
Diseases of Affluence - kareemm
http://maisonneuve.org/pressroom/article/2010/nov/15/the-diseases-affluence/
======
Mz
Really fascinating piece. Most interesting medical paragraph in the piece:

 _ONE OF THE COMMON PITFALLS for clinicians who treat type two diabetes occurs
when they prescribe metformin to young women. Metformin decreases insulin
resistance, which helps reduce blood sugar. Insulin resistance is also what
causes infertility in women with polycystic ovary syndrome, as well as type
two diabetes. Often, women thought to be infertile become pregnant after
taking metformin. Sometimes, of course, this delights them, but sometimes it
does not. Contraception does not normally seem like one of the things diabetes
doctors need to emphasize. But obesity commonly underlies infertility in
women, just as it also causes the growth of facial hair. And, in men, the
growth of breast tissue. Adipose tissue secretes estrogens and insulin
resistance increases levels of androgens. Diabetes is overwhelmingly the most
common cause of male impotence in the developed world. Men and women are
designed to move, and when we do not, our immobility reduces us in every
respect._

Most interesting non-medical paragraph:

 _THE OLDEST of the bowhead whales in the Arctic Ocean have lived for two
hundred years. We know this because when they are killed and examined today,
we find ivory harpoon heads lodged in their skin. The implication is that they
were large enough to be hunted prior to the arrival of the Hudson Bay Company
and its steel harpoon heads in the 1830s. Isotopic analysis of the whales’
eyes confirms the point: these whales were calves during the Napoleonic Wars.
They are certainly the longest-lived mammals on the planet. Indeed, they may
be the longest-lived complex animals of any sort._

Thank you for posting this.

~~~
bambax
I would argue the most interesting non-medical paragraph is this one:

 _The Polynesians did not have lodestones with which to make compasses, and
their navigation system does not emphasize the stars, but the sea itself. The
different wave patterns are studied and observed, as many, improbably, as
fourteen simultaneously. (...) Navigating by wave train alone, the waves were
best felt with the testicles; the navigator on each canoe had a special cabin
he hunkered in. The idea, however, of making sense out of an interference
pattern involving more than three or four wave systems is mind-boggling. The
mathematical complexity of a fourteen-source interference pattern would appear
more than can be held by any human brain. Or scrotum._

And apparently, it's true!

[http://www.cseg.ca/publications/recorder/2008/09sep/sep2008-...](http://www.cseg.ca/publications/recorder/2008/09sep/sep2008-science-
break.pdf)

~~~
Mz
:-)

A) I started to say "best" but felt that would be more open to argument. So I
used the phrase "most interesting" in hopes that it would be accepted that
what an individual finds "most interesting" is personal.

B) I'm actually very fascinated by a lot of stuff having to do with human
sexuality (though that is not really what this is about) and not terribly shy
about discussing it. However, I have found that it is best to tread lightly in
that regard as a woman in a male dominated forum. So I thought it best to
leave out any references to testicles the article made. :-D (On previous
occasions, making similar observations has resulted in downvotes here.)

I also refrained from speculating out loud about some of the causes of issues
described in the article. I do have some thoughts and I read the article
because it fits very nicely with my interests in getting myself well against
very long odds, but what I believe to be true is very far from
accepted/conventional wisdom on such topics. It often gets either ignored or
downvoted here. :-/

But thank you for replying. Have an upvote. :-)

~~~
bambax
I did refrain from asking whether this particular navigation technique
contributed to the prejudice that women can't drive...

> what I believe to be true is very far from accepted/conventional wisdom on
> such topics. It often gets either ignored or downvoted here. :-/

I had a weird experience on HN some time ago when I tried to argue that death
was actually a good thing and was immediately downvoted.

It seems people downvote comments they perceive to be "contrarian", ie
insincere and artificially opposed to mainstream; the problem of course is
that it's very difficult to discriminate ingenuous from disingenious
contrarian opinions.

Just because one thinks different does not mean they do it on purpose. And in
the end, only the truth should matter; even if a point is actually being
argued disingeniously, this fact alone doesn't make it wrong...

~~~
randallsquared
_I had a weird experience on HN some time ago when I tried to argue that death
was actually a good thing and was immediately downvoted.

