Saturday, 17 November 2018

Ways to End and also prevent disease

re you in complete control of your life? Take a moment and think about this question. If you’re honest with yourself, you’ll find that you’re left with no other choice than to acknowledge that you’re not in complete control of your life. If you were to lose a loved one, the company your works for were to go bankrupt, or you got in a car accident while sitting in the backseat of a friend’s car, that would obviously affect you. None of us are completely immune to the consequences of events like these. We’re all affected, to some extent, by what goes on around us.
I think that’s something pretty much everyone acknowledges. What I don’t think everyone acknowledges though, is that there are things that in some respects play an arguably more important role in shaping our lives than those that have to do with the portion of our environment we observe with our naked eyes – the people around us, stock prices, traffic, and so forth. They may not have such an acute and dramatic effect on us as the unpredictable life events mentioned earlier, but they can exert great power over our actions. As you probably guessed from reading the title of the article, the things – or more specifically organisms – I’m talking about are microbes.
The forces that shape our behavior

A lot of people view the human body as a machine or as a structure that was designed, in its current form, by some divine force. What these people fail to realise is that the human body is actually a product of a long series of evolutionary events. Over time, apparatus that regulate all aspects of how the body functions have been put in place and sculpted by evolutionary forces. These apparatus don’t just regulate the body’s internal temperature, metabolic system, and blood flow, but they also affect things such as appetite, behavior, and cognition.

There’s an evolutionary explanation for why we like sugary foods, why we have a tendency to take it easy and rest when an opportunity to do so present itself, why we are attracted to the types of people we’re attracted to, and why we feel and think the way we do. Nothing is by accident. Our behavior is largely determined by the evolution-produced systems that are in place in our bodies. Obviously, we do have the power to make conscious decisions regarding what we eat, who we spend our time with, and so on; however, what is important to acknowledge is that there are underlying forces that shape and guide our choices. There’s a reason why we make the choices we make.

Not only are there powerful, evolved systems in place inside our own bodies that shape what we do, but there are also powerful machineries inside the cells of other organisms that can affect how we function and behave. The reason why this is the case is that no organism evolves in complete isolation. We’re all part of a larger system in which there is an evolutionary arms race going on. We have co-evolved alongside other organisms, including a mist of microscopic ones.
We live in a microbial world

To someone who is unfamiliar with the scientific literature on the human microbome, the statement that our lives are controlled by bacteria and other microscopic life forms may seem far-fetched; however, to someone who has digged into the science on all of this, it probably doesn’t. Obviously, your microbiome is not the only factor that is responsible for determining what you do and the choices you make; however, it’s definitely among the main forces that shape your actions, perhaps even the main force.

Many microorganisms have evolved ways of manipulating larger organisms like ourselves in such a way that they attain a fitness benefit (i.e., they get better at surviving and reproducing). For example, some microbes are capable of controlling our eating behavior in ways that benefit them in the sense that they steer us towards food that contains nutrients that they can derive energy from. The microbes that colonize our bodies also affect many other aspects of our biology and behavior. Actually, they seem to be involved in pretty much everything that goes on inside us…

When we think about it, it’s not really that surprising that microbes have such a profound impact on our lives. After all, they greatly outnumber us. In your intestine, there are a lot more microbes than there are humans on this planet. Each of these tiny microbes all have their own agenda and are capable of producing many different types of compounds, some of which can enter into your bloodstream and travel to various organs in your body.
We’re microbe-carrying vessels

In the absence of microbes, the human body is hollow and unlifelike; its systems working as partial capacity. Unfortunately, many contemporary humans are damaged in this sense. They’re obviously not devoid of microbial houseguests; however, many of the guests they have are not friendly to them. Also they don’t have enough guests to fill all their beds. The result is that they don’t feel that great and are easily perturbed by the unpredictable events of life.

As I see it, many of the health woes that plague the modern man are symptoms of microbiome “deficiencies” and dysfunction. Dysbiosis and lack of microbiota diversity produce many physical manifestations; hence, it is often possible to determine the state of a person’s microbiota simply by looking at him, examining his skin, hair, and oral health, and/or paying attention to his behaviors. If he “glows” and looks fit, then chances are his microbiota is in good shape, whereas if he looks “broken down” and/or is constantly on the lookout for sugary, calorie-dense foods, then chances are he’s suffering on the inside.

