What Are the Root Causes of Modern Illness? 16 Questions With Researcher and Therapist Begoña Ruiz Núñez

begoña-ruiz-núñezOver the years I’ve read countless scientific papers on nutrition, health, and medicine. While I found many of these papers very interesting, only a few left a lasting impression on me. A couple of years back, I came across one such fascinating piece of writing. The paper, entitled Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low-grade inflammation in an evolutionary context, blew my mind. I didn’t have to do much reading before I realised that I had come across a truly great article on evolutionary health/medicine.

The thing that separates this review article from most other papers on the same topic is that it contains a comprehensive overview of the evolutionary mismatches that underlie the diseases of civilization. It doesn’t just focus on one thing, such as omega-3 intake, physical activity levels, or sun exposure, but rather brings together and organizes many different environmental factors that affect human health. Unlike many other scientists, the authors of this paper see the forest for the trees! It’s definitely one of my favorite articles on health/medicine.

Quite recently, the lead author of the paper, Begoña Ruiz Núñez, commented on a post I put up here on the site. This gave me the idea of asking her to do a short interview about her research work. So, I contacted her, and I quickly found out that she is a lovely lady. It turned out she was more than happy to share her thoughts on health, nutrition, and medicine…

1. Who are you? What’s your profession and educational background?
I am a physiotherapist and an osteopath. I think every therapist who’s been in contact with patients has realized there is a lot more to medicine than manual therapy. Some time ago, I came across clinical Psycho-Neuro-Immunology (cPNI), and that’s when my journey really started.

2. How did you get interested in ancestral health and Darwinian/evolutionary medicine?
cPNI is mainly based on scientific research and searches for ways of bringing patients back to health. Lifestyle interventions, including diet changes, are integral to cPNI. A while back, I started reading about the evolution of Homo sapiens sapiens and evolutionary medicine. This then led me over to Prof. Frits Muskiet, my mentor and one of my earlier teachers, who invited me to do a PhD with him in the Netherlands. I accepted his invitation.

3. What’s the main focus of your research?
My research began as a continuation of the work Dr. Kuipers and Dr. Luxwolda have done on actual hunter-gatherer populations. Among other things, our research group has compared the health condition of hunter-gatherers to that of healthy people living in the Netherlands, searching for differences in serum lipoproteins, lipids, red blood cell-fatty acid content, and many other markers.
Then things became much more complicated and we published a couple of reviews. I also started doing research on astaxanthin, an amazing carotenoid, and began collaborating with different research groups. Now I’m still busy with an important study on chronic fatigue. I always approach medicine and research from an evolutionary angle and seek to understand how (environmental) mismatches with our genome make us ill.

4. In 2013, you published an outstanding paper entitled Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low-grade inflammation in an evolutionary context. Can you briefly summarize what that article is about?
Well, I guess the title of the paper says it all. We wanted to summarize what the main causes of Western diseases are, pointing out all the mismatches in our current lifestyle that may drive us to a state of (low-grade) chronic inflammation; that is, a continuous state of unsolved inflammation due to high amounts of low-intensity-long-duration stressors (as opposed to the high-intensity-short-duration stressors that we are designed for).

5. In the concluding remarks of that paper (quote below) you basically manage to explain the origin and solution to chronic western illness in 4 sentences. Kudos!! I honestly think this is the best and most concise formulation of this issue that I’ve ever come across. I’ve read a lot of papers and articles on health and medicine, so that’s saying quite a lot. Is there anything you would add to that paragraph to make it even more “complete”, or do you feel it says everything that needs to be said?

It has become clear that most, if not all, typically Western chronic illnesses find their primary cause in an unhealthy lifestyle and that systemic low grade inflammation is a common denominator. From an evolutionary point of view, the current conflict between environment and our Paleolithic genome traces back to our brain growth and the ensuing intimate relationship between inflammation and metabolism. The present disbalance between inflammatory and anti-inflammatory stimuli does not originate from a single cause and can consequently also not be solved by a single “magic bullet”. Resolution of the conflict between environment and our ancient genome might be the only effective manner to arrive at “healthy aging” and to achieve this objective we might have to return to the lifestyle of the Paleolithic era according to the culture of the 21st century.

