatically. The message from scientists is in: this is not only because of improved diagnostics. It is a real, substantial, undeniable increase in the prevalence of all these types of disease. This trend cannot be explained by mere genetics, since our genetic makeup hasn’t changed in a single generation and cannot change with a frequency anywhere close to that.
What might explain it then? I (and science) would like to claim that the cause is multifaceted. When you look at what these symptoms tell us, their message is loud and clear: we simply live our lives wrongly. We live vastly different lives from our ancestors on the savannah and our genetics hasn’t had nearly enough time to adapt. As a consequence many fundamental human needs are not being met. And the more of them left unmet the larger the risk of developing a “lifestyle diseases”; diseases of modernity.
What then, specifically, triggers this kind of lifestyle-induced health-collapse?
The pool of triggers that cause diseases of modernity
1) We eat foods that Homo sapiens isn’t adapted to digesting and absorbing. Often as much as 70% of our diet consists of food alien to our species — like grains, large amounts of sugar, dairy, processed plant oils etc. Sugar intake has increased dramatically, from 1.8 kg per person and year in 1700 to ∼65 kg in 2000 (data from UK and US).
2) The foods we eat tend to have low nutrient density compared to their pre-industrial and wild equivalents. (ref1, ref2, ref3, ref4)
3) We don’t move enough. (ref1, ref2)
4) We aren’t exposed to the microflora our immune systems need to develop properly. (ref1, ref2)
5) We’re sleep deprived.
5) We have a disturbed circadian rhythm, either self-elected or because of work. (ref1, ref2)
7) We’re exposed to very high levels of prolonged stress. Our stress systems are meant for intense, short-term stressors. (ref1, ref2)
8) We spend too little time in nature. (ref1, ref2)
9) We spend too little time in the sun and end up with vitamin D-deficiency and miss out on the positive effects of nitric oxide from UV exposure. (ref1, ref2, ref3)
10) We experience a lack of meaning in life.
11) We experience a lack of social connections and context.
12) We’re exposed to high levels of toxic substances such as air pollution, mold, heavy metals, pesticides etc.
13) We overuse antibiotics and risk wrecking our intestinal flora.
14) We are subject to chronic microbial infections that make up massive sources of inflammation: bacteria, viruses, parasites and fungi our heavily burdened immune systems can’t handle – partly because our diets and lifestyles problems have damaged them. (ref1, ref2)
15) Nutritional deficiencies are common, due to
- impaired uptake due to inflammation of the intestinal lining because of point 1 and 13
- too low intake or production (point 2 and 9)
- high demand because of processes consuming high levels of nutrients (points 7, 12 and 14)
16) We develop an impaired intestinal health, disturbed intestinal flora and increased intestinal permeability because of point 1, 2, 4, 7 (ref), 12, 13, 14, and 15, which has been shown to have a tremendous impact on the development of autoimmune diseases.
How complex causation is often involved
It is clear that the causation is complex and sometimes reciprocal, where two phenomena can cause each other. Nutrient deficiency can, for example, cause sub-optimal function of the intestinal lining, which in turn can cause impaired nutrient uptake leading to nutrient deficiency. Also, some people carry genetic variations that render them sensitive to developing for example issues with methylation, or problems recognising the body’s own tissues and pathogens. Worth mentioning is also that the experience of psychological or physical trauma (such as an accident or surgery) can cause huge immune-related problems.
All these factors have been shown in scientific articles to contribute to inflammation and chronic and mental illnesses. This happens either directly by inducing inflammation, or indirectly by weakening the body and its immune system. Our hormonal and nervous systems, immune defense, intestines, muscles, skin, and all other organs and tissues can be affected.
With that said, I don’t believe it’s sufficient to exercise more, sleep better and hang out with friends to reverse a severe chronic condition. Often there is something more powerful driving the inflammatory process. But if you do do these things, it decreases the risk of developing a condition. And for those already sick it makes it more likely that treatment will succeed by tipping the balance in favour of healing.
Note that it’s not obvious what came first – sleep deprivation or lack of exercise and social interaction could very well be the result of disease and not its cause. That’s why it’s so important to take a thorough patient history.
Standard health care is not equipped to handle inflammatory diseases
You might start to appreciate the complexity involved in deteriorating health. That’s why doctors often fail to see the connection between a certain causative factor and inflammatory disease. People want clear, simple connections, preferably research showing that A (only) causes B (only). I have a genuine understanding for that. Evidence-based medicine is a central value in today’s health care. That’s a good thing, but there is seldom any room for complexity and ambiguity, and that sometimes goes for research as well.
Importantly, even though the scientific publications explaining all this are out there, doctors don’t and can’t make use of much of the information that does exist because they’re stressed to the limit and weighed down by administrative burden. Many get burnt out. When that’s your work environment sitting down with a patient and doing some real detective work to find out exactly what has caused their symptoms is simply nothing they can afford to do. At a regular doctor’s appointment you usually get about 15 minutes and those minutes will mostly be used to try to find out which preexisting box to fit you in. At a specialist’s office you get more time, but that does not mean they’ll be looking for fundamental causes – they will rather try to chart your symptoms carefully to conclude what diagnosis to give you, which may not help you very much in the end. I was myself investigated for hours at one of Sweden’s top hospitals and at a private neurologist’s office for my neurological symptoms, but no one even considered testing for Lyme disease. They just aren’t institutionally equipped to handle the complexity and ambiguity of diffuse chronic illnesses.
As I said, the publications are out there but there’s no time to read them. Doctors are instead waiting for directives from above and aren’t always even allowed to think outside the box (they might even get sued if they do). And don’t forget that it takes a long time for scientific findings to be accepted as orthodoxy – medical practice is on average 17 years behind research, a concept called “from bench to bedside”. And even that’s being optimistic; listen: the vast majority of published findings in medical research will never amount to anything – no new recommendations, no protocols, no guidelines or drugs. A medical researcher can publish hundreds of articles during their lifetime without any of it ever coming to clinical use.
That’s why you have to let go of the thought that your doctor will make you well. Not because they don’t wish you well, but because they most probably does not have the time, knowledge or professional authority to look beyond their box.
So, how do we get out of this mess?
1) Try to find out what might have caused our particular symptoms.
2) Treat the underlying causes and repair the damage as well as we can.
3) Acknowledge human evolutionary history and return to the lifestyle and diet we’re adapted to, as best we can; focus on lifestyle changes that provides the highest gain-to-effort ratio.
In the next article I’ll tell you about how inflammation from all of these sources contribute to disease.