One of the main reasons why the microbes that colonize our bodies have such a profound impact on our lives is that they regulate our immune systems. Much of human behavior is affected by immune-related factors. Not only does inflammation – an activation of the immune systems – play a role in pretty much every chronic health disorder known to man, but immune status has also been shown to be an important predictor of behavior. People who are inflamed are typically fatigued and depressed and lack sex drive (13, 14, 15, 16). They are more likely to want to spend their days in bed than people who don’t have a fire burning inside them.


The human body is an amazing structure. Unlike what some creationists claim, this structure was not created and put here on Earth in its present form by some divine force; rather, it was sculpted by evolutionary forces over billions of years. Over time, its various constituents have changed in form and function as a result of the workings of natural selection, in conjunction with mutations, genetic drift, and other factors responsible for causing evolutionary change.

Given that there has been ample time for natural selection to mold the genetic recipes that we humans carry with us, it may seem strange that our bodies aren’t better designed. In some ways, they seem almost perfect: Our hearts are constantly pumping out fresh, oxygenated blood to the various organs of our bodies; our muscles rapidly adapt following exposure to novel stimuli; and our digestive systems are highly proficient at turning many different types of foodstuffs into energy that our cells can use.

However, in others ways, our bodies seem flawed and damaged. Many of us have or will develop shortsightedness, heart disease, and acne vulgaris; our bones get fragile and weak when we get older; and over time, deleterious mutations develop inside our cells, something that can lead to cancer. Upon first inspection, it can seem like the human body was created by a negligent, sloppy, and unskilled designer.

Why is it that our bodies aren’t better designed? Why do so many of us get sick? Why aren’t we more robustly built?

In my recent article entitled The 6 Reasons Why Diseases Exist, I made the case that the answers to the questions can be found within the realm of evolutionary science. One of the main reasons our bodies aren’t unshakable and immune to disease is that the primary currency of evolution isn’t health, but reproductive success. Moreover, natural selection can’t do magic. It can’t go back and completely rebuild a structure from scratch; it has to work with what it’s got at hand.

Finally, natural selection is not as fast as Usain Bolt; it can’t keep pace with a rapidly changing environment. It takes time for adaptations to spread within a population, particularly if the environmental pressures are weak. If the speed of environmental change exceeds the speed at which natural selection operates, a conflict between the environment and the genetic make-up of the organisms that live in that environment may arise.

This leads us over to the main topic of today’s article…
The human body isn’t as flawed as it may seem

The human body isn’t as poorly “designed” as it may seem. It’s certainly true that it isn’t “perfect”; however, it’s not as flawed as it seems to be. As you undoubtedly know if you’re a regular reader of this blog, many of the health problems that affect the modern man don’t arise because of deleterious mutations or “design flaws”, but rather due to gene-environment incompatibilities.

Imagine that you had to uproot your whole existence, pack all your things, and move to a faraway place where you knew no one and the culture and language were very different from that of the place from which you came. It would probably take you quite some time to adjust to your new circumstances and find your place in the new and unfamiliar world. For some time, you would probably feel very confused and lost. It may even be that you would never fully get over what’s happened and get mentally comfortable with your new life.

This is not so different from how the human genome “feels” when it’s placed in a modern environment. From the perspective of the genes found inside our bodies, the manufactured milieu that we humans have created for ourselves is a foreign place that’s very different from the place in which they came into existence. The human genetic make-up expresses itself in strange and evolutionarily abnormal ways when it’s exposed to stimuli produced by highly processed foods, antibiotics, and many other things associated with our modern way of life.

This is true regardless of whether the genome in question is the one found inside you, your neighbor, or any other person here on Earth. Some people are more susceptible to the harmful effects of novel environmental agents than others; however, none of us are fully resistant to damage. We’re all inadequately adapted for the modern conditions of life. We all express a deleterious phenotype if we eat modern refined foods, don’t exercise, use strong pharmaceutical drugs, and/or expose ourselves to a lot of technology and artificial light at night.

