Dietary Risk Factors for Heart Disease and Cancer

Based on a study of 42 European countries, a recent scientific paper reported that, “the highest CVD [cardiovascular disease] prevalence can be found in countries with the highest carbohydrate consumption, whereas the lowest CVD prevalence is typical of countries with the highest intake of fat and protein.” And that, “The positive effect of low-carbohydrate diets on CVD risk factors (obesity, blood lipids, blood glucose, insulin, blood pressure) is already apparent in short-term clinical trials lasting 3–36 months (58) and low-carbohydrate diets also appear superior to low-fat diets in this regard (36, 37).” Basically, for heart health, this would suggest eating more full-fat dairy, eggs, meat, and fish while eating less starches, sugar, and alcohol. That is to say, follow a low-carb diet. It doesn’t mean eat any low-carb diet, though, for the focus is on animal foods.

By the way, when you dig into the actual history of the Blue Zones (healthy, long-lived populations), what you find is that their traditional diets included large portions of animal foods, including animal fat (Blue Zones Dietary Myth, Eat Beef and Bacon!, Ancient Greek View on Olive Oil as Part of the Healthy Mediterranean Diet). The longest-lived society in the entire world, in fact, is also the one with the highest meat consumption per capita, even more than Americans. What society is that? Hong Kong. In general, nutrition studies in Asia has long shown that those eating more meat have the best health outcomes. This contradicts earlier Western research, as we’re dealing with how the healthy user effect manifests differently according to culture. But even in the West, the research is ever more falling in line with the Eastern research, such as with the study I quoted above. And that study is far from being the only one (Are ‘vegetarians’ or ‘carnivores’ healthier?).

This would apply to both meat-eaters and vegetarians, as even vegetarians could put greater emphasis on nutrient-dense animal foods. It is specifically saturated fat and animal proteins that were most strongly associated with better health, both of which could be obtained from dairy and eggs. Vegans, on the other hand, would obviously be deficient in this area. But certain plant foods (tree nuts, olives, citrus fruits, low-glycemic vegetables, and wine, though not distilled beverages) also showed some benefit. Considering plant foods, those specifically associated with greater risk of heart disease, strokes, etc were those high in carbohydrates such as grains. Unsurprisingly, sunflower oil was a risk factor, probably related to seed oils being inflammatory and oxidative (not to mention mutagenic); but oddly onions were also likewise implicated, if only weakly. Other foods showed up in the data, but the above were the most interesting and important.

Such correlations, of course, can’t prove causation. But it fits the accumulating evidence: “These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs. The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products, which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.” All of that seems straightforward, according to the overall data from nutrition studies (see: Uffe Ravnskov, Richard Smith, Robert Lustig, Eric Westman, Ben Bikman, Gary Taubes, Nina Teicholz, etc). About saturated fat not being linked to CVD risk, Andrew Mente discusses a meta-analysis he worked on and another meta-analysis by another group of researchers, Siri-Tarino PW et al (New Evidence Reveals that Saturated Fat Does Not Increase the Risk of Cardiovascular Disease). Likewise, many experts no longer see cholesterol as a culprit either (Uffe Ravnskov et al, LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature).

Yet one other odd association was discovered: “In fact, our ecological comparison of cancer incidence in 39 European countries (for 2012; (59)) can bring another important argument. Current rates of cancer incidence in Europe are namely the exact geographical opposite of CVDs (see Fig. 28). In sharp contrast to CVDs, cancer correlates with the consumption of animal food (particularly animal fat), alcohol, a high dietary protein quality, high cholesterol levels, high health expenditure, and above average height. These contrasting patterns mirror physiological mechanisms underlying physical growth and the development of cancer and CVDs (60). The best example of this health paradox is again that of French men, who have the lowest rates of CVD mortality in Europe, but the highest rates of cancer incidence. In other words, cancer and CVDs appear to express two extremes of a fundamental metabolic disbalance that is related to factors such as cholesterol and IGF-1 (insulin-like growth factor).”

That is an argument people have made, but it’s largely been theoretical. In response, others have argued the opposite position (High vs Low Protein, Too Much Protein?, Gundry’s Plant Paradox and Saladino’s Carnivory, Carcinogenic Grains). It’s true that, for example, eating meat increases IGF-1, at least temporarily. Then again, eating in general does the same. And on a diet low enough in carbs, it’s been shown in studies that people naturally reduce their calorie intake, which would reduce IGF-1. And for really low-carb, the ketogenic diet is specifically defined as being low in animal protein while higher in fat. A low-carb diet is not necessarily a high-animal protein diet, especially when combined with intermittent fasting such as OMAD (one meal a day) with long periods of downregulated IGF-1. Also, this study didn’t appear to include plant proteins in the data, and so we don’t know if eating lots of soy, hemp protein powder, etc would show similar results; although nuts were mentioned in the report as being similar to meat in correlating to CVD health but, as far as I know, not mentioned in terms of cancer. What would make animal proteins more carcinogenic than plant proteins or, for that matter, plant carbohydrates? The hypothetical mechanism is not clear.

This anomaly would’ve been more interesting if the authors had surveyed the research literature. It’s hard to know what to make of it since other studies have pointed to the opposite conclusion, that the risks of these two are closely linked, rather than being inversely associated: “Epidemiologically, a healthy lifestyle lessens the risk of both cardiovascular disease and cancer, as first found in the Nurses’ Health study” (Lionel Opie, Cancer and cardiovascular disease; see Rob M. Van Dam, Combined impact of lifestyle factors on mortality). “Research has shown there are interrelationships among type 2 diabetes, heart disease, and cancer. These interrelationships may seem coincidental and based only on the fact these conditions share common risk factors. However, research suggests these diseases may relate to one another in multiple ways and that nutrition and lifestyle strategies used to prevent and manage these diseases overlap considerably” (Karen Collins, The Cancer, Diabetes, and Heart Disease Link).

Yet other researchers did find the same inverse relationship: “We herein report that, based on two separate medical records analysis, an inverse correlation between cancer and atherosclerosis” (Matthew Li et al, If It’s Not One Thing, It’s Another). But there was an additional point: “We believe that the anti-inflammatory aspect of cancer’s pan-inflammatory response plays an important role towards atherosclerotic attenuation.” Interesting! In that case, one of the key causal mechanisms to be considered is inflammation. Some diets high in animal proteins would be inflammatory, such as the Standard American Diet, whereas others would be anti-inflammatory. Eliminating seed oils (e.g., sunflower oil) would by itself reduce inflammation. Reducing starches and sugar would help as well. So, is it the meat that increases cancer or is it what the meat is being cooked in or eaten with? That goes back to the healthy and unhealthy user effects.

As this confounding factor is central, we might want to consider the increasingly common view that inflammation is involved in nearly every major disease. “For example, inflammation causes or is a causal link in many health problems or otherwise seen as an indicator of health deterioration (arthritis, depression, schizophrenia, etc), but inflammation itself isn’t the fundamental cause since it is a protective response itself to something else (allergens, leaky gut, etc). Or as yet another example, there is the theory that cholesterol plaque in arteries doesn’t cause the problem but is a response to it, as the cholesterol is essentially forming a scab in seeking to heal injury. Pointing at cholesterol would be like making accusations about firefighters being present at fires” (Coping Mechanisms of Health).

