Diseases of Civilization

Update: In my post “Vindicating Gary Taubes: A Smackdown of Seth Yoder,” I retract the criticisms I make of Gary Taubes in "The Case Against the Case Against Sugar: Seth Yoder vs. Gary Taubes.”

In "Obesity Is Always and Everywhere an Insulin Phenomenon" I quote Gary Taubes at some length about the dramatically higher incidence of diseases such as heart disease, cancer, diabetes, etc. in countries with a modern diet and lifestyle. But having realized from reading Seth Yoder's devastating post how unreliable a reporter Gary Taubes is, as I detailed in "The Case Against the Case Against Sugar: Seth Yoder vs. Gary Taubes, I wanted to document that while various authors disagree about the causes of what are variously called the "Diseases of Civilization," "Western Diseases" and "Diseases of Affluence," there is broad agreement about the fact that these diseases are rare among less affluent groups with longstanding indigenous diets and lifestyles.  

Let me start with some passages from The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet by Nina Teicholz. Nina's main concern is to exonerate dietary fat and animal food more generally as the causes of the Diseases of Civilization. After beginning Chapter 1 by talking about Inuit's meat-heavy diet, Nina turns other groups (I have added the group names in bold as subheadings):

The Masai and Samburus: Across the globe half a century later, George V. Mann, a doctor and professor of biochemistry who had traveled to Africa, had a similarly counterintuitive experience. Although his colleagues in the United States were lining up in support of an increasingly popular hypothesis that animal fats cause heart disease, in Africa Mann was seeing a totally different reality. He and his team from Vanderbilt University took a mobile laboratory to Kenya in the early 1960s in order to study the Masai people. Mann had heard that the Masai men ate nothing but meat, blood, and milk—a diet, like the Inuits’, comprised of almost entirely animal fat—and that they considered fruits and vegetables fit to be eaten only by cows.

Mann was building upon the work of A. Gerald Shaper, a South African doctor working at a university in Uganda, who had traveled farther north to study a similar tribe—the Samburus. A young Samburu man would drink from 2 to 7 liters of milk each day, depending on the season, which worked out on average to well over a pound of butterfat. His cholesterol intake was sky-high, especially during periods when he would add 2 to 4 pounds of meat to his daily diet of milk. Mann found the same with the Masai: the warriors drank 3 to 5 liters of milk daily, usually in two meals. When milk ran low in the dry season, they would mix it with cow blood. Not shirking the meat, they ate lamb, goat, and beef regularly, and on special occasions or on market days, when cattle were killed, they would eat 4 to 10 pounds of fatty beef per person. For both tribes, fat was the source of more than 60 percent of their calories, and all of it came from animal sources, which meant that it was largely saturated. For the young men of the warrior (“murran”) class, Mann reported that “no vegetable products are taken.”

Despite all of this, the blood pressure and weight of both these Masai and the Samburu peoples were about 50 percent lower than their American counterparts—and, most significantly, these numbers did not rise with age. “These findings hit me very hard,” said Shaper, because they forced him to realize that it was not biologically normal for cholesterol, blood pressure, and other indicators of good health automatically to worsen with aging, as everyone in the United States assumed. In fact, a review of some twenty-six papers on various ethnic and social groups concluded that in relatively small homogenous populations living under primitive conditions, “more or less undisturbed by their contacts with civilization,” an increase in blood pressure was not part of the normal aging process. Was it possible that we in the Western world were the anomaly, driving up our blood pressure and generally ruining our health by some aspect of our diet or modern way of life?

True, the Masai were free from the kind of emotional and competitive stresses that gnaw away at the citizens of more “civilized” countries and which some people believe contribute to heart disease. The Masai also got more exercise than desk-bound Westerners: these tall, slender shepherds would walk for many miles each day with their cattle, searching for food and water. Mann thought that perhaps all this exercise might be protecting the Masai from heart disease.II But he also acknowledged that subsistence was “easy” and “labor light,” and that the elders, who “seem sedentary,” were not dying from heart attacks, either.

If our current belief about animal fat is correct, then all the meat and dairy these tribesmen were eating would have caused an epidemic of heart disease in Kenya. However, Mann found exactly the opposite—he could identify almost no heart disease at all. He documented this by performing electrocardiograms on four hundred of the men, among whom he found no evidence of a heart attack. (Shaper did the same test on one hundred of the Samburu and found “possible” signs of heart disease in only two cases.) Mann then performed autopsies on fifty Masai men and found only one case with “unequivocal” evidence of an infarction. Nor did the Masai suffer from other chronic diseases, such as cancer or diabetes. ...

