Ancient Atherosclerosis?

In reading about health, mostly about diet and nutrition, I regularly come across studies that are either poorly designed or poorly interpreted. The conclusions don’t always follow from the data or there are so many confounders that other conclusions can’t be discounted. Then the data gets used by dietary ideologues.

There is a major reason I appreciate the dietary debate among proponents of traditional, ancestral, paleo, low-carb, ketogenic, and some other related views (anti-inflammatory diets, autoimmune diets, etc such as the Wahls Protocol for multiple sclerosis and Bredesen Protocol for Alzheimer’s). This area of alternative debate leans heavily on questioning conventional certainties by digging deep into the available evidence. These diets seem to attract people capable of changing their minds or maybe it is simply that many people who eventually come to these unconventional views do so after having already tried numerous other diets.

For example, Dr. Terry Wahls is a clinical professor of Internal Medicine, Epidemiology, and Neurology  at the University of Iowa while also being Associate Chief of Staff at a Veterans Affairs hospital. She was as conventional as doctors come until she developed multiple sclerosis, began researching and experimenting, and eventually became a practitioner of functional medicine. Also, she went from being a hardcore vegetarian following mainstream dietary advice (avoided saturated fats, ate whole grains and legumes, etc) to embracing an essentially nutrient-dense paleo diet; her neurologist at the Cleveland Clinic referred her to Dr. Loren Cordain’s paleo research at Colorado State University. Since that time, she has done medical research and, recently having procured funding, she is in the process of doing a study in order to further test her diet.

Her experimental attitude, both personally and scientifically, is common among those interested in these kinds of diets and functional medicine. This experimental attitude is necessary when one steps outside of conventional wisdom, something Dr. Wahls felt she had to do to save her own life — a motivating factor of health crisis that leads many people to try a paleo, keto, etc diet after trying all else (these involve protocols to deal with serious illnesses, such as ketosis being medically used for treatment of epileptic seizures). Contradicting professional opinion of respected authorities (e.g., the American Heart Association), a diet like this tends to be an option of last resort for most people, something they come to after much failure and worsening of health. That breeds a certain mentality.

On the other hand, it should be unsurprising that people raised on mainstream views and who hold onto those views long into adulthood (and long into their careers) tend not to be people willing to entertain alternative views, no matter what the evidence indicates. This includes those working in the medical field. Some ask, why are doctors so stupid? As Dr. Michael Eades explains, it’s not that they’re stupid but that many of them are ignorant; to put it more nicely, they’re ill-informed. They simply don’t know because, like so many others, they are repeating what they’ve been told by other authority figures. And the fact of the matter is most doctors never learned much about certain topics in the first place: “A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of the eighteen questions correctly. In short, most mainstream doctors would fail nutrition” (Dr. Will Cole, Ketotarian).

The reason people stick to the known, even when it is wrong, is because it is familiar and so it feels safe (and because of liability, healthcare workers and health insurance companies prefer what is perceived as safe). Doctors, as with everyone else, are dependent on heuristics to deal with a complex world. And doctors, more than most people, are too busy to explore the large amounts of data out there, much less analyze it carefully for themselves.

This maybe relates to why most doctors tend to not make the best researchers, not to dismiss those attempting to do quality research. For that reason, you might think scientific researchers who aren’t doctors would be different than doctors. But that obviously isn’t always the case because, if so, Ancel Keys low quality research wouldn’t have dominated professional dietary advice for more than a half century. Keys wasn’t a medical professional or even trained in nutrition, rather he was educated in a wide variety of other fields (economics, political science, zoology, oceanography, biology, and physiology) with his earliest research done on the physiology of fish.

I came across yet another example of this, although less extreme than that of Keys, but also different in that at least some of the authors of the paper are medical doctors. The study in question involved the participation of 19 people. The paper is “Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations,” peer-reviewed and published (2013) in the highly respectable Lancet Journal (Keys’ work, one might note, was also highly respectable). This study on atherosclerosis was well reported in the mainstream news outlets and received much attention from those critical of paleo diets, offered as a final nail in the coffin, claimed as being absolute proof that ancient people were as unhealthy as we are.

The 19 authors conclude that, “atherosclerosis was common in four preindustrial populations, including a preagricultural hunter-gatherer population, and across a wide span of human history. It remains prevalent in contemporary human beings. The presence of atherosclerosis in premodern human beings suggests that the disease is an inherent component of human ageing and not characteristic of any specific diet or lifestyle.” There you have it. Heart disease is simply in our genetics — so take your statin meds like your doctor tells you to do, just shut up and quit asking questions, quit looking at all the contrary evidence.