The list of diseases and health problems that are wholly, largely, or partly caused by gene-environment conflicts is staggering. It contains myopia, acne vulgaris, colon cancer, diabetes, lower crossed syndrome, obesity, malocclusion, and many other health disorders (1, 2, 3, 4, 5). Moreover, it has poor general health written with big letters on the top. This entry is there to make it clear that evolutionary mismatches don’t just produce diseases per se, they can also create malaise. Very few, if any, contemporary humans are truly healthy. Some people have never been diagnosed with a disease; however, that doesn’t necessarily mean that their bodies are working at a peak level.

Here’s what Harvard Professor Daniel Lieberman had to say about the prevalence of mismatch diseases in the excellent book The Story of the Human Body: Evolution, Health, and Disease:

    I don’t think it is possible to overemphasize just how important mismatch diseases are. You are most likely going to die from a mismatch disease. You are most likely to suffer from disabilities caused by mismatch diseases. Mismatch diseases contribute to the bulk of health-care spending throughout the world. (2)

Mismatch resolution explained

Simply stated, mismatch resolution involves resolving mismatches that exist between genes and environment. It’s not a generic approach to healing that involves following a strict set of rules; rather, it’s a general set of principles that one can use to understand, prevent, and treat disease. Diet and lifestyle interventions obviously play an important role in the context of mismatch resolution; however, other things, such as medical treatments aimed at manipulating the human microbiota, are also a valuable part of the toolkit of evolutionarily oriented physicians.

The goal of mismatch resolution is not to turn the clock back and bring the human species back into the wild. Rather, the goal is to remedy some of the damage that we’ve caused via our reckless and irresponsible behaviors in the context of niche construction, and harmonize the inharmonious relationship between the human genome and the modern environment by adjusting our modern lifestyle in such a way that It agrees better with the genetic legacy that has been passed down to us from our ancestors.

In the infographic below, which I recently created, I’ve illustrated what happens when the human genome is exposed to a modern environment and why mismatch resolution is such an important part of Darwinian medicine.

the-human-condition
Where are we heading?

The idea that a major reason why so many contemporary humans are in poor health is that our genes aren’t compatible with our milieu is an essential part of the foundational structure upon which the field of Darwinian medicine is built. It’s far from the only premise that’s important in the context of evolutionary health promotion; however, it does hold a unique place within the world of (r)evolutionary medicine.

Sadly, this powerful concept has not yet made its way into institutions that educate nutritionists, doctors, and other health professionals. Most health practitioners didn’t learn anything about evolutionary mismatches, hunter-gatherers, organic fitness, or other ancestral health-related things in school. I believe this represents a major flaw of our educational system.

A health professional who’s knowledgeable about the evolutionary mismatch concept operates at a very different level than those who are in the dark about this concept. When compared to the latter, the former has a much easier time finding his way in the jungle that is modern medicine, seeing as he’s accompanied by an evolutionary guide that points him in the right direction.

If evolutionary theories, ancestral health concepts, and ethnographic research pertaining to the health of hunter-gatherers and traditional people were to be incorporated into medical training and health care, our medical system as a whole would be elevated to a new level. Not every disease and health problem can effectively be addressed via mismatch resolution; however, there is no doubt in my mind that many can.

Perhaps needless to say, not every patient is interested in changing the way he lives his life in such a way that his genome comes into better alignment with his milieu. Many just want a quick fix; a drug that can help ease their pain. With that said, I think this group of patients is in a minority. Particularly people who are very sick are typically highly motivated to put in the effort that is required of them to get better.

In the future, I hope mismatch resolution, which includes microbiome restoration, becomes a prioritized part of health care. I don’t know if it will, but if it is, I think it could dramatically change the way medicine is practiced. Not only will we become better at preventing and treating human diseases, but we will also get better at preventing and treating diseases that affect pets and other animals, seeing as the evolutionary rules that apply to us also apply to them. At some point, mismatch resolution will have to become a part of health care, or else, we won’t be able to restore the health of our species, nor the health of the animals we’ve domesticated.

We can’t expect natural selection to eliminate our problems, seeing as most of the diseases of civilization have little impact impact on reproductive success in the context of the modern, built environment. Furthermore, we can’t expect to be able to develop technology that allows us to edit our genomes in such a way that we become resistant to all disease, seeing as most diseases arise as a result of complex genome-environment interactions, not as a result of one or a couple of deleterious genes.