It seems people downvote comments they perceive to be "contrarian" [...]_

You should probably choose another example, since "death is necessary and
ultimately a good thing" is the mainstream view, not contrarian at all.

~~~
CapitalistCartr
I, too, have never found appreciating the upside to death a common or popular
view. I'd be interested to know your social circle; it sounds much more
interesting than mine.

~~~
randallsquared
_My_ social circle mostly wants to live forever, but that's because I've
surrounded myself with transhumanists and libertarians, who are a lot less
deathist than the population in general. :)

------
DanielBMarkham
When done well, articles like this subtly switch tone from beginning to end.

At the beginning, the tone is something like "we live in a great society,
where wondrous things are possible, but we have problems"

At the end, the tone is something like "Progress hurts us. It is better to
avoid modernity in its entirity"

Of course, the second statement is never fully fleshed out: to do so would
show the many problems it has.

Everybody dreams of a simple world, living close to nature, part of a
community and practicing a long-lasting culture. To see a native people in the
South Pacific go from fishing to Big Macs and spam in a generation is
ascetically displeasing.

But remember: the average life expectancy of an Afghan is _39 years_. These
supposedly fit and healthy societies had entire generations that never saw the
age of 50.

I used to be a big fan of a certain culture -- until I read modern doctor's
accounts of members of that culture who relied on traditional remedies instead
of modern medicine. I used to be a big fan of going back to some of the old
ways of primitive peoples -- until I read "Culture cult" (A must-read if you
are interested in this sort of thing)
[http://www.amazon.com/gp/product/0813338638?ie=UTF8&tag=...](http://www.amazon.com/gp/product/0813338638?ie=UTF8&tag=whtofi-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=0813338638)

The fact is -- it's never a simple comparison. You can pick and choose and
make the case that such ways of living are better -- or you can do the same
thing to make the case they are worse. Doctors can tell you horrific stories
about all sorts of cultures and societies. The grass is always greener on the
other side of the fence, that is, we always think the other culture or way of
life is better. Many times it is not.

I am a firm believer that some trade-offs are better for societies than
others. It's not all just the same. And these are extremely serious health
issues. I do not mean to make light of them at all. Perhaps we can learn some
lessons from more traditional societies that we can apply. But we need to be
very careful about when performing such analysis that we don't step over the
line from selecting good things to frank prejudice towards any sort of
traditional or primitive society. We romanticize peoples instead of looking at
them the way they really are. It's a feel-good thing, sure, but our feelings
rarely match up to the actual state of things, no matter how many good essays
like this we read. (And this was a great essay)

~~~
zach
> But remember: the average life expectancy of an Afghan is _39 years_. These
> supposedly fit and healthy societies had entire generations that never saw
> the age of 50.

That's life expectancy at birth, because Afghanistan (understandably)
currently has the highest rate of under-5 mortality. Life expectancy upon
reaching age 5 is probably still over 50 years, although these are the rosier
1990-95 figures:

[http://www.worldlifeexpectancy.com/country-health-
profile/af...](http://www.worldlifeexpectancy.com/country-health-
profile/afghanistan)

~~~
notahacker
That link is useful in refuting some of the article's other claims, such as
suggestion that heart attacks are "almost unknown" amongst the Pashtuns.

