The currently reigning health care paradigm that guides medical research and practise, governs health-related policy-making, and contributes to shaping public opinions on issues pertaining to sun exposure, nutrition, exercise, and the like in the modern world doesn’t have an evolutionary backbone. It was created from a formula devoid of Darwinian elements, and as a result, it appears misshapen when viewed under evolutionary light. This is not to say that its appearance is ghastly in every respect; however, there’s no doubt that it could benefit from some evolutionary retouching.
This is something many evolutionary thinkers, including a number of researchers involved in the emerging field of Darwinian/evolutionary medicine, have pointed out. But how would a new and improved paradigm look? How should it be formulated?
Earlier this year, I received an e-mail that brought up this very issue. The message came from a man named John who shares my enthusiasm for evolutionary health and Paleolithic nutrition and who wanted my input on a health care paradigm he’d created on the basis of evolutionary medical theories. I thought the inquiry was an interesting one, and was also very impressed by the model he’d created, so I sent him a message back asking if it would be okay if I shared his question and paradigm here on the site, together with my inputs. He was most agreeable and happy to share his work…
How should evolutionary medicine be articulated?
Before we jump in with John’s question, I thought I’d share a few thoughts pertaining to the way evolutionary theory is applied to medicine, so as to set the thematic stage for this edition of Ask Eirik.
Everyone who’s involved in Darwinian/evolutionary medicine acknowledges that the field is based on the idea that we can learn a lot about health, nutrition, and medicine by studying the nature and processes of evolution; however, beyond that, there is no universally accepted definition of the enterprise. People vary with respect to how they interpret it, the angle from which they approach it, and the terms (e.g., evolutionary nutrition, ancestral health, Paleo) they use to describe the principles and ideas they prescribe to and promote, in part because evolutionary medicine is a broad field that connects medical professionals, nutritionists, coaches, researchers, and health aficionados from a number of different areas of work.
The discipline’s ability to bring people together behind a shared Darwinian ideology is one of its ultimate strengths. It represents a great opportunity, in the sense that it could potentially bring order to the world of health and medicine, bringing its many currently disconnected parts into a unified whole. Also, the fact that the discipline brings people with different skill sets and ideas together allows for sharing of information and ideas and fruitful discussions.
That said, it also represents a challenge of sorts in the sense that people from different backgrounds who’ve accumulated dissimilar sets of beliefs as a result of inter-individual variations in upbringing, cultural practices, educational history, personal health experiences, and research work aren’t necessarily going to agree on the direction in which one should head and manage to work peacefully side-by-side in the pursuit of a shared goal. In other words, they won’t effortlessly come together as one. Not everybody is going to view things the same way. The way I’ve come to view and approach evolutionary health and medicine, for example, differs somewhat from the way certain other individuals view and approach it. For that reason, as well as to bring attention to the paradigm John sent me, I decided to share his inquiry here on the site…
With that said, let’s jump in with the e-mail I received from John…
Eirik: I enjoy your social media educational work. I have been promoting the so-called paleo lifestyle to my patients since 2006 with great success. I agree with you that many people (including health professionals) can have different understandings and differing ‘versions’ of so-called Paleo/Ancestral, etc. In my own practice, I focus less on lists of foods and focus more on helping regular people to understand the underpinnings/foundations of evolution (a rather difficult tast at times in the USA where #1 the education is not that great and #2 people can be very stubborn because they are often taught at their churches that this is bad). Anyway, I have tried to develop a concise premise or paradigm statement regarding so-called Paleo Medicine or Evolutionary Medicine, etc. I have sought and received feedback on it from some very well-known people in the paleo field and as a result the statement has evolved a bit over time (no pun intended). I would love it if you would read this latest iteration and give me your honest feedback. What would you change in this “premise” statement, if anything? Any feedback would be highly appreciated. Thank you.
John Collins, DC. http://www.lifefrealigned.com
Here’s the paradigm:
A Suggested Paleo Paradigm (aka Wellness Paradigm)
- Given, that human genetics have undergone relatively little change since the dawn of agriculture at end of the late Paleolithic era.
- Given, that the prevalence of chronic illnesses (diabetes, cancer and cardiovascular disease, et al) has increased rapidly in recent times and these illnesses are now the primary cause of disability and premature death in developed nations.
- Given, that it is widely accepted that most chronic illness, while multi-causal, are primarily environment/habitat/lifestyle-induced.
Therefore, until proven otherwise, it is reasonable to hypothesize that the following is true:
- Humans are predominantly evolutionarily-adapted to the environment(s)/habitat(s) of the late Paleolithic time period.
- Chronic physiological (cellular) stress is being caused by the chronic “mismatch” between humans’ “ancient” cells and their modern lifestyle/environment/habitat.