What exacerbates or moderates inflammation will be pivotal to overall health (Essentialism On the Decline), especially the nexus of disease called metabolic syndrome/derangement or what used to be called syndrome X: insulin resistance, diabetes, obesity, heart disease, strokes, etc. In fact, other researchers point directly to inflammation as being a common factor of CVD and cancer: “Although commonly thought of as two separate disease entities, CVD and cancer possess various similarities and possible interactions, including a number of similar risk factors (e.g. obesity, diabetes), suggesting a shared biology for which there is emerging evidence. While chronic inflammation is an indispensible feature of the pathogenesis and progression of both CVD and cancer, additional mechanisms can be found at their intersection” (Ryan J. Koene et al, Shared Risk Factors in Cardiovascular Disease and Cancer). But it might depend on the specific conditions how inflammation manifests as disease — not only CVD or cancer but also arthritis, depression, Alzheimer’s, etc.

This is the major downfall of nutrition studies, as the experts in the field find themselves hopelessly mired in a replication crisis. There is too much contradictory research and, when much of the research has been repeated, it simply did not replicate. That is to say much of it is simply wrong or misinterpreted. And as few have attempted to replicate much of it, we aren’t entirely sure what is valid and what is not. That further problemetizes meta-analyses, despite how potentially powerful that tool can be when working with quality research. The study I’ve been discussing here was an ecological study and that has its limitations. The researchers couldn’t disentangle all the major confounding factors, much less control for them in the first place, as they were working with data across decades that came from separate countries. Even so, it’s interesting and useful info to consider. And keep in mind that almost all official dietary recommendations are based on observational (associative, correlative, epidemiological) studies with far fewer controls. This is the nature of the entire field of nutrition studies, as long-term randomized and controlled studies on humans are next to impossible to do.

So, as always, qualifications must be made. The study’s authors state that, “In items of smaller importance (e.g. distilled beverages, sunflower oil, onions), the results are less persuasive and their interpretation is not always easy and straightforward. Similar to observational studies, our ecological study reflects ‘real-world data’ and cannot always separate mutual interactions among the examined variables. Therefore, the reliance on bivariate correlations could lead to misleading conclusions. However, some of these findings can be used as a starting point of medical hypotheses, whose validity can be investigated in controlled clinical trials.” Nonetheless, “The reasonably high accuracy of the input data, combined with some extremely high correlations, together substantially increase the likelihood of true causal relationships, especially when the results concern principal components of food with high consumption rates, and when they can be supported by other sources.”

This data is meaningful in offering strong supporting evidence. The finding about animal foods and starchy foods is the main takeaway, however tentative the conclusion may be for real world application, at least in taking this evidence in isolation. But the inverse correlation of CVD risk and cancer risk stands out and probably indicates confounders across populations, and that would be fertile territory for other researchers to explore. The main importance to this study is less in the specifics and more in how it further challenges the broad paradigm that has dominated nutrition studies for the past half century or so. The most basic point is that the diet-heart hypothesis simply doesn’t make sense of the evidence and it never really did. When the hypothesis was first argued, heart disease was going up precisely at the moment saturated fat intake was going down, since seed oils had replaced lard as the main fat source in the decades prior. Interestingly, lard has been a common denominator among most long-lived populations, from the Okinawans to Rosetans (Ancient Greek View on Olive Oil as Part of the Healthy Mediterranean Die, Blue Zones Dietary Myth).

This study is further support for a new emerging understanding, as seen with the American Heart Association backing off from its earlier position (Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines). Fat is not the enemy of humanity, as seen with the high-fat ketogenic diet where fat is used as the primary fuel, instead of carbohydrates (Ketogenic Diet and Neurocognitive Health, The Ketogenic Miracle Cure, The Agricultural Mind). In fact, we wouldn’t be here without fat, as it is the evolutionary and physiological norm, specifically in terms of low-carb (Is Ketosis Normal?, “Is keto safe for kids?”). Instead, that too many carbohydrates are unhealthy used to be common knowledge (American Heart Association’s “Fat and Cholesterol Counter” (1991)). Consensus on this shifted a half century ago, the last time when low-carb diets were still part of mainstream thought, and now we are shifting back the other way. The old consensus will be new again.

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Carbohydrates, not animal fats, linked to heart disease across 42 European countries
by Keir Watson

Key findings

  • Cholesterol levels were tightly correlated to the consumption of animal fats and proteins – Countries consuming more fat and protein from animal sources had higher incidence of raised cholesterol
  • Raised cholesterol correlated negatively with CVD risk – Countries with higher levels of raised cholesterol had fewer cases of CVD deaths and a lower incidence of CVD risk factors
  • Carbohydrates correlated positively with CVD risk – the more carbohydrates consumed (and especially those with high GI such as starches) the more CVD
  • Fat and Protein correlated negatively with CVD risk – Countries consuming more fat and protein from animal and plant sources had less CVD. The authors speculate that this is because increasing fat and protein in the diet generally displaces carbohydrates.

Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries
Pavel Grasgruber,* Martin Sebera, Eduard Hrazdira, Sylva Hrebickova, and Jan Cacek

Results

We found exceptionally strong relationships between some of the examined factors, the highest being a correlation between raised cholesterol in men and the combined consumption of animal fat and animal protein (r=0.92, p<0.001). The most significant dietary correlate of low CVD risk was high total fat and animal protein consumption. Additional statistical analyses further highlighted citrus fruits, high-fat dairy (cheese) and tree nuts. Among other non-dietary factors, health expenditure showed by far the highest correlation coefficients. The major correlate of high CVD risk was the proportion of energy from carbohydrates and alcohol, or from potato and cereal carbohydrates. Similar patterns were observed between food consumption and CVD statistics from the period 1980–2000, which shows that these relationships are stable over time. However, we found striking discrepancies in men’s CVD statistics from 1980 and 1990, which can probably explain the origin of the ‘saturated fat hypothesis’ that influenced public health policies in the following decades.

Conclusion

Our results do not support the association between CVDs and saturated fat, which is still contained in official dietary guidelines. Instead, they agree with data accumulated from recent studies that link CVD risk with the high glycaemic index/load of carbohydrate-based diets. In the absence of any scientific evidence connecting saturated fat with CVDs, these findings show that current dietary recommendations regarding CVDs should be seriously reconsidered. […]

Irrespective of the possible limitations of the ecological study design, the undisputable finding of our paper is the fact that the highest CVD prevalence can be found in countries with the highest carbohydrate consumption, whereas the lowest CVD prevalence is typical of countries with the highest intake of fat and protein. The polarity between these geographical patterns is striking. At the same time, it is important to emphasise that we are dealing with the most essential components of the everyday diet.