But even ignoring all else, does the evidence from this paper support their conclusion? No. It doesn’t require much research or thought to ascertain the weak case presented. In the paper itself, on multiple occasions including in the second table, they admit that three out of four of the populations were farmers who ate largely an agricultural diet and, of course, lived an agricultural lifestyle. At most, these examples can speak to the conditions of the neolithic but not the paleolithic. Of these three, only one was transitioning from an earlier foraging lifestyle, but as with the other two was eating a higher carb diet from foods they farmed. Also, the most well known example of the bunch, the Egyptians, particularly point to the problems of an agricultural diet — as described by Michael Eades in Obesity in ancient Egypt:

“[S]everal thousand years ago when the future mummies roamed the earth their diet was a nutritionist’s nirvana. At least a nirvana for all the so-called nutritional experts of today who are recommending a diet filled with whole grains, fresh fruits and vegetables, and little meat, especially red meat. Follow such a diet, we’re told, and we will enjoy abundant health.

“Unfortunately, it didn’t work that way for the Egyptians. They followed such a diet simply because that’s all there was. There was no sugar – it wouldn’t be produced for another thousand or more years. The only sweet was honey, which was consumed in limited amounts. The primary staple was a coarse bread made of stone-ground, whole wheat. Animals were used as beasts of burden and were valued much more for the work they could do than for the meat they could provide. The banks of the Nile provided fertile soil for growing all kinds of fruits and vegetables, all of which were a part the low-fat, high-carbohydrate Egyptian diet. And there were no artificial sweeteners, artificial coloring, artificial flavors, preservatives, or any of the other substances that are part of all the manufactured foods we eat today.

“Were the nutritionists of today right about their ideas of the ideal diet, the ancient Egyptians should have had abundant health. But they didn’t. In fact, they suffered pretty miserable health. Many had heart disease, high blood pressure, diabetes and obesity – all the same disorders that we experience today in the ‘civilized’ Western world. Diseases that Paleolithic man, our really ancient ancestors, appeared to escape.”

With unintentional humor, the authors of the paper note that, “None of the cultures were known to be vegetarian.” No shit. Maybe that is because until late in the history of agriculture there were no vegetarians and for good reason. As Weston Price noted, there is a wide variety of possible healthy diets as seen in traditional communities. Yet for all his searching for a healthy traditional community that was strictly vegan or even vegetarian, he could never find any; the closest examples were those that relied largely on such things as insects and grubs because of a lack of access to larger sources of protein and fat. On the other hand, the most famous vegetarian population, Hindu Indians, have one of the shortest lifespans (to be fair, though, that could be for other reasons such as poverty-related health issues).

Interestingly, there apparently has never been a study done comparing a herbivore diet and a carnivore diet, although one study touched on it while not quite eliminating all plants from the latter. As for fat, there is no evidence that it is problematic (vegetable oils are another issue), if anything the opposite: “In a study published in the Lancet, they found that people eating high quantities of carbohydrates, which are found in breads and rice, had a nearly 30% higher risk of dying during the study than people eating a low-carb diet. And people eating high-fat diets had a 23% lower chance of dying during the study’s seven years of follow-up compared to people who ate less fat” (Alice Park, The Low-Fat vs. Low-Carb Diet Debate Has a New Answer); and “The Mayo Clinic published a study in the Journal of Alzheimer’s Disease in 2012 demonstrating that in individuals favoring a high-carb diet, risk for mild cognitive impairment was increased by 89%, contrasted to those who ate a high-fat diet, whose risk was decreased by 44%” (WebMD interview of Dr. David Perlmutter). Yet the respectable authorities tell us that fat is bad for our health, making it paradoxical that many fat-gluttonous societies have better health. There are so many paradoxes, according to conventional thought, that one begins to wonder if conventional thought is the real paradox.

Now let me discuss the one group, the Unangan, that at first glance stands out from the rest. The authors say that the, “five Unangan people living in the Aleutian Islands of modern day Alaska (ca 1756–1930 CE, one excavation site).” Those mummies are far different than those from the other populations that came much earlier in history. Four of the Unangan died around 1900 and one around 1850. Why does that matter? Well, for the reason that their entire world was being turned on its head at that time. The authors claim that, “The Unangan’s diet was predominately marine, including seals, sea lions, sea otters, whale, fish, sea urchins, and other shellfish and birds and their eggs. They were hunter-gatherers living in barabaras, subterranean houses to protect against the cold and fierce winds.” They base this claim on the assumption that these particular mummified Unangan had been eating the same diet as their ancestors for thousands of years, but the evidence points in the opposite direction.