The Sikhs and the Hunzas: In the early 1900s, for instance, Sir Robert McCarrison, the British government’s director of nutrition research in the Indian Medical Service and perhaps the most influential nutritionist of the first half of the twentieth century, wrote that he was “deeply impressed by the health and vigour of certain races there. The Sikhs and the Hunzas,” notably, suffered from “none of the major diseases of Western nations such as cancer, peptic ulcer, appendicitis, and dental decay.” These Indians in the north were generally long-lived and had “good physique[s],” and their vibrant health stood “in marked contrast” to the high morbidity of other groups in the southern part of India who ate mainly white rice with minimal dairy or meat. McCarrison believed he could rule out causes other than nutrition for these differences, because he found that he could reproduce a similar degree of ill-health when feeding experimental rats a diet low in milk and meat. The healthy people McCarrison observed ate some meat but mostly “an abundance” of milk and milk products such as butter and cheese, which meant that the fat content of their diet was mainly saturated.

Native Americans of the Southwest between 1898 and 1905: Meanwhile, the Native Americans of the Southwest were observed between 1898 and 1905 by the physician-turned-anthropologist Aleš Hrdlička, who wrote up his observations in a 460-page report for the Smithsonian Institute. The elders among the Native Americans he visited would likely have been raised on a diet of predominantly meat, mainly from buffalo until losing their traditional way of life, yet, as Hrdlička observed, they seemed to be spectacularly healthy and lived to a ripe old age. The incidence of centenarians among these Native Americans was, according to the 1900 US Census, 224 per million men and 254 per million women, compared to only 3 and 6 per million among men and women in the white population. Although Hrdlička noted that these numbers were probably not wholly accurate, he wrote that “no error could account for the extreme disproportion of centenarians observed.” Among the elderly he met of age ninety and up, “not one of these was either much demented or helpless.”

Hrdlička was further struck by the complete absence of chronic disease among the entire Indian population he saw. “Malignant diseases,” he wrote, “if they exist at all—that they do would be difficult to doubt—must be extremely rare.” He was told of “tumors” and saw several cases of the fibroid variety, but never came across a clear case of any other kind of tumor, nor any cancer. Hrdlička wrote that he saw only three cases of heart disease among more than two thousand Native Americans examined, and “not one pronounced instance” of atherosclerosis (buildup of plaque in the arteries). Varicose veins were rare. Nor did he observe cases of appendicitis, peritonitis, ulcer of the stomach, nor any “grave disease” of the liver. Although we cannot assume that meat eating was responsible for their good health and long life, it would be logical to conclude that a dependence on meat in no way impaired good health.

Colonial Africa and Asia: In Africa and Asia, explorers, colonialists, and missionaries in the early twentieth century were repeatedly struck by the absence of degenerative disease among isolated populations they encountered. The British Medical Journal routinely carried reports from colonial physicians who, though experienced in diagnosing cancer at home, could find very little of it in the African colonies overseas. So few cases could be identified that “some seem to assume that it does not exist,” wrote George Prentice, a physician who worked in Southern Central Africa, in 1923. Yet if there were a “relative immunity to cancer” it could not be attributed to the lack of meat in the diet ...

Gary Taubes claims that the Diseases of Civilization were brought on by the consumption of sugar and white flour. T. Colin Campbell and Thomas M. Campbell II claim that the Diseases of Civilization are caused primarily by the consumption of animal protein in their book The China Study. (See "Meat Is Amazingly Nutritious—But Is It Amazingly Nutritious for Cancer Cells, Too?") Here is their description of the Diseases of Civilization:

It doesn’t take a scientist to figure out that the possibility of death has been holding pretty steady at 100% for quite some time. There’s only one thing that we have to do in life, and that is to die. I have often met people who use this fact to justify their ambivalence toward health information. But I take a different view. I have never pursued health hoping for immortality. Good health is about being able to fully enjoy the time we do have. It is about being as functional as possible throughout our entire lives and avoiding disabling, painful, and lengthy battles with disease. There are many better ways to die, and to live.

Because the China Cancer Atlas had mortality rates for more than four dozen different kinds of disease, we had a rare opportunity to study the many ways that people die. We wondered: Do certain diseases tend to cluster in certain areas of the country? For example, did colon cancer occur in the same regions as diabetes? If this proved to be the case, we could assume that diabetes and colon cancer (or other diseases that clustered) shared common causes. These causes could include a variety of possibilities, ranging from the geographic and environmental to the biological. However, because all diseases are biological processes (gone awry), we can assume that whatever “causes” are observed, they will eventually operate through biological events.

When these diseases were cross-listed in a way that allowed every disease rate to be compared with every other disease rate,11 two groups of diseases emerged: those typically found in more economically developed areas (diseases of affluence) and those typically found in rural agricultural areas (diseases of poverty)12 (Chart 4.4).