Health expenditure – the main confounder in this study – is clearly related to CVD mortality, but its influence is not apparent in the case of raised blood pressure or blood glucose, which depend on the individual lifestyle. It is also difficult to imagine that health expenditure would be able to completely reverse the connection between nutrition and all the selected CVD indicators. Therefore, the strong ecological relationship between CVD prevalence and carbohydrate consumption is a serious challenge to the current concepts of the aetiology of CVD.

The positive effect of low-carbohydrate diets on CVD risk factors (obesity, blood lipids, blood glucose, insulin, blood pressure) is already apparent in short-term clinical trials lasting 3–36 months (58) and low-carbohydrate diets also appear superior to low-fat diets in this regard (36, 37). However, these findings are still not reflected by official dietary recommendations that continue to perpetuate the unproven connection between saturated fat and CVDs (25). Understandably, because of the chronic nature of CVDs, the evidence for the connection between carbohydrates and CVD events/mortality comes mainly from longitudinal observational studies and there is a lack of long-term clinical trials that would provide definitive proof of such a connection. Therefore, our data based on long-term statistics of food consumption can be important for the direction of future research.

In fact, our ecological comparison of cancer incidence in 39 European countries (for 2012; (59)) can bring another important argument. Current rates of cancer incidence in Europe are namely the exact geographical opposite of CVDs (see Fig. 28). In sharp contrast to CVDs, cancer correlates with the consumption of animal food (particularly animal fat), alcohol, a high dietary protein quality, high cholesterol levels, high health expenditure, and above average height. These contrasting patterns mirror physiological mechanisms underlying physical growth and the development of cancer and CVDs (60). The best example of this health paradox is again that of French men, who have the lowest rates of CVD mortality in Europe, but the highest rates of cancer incidence. In other words, cancer and CVDs appear to express two extremes of a fundamental metabolic disbalance that is related to factors such as cholesterol and IGF-1 (insulin-like growth factor).

Besides total fat and protein consumption, the most likely preventive factors emerging in our study include fruits (particularly citrus fruits), wine, high-fat dairy products (especially cheese), sources of plant fat (tree nuts, olives), and potentially even vegetables and other low-glycaemic plant sources, provided that they substitute high-glycaemic foods. Many of these foodstuffs are the traditional components of the ‘Mediterranean diet’, which again strengthens the meaningfulness of our results. The factor analysis (Factor 3) also highlighted coffee, soybean oil and fish & seafood, but except for the fish & seafood, the rationale of this finding is less clear, because coffee is strongly associated with fruit consumption and soybean oil is used for various culinary purposes. Still, some support for the preventive role of coffee does exist (61) and hence, this observation should not be disregarded.

Similar to the “Mediterranean diet”, the Dietary Approaches to Stop Hypertension (DASH) diet, which is based mainly on fruits, vegetables, and low-fat dairy, also proved to be quite effective (62). However, our data indicate that the consumption of low-fat dairy may not be an optimal strategy. Considering the unreliability of observational studies highlighting low-fat dairy and the existence of strong bias regarding the intake of saturated fat, the health effect of various dairy products should be carefully tested in controlled clinical studies. In any case, our findings indicate that citrus fruits, high-fat dairy (such as cheese) and tree nuts (walnuts) constitute the most promising components of a prevention diet.

Among other potential triggers of CVDs, we should especially stress distilled beverages, which consistently correlate with CVD risk, in the absence of any relationship with health expenditure. The possible role of sunflower oil and onions is much less clear. Although sunflower oil consistently correlates with stroke mortality in the historical comparison and creates very productive regression models with some correlates of the actual CVD mortality, it is possible that both these food items mirror an environment that is deficient in some important factors correlating negatively with CVD risk.

A very important case is that of cereals because whole grain cereals are often propagated as CVD prevention. It is true that whole grain cereals are usually characterised by lower GI and FII values than refined cereals, and their benefits have been documented in numerous observational studies (63), but their consumption is also tied with a healthy lifestyle. All the available clinical trials have been of short duration and have produced inconsistent results indicating that the possible benefits are related to the substitution of refined cereals for whole grain cereals, and not because of whole grain cereals per se (64, 65). Our study cannot differentiate between refined and unrefined cereals, but both are highly concentrated sources of carbohydrates (~70–75% weight, ~80–90% energy) and cereals also make up ~50% of CA energy intake in general. To use an analogy with smoking, a switch from unfiltered to filtered cigarettes can reduce health risks, but this fact does not mean that filtered cigarettes should be propagated as part of a healthy lifestyle. In fact, even some unrefined cereals [such as the ‘whole-meal bread’ tested by Bao et al. (32)] have high glycaemic and insulin indices, and the values are often unpredictable. Therefore, in the light of the growing evidence pointing to the negative role of carbohydrates, and considering the lack of any association between saturated fat and CVDs, we are convinced that the current recommendations regarding diet and CVDs should be seriously reconsidered.

Coping Mechanisms of Health

Carl Jung argued that sometimes what seems like mental illness is in actuality an effective coping mechanism. He advised against treating the coping mechanism as the problem without understanding what it is a response to. The problem itself could be made worse. Some people have found a careful balance that allows them to function in the world, no matter how dysfunctional it may seem to others, from addiction to dissociation. We need to have respect and compassion for how humans cope with difficulties.

There is something similar in physical health. Consider obesity. Is it always the cause of health problems? Or might it be the body’s way of protecting against other health problems? That is what was explored in a recent study mentioned by Gabor Erdosi. It is Friendly Fat Theory – Explaining the Paradox of Diabetes and Obesity by Rajiv Singla et al. The authors write:

“Obesity has been called the mother of all diseases and, historically, has been strongly linked to diabetes. However, there are still some paradoxes that exist in diabetes epidemiology and obesity and no unifying hypothesis has been proposed to explain these paradoxical phenomena. Despite the ever-increasing prevalence of both obesity and diabetes, differential relationships exist between diabetes and the extent of obesity in various different ethnic groups. In addition, people with a higher body mass index have been shown to have an improved survival advantage in terms of chronic diabetes complications, especially cardiovascular complications. This narrative review attempts to explain these paradoxical and complex relationships with a single unifying theory. We propose that adipocytes are actually friends of the human body to prevent the occurrence of diabetes and also help in mitigating the complications of diabetes. Adipose tissue actually acts as a reservoir of free fatty acids, responsible for insulin resistance, and prevents their overflow into insulin-sensitive tissues and, therefore, friendly fat theory.”

L. Amber O’Hearn responded, “Wait, are you saying the body is actually trying to be healthy and that many symptoms we see in connection with disease are functionally protective coping mechanisms? Yes, indeed.” Following that, someone else mentioned that this perspective was argued by Dr. Jason Fung in an interview with Peter Attia, podcast #59. I’m sure many others have said similar things. It’s not difficult to understand for anyone familiar with some of the science.