Questioning this assumption, Jeffery Gerber explains that, “During life (before 1756–1930 CE) not more than a few short hundred years ago, the 5 Unangan/Aleut mummies were hardly part of an isolated group. The Fur Seal industry exploded in the 18th century bringing outside influence, often violent, from countries including Russia and Europe. These mummies during life, were probably exposed to foods (including sugar) different from their traditional diet and thus might not be representative of their hunter-gatherer origins” (Mummies, Clogged Arteries and Ancient Junk Food). One might add that, whatever Western foods that may have been introduced, we do know of another factor — the Government of Nunavat official website states that, “European whalers regularly travelled to the Arctic in the late 17th and 18th century. When they visited, they introduced tobacco to Inuit.” Why is that significant? Tobacco is a known risk factor for atherosclerosis. Gideon Mailer and Nicola Hale, in their book Decolonizing the Diet, elaborate on the colonial history of the region (pp. 162-171):

“On the eve of Western contact, the indigenous population of present-day Alaska numbered around 80,000. They included the Alutiiq and Unangan communities, more commonly defined as Aleuts, Inupiat and Yupiit, Athabaskans, and the Tinglit and Haida groups. Most groups suffered a stark demographic decline from the mid-eighteenth century to the mid-nineteenth century, during the period of extended European — particularly Russian — contact. Oral traditions among indigenous groups in Alaska described whites as having taken hunting grounds from other related communities, warning of a similar fate to their own. The Unangan community, numbering more than 12,000 at contact, declined by around 80 percent by 1860. By as early as the 1820s, as Jacobs has described, “The rhythm of life had changed completely in the Unangan villages now based on the exigencies of the fur trade rather than the subsistence cycle, meaning that often villages were unable to produce enough food to keep them through the winter.” Here, as elsewhere, societal disruption was most profound in the nutritional sphere, helping account for the failure to recover population numbers following disease epidemics.

“In many parts of Alaska, Native American nutritional strategies and ecological niches were suddenly disrupted by the arrival of Spanish and Russian settlers. “Because,” as Saunt has pointed out “it was extraordinarily difficult to extract food from the challenging environment,” in Alaska and other Pacific coastal communities, “any disturbance was likely to place enormous stress on local residents.” One of indigenous Alaska’s most important ecological niches centered on salmon access points. They became steadily more important between the Paleo-Eskimo era around 4,200 years ago and the precontact period, but were increasingly threatened by Russian and American disruptions from the 1780s through the nineteenth century. Dependent on nutrients and omega fatty acids such as DHA from marine resources such as salmon, Aleut and Alutiiq communities also required other animal products, such as intestines, to prepare tools and waterproof clothing to take advantage of fishing seasons. Through the later part of the eighteenth century, however, Russian fur traders and settlers began to force them away from the coast with ruthless efficiency, even destroying their hunting tools and waterproof apparatus. The Russians were clear in their objectives here, with one of their men observing that the Native American fishing boats were “as indispensable as the plow and the horse for the farmer.”

“Here we are provided with another tragic case study, which allows us to consider the likely association between disrupted access to omega-e fatty acids such as DHA and compromised immunity. We have already noted the link between DHA, reduced inflammation and enhanced immunity in the millennia following the evolution of the small human gut and the comparatively larger human brain. Wild animals, but particularly wild fish, have been shown to contain far higher proportions of omega-3 fatty acids than the food sources that apparently became more abundant in Native American diets after European contact, including in Alaska. Fat-soluble vitamins and DHA are abundantly found in fish eggs and fish fats, which were prized by Native Americans in the Northwest and Great Lakes regions, in the marine life used by California communities, and perhaps more than anywhere else, in the salmon products consumed by indigenous Alaskan communities. […]

“In Alaska, where DHA and vitamin D-rich salmon consumption was central to precontact subsistence strategies, alongside the consumption of nutrient-dense animal products and the regulation of metabolic hormones through periods of fasting or even through the efficient use of fatty acids or ketones for energy, disruptions to those strategies compromised immunity among those who suffered greater incursions from Russian and other European settlers through the first half of the nineteenth century.