I’ve made the case many times here on the site that a widespread incorporation of evolutionary health principles into our medical system could transform the health of contemporary Homo sapiens. I’m not the only one who holds such a belief. Several other health practitioners and researchers do as well. Today, I’m talking with one such person. His name is Iver Mysterud, and he is a renowned biologist and a leading expert on Darwinian medicine and evolutionary biology.

Iver has written numerous books, articles, and scientific papers on topics related to evolutionary health, including the seminal paper Evolutionary health promotion (2002), which he co-authored together with some of the most prominent evolutionary scientists of our age. He is also a professor, working in the Department of Biosciences at the University of Oslo, and co-editor of a Norwegian health/nutrition magazine.

I’m super excited to have him come talk about his views about nutrition and health here on Darwinian-Medicine.com. I hope you enjoy the interview and learn a thing or two. Let me know in the comment section if you have any questions or comments related to the things we talk about.
17 questions with Iver Mysterud

iver-mysterud1. Please share a little about yourself. Who are you? What’s your profession and educational background? What’s the main focus of your current work/research?

I am definitely a product of my familial background and upbringing. My mother, Åse Mysterud (b. 1935), worked as a teacher in mathematics and physical exercise, and my father, Ivar Mysterud (b. 1938) is a biologist that worked – and still works as an emeritus – as a researcher in biology at the University of Oslo. My parents took me cross-country skiing in the winters, and we did open air life in the summers. My father also took me and my brother hunting small and large game in the falls. Dad is a zoologist that worked with the interaction between large carnivores and husbandry when I grew up, and he took me along out in the field doing field work. He also sent me to two American colleagues and friends to work on black bears in their research groups. I visited Dr. John Beecham in Idaho during the summer when I was 15 years old (1981) and Dr. Michael R. Pelton in Tennessee when I was 18 years old (1984). Already as a small kid I decided to become a biologist and researcher when I became older.

I discussed biology and behavior with my dad since I was very young, and an evolutionary approach is integral to that. I therefore was brought up with an evolutionary approach to life, and an important part of that is our own species. I have always been interested in human behavior.

Looking for challenges, I paid my duty in an elite group in the Norwegian army before studying natural sciences at the University of Oslo from 1986 to 1990. Not unexpectedly, I wrote a master’s thesis on wolf behavior (1992) before working together with my father on several projects about large carnivores for some years. Then I gradually started reading more and more about humans and evolution, and from 1997 to 2003 wrote a large overview book in Norwegian (Mennesket og moderne evolusjonsteori, published 2003), which in 2005 was accepted as a PhD thesis, so I got my doctoral degree that year.

In parallel to my scientific work, from 2002 I started writing popular articles for a Norwegian health magazine (Mat&helse), of which many were about evolution and medicine. In 2010, the staff (excluding the editor) founded our own health magazine (Helsemagasinet vitenskap & fornuft), where I currently work as scientific editor and writer. Evolutionary approaches are of course part of the foundation of the magazine. Each spring, I teach a class about humans and evolution at the Department of Biosciences at the University of Oslo, which has been ongoing since 1996. However, I devote most of my time to work for the health magazine. I have therefore to a large extent moved from research to popularization of research.

2. You were one of the very first people to recognize that, if applied correctly, principles of evolutionary biology can prove extremely useful for preventing and treating disease. Could you please share how you first came upon this discovery? How did you get interested in Darwinian/evolutionary medicine?

My father attended a scientific conference in USA in May 1990, where he met and learned to know George C. Williams. Williams planned to go to Europe in October, and my father invited him to Oslo. Williams was then working on the now seminal paper The dawn of Darwinian medicine, and he gave a talk about it at the Department of Biology, University of Oslo. We spent the evening at my parent’s house, sharing a good meal and discussing interesting topics. I then learned to know both George and his lovely wife Doris. This was long before the internet age, and George sent us a physical copy of the manuscript. I therefore got access to their important paper long before it was printed in The Quarterly Review of Biology (1991). I read it with interest several times, and from then on was a “convert” and strong spokesperson about the usefulness of applying evolutionary ideas/principles/theories to topics in medicine.