For example, inflammation causes or is a causal link in many health problems or otherwise seen as an indicator of health deterioration (arthritis, depression, schizophrenia, etc), but inflammation itself isn’t the fundamental cause since it is a protective response itself to something else (allergens, leaky gut, etc). Or as yet another example, there is the theory that cholesterol plaque in arteries doesn’t cause the problem but is a response to it, as the cholesterol is essentially forming a scab in seeking to heal injury. Pointing at cholesterol would be like making accusations about firefighters being present at fires. To bring it back to diabetes, consider the amyloid plaque in the brain commonly found with Alzheimer’s, i.e., type 3 diabetes. Amy Berger, based on the work of others (Dale Bredesen, Sónia Correia, Mortimer Mamelak, etc), speculates that the amyloid beta (Aβ) peptide plays a neuroprotective role in reducing continuously high levels of glucose, but in dealing with insulin the resulting Aβ plaques are unable to be cleared out. Those plaques would, therefore, be a symptom and not a cause.

As Berger say, “Aβ plaques can be likened to a fever: Fever is a natural protective mechanism the body employs to kill and neutralize invading pathogens. (The goal is to raise the body’s core temperature to a level that is fatal to the bugs and viruses that cause illness.) However, even though it is a protective mechanism, if a fever goes too high, it can have disastrous effects for other parts of human physiology. The same can be said of Aβ. It might start as a defensive step in the brain, but it progresses to a point where, rather than being helpful, it becomes harmful.” Drug companies have targeted these plaques and have successfully decreased them. The result wasn’t as expected. Instead of improving, the condition of Alzheimer’s patients worsened. Blocking amyloid beta peptide, it turns out, was not a beneficial thing. That complies with the theory of a neuroprotective role.

One could look to numerous other things, as the basic principal is widely applicable. The body is always seeking the healthiest balance under any conditions, even if less than optimal. So, in seeking greater health, we must realize that the body-mind of an individual is a system that is part of larger systems. To get different results, the totality of the situation needs to be shifted into a new balance. That is why something like ketosis can dramatically improve so many health issues, as it completely alters the functioning of gut health, metabolism, immune response, hormonal system, neurocognition, and on and on. That diet could have that kind of impact should not be hard to understand. Think about the multiple links, direct and indirect, between the gut and the brain — multiply that by hundreds of other major connections within our biology.

The failing of conventional medicine is that it has usually been a symptoms-based approach. Diagnosis is determined by patterns of symptoms. Too often that then is used to choose a medication or surgical intervention to treat those symptoms. Underlying causes are rarely understood or even considered. Partly, that is because of a lack of knowledge and the related low quality of many medical studies. But more problematic is that the dominant paradigm constrains thought, shuts down the ability to imagine other ways of doing medicine. The above study, however, suggests that we should understand what purpose something is serving. Obesity isn’t merely too much fat. Instead of being the problem itself, obesity might be the body’s best possible solution under those conditions.

What if so many of our supposed problems operate in a similar manner? What if instead of constantly fighting against what we deem as bad we sought understanding first about what purpose is being served and then sought some other means of accomplishing that end? Think about the short-term thinking that has been observed under conditions of poverty and high inequality. Instead of judging people as inferior, we could realize that short-term thinking makes perfect sense in evolutionary terms, as extreme stress indicates that immediate problems must be dealt with first. Rather than blaming the symptom or scapegoating the victim, we should look at the entire context of what is going on. If we don’t like the results we are getting as individuals and as a society, we better change the factors that lead to those results. It’s a simple and typically overlooked insight.

We aren’t isolated individuals. We are an inseparable aspect of a larger world. Every system within our bodies and minds, every system in society and the environment is integral to our holistic functioning as human beings. Everything is connected in various ways. Change one thing and it will ripple outward.

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It’s The Insulin Resistance, Stupid: Part 1 & Part 2
by Timothy Noakes

Most Mainstream Doctors Would Fail Nutrition

To return to the topic at hand, the notion of food as medicine, a premise of the paleo diet, also goes back to the ancient Greeks — in fact, originates with the founder of modern medicine, Hippocrates (he also is ascribed as saying that, “All disease begins in the gut,” a slight exaggeration of a common view about the importance of gut health, a key area of connection between the paleo diet and alternative medicine). What we now call functional medicine, treating people holistically, used to be standard practice of family doctors for centuries and probably millennia, going back to medicine men and women. But this caring attitude and practice went by the wayside because it took time to spend with patients and insurance companies wouldn’t pay for it. Traditional healthcare that we now think of as alternative is maybe not possible with a for-profit model, but I’d say that is more of a criticism of the for-profit model than a criticism of traditional healthcare.

Diets and Systems

Related to diet, Pezeshki does bring up the issue of inflammation. As I originally came around to my present diet from a paleo viewpoint, I became familiar with the approach of functional medicine that puts inflammation as a central factor (Essentialism On the Decline). Inflammation is a bridge between the physiological and the psychological, the individual and the social. Where and how inflammation erupts within the individual determines how a disease condition or rather a confluence of symptoms gets labeled and treated, even if the fundamental cause originated elsewhere, maybe in the ‘external’ world (socioeconomic stress, transgenerational trauma, environmental toxins, parasites because of lack of public sanitation, etc. Inflammation is linked to leaky gut, leaky brain, arthritis, autoimmune disorders, mood disorders, ADHD, autism, schizophrenia, impulsivity, short-term thinking, addiction, aggression, etc — and such problems increase under high inequality.

There are specific examples to point to. Diabetes and mood disorders co-occur. There is the connection of depression and anhedonia, involving the reward circuit and pleasure, which in turn can be affected by inflammation. Also, inflammation can lead to changes in glutamate in depression, similar to the glutamate alterations in autism from diet and microbes, and that is significant considering that glutamate is not only a major neurotransmitter but also a common food additive. Dr. Roger McIntyre writes that, “MRI scans have shown that if you make someone immune activated, the hypervigilance center is activated, activity in the motoric region is reduced, and the person becomes withdrawn and hypervigilant. And that’s what depression is. What’s the classic presentation of depression? People are anxious, agitated, and experience a lack of spontaneous activity and increased emotional withdrawal” (Inflammation, Mood Disorders, and Disease Model Convergence). Inflammation is a serious condition and, in the modern world, quite pervasive. The implications of this are not to be dismissed.

Essentialism On the Decline

In reading about paleolithic diets and traditional foods, a recurring theme is inflammation, specifically as it relates to the health of the gut-brain network and immune system.

The paradigm change this signifies is that seemingly separate diseases with different diagnostic labels often have underlying commonalities. They share overlapping sets of causal and contributing factors, biological processes and symptoms. This is why simple dietary changes can have a profound effect on numerous health conditions. For some, the diseased state expresses as mood disorders and for others as autoimmune disorders and for still others something entirely else, but there are immense commonalities between them all. The differences have more to do with how dysbiosis and dysfunction happens to develop, where it takes hold in the body, and so what symptoms are experienced.