“A collapse in sustainable subsistence practices among the Aleuts of Alaska exacerbated population decline during the period of Russian contact. The Russian colonial regime from the 1740s to 1840s destroyed Aleut communities through open warfare and by attacking and curtailing their nutritional resources, such as sea otters, which Russians plundered to supply the Chinese market for animal skins. Aleuts were often forced into labor, and threatened by the regular occurrence of Aleut women being taken as hostages. Curtailed by armed force, Aleuts were often relocated to the Pribilof Islands or to California to collect seals and sea otters. The same process occurred as Aleuts were co-opted into Russian expansion through the Aleutian Islands, Kodiak Island and into the southern coast of Alaska. Suffering murder and other atrocities, Aleuts provided only one use to Russian settlers: their perceived expertise in hunting local marine animals. They were removed from their communities, disrupting demography further and preventing those who remained from accessing vital nutritional resources due to the discontinuation of hunting frameworks. Colonial disruption, warfare, captivity and disease were accompanied by the degradation of nutritional resources. Aleut population numbers declined from 18,000 to 2,000 during the period of Russian occupation in the first half of the nineteenth century. A lag between the first period of contact and the intensification of colonial disruption demonstrates the role of contingent interventions in framing the deleterious effects of epidemics, including the 1837-38 smallpox epidemic in the region. Compounding these problems, communities used to a relatively high-fat and low-fructose diet were introduced to alcohol by the Russians, to the immediate detriment of their health and well-being.”

The traditional hunter-gatherer diet, as Mailer and Hale describe it, was high in the nutrients that protect against inflammation. The loss of these nutrients and the simultaneous decimation to the population was a one-two punch. Without the nutrients, their immune systems were compromised. And with their immune systems compromised, they were prone to all kinds of health conditions, probably including heart disease which of course is related to inflammation. Weston A. Price, in Nutrition and Physical Degeneration, observed that morbidity and mortality of health conditions such as heart disease rise and fall with the seasons, following precisely the growth and dying away of vegetation throughout the year (which varies by region as do the morbidity and mortality rates; the regions of comparison were in the United States and Canada). He was able to track this down to the change of fat soluble vitamins, specifically vitamin D, in dairy. When fresh vegetation was available, cows ate it and so produced more of these nutrients and presumably more omega-3s at the same time.

Prior to colonization, the Unang would have had access to even higher levels of these protective nutrients year round. The most nutritious dairy taken from the springtime wouldn’t come close in comparison to the nutrient profile of wild game. I don’t know why anyone would be shocked that, like agricultural populations, hunter-gatherers also experience worsening health after loss of wild resources. Yet the authors of the mummy studies act like they made a radical discovery that throws to the wind every doubt anyone ever had about simplistic mainstream thought. It turns out, they seem to be declaring, that we are all victims of genetic determinism after all and so toss out your romantic fairy tales about healthy primitives from the ancient world. The problem is all the evidence that undermines their conclusion, including the evidence that they present in their own paper, that is when it is interpreted in full context.

As if responding to the researchers, Mailer and Hale write (p. 186): “Conditions such as diabetes are thus often associated with heart disease and other syndromes, given their inflammatory component. They now make up a huge proportion of treatment and spending in health services on both sides of the Atlantic. Yet policy makers and researchers in those same health services often respond to these conditions reactively rather than proactively — as if they were solely genetically determined, rather than arising due to external nutritional factors. A similarly problematic pattern of analysis, as we have noted, has led scholars to ignore the central role of nutritional change in Native American population loss after European contact, focusing instead on purportedly immutable genetic differences.”

There is another angle related to the above but somewhat at a tangent. I’ll bring it up because the research paper mentions it in passing as a factor to be considered: “All four populations lived at a time when infections would have been a common aspect of daily life and the major cause of death. Antibiotics had yet to be developed and the environment was non-hygienic. In 20th century hunter-foragers-horticulturalists, about 75% of mortality was attributed to infections, and only 10% from senescence. The high level of chronic infection and inflammation in premodern conditions might have promoted the inflammatory aspects of atherosclerosis.”

This is familiar territory for me, as I’ve been reading much about inflammation and infections. The authors are presenting the old view of the immune system, as opposed to that of functional medicine that looks at the entire human. An example of the latter is the hygiene hypothesis that argues it is the exposure to microbes that strengthens the immune system and there has been much evidence in support of it (such as children raised with animals or on farms being healthier as adults). The researchers above are making an opposing argument that is contradicted by populations remaining healthy when lacking modern medicine as long as they maintain traditional diet and lifestyle in a healthy ecosystem, including living soil that hasn’t been depleted from intensive farming.