3. Together with Loren Cordain, Staffan Lindeberg, Boyd Eaton, and several other Darwinian medicine pioneers you published a seminal paper in 2002 entitled Evolutionary health promotion. Could your briefly summarize the key points of that article?

Our main argument is that contemporary approaches to health promotion are hampered by a systematic lack of an overall conceptual framework, a deficiency that might be corrected by adopting evolutionary premises. We then emphasize the mismatch argument, i.e. that changes in lifestyle and culture has been a more rapid process than the genes have been able to follow. In other words, we are genetically, biochemically and physiologically adapted to another physical/chemical environment, diet, lifestyle and in some ways social environment than most of us are confronted with today. A consequence of this mismatch can be poor health and miserable lives. By better characterizing differences between ancient and modern life patterns and then identifying which of these affect the development of disease, we will get more effective health promotion and be better able to prevent and cure disease.

4. How was it to collaborate with such an esteemed group of scientists?

It was a privilege to be included in that group of distinguished, influential and pioneering scientists. I was invited because of extensive contact with Dr. S. Boyd Eaton, but knew several of the others as well. Eaton wanted to bring together various eager scientists that in various ways shared a conviction that an evolutionary approach was important to better understand health and disease.

5. You’ve publicly voiced the opinion that governmental nutrition guidelines should be revised. What are, in your opinion, wrong with the dietary guidelines? What needs to change? Are the guidelines of all industrialized nations equally bad, or are some nations worse off than others?

The official guidelines in Norway and other western countries are quite similar. They lack an emphasis of evolutionary principles and research, i.e. an emphasis of what kind of food we as a species have become genetically well adapted to during our evolutionary past. For me on the other hand, a focus on such food is a logical point of departure. To what extent humans – or local groups – have become adapted to or tolerate foods that came with the agricultural revolution or more recently, is an empirical question to settle.

In addition to a lack of evolutionary arguments and research, the official guidelines neglect the historical experience of indigenous/traditional peoples – what they ate and how their health was. A third problem with the dietary guidelines is that they do not take into account the varying metabolic and hormonal effects of food. An evolutionary approach is not only relevant for adaptation or not to modern food groups (cow’s milk, grains, legumes, white sugar etc.), but also for the composition of macronutrients. The guidelines do not emphasize that we hormonally are NOT well adapted to a diet high in carbohydrates, particularly refined carbohydrates that gives a fast increase in blood glucose.

A fourth aspect that the official guidelines ignore is the fact that foods differ considerably in biological availability (bioavailability) of nutrients. For example, even if cereal grains contain iron and zinc, these minerals are not easily absorbed by the digestive system. The same is true of magnesium and iron absorption from cow’s milk. On the other hand, meat contains bioavailable nutrients like iron and zinc, and fruits and vegetables contain a host of well-absorbed antioxidants. Thus, bioavailability is better for food groups that our species has eaten for a long time and become well genetically and biochemically adapted to, but not to modern food groups.

A fifth topic that the official guidelines ignore is the fact that various individuals for genetic reasons need different amounts of nutrients to avoid disease in modern environments.

A sixth ignored topic is that food supplements, in addition to healthy foods, may be necessary for modern humans to achieve the best possible health. It is imperative to emphasize the difference between the average nutrient requirement to prevent deficiencies and the optimal nutrient intake needed to achieve the highest level of health possible, in a world with lots of pollution and somewhat lower nutrient contents of foods compared to only 50 or 100 years ago.

See the following article for a more elaborate discussion of these topics:
Mysterud, I., Poleszynski, D.V., Lindberg, F. & Bruset, S. 2008. To eat or what not to eat, that’s the question: A critique of the official Norwegian dietary guidelines. In: Trevathan, W.R., Smith, E.O. & McKenna, J.J. (eds.). Evolutionary medicine and health: new perspectives. New York, NY: Oxford University Press, pp. 96-115.)

6. You’ve written several books and articles (e.g., here, here) on nutrition and healthy living. What is your overarching health philosophy? What are the key ingredients that you feel are needed to produce a healthy human being?