From a paleo diet perspective in treating both patients and her own multiple sclerosis, Terry Wahls gets at this point in a straightforward manner (p. 47): “In a very real sense, we all have the same disease because all disease begins with broken, incorrect biochemistry and disordered communication within and between our cells. […] Inside, the distinction between these autoimmune diseases is, frankly, fairly arbitrary”. In How Emotions Are Made, Lisa Feldman Barrett wrote (Kindle Locations 3834-3850):

“Inflammation has been a game-changer for our understanding of mental illness. For many years, scientists and clinicians held a classical view of mental illnesses like chronic stress, chronic pain, anxiety, and depression. Each ailment was believed to have a biological fingerprint that distinguished it from all others. Researchers would ask essentialist questions that assume each disorder is distinct: “How does depression impact your body? How does emotion influence pain? Why do anxiety and depression frequently co-occur?” 9

“More recently, the dividing lines between these illnesses have been evaporating. People who are diagnosed with the same-named disorder may have greatly diverse symptoms— variation is the norm. At the same time, different disorders overlap: they share symptoms, they cause atrophy in the same brain regions, their sufferers exhibit low emotional granularity, and some of the same medications are prescribed as effective.

“As a result of these findings, researchers are moving away from a classical view of different illnesses with distinct essences. They instead focus on a set of common ingredients that leave people vulnerable to these various disorders, such as genetic factors, insomnia, and damage to the interoceptive network or key hubs in the brain (chapter 6). If these areas become damaged, the brain is in big trouble: depression, panic disorder, schizophrenia, autism, dyslexia, chronic pain, dementia, Parkinson’s disease, and attention deficit hyperactivity disorder are all associated with hub damage. 10

“My view is that some major illnesses considered distinct and “mental” are all rooted in a chronically unbalanced body budget and unbridled inflammation. We categorize and name them as different disorders, based on context, much like we categorize and name the same bodily changes as different emotions. If I’m correct, then questions like, “Why do anxiety and depression frequently co-occur?” are no longer mysteries because, like emotions, these illnesses do not have firm boundaries in nature.”

What jumped out at me was the conventional view of disease as essentialist, and hence the related essentialism in biology and psychology.

Stress and Shittiness

What causes heart disease – Part 63
by Malcolm Kendrick

To keep this simple, and stripping terminology down things down to basics, the concept I am trying to capture, and the word that I am going to use, here to describe the factor that can affect entire populations is ‘psychosocial stress’. By which I mean an environment where there is breakdown of community and support structures, often poverty, with physical threats and suchlike. A place where you would not really want to walk down the road unaccompanied.

This can be a zip code in the US, known as postcode in the UK. It can be a bigger physical area than that, such as a county, a town, or whole community – which could be split across different parts of a country. Such as native Americans living in areas that are called reservations.

On the largest scale it is fully possible for many countries to suffer from major psychosocial stress at the same time. […] Wherever you look, you can see that populations that have been exposed to significant social dislocation, and major psychosocial stressors, have extremely high rate of coronary heart disease/cardiovascular disease.

The bad news is we’re dying early in Britain – and it’s all down to ‘shit-life syndrome’
by Will Hutton

Britain and America are in the midst of a barely reported public health crisis. They are experiencing not merely a slowdown in life expectancy, which in many other rich countries is continuing to lengthen, but the start of an alarming increase in death rates across all our populations, men and women alike. We are needlessly allowing our people to die early.

In Britain, life expectancy, which increased steadily for a century, slowed dramatically between 2010 and 2016. The rate of increase dropped by 90% for women and 76% for men, to 82.8 years and 79.1 years respectively. Now, death rates among older people have so much increased over the last two years – with expectations that this will continue – that two major insurance companies, Aviva and Legal and General, are releasing hundreds of millions of pounds they had been holding as reserves to pay annuities to pay to shareholders instead. Society, once again, affecting the citadels of high finance.

Trends in the US are more serious and foretell what is likely to happen in Britain without an urgent change in course. Death rates of people in midlife(between 25 and 64) are increasing across the racial and ethnic divide. It has long been known that the mortality rates of midlife American black and Hispanic people have been worse than the non-Hispanic white population, but last week the British Medical Journal published an important study re-examining the trends for all racial groups between 1999 and 2016 .

The malaises that have plagued the black population are extending to the non-Hispanic, midlife white population. As the report states: “All cause mortality increased… among non-Hispanic whites.” Why? “Drug overdoses were the leading cause of increased mortality in midlife, but mortality also increased for alcohol-related conditions, suicides and organ diseases involving multiple body systems” (notably liver, heart diseases and cancers).

US doctors coined a phrase for this condition: “shit-life syndrome”. Poor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighbourhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare. Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological side-effects, that is the killer.

The UK is not just suffering shit-life syndrome. We’re also suffering shit-politician syndrome.
by Richard Murphy

Will Hutton has an article in the Guardian in which he argues that the recent decline in the growth of life expectancy in the UK (and its decline in some parts) is down to what he describes as ‘shit-life syndrome’. This is the state where life is reduced to an exercise in mere survival as a result of the economic and social oppression lined up against those suffering the condition. And, as he points out, those suffering are not just those on the economic and social margins of society. In the UK, as in the US, the syndrome is spreading.

The reasons for this can be debated. I engaged in such argument in my book The Courageous State. In that book I argued that we live in a world where those with power do now, when they identify a problem, run as far as they might from it and say the market will find a solution. The market won’t do that. It is designed not to do so. Those suffering shit-life syndrome have, by default, little impact on the market. That’s one of the reasons why they are suffering the syndrome in the first place. That is why so much of current politics has turned a blind eye to this issue.

And they get away with it. That’s because the world of make belief advertising which drives the myths that underpin the media, and in turn out politics, simply pretends such a syndrome does not exist whilst at the same time perpetually reinforcing the sense of dissatisfaction that is at its core.

With Brexit, It’s the Geography, Stupid
by Dawn Foster

One of the major irritations of public discourse after the United Kingdom’s Brexit vote has been the complete poverty of analysis on the reasons behind different demographics’ voting preferences. Endless time, energy, and media attention has been afforded to squabbling over the spending of each campaign for and against continued European Union membership — and now more on the role social media played in influencing the vote — mirroring the arguments in the United States that those who voted to Leave were, like Trump voters, unduly influenced by shady political actors, with little transparency behind political ads and social media tactics.

It’s a handy distraction from the root causes in the UK: widening inequality, but also an increasingly entrenched economic system that is geographically specific, meaning your place of birth and rearing has far more influence over how limited your life is than anything within your control: work, education and life choices.

Across Britain, territorial injustice is growing: for decades, London has boomed in comparison to the rest of the country, with more and more wealth being sucked towards the southeast and other regions being starved of resources, jobs and infrastructure as a result. A lack of secure and well-remunerated work doesn’t just determine whether you can get by each month without relying on social security to make ends meet, but also all aspects of your health, and the health of your children. A recent report by researchers at Cambridge University examined the disproportionate effect of central government cuts on local authorities and services: inner city areas with high rates of poverty, and former industrial areas were hardest hit. Mia Gray, one of the authors of the Cambridge report said: “Ever since vast sums of public money were used to bail out the banks a decade ago, the British people have been told that there is no other choice but austerity imposed at a fierce and relentless rate. We are now seeing austerity policies turn into a downward spiral of disinvestment in certain people and places. This could affect the life chances of entire generations born in the wrong part of the country.”

Life expectancy is perhaps the starkest example. In many other rich countries, life expectancy continues to grow. In the United Kingdom it is not only stalling, but in certain regions falling. The gap between the north and south of England reveals the starkest gap in deaths among young people: in 2015, 29.3 percent more 25-34-year-olds died in the north of England than the south. For those aged 35-44, the number of deaths in the north was 50 percent higher than the south.