This isn’t only about agriculturalists versus hunter-gatherers. The distinction between populations goes deeper into culture and environment. Weston A. Price discovered this simple truth in finding healthy populations among both agriculturalists and hunter-gatherers, but it was specific populations under specific conditions. Also, at the time when he traveled in the early 20th century, there were still traditional communities living in isolation in Europe. One example is Loetschenatal Valley in Switzerland, while visiting the country in two separate trips in the consecutive years of 1931 and 1932 — as he writes of it:

“We were told that the physical conditions that would not permit people to obtain modern foods would prevent us from reaching them without hardship. However, owing to the completion of the Loetschberg Tunnel, eleven miles long, and the building of a railroad that crosses the Loetschental Valley, at a little less than a mile above sea level, a group of about 2,000 people had been made easily accessible for study, shortly prior to 1931. Practically all the human requirements of the people in that valley, except a few items like sea salt, have been produced in the valley for centuries.”

He points out that, “Notwithstanding the fact that tuberculosis is the most serious disease of Switzerland, according to a statement given me by a government official, a recent report of inspection of this valley did not reveal a single case.” In Switzerland and other countries, he found an “association of dental caries and tuberculosis.” The commonality was early life development, as underdeveloped and maldeveloped bone structure led to diverse issues: crowded teeth, smaller skull size, misaligned features, and what was called tubercular chest. And that was an outward sign of deeper and more systemic developmental issues, including malnutrition, inflammation, and the immune system:

“Associated with a fine physical condition the isolated primitive groups have a high level of immunity to many of our modern degenerative processes, including tuberculosis, arthritis, heart disease, and affections  of the internal organs. When, however, these individuals have lost this high level of physical excellence a definite lowering in their resistance to the modern degenerative processes has taken place. To illustrate, the narrowing of the facial and dental arch forms of the children of the modernized parents, after they had adopted the white man’s food, was accompanied by an increase in susceptibility to pulmonary tuberculosis.”

Any population that lost its traditional way of life became prone to disease. But this could often as easily be reversed by having the diseased individual return to healthy conditions. In discussing Dr. Josef Romig, Price said that, “Growing out of his experience, in which he had seen large numbers of the modernized Eskimos and Indians attacked with tuberculosis, which tended to be progressive and ultimately fatal as long as the patients stayed under modernized living conditions, he now sends them back when possible to primitive conditions and to a primitive diet, under which the death rate is very much lower than under modernized  conditions. Indeed, he reported that a great majority of the afflicted recover under the primitive type of living and nutrition.”

The point made by Mailer and Hale was earlier made by Price. As seen with pre-contact Native Alaskans, the isolated traditional residents of Loetschenatal Valley had nutritious diets. Price explained that he “arranged to have samples of food, particularly dairy products, sent to me about twice a month, summer and winter. These products have been tested for their mineral and vitamin contents, particularly the fat-soluble activators. The samples were found to be high in vitamins and much higher than the average samples of commercial dairy products in America and Europe, and in the lower areas of Switzerland.” Whether fat and organ meats from marine animals or dairy from pastured alpine cows, the key is high levels of fat soluble vitamins and, of course, omega-3 fatty acids procured from a pristine environment (healthy soil and clean water with no toxins, farm chemicals, hormones, etc). It also helped that both populations ate much that was raw which maintains the high nutrient content that is partly destroyed through heat.

Some might find it hard to believe that what you eat can determine whether or not you get a serious disease like tuberculosis. Conventional medicine tells us that the only thing that protects us is either avoiding contact or vaccination. But this view is being seriously challenged, as Mailer and Hale make clear (p. 164): “Several studies have focused on the link between Vitamin D and the health outcomes of individuals infected with tuberculosis, taking care to discount other causal factors and to avoid determining causation merely through association. Given the historical occurrence of the disease among indigenous people after contact, including in Alaska, those studies that have isolated the contingency of immunity on active Vitamin D are particularly pertinent to note. In biochemical experiments, the presence of the active form of vitamin D has been shown to have a crucial role in the destruction of Mycobacterium tuberculosis by macrophages. A recent review has found that tuberculosis patients tend to retain a lower-than-average vitamin D status, and that supplementation of the nutrient improved outcomes in most cases.” As an additional thought, the popular tuberculosis sanitoriums, some in the Swiss Alps, were attractive because “it was believed that the climate and above-average hours of sunshine had something to do with it” (Jo Fahy, A breath of fresh air for an alpine village). What does sunlight help the body to produce? Vitamin D.