The actual data suggests that Afghanistan is in the top 10 nations for numbers
of coronary heart disease deaths per 100,000 population. The USA isn't even in
the top 100. Sure, it isn't the leading killer out there, and it's lack of
medical attention more than lifestyle factors driving that death rate up, but
it's utterly false to insinuate that less fatty food renders heart problems
irrelevant in that part of the world...

~~~
zach
Great point. There are other lifestyle factors besides diet playing a part as
well. Particularly, that Afghanistan is probably one of the most stressful
countries in the world in which to live over the last 35 years.

------
wyclif
My wife comes from a country that would be considered "third world" in many
ways, and the diet there is much more traditional and seasonal: rice, lots of
tropical fruit and veg, and a number of different fish. A variation on the
Asian diet. Notably, there is not much obesity-- not nearly as much as in
Western nations.

It's not just diet, it's also general activity level during the day, because
only the wealthy own automobiles and average people walk and bike _much_ more
than in the West-- where I'm from, people dress up in fancy "workout" clothes
to go for a brisk walk, jog for 1 mile or km, or take a bike ride!

------
c0riander
The thing this article drives home, to me, is that in "impoverished"
circumstances -- i.e. an environment where there is not a surfeit of resources
-- the external environment serves to regulate the body, health, and
longevity. In Western(ized) cultures, cultures of plenty, we shift from being
regulated (and controlled) primarily by our environment, to having to regulate
ourselves. Learning that self-discipline, as a culture and a species, is an
arduous process, and as we've seen, the affluent and educated tend to have a
leg up in doing so.

I think it could be a more productive conversation if we treated "diseases of
affluence" as ones that required different human responses than the diseases
we've faced in the past -- the search for the pathway to instilling the
requisite behaviors for healthy survival seems to me like a better expenditure
of energy than simply bemoaning progress's ills.

------
guelo
Great article, made me want to run off to the wilderness and get moving
building something, being self sufficient. I feel like I'm melting in my
chair. But instead I'll go check out what's on reddit.

~~~
sliverstorm
The cool thing is once you get the ball rolling, it keeps on rolling. Ever
since I improved my diet and started exercising, I have times when I just
_really_ , _really_ want to jump up and down, run laps, do pushups, lift
something heavy...

You do have to keep it up though.

------
coolgeek
This was an engaging read. But the implication that urbanization causes
obesity is not only unsupported by the author, but almost certainly
fallacious. (Correlation, after all, does not imply causation)

The cause of obesity is quite clearly refined carbohydrates, and the greater
prevalence among the less affluent is directly due to carbohydrates being less
expensive per calorie than vegetables and meats. (This is exacerbated by a) 40
years of misinformed nutritional recommendations, and b) government financial
incentives to the agriculture industry).

Not only is the author wrong about the cause of this problem, but he is
wrongheaded in his demonization of urbanization. There are very clearly
measurable negative environmental impacts caused by suburbanization and
exurbanization. Urbanites, OTOH, have a significantly smaller per capita
environmental impact.

------
jerf
When the solution is "stop eating so many refined carbs", I'm sorry, but I
have a had time then trying to penumbrically emanate the blame out to
"urbanization" or "wealth". The problem is that the US government decided to
blame fat, despite all the evidence to the contrary. If they had not done that
forty years ago, there's every reason to believe that we would in fact be
every bit as urban and every bit as wealthy (if not even more so), yet not
fat. There's nothing but correlation for those things; the causation is
confined to eating too many refined carbs. I reject modern-day Puritan's
attempts to load their Puritanical views onto the really-rather-simple problem
of obesity; the first order problem is too many carbs and if there's a second
order problem it would be government, not urbanization or wealth.

~~~
Ixiaus
The first problem is a society that doesn't, inherently, teach happiness to
its newest members - we are reared with the idea that hard work and submission
are the rules of this game. That in turn produces a large population of
generally crabby, unhappy, and dependent people (dependent in the sense that
everyone looks to everyone else for their happiness - people blame
governments, people blame their spouses, for doing something that makes them
unhappy).

Junk food, drugs, sitcoms, and strip malls are all the result of people
discovering that a number of substances and emotional states can be cheaply
produced (a result of industrialization/modernization) that excite the nervous
system. Many often excite dopamine release in the brain which makes a lot of
it addictive.

This is also a product of population growth - substances that are cheap and
easy to produce make feeding and keeping alive a larger population much
easier. You therefore, will always, have a large cross section of any given
modern population that can only stay alive by consuming cheap sustenance that
excites their nervous system to mask how nutritionally poor it is. Only sad
thing is, it usually keeps them there.

I consider MSG and Wheat (the grain, yes) to be far worse that narcotics.

Obesity isn't the government's fault. It isn't the corporation's fault even,
they are simply the _result_ of a condition. The fault is in the people.
People need to start taking responsibility for their own happiness - as they
do that, the conditions will improve. But it is the individual's journey, not
the group's.