In areas left behind economically, such as the ex-mining towns in the Welsh valleys, the post-industrial north of England, and former seaside holiday destinations that have been abandoned as people plump for cheap European breaks, doctors informally describe the myriad tangle of health, social and economic problems besieging people as “Shit Life Syndrome”. The term, brought to public attention by the Financial Times, sounds flippant, but it attempts to tease out the cumulative impact of strict and diminished life chances, poor health worsened by economic circumstances, and the effects of low paid work and unemployment on mental health, and lifestyle issues such as smoking, heavy drinking, and lack of exercise, factors worsened by a lack of agency in the lives of people in the most deprived areas. Similar to “deaths of despair” in the United States, Shit Life Syndrome leads to stark upticks in avoidable deaths due to suicide, accidents, and overdoses: several former classmates who remained in the depressed Welsh city I grew up in have taken their own lives, overdosed, or died as a result of accidents caused by alcohol or drugs. Their lives prior to death were predictably unhappy, but the opportunity to turn things around simply didn’t exist. To move away, you need money and therefore a job. The only vacancies that appear pay minimum wage, and usually you’re turned away without interview.

Simply put, it’s a waste of lives on an industrial scale, but few people notice or care. One of the effects of austerity is the death of public spaces people can gather without being forced to spend money. Youth clubs no longer exist, and public health officials blame their demise on the rise in teenagers becoming involved in gangs and drug dealing in inner cities. Libraries are closing at a rate of knots, despite the government requiring all benefits claims to be submitted via computers. More and more public spaces and playgrounds are being sold off to land-hungry developers, forcing more and more people to shoulder their misery alone, depriving them of spaces and opportunities to meet people and socialise. Shame is key in perpetuating the sense that poverty is deserved, but isolation and loneliness help exacerbate the self-hatred that stops you fighting back against your circumstances.

“Shit-Life Syndrome” (Oxycontin Blues)
by Curtis Price

In narrowing drug use to a legal or public health problem, as many genuinely concerned about the legal and social consequences of addiction will argue, I believe a larger politics and political critique gets lost (This myopia is not confined to drug issues. From what I’ve seen, much of the “social justice” perspective in the professional care industry is deeply conservative; what gets argued for amounts to little more than increased funding for their own services and endless expansion of non-profits). Drug use, broadly speaking, doesn’t take place in a vacuum. It is a thermometer for social misery and the more social misery, the greater the use. In other words, it’s not just a matter of the properties of the drug or the psychological states of the individual user, but also of the social context in which such actions play out.

If we accept this as a yardstick, then it’s no accident then that the loss of the 1984-1985 U.K. Miners’ Strike, with the follow-on closure of the pits and destruction of pit communities’ tight-knit ways of life, triggered widespread heroin use (2). What followed the defeat of the Miners’ Strike only telescoped into a few years the same social processes that in much of the U.S. were drawn out, more prolonged, insidious, and harder to detect. Until, that is, the mortality rates – that canary in the epidemiological coalmine -sharply rose to everyone’s shock.

US doctors have coined a phrase for the underlying condition of which drug use and alcoholism is just part: “shit-life syndrome.” As Will Hutton in the Guardian describes it,

“Poor working-age Americans of all races are locked in a cycle of poverty and neglect, amid wider affluence. They are ill educated and ill trained. The jobs available are drudge work paying the minimum wage, with minimal or no job security. They are trapped in poor neighborhoods where the prospect of owning a home is a distant dream. There is little social housing, scant income support and contingent access to healthcare. Finding meaning in life is close to impossible; the struggle to survive commands all intellectual and emotional resources. Yet turn on the TV or visit a middle-class shopping mall and a very different and unattainable world presents itself. Knowing that you are valueless, you resort to drugs, antidepressants and booze. You eat junk food and watch your ill-treated body balloon. It is not just poverty, but growing relative poverty in an era of rising inequality, with all its psychological side-effects, that is the killer”(3).

This accurately sums up “shit-life syndrome.” So, by all means, end locking up non-violent drug offenders and increase drug treatment options. But as worthwhile as these steps may be, they will do nothing to alter “shit-life syndrome.” “Shit-life syndrome” is just one more expression of the never-ending cruelty of capitalism, an underlying cruelty inherent in the way the system operates, that can’t be reformed out, and won’t disappear until new ways of living and social organization come into place.

The Human Kind, A Doctor’s Stories From The Heart Of Medicine
Peter Dorward
p. 155-157

It’s not like this for all kinds of illness, of course. Illness, by and large, is as solid and real as the chair I’m sitting on: and nothing I say or believe about it will change its nature. That’s what people mean when they describe an illness as ‘real’. You can see it and touch it, and if you can’t do that, then at least you can measure it. You can weigh a tumour; you can see on the screen the ragged outline of the plaque of atheroma in your coronary artery which is occluded and crushing the life out of you, and you would be mad to question the legitimacy of this condition that prompts the wiry cardiologist to feed the catheter down the long forks and bends of your clogged arterial tree in order to feed an expanding metal stent into the blocked artery and save you.

No one questions the reality and medical legitimacy of those things in the world that can be seen, felt, weighed, touched. That creates a deep bias in the patient; it creates a profound preference among us, the healers.

But a person is interactive . Minds can’t exist independently of other minds: that’s the nature of our kind. The names we have for things in the world and the way that we choose to talk about them affect how we experience them. Our minds are made of language, and grammar, intentions, emotions, perceptions and memory. We can only experience the world through the agency of our minds, and how our minds interact with others. Science is a great tool for talking about the external world: the world that is indifferent to what we think. Science doesn’t begin to touch the other, inner, social stuff. And that’s a challenge in medicine. You need other tools for that.

‘Shit-life syndrome,’ offers Becky, whose skin is so pale it looks translucent, who wears white blouses with little ruffs buttoned to the top and her blonde hair in plaits, whose voice is vicarage English and in whose mouth shit life sounds anomalous. Medicine can have this coarsening effect. ‘Shit-life syndrome provides the raw material. We doctors do all the rest.’

‘Go on…’

‘That’s all I ever seem to see in GP. People whose lives are non-specifically crap. Women single parenting too many children, doing three jobs which they hate, with kids on Ritalin, heads wrecked by smartphone and tablet parenting. Women who hate their bodies and have a new diagnosis of diabetes because they’re too fat. No wonder they want a better diagnosis! What am I meant to do?’

I like to keep this tutorial upbeat. I don’t like it to become a moan-fest, which is pointless and damaging. Yet, I don’t want to censor.

‘… Sometimes I feel like a big stone, dropped into a river of pain. I create a few eddies around me, the odd wave or ripple, but the torrent just goes on…’

‘… I see it different. It’s worse! I think half the time we actually cause the problems. Or at least we create our own little side channels in the torrent. Build dams. Deep pools of misery of our own creation!’

That’s Nadja. She’s my trainee. And I recognise something familiar in what she is saying – the echo of something that I have said to her. It’s flattering, and depressing.