As an additional perspective, James C. Scotts’ Against the Grain, writes that, “Virtually every infectious disease caused by micro-organisms and specifically adapted to Homo sapiens has arisen in the last ten thousand years, many of them in the last five thousand years as an effect of ‘civilisation’: cholera, smallpox, measles, influenza, chickenpox, and perhaps malaria” It is not only that agriculture introduces new diseases but also makes people susceptible to them. That might be true, as Scott suggests, even of a disease like malaria. The Piraha are more likely to die of malaria than anything else, but that might not have been true in the past. Let me offer a speculation by connecting to the mummy study.

The Ancestral Puebloans, one of the groups in the mummy study, were at the time farming maize (corn) and squash while foraging pine nuts, seeds, amaranth (grain), and grasses. How does this compare to the more recent Piraha? A 1948 Smithsonian publication, Handbook of South American Indians ed. Julian H. Steward, reported that, “The Pirah grew maize, sweet manioc (macaxera), a kind of yellow squash (jurumum), watermelon, and cotton” (p. 267). So it turns out that, like the Ancestral Puebloan, the Piraha have been on their way toward a more agricultural lifestyle for a while. I also noted that the same publication added the detail that the Piraha “did not drink rum,” but by the time Daniel Everett met the Piraha in 1978 traders had already introduced them to alcohol and it had become an occasional problem. Not only were they becoming agricultural but also Westernized, two factors that likely contributed to decreased immunity.

Like other modern hunter-gatherers, the Piraha have been effected by the Neolithic Revolution and are in many ways far different from Paleolithic hunter-gatherers. Ancient dietary habits are shown in the analysis of ancient bones — M.P. Richards writes that, “Direct evidence from bone chemistry, such as the measurement of the stable isotopes of carbon and nitrogen, do provide direct evidence of past diet, and limited studies on five Neanderthals from three sites, as well as a number of modern Palaeolithic and Mesolithic humans indicates the importance of animal protein in diets. There is a significant change in the archaeological record associated with the introduction of agriculture worldwide, and an associated general decline in health in some areas. However, there is an rapid increase in population associated with domestication of plants, so although in some regions individual health suffers after the Neolithic revolution, as a species humans have greatly expanded their population worldwide” (A brief review of the archaeological evidence for Palaeolithic and Neolithic subsistence). This is further supported in the analysis of coprolites. “Studies of ancient human coprolites, or fossilized human feces, dating anywhere from three hundred thousand to as recent as fifty thousand years ago, have revealed essentially a complete lack of any plant material in the diets of the subjects studied (Bryant and Williams-Dean 1975),” Nora Gedgaudas tells us in Primal Body, Primal Mind (p. 39).

This diet changed as humans entered our present interglacial period with its warmer temperatures and greater abundance of vegetation, which was lacking during the Paleolithic Period: “There was far more plant material in the diets of our more recent ancestors than our more ancient hominid ancestors, due to different factors” (Gedgaudas, p. 37). Following the earlier megafauna mass extinction, it wasn’t only agriculturalists but also hunter-gatherers who began to eat more plants and in many cases make use of cultivated plants (either that they cultivated or that they adopted from nearby agriculturalists). To emphasize how drastic was this change, this loss of abundant meat and fat, consider the fact that humans have yet to regain the average height and skull size of Paleolithic humans.

The authors of the mummy study didn’t even attempt to look at the data of Paleolithic humans. The populations compared are entirely from the past few millennia. And the only hunter-gatherer group included was post-contact. So, why are the authors so confident in their conclusion? I presume they were simply trying to get published and get media attention in a highly competitive market of academic scholarship. These people obviously aren’t stupid, but they had little incentive to fully inform themselves either. All the info I shared in this post I was able to gather in about a half an hour of several web searches, not exactly difficult academic research. It’s amazing the info that is easily available these days, for those who want to find it.

Let me make one last point. The mummy study isn’t without its merits. The paper mentions other evidence that remains to be explained: “We also considered the reliability and previous work of the authors. Autopsy studies done as long ago as the mid-19th century showed atherosclerosis in ancient Egyptians. Also, in more recent times, Zimmerman undertook autopsies and described atherosclerosis in the mummies of two Unangan men from the same cave as our Unangan mummies and of an Inuit woman who lived around 400 CE. A previous study using CT scanning showed atherosclerotic calcifications in the aorta of the Iceman, who is believed to have lived about 3200 BCE and was discovered in 1991 in a high snowfield on the Italian-Austrian border.”

