Let’s imagine that the field of medicine is a vast forest that covers large areas of landscape. The trees of this forest represent all of the different things that make up the medical discipline. Some of the trees represent different hormones, receptors, genes, and cells that are found inside the human body; others make up nutrients, toxins, and lifestyle factors that affect human health; and yet others represent bacteria, fungi, worms, and other organisms that are a part of Homo sapiens sapiens’ environment.
Everyone who’s ever taken an interest in the arts and science of medicine has come across this forest on their journey through life. This includes health/nutrition scientists, nutritionists, physiotherapists, personal trainers, and all other health/fitness professionals. Upon arrival at the forest, most of these people go straight in and start wandering around. They walk on many different paths and explore the green space, and every now and then, they stop and have a look at the trees around them. Some become so fascinated by the colors, structure, and beauty of some of the trees they come across that they end up spending years – or sometimes even the rest of their life – gazing at those trees and examining their every detail.
Not everyone chooses this path though. A small number of the people who enter the forest choose a different route. They realise – perhaps because they talk to other travelers or stop and think about what they’re doing – that it’s virtually impossible to get an overview of what the whole forest looks like when they’re done on “the ground floor”, walking amidst large, bushy trees that obscure their visibility. They understand that they are only seeing some of the individual components of the forest; they don’t get to see the whole woodland. In other words, they recognize that if all they do is walk around on the forest floor, they’ll only see some pieces of a larger puzzle; they’ll never get too appreciate the whole puzzle in its complete form.
For that reason, they pull back and start looking for high ground. They ascend a mountain or climb a tall tree, and thereby attain a bird’s-eye view of the forest. From that position, they’re not able to make out how each of the individual components of the green space are put together or examine the details of every tree; however, they are able to see how the whole forest is structured. They get to see where streams of water are coming in, what types of trees that predominate in different parts of the area, and how the various elements of the forest are connected. In other words, they get to mentally design a map of the whole forest.
After they’ve taken some time to appreciate what the forest looks like from a bird’s-eye perspective, these people – who’ve climbed trees or walked up on mountain tops – typically go back down into the forest and venture into areas of it that they have decided, based on their top-down examination of the green space, that they are keen to explore. The difference between their situation now and before they were up on the high ground is that they now have a map in hand that helps them navigate the natural environment they find themselves in. Moreover, they know what the whole forest looks like. They appreciate the fact that the things they’re seeing when they are walking down on the forest floor are only parts of a larger structure.
Seeing medicine from a bird’s-eye view
The little story above perfectly describes the main limitation/problem with the conventional approach to medicine.
Students who study health-related subjects, such as nutrition and medicine, learn about the different cells and receptors that are involved in different diseases, how nutrients are digested and absorbed, what the molecular mechanisms of different diseases are, and how pathogens can make us sick. In other words, they learn a lot about some of the trees that make up the forest of medicine. However, they never get to see the whole forest. I should know, as I’ve studied both nutrition and sports science.
The same is true for people who don’t choose the route of academia, but rather encounter the forest of medicine via a different path. They typically walk straight in among the trees and stay down at the forest floor their whole life.
So, how can we get to see medicine from a bird’s-eye view? Climbing a tree in real life obviously won’t help much. What would help, though, is to take a step back and look at the field from an evolutionary/biological perspective. This perspective is in many ways analogous to the bird’s-eye perspective in the scenario discussed above, in the sense that it provides the viewer with an overview of something that is large and complex. Moreover, it provides the viewer with the knowledge he needs to design a map or model that helps him navigate the tumultuous landscape he’s seeing.
This perspective doesn’t allow for an examination of the details of each of the smaller components that make up the field of medicine; however, it does allow us to see what the whole field looks like: how it’s put together and how its constituents are connected. Assembling this knowledge is absolutely crucial for making sense of health and disease. Just like it’s good to have a map when you travel into a large forest, it’s really good to have a map when you set out to navigate through the field of medicine. When you have a map, you’re much less likely to travel in the wrong direction and get lost or confused.
I think the main reason there is so much confusion, disorder, and conflict in medicine and nutrition is that these fields – in their present form – lack a strong foundation. They haven’t got anything solid to stand on. I would argue that adding some evolutionary and biological theories and concepts to the foundations of these disciplines would help give them much better footing.
Finding high ground
If you’re knowledgeable about medical sciences and Darwinian medicine, you probably understand how everything I’ve talked about so far is applicable to real life. However, if you don’t, then no worries. In order to make things seem less abstract, I thought I’d finish with some examples that illustrate what I want to get across with today’s article.
Very recently, I put up an interview here on the blog with Begoña Ruiz Núñez, author of an excellent review paper on evolutionary health/nutrition entitled Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low-grade inflammation in an evolutionary context. That paper can be used to illustrate what I mean by seeing the forest for the trees. Unlike many other researchers, the authors of that paper do see the forest for the trees. They acknowledge that clinical trials and meta-analyses only tell us so much. They understand that it’s impossible to make sense of health, nutrition, and medicine if you don’t possess knowledge about human evolution and biology. Moreover, they acknowledge that it’s the totality of exposures that matter. There is no single magic bullet, nutritional product, or drug that will bring us good health.
A lot of other people, including many scientists, don’t seem to understand that. Instead of finding high ground in order to see the whole forest, they focus on one or a few trees. Some only focus on the trees that represent different carbohydrates and make the case that the key to health and longevity is to eat virtually no sugar and starch; others stand looking at the trees that represent strength training and argue that lifting weights on a regular basis is more important than anything else when it comes to optimizing health and longevity; some only pay attention to a few trees that represent important receptors involved in the pathogenesis of cardiovascular disease and spend their whole careers trying to develop drugs that manipulate these receptors; and yet others focus exclusively on the group of trees that represent vitamins and minerals and promote the idea that correcting micronutrient deficiencies should be the primary focus of nutritionists.
Many of these people obviously realise that the tree or trees they are looking at aren’t the only trees in their vicinity; however, since they are standing down on the forest floor, surrounded by large trees and bushes, they are incapable of seeing the whole forest – they only see small parts of it; hence, they can’t appreciate the totality of it.
A lot of health/fitness gurus, scientists, nutritionists, and health practitioners have specialized in just one thing, such as intermittent fasting, low-carbohydrate dieting, or sleep optimization. From the perspective of gaining followers and bringing attention to a specific facet of health/fitness, that’s a smart approach. I don’t have anything against that approach. There’s absolutely nothing wrong in focusing more on certain trees than others. That said, we should always remember that there are more trees out there and that every tree is just a small part of a larger ecosystem.
I don’t claim to have all the answers, but if there’s one thing I’ve learned, it’s that it’s extremely important to see the forest for the trees. If we don’t, we may quickly become lost, confused, and disoriented.