~~~
jerf
I don't disagree with the message that people are responsible for their own
happiness. But right now, a "health conscious" person can go out, realize they
need to eat a good diet, and be filled unto overflowing with actively harmful
advice pushed by virtually every authority in existence. At some point they've
done their due diligence and can no longer be blamed for the result.

------
lkrubner
What can we make of an opening like this?

"Everywhere Western ideas touch down, people get fatter. Urbanization is
literally making us sick."

What about China? It has had some large cities for several thousand years now.
Did people in China get fat 3,000 years ago?

In the USA, since 1945, the trend has been away from the cities and towards.
Why not write "suburbanization is making us fatter?"

The article is on solid ground when it writes about insulin and fat. But
nowhere does it offer much evidence about what is causing insulin resistance
in the West. The truth is that this is still a subject of much research. There
are a lot of theories out there, but no one is sure of the cause.

The sentence "Urbanization is literally making us sick" is ridiculous.

~~~
Mz
I agree that the article didn't really make the point it initial indicated it
would make and never really did get back to this initial assertion. I liked it
anyway for other reasons. It is rich in certain kinds of information that
interest me and which are often not put together. I don't think it did a great
job of drawing conclusions and backing them up. I still felt it had a lot of
value for me.

------
marze
Quite interesting.

The fact that native people eating their traditional diet do not have the
western diseases of stroke, heart disease, diabetes, etc., is well documented,
as is the fact that those same native peoples who adopt a western diet do
suffer from the western diseases.

Those facts alone prove that the western diseases not genetic but
environmental and thus avoidable. Anyone who wishes to avoid them can do so,
but they need to figure out how, which may not be obvious.

~~~
ascott
There was a study of the town Roseto, Pennsylvania in the 1950s that may
explain why this is the case. They ate a traditional american diet, exercised
the same amount as other americans, etc. But they had almost no heart disease,
which was astounding at the time.

The difference was that everyone in town was very social. They would
frequently share meals with neighbors, and several family generations would
live together under the same roof. The conclusion the study came to was that
the excellent health was from community and social connections.

[http://www.nytimes.com/2008/11/30/books/chapters/chapter-
out...](http://www.nytimes.com/2008/11/30/books/chapters/chapter-
outliers.html?_r=1)

I think these social connections become necessary for survival in poor areas.
So they are resistant to diseases of affluence when their diet changes.

------
sliverstorm
_The women, when they want to be particularly biting about their men, complain
that “he doesn’t even own a gun anymore.”_

Oooh, that enchants my imagination. I do hope I someday get a chance to live
in a world where _everyone_ hunts, no matter how small that world is, even if
only for a little while.

~~~
pyre
Yes. Everyone should run out into the woods with a six-pack in one hand and a
gun in the other, kill a bunch of animals, and then leave their bodies in the
woods so that the local authorities can't catch you as having hunted more than
your alloted share of animals!

I'm of the mind that the number of hunters that want to conserve wildlife and
'be responsible' is far out-weighed by the number of people that view hunting
as a way to, "shoot guns, kill things and get drunk." Those people have been
hunting, and obviously haven't learned much from it (unless that's the kind of
world you are implying that you want to live in). Why do you think that the
majority of people will somehow take away _more_ from it then these people
have?

While I have more respect for people that hunt their food than the people that
just buy it at the store (but wouldn't have the balls to kill the animals
themselves), I think that sending people out into the wilderness to kill a
bunch of animals just so that they can 'learn valuable life lessons' is a
morally wrong (or at least ambiguous) proposition. Why not bring to life The
Running Man (or Battle Royale) as a real-life 'coming of age' instead? (Hint:
Because of the societal view that animals are somehow 'below us' and that as
humans we have the god-given right -- hey, it's even in the Bible -- to do
whatever we want to non-human animals. Therefore killing an animal is no
different than tearing a piece of fabric or smashing a light bulb.)

[Note: I'm not some hippie that "just doesn't know because he's never been
hunting." I _have_ been hunting. I got over the "Omg! I killed an animal!" and
spent a few years of my life killing and eating animals in the fall during
hunting season.]

~~~
sliverstorm
I meant hunts because you need to hunt to get the meat you need to survive &
stay healthy. Not hunts for pleasure.