Let’s break that down. Further examples of Egyptian mummies is irrelevant, as their diet was so strikingly similar to the idealized Western diet recommended by mainstream doctors, dieticians, and nutritionists. That leaves the rest to account for. The older Unangan mummies are far more interesting and any meaningful paper would have led with that piece of data, but even then it wouldn’t mean what the authors think it means. Atherosclerosis is one small factor and not necessarily as significant as assumed. From a functional medicine perspective, it’s the whole picture that matters in how the body actually functions and in the health that results. If so, atherosclerosis might not indicate the same thing for all populations. In Nourishing Diets, Morell writes that (pp. 124-5),

“Critics have pointed out that Keys omitted from his study many areas of the world where consumption of animal foods is high and deaths from heart attack are low, including France — the so-called French paradox. But there is also a Japanese paradox. In 1989, Japanese scientists returned to the same two districts that Keys had studied. In an article titled “lessons fro Science from the Seven Countries Study,” they noted that per capita consumption of rice had declined, while consumption of fats, oils, meats, poultry, dairy products and fruit had all increased. […]

“During the postwar period of increased animal consumption, the Japanese average height increased three inches and the age-adjusted death rate from all causes declined from 17.6 to 7.4 per 1,000 per year. Although the rates of hypertension increased, stroke mortality declined markedly. Deaths from cancer also went down in spite of the consumption of animal foods.

“The researchers also noted — and here is the paradox — that the rate of myocardial infarction (heart attack) and sudden death did not change during this period, in spite of the fact that the Japanese weighed more, had higher blood pressure and higher cholesterol levels, and ate more fat, beef and dairy foods.”

Right here in the United States, we have are own ‘paradox’ as well. Good Calories, Bad Calories by Gary Taubes makes a compelling argument that, based on the scientific research, there is no strong causal link between atherosclerosis and coronary heart disease. Nina Teicholz has also written extensively about this, such as in her book The Big Fat Surprise; and in an Atlantic piece (How Americans Got Red Meat Wrong) she lays out some of the evidence showing that Americans in the 19th century, as compared to the following century, ate more meat and fat while they ate fewer vegetables and fruits. Nonetheless: “During all this time, however, heart disease was almost certainly rare. Reliable data from death certificates is not available, but other sources of information make a persuasive case against the widespread appearance of the disease before the early 1920s.” Whether or not earlier Americans had high rates of atherosclerosis, there is strong evidence indicating they did not have high rates of heart disease, of strokes and heart attacks. The health crisis for these conditions, as Tiecholz notes, didn’t take hold until the very moment meat and animal fat consumption took a nosedive. So what gives?

The takeaway is this. We have no reason to assume that atherosclerosis in the present or in the past can tell us much of anything about general health. Even ignoring the fact that none of the mummies studied was from a high protein and high fat Paleo population, we can make no meaningful interpretations of the presence of atherosclerosis among some of the individuals. Going by modern data, there is no reason to jump to the conclusion that they had high mortality rates because of it. Quite likely, they died from completely unrelated health issues. A case in point is that of the Masai, around which there is much debate in interpreting the data. George V. Mann and others wrote a paper, Atherosclerosis in the Masai, that demonstrated the complexity:

“The hearts and aortae of 50 Masai men were collected at autopsy. These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious.”

Put this in the context provided in What Causes Heart Disease? by Sally Fallon Morell and Mary Enig: “The factors that initiate a heart attack (or a stroke) are twofold. One is the pathological buildup of abnormal plaque, or atheromas, in the arteries, plaque that gradually hardens through calcification. Blockage most often occurs in the large arteries feeding the heart or the brain. This abnormal plaque or atherosclerosis should not be confused with the fatty streaks and thickening that is found in the arteries of both primitive and industrialized peoples throughout the world. This thickening is a protective mechanism that occurs in areas where the arteries branch or make a turn and therefore incur the greatest levels of pressure from the blood. Without this natural thickening, our arteries would weaken in these areas as we age, leading to aneurysms and ruptures. With normal thickening, the blood vessel usually widens to accommodate the change. But with atherosclerosis the vessel ultimately becomes more narrow so that even small blood clots may cause an obstruction.”

A distinction is being made here that maybe wasn’t being made in the the mummy study. What gets measured as atherosclerosis could correlate to diverse health conditions and consequences in various populations across dietary lifestyles, regional environments, and historical and prehistorical periods. Finding atherosclerosis in an individual, especially a mummy, might not tell us any useful info about overall health.