Wow, thanks (blush). You are asking that to the main author, who’s read it like three hundred times! I am a therapist and a teacher, who includes this concept in her daily life, to treat patients and to help therapists treat their own patients. I always tell them that the immune system wants to be at ease, that every reaction our body produces is directed to reach a state of homeostasis. In our Western society, we are constantly attacking our bodies; we don’t allow them to recover. We’re not giving them what they need to reach that homeostatic state. That is the big difference between us and our Paleolithic era ancestors.

6. Last year you published a very interesting study entitled Influence of a 10-Day Mimic of Our Ancient Lifestyle on Anthropometrics and Parameters of Metabolism and Inflammation: The “Study of Origin. In that study you instructed 55 apparently healthy individuals to engage in a 10-day trip through the Pyrenees, with the purpose of seeing what happens to the health condition of industrialized people when they are put into “Stone Age conditions”. What was the inspiration for doing that study? What did you expect to see, and what did you see? Were the results surprising?
Well, we are all aware of the concept of evolutionary medicine and the concept of evolution. As I have mentioned earlier, there is a mismatch between the genome of Homo sapiens sapiens and our modern environment. This mismatch may be at the root of some (if not all) Western diseases. Therefore, why shouldn’t we try to put people in Paleo-like conditions and see what happens in their bodies?

7. You focus a lot on inflammation in your research. If you were to explain what inflammation is to someone who doesn’t know anything about it, what would you say?
Inflammation is the way the body complains when something is wrong. It can manifest itself in many different ways. Bleeding, nausea, pain, tiredness, irritability, discomfort, and many different diseases can develop as a result of inflammation. Inflammation is not always something negative; it’s only “bad” when its duration exceeds the normal (physiologic) recovery time. It is normal to be tired after you’ve run for 2 hours; however, it’s not normal to be tired if you haven’t done any strenuous activity or physically harmed yourself.

8. Can you give a short description of how our conditions of life have changed throughout evolution with respects to inflammation? What’s the difference between the doughnut-eating, modern man and a Paleolithic hunter-gatherer with respects to the inflammatory milieu in their bodies?
Well, I think that question answers itself! We eat 5-6 times a day, we sleep too little, we are chronically stressed, and we don’t move at all. Our diets are also a mess. We consume too much processed foods and grains and too little omega 3-PUFA and antioxidants, among other things. Not exactly the environment in which the traditional Maasai or the Hadzabe live today…

9. I’ve made the case many times on www.Darwinian-Medicine.com that most people in the world today (in particularly those living in western societies) are chronically inflamed. They don’t necessarily have markedly elevated levels of proinflammatory cytokines in their blood, but their immune systems are in a somewhat heightened state, due to chronic immune responses triggered for example by accumulation of excess adipose tissue or translocation of bacterial endotoxins from the gut into systemic circulation. Do you agree with this perspective? If so, what do you consider to be the most important thing that we can do to cool down our inflamed bodies?
A paper from Dr. Rainer Straub entitled Evolutionary medicine and chronic inflammatory state—known and new concepts in pathophysiology explains this issue perfectly. The immune system can only be active 3-4 days with an innate response, plus 3-4 weeks with an adaptive response. From then on, we start having problems. In the aforementioned paper, Dr Straub discusses how Homo sapiens sapiens shifts towards low grade inflammatory state from day 42, which may not exactly mean heightened, but in many cases, hibernated.
The solution starts with resolving the conflict between our genome and our environment. Exercise (individually tailored), healthy eating (species-appropriate diet), supplementation when necessary (vitamin D3, EPA, DHA…), and psychological support (if needed) can help bring about a resolution of the conflict.

10. If an overweight person who adheres 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.)
I think we can merge the previous question with this one. I would inform him/her what healthy eating is, what the benefits are, and how a healthy diet would affect his/her bodyweight. I would prescribe some exercise, adapted to his/her condition and motivation. I might also share a couple of techniques that he/she can use to reduce stress and cope with his/her daily issues. Yoga and meditation are powerful weapons when used properly.