Try to keep your life in accordance with our evolutionary history and the environments humans then lived in. Although we have a useful design for living as hunterers and gatherers, it is not good enough in a new environment. It is therefore important to incorporate several aspects of a normal hunter-gatherer life into our modern life. It is of course no goal and totally impossible for the contemporary human population to live as hunter-gatherers, but we can learn from their way of life. Like Desmond Morris and several evolutionary researchers/authors have emphasized, modern humans live in a kind of zoo. It is then imperative to design the zoo as much like nature as necessary to keep us healthy and happy. It is then wise to eat in a way that is similar to how our hunter-gatherer ancestors ate. Of particular importance here is to keep a stable blood sugar by either eating a low-glycemic diet or a low carb/high fat diet. And one should make sure that one actually tolerates the modern food groups, like cow’s milk and grains.

In addition, to stay healthy in the zoo, we need to use our bodies. Hunters and gatherers use their bodies a lot during their daily activities, but we need to plan using our bodies during the day. A group of researchers have published a plan based on the activity levels of hunter-gatherers that is useful for us.

Further, to stay healthy, one need to spend some time outside during daylight (sunlight to produce vitamin D, light through the eyes to synchronize various rhythms). In addition, breathing as clean air as possible is a goal. Achieving it is easy in most of Norway, but difficult in large cities around the world (like in Beijing). Spending time barefoot outside (“grounding”, “earthing”) is also a factor that has gained some momentum the last years, which seems to improve health and counteract various health problems. Using shoes with insulating rubber soles is a new phenomenon which may separate us from the ground contact we have had during most of our evolutionary past. Also, drinking water without pollution is central for good health, which may be problematic in certain parts of the world.

As a social species, it is important for us to keep contact with family and friends throughout our lives. We used to be part of tightly knit social groups, but today many people feel socially isolated, living without contact with their family in rather “anonymous” large cities. That is a recipe for poor health.

A last point is not to change our physical environment in such a way that it becomes markedly different from the environments in which we evolved. Of particular concern to me is our rapidly increasing use of wireless communication. Our bodies were not exposed to those frequencies in the past, and a lot of scientific data indicate that exposure to radiofrequency radiation is a stressful factor, which over the long run may produce disease. Since our health authorities are not convinced that radiation from wireless communication is a problem, the best one can do is use mobile phones and similar devices with prudence and caution. For example: Don’t talk for a long time in the phone, text as much as possible, never have a mobile phone turned on by your bed (except in flight mode), turn off the router during night, don’t let small children use mobile phones and tablets etc. (since they tolerate less radiation).

7. If an overweight person adhering to an unhealthy, western diet and lifestyle came up to you and asked what he should do to lose weight and improve his health, what would you say? Please share 5 general tips. (Assume that the person suffers from no serious health problems.)

    NEVER drink sugar-sweetened soft drinks. Reduce the intake of carbohydrates, particularly those with a high glycemic index. The more overweight, the less carbs should be eaten. Instead of carbs, get your energy from various kinds of fats (but not artificially produced trans fats; keep a balanced intake between omega-3 and 6-fatty acids).
    Make sure you actually tolerate the foods you eat. Food allergy/intolerance may be a contributing factor to overweight.
    Make sure to get enough sleep.
    Try to stress down as much as possible. Stress can be a contributing factor to overweight. It is not enough to change diet.
    When you get a lighter body and get more energy, start exercising.

8. Over the past millennia, we humans have gradually disconnected ourselves from Mother Nature. This has produced a range of evolutionary mismatches, one of which has to do with a loss of contact with the natural surfaces of the Earth. You’ve made the case that physical contact with the ground is important for achieving and maintaining good health. Could you please describe what earthing is all about, as well as briefly describe the underlying mechanisms that link earthing with changes in health? A lot of people rarely or never touch natural ground with their bare feet. What are the consequences of this? How can someone who lives in the modern, industrialized world attain the benefits of earthing without having to frequently travel long distances in order to be able to walk around barefoot in a natural environment?

As mentioned, “earthing” is about spending time barefoot outside. Throughout time, we humans have sat, stood, strolled, and slept on the ground – the skin of our bodies touching the Earth. Such ordinary contact has always served as a conduit for transferring the Earth’s natural, gentle, negative charge underfoot into the body. Using shoes with insulating rubber soles separates us from the ground and blocks the negative charge entering our bodies. It is for example suggested that lack of earthing may contribute to inflammation in the body, and inflammation is involved in most chronic disease. Research indicates that earthing may relieve stress, reduce pain, give deeper sleep and speed healing and recovery. Commercial interests have developed various technologies, like a sleeping sheet, that can be used when in bed. It keeps you earthed through grounded electrical cables.