- This chronic physiological stress can sometimes result in cellular fatigue->cellular-breakdown->cellular-failure->cellular-dysfunction->chronic disease.
- The most successful disease-prevention and/or health-promotion strategy is one that attempts to optimize the human cellular environment, by mimicking or re-creating (to the best of our abilities and understanding) a late-Paleolithic cellular environment. This is accomplished in at least two ways: a) by way of our active choices regarding diet, physical activity, social engagement, etc. and b) via public health policy or other large-scale societal changes that help to improve or optimize our human “habitat”. Such changes can help to improve or normalize our cellular environment, so that our cells can thrive and function more optimally, resulting in increased likelihood for health and longevity for individuals and society at-large.
Great paradigm, John!!
As you undoubtedly know if you’ve followed my work here on the site, my approach to health and medicine is very much aligned with the one you describe in your paradigm. Like me, you place great emphasis on the evolutionary mismatch concept and argue that the core message of the evolutionary health movement should be that mismatch resolution should be the no.1 priority of modern health care.
I can’t find much, if anything, seriously wrong with the paradigm. It’s well formulated! I do have a couple of suggestions though, which may help augment the model you’ve created.
1. Personally, I don’t think I’d choose the title you’ve chosen for the paradigm, in part because it may appear somewhat restrictive, in the sense that many people associate the word Paleo with a diet. Your paradigm obviously covers a lot more than nutrition, so it may be better to find another name, for example one that relates to evolutionary medicine, which is a term that is a lot more broad, with respects to what it covers, than Paleo.
Paleo is a household term. It’s something everyone has heard about. This could work against you, in part because the term has been misused by some people, some of which have exploited it for financial gain and/or disconnected it from its scientific underpinnings. On the flip side though, it could also work in your favor, as it confers immediate recognition and may help get people interested in the paradigm. Also, by using the term, you could potentially help augment the Paleo “brand” by associating it with sound, scientific ideas and principles.
In other words, there are both pros and cons to using that name. The same can be said for other names as well though. Any name with the word evolution or evolutionary in it will bring up negative connotations in some people’s minds, as a substantial part of the human population are opposed to evolutionary ideas about the nature of life, often for religious reasons, as you point out in your e-mail message. Personally, I wouldn’t let this dictate the choosing of a name if I were you, but it’s certainly something it’s good to be aware of. As for the term Wellness Paradigm, I think that’s way too broad and doesn’t capture the essence of the paradigm you’ve created.
In the end, in choosing a name, you may want to think about what kinds of terms you generally use and favor, as well as what you intend to do with the paradigm. If your work is closely associated with Paleo, you may want to include that name in your title, whereas if that’s not the case, you may want to choose another term.
2. Immediately upon seeing and reading the outline, I found the wording/phrasing in the beginning a bit strange. I’m thinking about the repeated use of “Given, that”, followed by “Therefore,”. The phrasing has grown on me, but perhaps it’s worth considering modifying it slightly.
3. You may want to include one or two extra points directly after point one, so as to enforce the notion that we all carry a hunter-gatherer legacy within us.
Suggestions as to what you could add:
1. Given, that more than 99.5% of the evolution of our genus Homo took place in the hunter-gatherer niche of the Paleolithic, conferring ample opportunity for natural selection to dovetail the human biology with such conditions.
2. Given, that humans (both past and present) who occupy a Paleolithic-like, natural environment are generally lean, healthy, and physically robust.
4. You may want to include the word inflammation somewhere, for example in connection to the things you mention under point 5 or 6. It’s at the very center of the etiology of the diseases of civilization, so I feel it should be mentioned by name. Personally, I’m not intimately familiar with all of the terms you use under points 6, but the sequel of events certainly appears reasonable. If you’re confident in that explanation, I suggest you keep it.
5. I would suggest that you add an additional, third way to combat disease/promote health under the last point in the paradigm. In other words, there’ll be an a, b, and c. Here’s what I had in mind for the latter:
c) via professionally conducted interventions aimed at restoring normal physiological functioning, such as for example therapies intended to correct muscular imbalances or microbiome abnormalities caused by novel environmental stimuli.
Other than that, I don’t think I have much to add. At least I can’t think of anything right now.
One thing I really like about the paradigm you’ve created is that you included a statement saying that we should focus on changing the state of our current environment in such a way that it becomes more conducive to health. This is a very important point, but it’s unfortunately often left out of discussions related to evolutionary health and nutrition. Typically, the sole focus is on our individual choices with respect to diet, sleep, physical activity, etc.
I hope this helps! If you manage to bring one or more of my suggestions in somehow, I think it could make a positive difference. That said, don’t feel in any way pressured to incorporate the things I’ve brought up. If you don’t like them or feel they would take up too much space, then feel free to leave them out.