The diseases shown in Chart 4.4 tend to be associated with diseases in their own list but not in the opposite list. A region in rural China that has a high rate of pneumonia, for example, will not have a high rate of breast cancer, but will have a high rate of a parasitic disease. The disease that kills most Westerners, coronary heart disease, is more common in areas where breast cancer also is more common. Coronary heart disease, by the way, is relatively uncommon in many developing societies of the world. This is not because people die at a younger age, thus avoiding these Western diseases. These comparisons are age-standardized rates, meaning that people of the same age are being compared.

Chart 4.4: Disease Groupings Observed in Rural China

  • Disease of Affluence (Nutritional extravagance) Cancer (colon, lung, breast, leukemia, childhood brain, stomach, liver), diabetes, coronary heart disease

  • Disease of Poverty (Nutritional inadequacy and poor sanitation) Pneumonia, intestinal obstruction, peptic ulcer, digestive disease, pulmonary tuberculosis, parasitic disease, rheumatic heart disease, metabolic and endocrine disease other than diabetes, diseases of pregnancy, and many others

 

Disease associations of this kind have been known for quite some time in the United States and other Western countries die from diseases of affluence. For this reason, these diseases are often referred to as Western diseases. Some rural counties had few diseases of affluence while other counties had far more. The core question of the China Study was this: Is it because of differences in dietary habits? [pp. 65, 66]

 

To give a couple of examples at the time of our study, the death rate from coronary heart disease was seventeen times higher among American men than rural Chinese men.16 The American death rate from breast cancer was five times higher than the rural Chinese rate. Even more remarkable were the extraordinarily low rates of coronary heart disease in the southwestern Chinese provinces of Sichuan and Guizhou. During a three-year observation period (1973–1975), not one single person died of coronary heart disease before the age of sixty-four, among 246,000 men in a Guizhou county and 181,000 women in a Sichuan county!17 After these low cholesterol data were made public, I learned from three very prominent heart disease researchers and physicians, Drs. Bill Castelli, Bill Roberts, and Caldwell Esselstyn, Jr., that in their long careers they had never seen a heart disease fatality among their patients who had blood cholesterol levels below 150 mg/dL. Dr. Castelli was the long-time director of the famous Framingham Heart Study of NIH; Dr. Esselstyn was a renowned surgeon at the Cleveland Clinic who did a remarkable study on reversing heart disease (chapter five); and Dr. Roberts has long been editor of the prestigious medical journal Cardiology. [p. 69]

My hero Jason Fung is a proponent of lowcarb diets, and would be sympathetic to the recommendations I make in "Forget Calorie Counting; It's the Insulin Index, Stupid," but in the following passage, he points to processed foods as a major cause of the Diseases of Civilization:

Humans evolved to eat a wide range of foods without detrimental health consequences. The Inuit peoples traditionally ate diets extremely high in animal products, which means high percentages of fat and protein. Others, such as the Okinawans, ate a traditional diet based on root vegetables, which means it’s high in carbohydrates. But both populations traditionally did not suffer metabolic diseases. These only appeared with the increasing Westernization of their diets. What humans haven’t evolved to eat are highly processed foods. During processing, the natural balance of macronutrients, fiber, and micronutrients is completely disrupted. For example, processing the wheat berry to remove all the fat and protein means that the result, white flour, is almost pure carbohydrates. Wheat berries are natural; white flour is not. It is also ground to an extremely fine consistency that greatly speeds the absorption of carbohydrates into the bloodstream. Most other processed grains suffer the same problems. Our body has evolved to handle natural foods, and when we feed it unnatural ones, the result is illness.

Thus, while there is no agreement about what aspect of the modern diet is most to blame for the Diseases of Civilization, there is something about the modern diet and lifestyle that is causing trouble. 

 

Don’t miss my other posts on diet and health. My views of Gary Taubes have evolved. I have an entire section below of links to posts about Gary Taubes and his work.

I. The Basics

II. Sugar as a Slow Poison

III. Anti-Cancer Eating

IV. Eating Tips

V. Calories In/Calories Out

VI. Wonkish

VIII. Debates about Particular Foods and about Exercise

IX. Gary Taubes

X. Twitter Discussions

XI. On My Interest in Diet and Health

See the last section of "Five Books That Have Changed My Life" and the podcast "Miles Kimball Explains to Tracy Alloway and Joe Weisenthal Why Losing Weight Is Like Defeating Inflation." If you want to know how I got interested in diet and health and fighting obesity and a little more about my own experience with weight gain and weight loss, see “Diana Kimball: Listening Creates Possibilities” and my post "A Barycentric Autobiography.