9. More than 150 years ago, Darwin published his seminal book On the Origin of Species. In the time that has passed since then, the pile of evidence supporting Darwin’s theory that all living organisms are a product of evolutionary processes has steadily grown. Despite this, there are still some people in the world today who don’t believe that evolution is a real thing. Why do you still think there is some opposition to the idea of evolution? Is religion solely to blame, or are other factors important as well?

As far as I can judge, the opposition is mainly from people believing in conservative interpretations of religion, like fundamental Christians in the USA. Although most natural and social scientists accept the reality of evolution, several social scientists have for several decades opposed the application of evolutionary principles to explain human behavior. Similarly, mainstream nutritionists do not emphasize an evolutionary approach to diet, many actually oppose it. This is probably because an evolutionary approach implicates that the modern approach to nutrition has been wrong the last 40 years. This may be hard to swallow, and people may feel threatened, risking a fall in status.

10. What aspects of Darwinian medicine are you the most passionate about?

The mismatch approach, i.e. that changes in lifestyle and culture has been a more rapid process than the genes have been able to follow. In other words, we are genetically, biochemically and physiologically adapted to another physical/chemical environment, diet, lifestyle and in some ways social environment than most of us are confronted with today. A consequence of this mismatch can be poor health and miserable lives.

George C. Williams and Randy Nesse summarized several useful evolutionary approaches to medicine in their seminal 1991 paper and highly readable 1994 book, e.g. that there are several defense mechanisms in the body that is not understood or emphasized in medicine. However, most of today’s disease burden is seldom or never encountered among people living as hunter gatherers, i.e. mimicking a lifestyle to which our species are probably best genetically adapted. Various factors in our modern environment are most certainly the main causes (in interaction with our genes). This points to the importance of the mismatch approach for the great majority of diseases inflicting the majority of people with a Western lifestyle. We talk about diseases like heart disease, diabetes type 2 and cancer, the most important kinds of psychopathology like depression and neurodegenerative diseases like Alzheimer’s disease. It also involves all kinds of neurodevelopmental diseases/problems, like ADHD and learning problems (dyslexia, dyspraxia). By using a mismatch approach it is possible in principle to explain/find the causes of such diseases and also find cures by changing or removing the environmental causes that is operative in the specific individual having a certain disease/problem.

11. What do you consider to be the most important things Darwinian/evolutionary medicine has to contribute to our current medical system?

If all people started eating more in accordance with evolutionary principles (i.e. what people ate in the past), the general health in our society would improve. This would mean far less chronic diseases, and less money spent on treating disease. During medical education, the students should learn much more about keeping people healthy, and spend less time learning how to treat symptoms of chronic disease (i.e. use of medication).

Using an evolutionary approach to medicine more generally will link medicine more closely to evolutionary biology. It will provide a better approach to finding out how humans are equipped to cope with disease. Our body has many adaptations, which treatment should not interfere with (except in extreme situations, e.g., very high fever). In addition, medicine will get better tools for studying how various kinds of pathogens will evolve.

12. What would you do if you were put in charge of improving public health? What would you focus on?

I would firstly focus on diet. At once I would have had a group of evolutionary-minded experts to develop new dietary guidelines. I would also put a quite high tax on white sugar, making it expensive to buy and use in various products. I would also focus much more on preventive medicine than is done today.

13. To me and you, as well as to other people who view the world through an evolutionary lens, it seems obvious that a foundation of evolutionary science is required to construct solid diet and health advice and that the changes in humans’ environment that have occurred over the past 10.000 years have been too rapid for adequate genetic adaptation to occur. Why do you think there are some people out there who are opposed to these ideas and/or brush them of as insignificant?

As mentioned, it is because they feel threatened by these ideas. It is not easy to accept that the dietary advice you have promoted for a long time, a lifetime for some researchers, have been wrong all along, and may actually have contributed to making people sick. For example, the longstanding recommendation to avoid cholesterol and saturated fat is a very bad advice. What the leading researches and health authorities should have done is to advise people to eat lots of eggs and various fats and radically cut down on sugars and “fast” carbohydrates.