Just for good measure, let’s tackle the last piece of remaining evidence the authors mention: “A previous study using CT scanning showed atherosclerotic calcifications in the aorta of the Iceman, who is believed to have lived about 3200 BCE and was discovered in 1991 in a high snowfield on the Italian-Austrian border.” Calling him Iceman, to most ears, sounds similar to calling an ancient person a caveman — implying that he was a hunter for it is hard to grow plants on ice. In response, Paul Mabry writes in Did Meat Eating Make Ancient Hunter Gatherers Get Heart Disease, showing what was left out in the research paper:

“Sometimes the folks trying to discredit hunter-gather diets bring in Ötzi, “The Iceman” a frozen human found in the Tyrolean Mountains on the border between Austria and Italy that also had plaques in his heart arteries. He was judged to be 5300 years old making his era about 3400 BCE. Most experts feel agriculture had reach Europe almost 700 years before that according to this article. And Ötzi himself suggests they are right. Here’s a quote from the Wikipedia article on Ötzi’s last meal (a sandwich): “Analysis of Ötzi’s intestinal contents showed two meals (the last one consumed about eight hours before his death), one of chamois meat, the other of red deer and herb bread. Both were eaten with grain as well as roots and fruits. The grain from both meals was a highly processed einkornwheat bran,[14] quite possibly eaten in the form of bread. In the proximity of the body, and thus possibly originating from the Iceman’s provisions, chaff and grains of einkorn and barley, and seeds of flax and poppy were discovered, as well as kernels of sloes (small plumlike fruits of the blackthorn tree) and various seeds of berries growing in the wild.[15] Hair analysis was used to examine his diet from several months before. Pollen in the first meal showed that it had been consumed in a mid-altitude conifer forest, and other pollens indicated the presence of wheat and legumes, which may have been domesticated crops. Pollen grains of hop-hornbeam were also discovered. The pollen was very well preserved, with the cells inside remaining intact, indicating that it had been fresh (a few hours old) at the time of Ötzi’s death, which places the event in the spring. Einkorn wheat is harvested in the late summer, and sloes in the autumn; these must have been stored from the previous year.””

Once again, we are looking at the health issues of someone eating an agricultural diet. It’s amazing that the authors, 19 of them, apparently all agreed that diet has nothing to do with a major component of health. That is patently absurd. To the credit of Lancet, they published a criticism of this conclusion (though these critics repeats their own preferred conventional wisdom, in their view on saturated fat) — Atherosclerosis in ancient populations by Gino Fornaciari and Raffaele Gaeta:

“The development of vascular calcification is related not only to atherosclerosis but also to conditions such as disorders of calcium-phosphorus metabolism, diabetes, chronic microinflammation, and chronic renal insufficiency.

“Furthermore, stating that atherosclerosis is not characteristic of any specific diet or lifestyle, but an inherent component of human ageing is not in agreement with recent studies demonstrating the importance of diet and physical activity.5 If atherosclerosis only depended on ageing, it would not have been possible to diagnose it in a young individual, as done in the Horus study.1

“Finally, classification of probable atherosclerosis on the basis of the presence of a calcification in the expected course of an artery seems incorrect, because the anatomy can be strongly altered by post-mortem events. The walls of the vessels might collapse, dehydrate, and have the appearance of a calcific thickening. For this reason, the x-ray CT pattern alone is insufficient and diagnosis should be supported by histological study.”

As far as I know, this didn’t lead to a retraction of the paper. Nor did this criticism receive the attention that the paper itself was given. None of the people who praised the paper bothered to point out the criticism, at least not among what I came across. Anyway, how did this weakly argued paper based on faulty evidence get published in the first place? And then how does it get spread by so many as if proven fact?

This is the uphill battle faced by anyone seeking to offer an alternative perspective, especially on diet. This makes meaningful debate next to impossible. That won’t stop those like me from slowly chipping away at the vast edifice of the dominant paradigm. On a positive note, it helps when the evidence used against an alternative view, after reinterpretation, ends up being strong evidence in favor of it.

6 thoughts on “Ancient Atherosclerosis?

  1. He had medicine with him that old iceman. I remember when they found him. His hat. Has magic in it. The bordering countries universities argued and litigated over his carcass?

  2. That’s ghoulish; I’d like to see more causes examined and fruitful doubts raised in the vast world of online health and diet articles. “This much coffee leads to distended knee syndrome, but with the right combination of veggies in the morning, it’s fine to drink!” I’m sure you’ve seen many takes like that. Twitter is too bonkers for a fitness blog, but maybe I’m just weird enough to try it.

    • I’m not surprised to find low standards of evidence and analysis in most short articles found online. Still, I expect more from a peer-reviewed academic piece in a major journal. Papers like that pop up in news reporting and social media. Then, after causing some commotion, they disappear again. In the brief period they attract attention, they rarely get much scrutiny. Most people return to their preferred ideologies. I look for contrary evidence all the time, but I want criticisms that are worth my time.

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