11. I see that many of your co-authors also do a lot of research on evolutionary/health medicine. Am I right to assume that you are part of a larger group of scientists who specialize in this area? If so, what are the dynamics of that group, and what are you planning to do next?
I have been asked to collaborate on several research projects related to evolutionary health/medicine, and I am open to collaborate on more projects if I’m asked. I must admit though that I am not an academia person – my first priority is not new research right now. I am really happy and proud of what we have published till now, but at the moment my first priority is to spread the word and work to reach more people and educate them on healthy living. I am now also collaborating with Daniel Pardi (we have previously published the Eifel Study together, which is based on the Origin Study), from HumanOS. We are working on some interesting things for the future. I´ll keep you updated.

12. What do you consider to be the most important things Darwinian/evolutionary medicine has to contribute to our current medical system?
I think our medical system needs an infusion of the following: Lifestyle interventions, holistic approaches to health and disease, evidence-based nutrition, and fitness.

13. What would you do if you were put in charge of improving public health? What would you focus on?
I would focus on bringing healthcare professionals up-to-date on the latest science. There is a huge gap between what is known/published in science and what is applied in medical care. Some doctors only look at the total cholesterol levels of their patients when they determine whether or not to prescribe statins. They fail to consider TG/HDL-C ratios and inflammatory values. And that is only one example. Wouldn’t it be better to prescribe a real healthy diet and an adapted exercise program?

14. 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 would love to see that happen, and I am actually working every day to make that change. It’s not easy to bring about big changes, but it’s important to never give up. Changes start with the man (woman) in the mirror.

15. Just out of curiosity, what kind of diet and lifestyle do you adhere to?
begoña-ruiz-núñez-climbing🙂 We don’t buy grains, sugar or dairy products at home. I eat 1-2 times a day. I mostly eat vegetables, fruit, fish, meat, mushrooms, and algae. I guess you can call that Paleo, but I don’t feel identified with that name. We buy as much organic, wild and fresh food as possible and try to avoid processed products. That said, I am a social person and don’t adhere to these principles 100% of the time. I live in Spain, and we do sport-climbing as much as we can. My lifestyle includes both high intensity and low intensity exercise, regular exposure to nature, eating 1-2 times a day after moving, and lots of sun exposure and vitamin D3 synthesis, which help reduce psycho-social stress 🙂

16. Anything else you’d like to add?
Thank you, Eirik, for the opportunity to do this interview. Have a lovely day!


  1. Sheliah Dehlavi says:

    Best article I have read in a long time. Thank you.

  2. Great interview! Thank you!

  3. I’d be interested in Begoña’s work with regards to chronic fatigue, is there a way to get involved?

    Sometimes I feel the advice is a bit ‘lacking’ for those already in a disease state. For example my fiance has struggled with chronic fatigue for 6years now, has always been fairly fit and certainly doesn’t have weight issues. Yes she needs to move more but chronic fatigue limits her activity. Her food intake is largely paleo with plenty of vegetables, doesn’t lead a very stressful life right now, though there were heightened times of stress before she got ill. While I agree with the lifestyle interventions, I’ve witnessed first hand that sometimes they’re not enough, clearly there is more to it otherwise my fiance would have recovered.

    • Hi Nick,

      Lifestyle is not only about eating and moving or being thin/fit. It also includes the way she deals with stress, it also includes psychosocial interventions. Actually, we are now working on a paper about CFS and there is lots of evidence about the problems these patients have in coping with psychosocial stress. It is not about the stress she leads now, it is about the way her immune system could cope or deal with the stituations before. There is a great paper from Straub that is cited in the interview about how the body can only cope with 41 days of stress. From then on, the HPA axis, the immune system, the sympathetic and the parasympathetic system cannot deal with it on a ´proper´way and disease manifests.

      Hope she can find a way to recover.


  1. […] recently, I put up an interview here on the blog with Begoña Ruiz Núñez, author of an excellent review paper on evolutionary […]

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