‘For example, take the issuing of sick notes. They’re the worst. We have all of these people who say they’re depressed, or addicted, or stressed, who stay awake all night because they can’t sleep for worry, and sleep all day so they can’t work, and they say they’re depressed or anxious, or have backache or work-related stress, and we drug them up and sign them off, but what they’re really suffering from are the symptoms of chronic unemployment and the misery of poverty, which are the worst illnesses that there are! And every time I sign one of these sick notes, I feel another little flake chipped off my integrity. You’re asking about vectors for social illness? Sick notes! It’s like we’re … shitting in the river, and worrying about the cholera!’

Strong words. I need to speak to Nadja about her intemperate opinions…

‘At least, that’s what he keeps saying,’ says Nadja, nodding at me.

Nadja’s father was a Croatian doctor, who fled the war there. Brought up as she was, at her father’s knee, on his stories of war and torture, of driving his motorbike between Kiseljac and Sarajevo and all the villages in between with his medical bag perched on the back to do his house calls, she can never quite believe the sorts of things that pass for ‘suffering’ here. It doesn’t make Nadja a more compassionate doctor. She sips her coffee, with a smile.

Aly, the one training to be an anaesthetist-traumatologist, says, ‘We shouldn’t do it. Simple as that. It’s just not medicine. We should confine ourselves to the physical, and send the rest to a social worker, or a counsellor or a priest. No more sick notes, no more doing the dirty work of governments. If society has a problem with unemployment, that’s society’s problem, not mine. No more convincing people that they’re sick. No more prescriptions for crap drugs that don’t work. If you can’t see it or measure it, it isn’t real. We’re encouraging all this pseudo-­illness with our sick notes and our crap drugs. What’s our first duty? Do no harm! End of.’

She’ll be a great trauma doctor, no doubt about it.

* * *

From Bad to Worse: Trends Across Generations
Rate And Duration of Despair
Trauma, Embodied and Extended
Facing Shared Trauma and Seeking Hope
Society: Precarious or Persistent?
Union Membership, Free Labor, and the Legacy of Slavery
The Desperate Acting Desperately
Social Disorder, Mental Disorder
Social Conditions of an Individual’s Condition
Society and Dysfunction
It’s All Your Fault, You Fat Loser!
To Grow Up Fast
Individualism and Isolation
To Put the Rat Back in the Rat Park
Rationalizing the Rat Race, Imagining the Rat Park
The Unimagined: Capitalism and Crappiness
Stress Is Real, As Are The Symptoms
On Conflict and Stupidity
Connecting the Dots of Violence
Inequality in the Anthropocene
Morality-Punishment Link

Death By Incuriosity

Whether or not curiosity killed the cat, it is the lack of curiosity that killed the human. And sadly, lack of curiosity is common among humans, if not cats.

There are two people I’ve known my entire life. They are highly intelligent and well educated professionals, both having spent their careers as authority figures and both enjoying positions of respect where others look up to them. One worked in healthcare and the other in higher education. They are people one would expect to be curious and I would add that both have above average intellectual capacity. They are accomplished men who know how to get things done.

I pick these examples because each has had health issues. It’s actually the one in healthcare who has shown the least curiosity about his own health. I suspect this is for the very reason he has been an authority figure in healthcare and so has acted in the role of defending establishment views. And nothing kills curiosity quicker than conventional thought.

This guy didn’t only lack curiosity in his own field of expertise, though. In general, he wasn’t one who sought out learning for its own sake. He had no habit of intellectual inquiry. So, he had no habit of intellectual curiosity to fall back on when he had a health scare. The bad news he received was a diagnosis of a major autoimmune disorder. I would assume that he took this as a death sentence and most doctors treat it that way, as no medication has shown any significant improvement. But recent research has shown dietary, nutritional, and lifestyle changes that have reversed the symptoms even in people with somewhat advanced stages of this disease.

Once diagnosed, he was already beginning to show symptoms. He had a brief window to respond during which he maintained his faculties enough that he might have been able to take action to seek remedy or to slow down the decline. But this window turned out to be brief and the choice he made was to do nothing with some combination of denial and fatalism. Inevitably, this attitude became a self-fulfilling prophecy. It was not the diagnosis but his lack of curiosity that was the death sentence. His mind is quickly disintegrating and he won’t likely live long.

The second guy has a less serious diagnosis. He a fairly common disease and he has known about it for a couple of decades. It is one of those conditions more easily managed if one takes a proactive attitude. But that would require curiosity to learn about the condition and to learn about what others have successfully done in seeking healing. The body will eliminate damage and regrow cells when the underlying problems are resolved or lessened while ensuring optimal nutrition and such, not that one is likely to learn about any of this from a standard doctor.

Like the healthcare figure, this educational figure’s first response was not curiosity. In fact, he spent the past couple of decades not even bothering to ask his doctor what exactly was his condition. He didn’t know how bad it was, didn’t know whether it was worsening or remaining stable. He apparently didn’t want to know. He has a bit more curiosity than most people, although it tends to be on narrow issues, none of them being health-related. The condition he has that risks the length and quality of his life, however, elicited no curiosity.

I had more opportunity to speak to him than to the other guy. In the past few months, we’ve had an ongoing discussion about health. I recently was able to get him to read about diet and health. But the real motivation was that his doctor told him to lose weight. Also, he was beginning to see serious symptoms of aging, from constant fatigue to memory loss. It was only after decades of major damage to his body that he finally mustered up some basic curiosity and still he is resistant. It’s easier to thoughtlessly continue what one has always done.

I sympathize and I don’t. Not much in our society encourages curiosity. I get that. It not only takes effort to learn but it also takes risk. Learning can require challenging what you and many others have assumed to be true. In this case, it might even mean challenging your doctor and taking responsibility for your own healthcare decisions. Maybe because these two are authority figures, it is their learned response to defer to authority and any dominant views that stand in for authority. That is the same for others as well. We are all trained from a young age to defer to authority (even if you were raised by wolves, you received such training, as it is a common feature of all social animals).

So, yes, I understand it is difficult and uncomfortable. Some people would rather physically die than allow their sense of identity die. And for many, their identities are tied into a rigid way of being and belonging. Curiosity might lead one to question not only the ideological beliefs and biases of others but, more importantly, one’s own. It could mean changing one’s identity and that is the greatest threat of all, something that effects me as much as anyone (but in my case, I’m psychologically attached to curiosity and so my identity might be a bit more fluid than most; the looseness of ego boundaries does come at a cost, as is attested by the psychiatric literature).

Yet, in the end, it is hard for me to grasp this passive attitude. I’ve always been questioning and so I can’t easily imagine being without this tendency (I have many weaknesses, limitations, and failures; but a lack of curiosity is not one of them). I do know what it is like to be ignorant and to feel lost in having no where to turn for guidance. In the past, knowledge was much harder to come by. When I was diagnosed with depression decades ago, after my own life threatening situation (i.e., suicide attempt), I was offered no resources to understand my condition. The reason for that is, at the time, doctors were as ignorant as anyone else when it came to depression and so much else. High quality information used to be a scarce and unreliable resource.