14. In 1996 you published a paper entitled The history, status and teaching of Darwinian medicine in Norway. Had some educational institutions opened their doors to Darwinian medicine back then? What has changed in the time since that paper was published? Has Darwinian medicine’s position within the educational system been strengthened or weakened? What changes have you observed both in Norway and globally?

Yes. Diaconia College of Nursing in Oslo is educating nurses, and physician Merete Steen worked there. In 1993, she published a short paper in the Journal of the Norwegian Medical Association (Steen M. Om kropp og miljø og legens øyne [About body and environment and the eyes of the physician]. Tidsskr Nor Lægeforen 1993; 113: 2440). Steen had “rediscovered” the healthy human body and appreciated the usefulness of viewing ourselves as evolutionary products of past interactions with the environment. She expressed that in her practice she had become too focused on the diseased body at the expense of understanding how the body’s design enhanced survival when threatened. In her clinical work, many of these defenses were treated as “enemies” which were to be fought. The Darwinian perspective gave her a better understanding of our physiological potential to cope with various environmental threats. Steen specifically stated that the view of our species as “old” in a “new” environment (the mismatch approach), was very useful when trying to understand the human condition in the industrialized world with accelerating environmental problems. She could not remember having been taught any of this during her medical education (completed 15 years earlier). She greatly appreciated the evolutionary perspective when teaching nursing students. For several years in the 1990s, Steen hired me to teach her nursing students about evolution and medicine.

In the 1990s, also students in several of Norway’s medical schools were taught a few hours about evolution, but not specifically about evolution and medicine. I am not updated about what medical students learn today. It is my impression that evolution and medicine are taught at certain medical schools in the USA, but I am not updated about specifics.

15. What do you feel it would take to make the general medical/nutritional establishment recognize the value and power of Darwinian medicine?

Although nutrition is formally a part of medicine, at least here in Norway, I think it is necessary to divide my answer. Medicine in general will have few problems incorporating evolutionary perspectives. That is actually what I experienced back in the 1990s when I started to write and lecture about the importance of evolution for medicine. I guess the reason is that an evolutionary perspective most often is a complementary approach. My experience is that physicians find evolutionary approaches interesting because it gives a new light on their own discipline.

Concerning nutritionists, the main answer is research. There are already a lot of research to back up the usefulness of an evolutionary perspective on diet, both concerning food groups and macronutrient composition. It is high time nutritionists read and used that literature. In addition, I think more high-quality research will persuade some of the most skeptical nutritionists. The leading Danish nutritionist Arne Astrup actually changed his mind about the usefulness of a low carbohydrate diet when he was faced with new scientific evidence. There is already much research on the usefulness of a low carb/high fat diet, and with such an approach to ever more diseases and problems, it will be steadily clearer that a such way of eating is healthy and counteracts disease. Mainstream nutritionists cannot ignore this in the long run.

16. How do you envision the future of Darwinian/evolutionary medicine? Do you think evolutionary theory will soon be widely incorporated into medical training and/or practice, or do you think the evolutionary approach will continue to take a backseat to the conventional medical approach, which largely focuses on the molecular and physiological mechanisms underlying disease?

I think the speed of the process will depend on enthusiastic individuals and spokespersons. Randy Nesse has achieved a lot in the USA, after his research, papers and lectures during several decades. If some influential individual or individuals within the medical system become persuaded of the usefulness of evolutionary approaches, change could be fast.

17. Anything else you’d like to add?

Even though I have argued/written for years about the usefulness of a Paleolithic diet, I am not opposed to all agricultural products. Particularly milk products with lots of fat, like butter, are superb for health, especially when the cows have been eating grass. In addition to the sugar (lactose), it is the proteins, particularly beta-casein, in cow’s milk that is problematic for some people, and one type of beta-casein (A1) is worse than the other (A2). Grains are problematic for several reasons, particularly when eaten in large amounts, partly because they contain a lot of starch. However, some people seem to tolerate smaller amounts well. Also, it should be noted that it is possible to use cultural techniques to improve the quality of grains before baking/eating them, such as sprouting, which increases the bioavailability of micronutrients in the grains.

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