It has turned out that much of past medical knowledge has proven wrong, only partly correct, or misinterpreted. Because of the power of the internet and social media, this has forced open professional and public debate. We suddenly find ourselves in an overabundance of knowledge. The lack of curiosity is the main thing now holding us back, as individuals and as a society. Still, that downplays the powerful psychological and social forces that keep people ignorant and incurious. For the older generations in particular, they didn’t grow up with easy access to knowledge and so now reaching old age they don’t have a lifetime of mental habit in place.

That is part of the difference. I’m young enough that the emerging forms of knowledge and media had a major impact on my developing brain and my developing identity. On the other hand, there is obviously more going on than mere generational differences. I look to my own generation and don’t see much more curiosity. I know people in my generation who have major health issues and their children have major health issues. Do most of these people respond with curiosity? No. Instead, I observe mostly apathy and indifference. There is something about our society that breeds helplessness, and no doubt there are plenty of reasons to be found for giving up in frustration.

That is something I do empathize with. There is nothing like decades of depression to form an intimacy with feelings of being powerless and hopeless. Nonetheless, I spent the decades of my depression constantly looking for answers, driven to question and doubt everything. I should emphasize the point that answers didn’t come easily, as it took me decades of research and self-experimentation to find what worked for me in dealing with my depression; curiosity of this variety is far from idle for it can be an immense commitment and investment.

My longing to understand never abandoned me, as somehow it was a habit I learned at a young age. That leaves me uncertain about why I learned that habit of open-minded seeking while most others don’t. It’s not as if I can take credit for my state of curiosity, as it is simply the way I’ve always been (maybe in the way an athlete, for random reasons of genetics and epigenecs, might be born with greater lung capacity and endurance). Even in my earliest memories, I was curious about the world. It is a defining feature of my identity, not an achievement I came to later in life.

Because it is so integral to my identity, I’m challenged to imagine those who go through life without feeling much inclination to question and doubt (as happier people may be challenged to imagine my sometimes paralyzing funks of depression). It is even further beyond my comprehension that, for many, not even the threat of death can inspire the most basic curiosity to counter that threat. How can death be more desirable than knowledge? That question implies that it is knowledge that is the greater threat. Put this on the level of national and global society and it becomes an existential threat. In facing mass extinction, ecosystem collapse, superstorms, and refugee crises, most humans are no more motivated to understand what we face, much less motivated to do anything about it.

We don’t have habits of curiosity. It isn’t our first response, not for most of us. And so we have no culture of curiosity, no resources of curiosity to turn to when times are dire. More than a lack of curiosity alone, it is a lack of imagination which is a constraint of identity. We can’t learn anything new without becoming something different. Curiosity is one of the most radical of acts. It is also the simplest of acts, requiring only a moment of wonder or probing uncertainty. But radical or simple, repeated often enough, it becomes a habit that might one day save your life.

Curiosity as an impulse is only one small part. The first step is admitting your ignorance. And following that, what is required is the willingness to remain in ignorance for a while, not grasping too quickly to the next thing that comes along, no matter who offers it with certainty or authority. You might remain in ignorance for longer than you’d prefer. And curiosity alone won’t necessarily save you. But incuriosity for certain will doom you.

* * *

For anyone who thinks I’m being mean-spirited and overly critical, I’d note that I’m an equal opportunity critic. I’ve written posts — some of my most popular posts, in fact — that have dissected the problems of the curious mind, specifically as liberal-mindedness such as seen with the trait openness. The downside to this mindset are many, as it true when considering any mindset taken in its fullest and most extreme form. For example, those who measure high on the openness trait have greater risk of addiction, a far from minor detriment. Curiosity and related attributes don’t always lead to beneficial results and happy ends. But from my perspective, it is better than the alternative, especially in these challenging times.

My argument, of course, is context-dependent. If you are living in an authoritarian state or locked away in prison, curiosity might not do you much good and instead might shorten your lifespan. So, assess your personal situation and act accordingly. If it doesn’t apply, please feel free to ignore my advocating for curiosity. My assumption that my audience shares with me a basic level of life conditions isn’t always a justified assumption. I apologize to anyone who finds themselves stuck in a situation where curiosity is dangerous or simply not beneficial. You have my sympathy and I hope things get better for you in that one day you might have the luxury to contemplate the pros and cons of curiosity.

I realize that life is not fair and that we don’t get to choose the world we are born into. If life was fair, a piece like this would be unnecessary and meaningless. In a society where we didn’t constantly have to worry about harmful advice, including from doctors, in a society where health was the norm, curiosity might not matter much in terms of life expectancy. The average hunter-gatherer no doubt lacks curiosity about their health, but they also lack the consequences of modern society’s unhealthy environment, lifestyle, and diet. As such, in some societies, how to have a healthy life is common knowledge that individuals pick up in childhood.

It would be wonderful to live in such a society. But speaking for myself, that isn’t the case and hence it is why I argue for the necessity of curiosity as a survival tool. Curiosity is only a major benefit where dangerous ignorance rules the social order and, until things change in this society, that major benefit will continue. This isn’t only about allegations of psychological weakness and moral failure. This is about the fate of our civilization, as we face existential crises. The body count of incuriosity might eventually be counted in the numbers of billions. We are long past the point of making excuses, specifically those of us living in relative privilege here in the West.

* * *

To make this concrete, let me give an example beyond anecdotal evidence. It is an example related to healthcare and deference to medical authority.

The United States is experiencing an opioid crisis. There are many reasons for this. Worsening inequality, economic hardship, and social stress are known contributors. We live in a shitty society that is highly abnormal, which is to say we didn’t evolve to act in healthy ways under unhealthy conditions. But there is also the fact that opiods have been overprescribed because of the huge profits to be had and also because painkillers fit conventional medicine’s prioritizing of symptom treatment.

Ignoring why doctors prescribe them, why do people take them? Everyone knows they are highly addictive and, in a significant number of cases, can destroy lives. Why take that risk unless absolutely necessary? It goes beyond addiction, as there are numerous other potential side effects. Yet, in discussing alternatives, Dr. Joseph Mercola points to an NPR piece (Jessica Boddy, POLL: More People Are Taking Opioids, Even As Their Concerns Rise):

“Indeed, the Centers for Disease Control and Prevention note that as many as 1 in 4 people who use opioid painkillers get addicted to them. But despite the drugs’ reputation for addiction, less than a third of people (29 percent) said they questioned or refused their doctor’s prescription for opioids. That hasn’t changed much since 2014 (28 percent) or 2011 (31 percent).

“Dr. Leana Wen, an emergency physician and commissioner of health for the City of Baltimore, says that’s the problem. She says patients should more readily voice their concerns about getting a prescription for narcotics to make sure if it really is the best option. […]

” “Ask why,” Wen says. “Often, other alternatives like not anything at all, taking an ibuprofen or Tylenol, physical therapy, or something else can be effective. Asking ‘why’ is something every patient and provider should do.” ”

* * *

“Knowing is half the battle. G.I. Joe!” That was great wisdom I learned as a child.