Diseases of Affluence

Really fascinating piece. Most interesting medical paragraph in the piece:<p><i>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.</i><p>Most interesting non-medical paragraph:<p><i>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.</i><p>Thank you for posting this.

When done well, articles like this subtly switch tone from beginning to end.<p>At the beginning, the tone is something like "we live in a great society, where wondrous things are possible, but we have problems"<p>At the end, the tone is something like "Progress hurts us. It is better to avoid modernity in its entirity"<p>Of course, the second statement is never fully fleshed out: to do so would show the many problems it has.<p>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.<p>But remember: the average life expectancy of an Afghan is <i>39 years</i>. These supposedly fit and healthy societies had entire generations that never saw the age of 50.<p>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) <a href="http://www.amazon.com/gp/product/0813338638?ie=UTF8&#38;tag=whtofi-20&#38;linkCode=as2&#38;camp=1789&#38;creative=390957&#38;creativeASIN=0813338638" rel="nofollow">http://www.amazon.com/gp/product/0813338638?ie=UTF8&#38;tag=...</a><p>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.<p>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)

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.<p>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 <i>much</i> 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!

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.<p>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.

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.

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)<p>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).<p>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.

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.

What can we make of an opening like this?<p>"Everywhere Western ideas touch down, people get fatter. Urbanization is literally making us sick."<p>What about China? It has had some large cities for several thousand years now. Did people in China get fat 3,000 years ago?<p>In the USA, since 1945, the trend has been away from the cities and towards. Why not write "suburbanization is making us fatter?"<p>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.<p>The sentence "Urbanization is literally making us sick" is ridiculous.

Quite interesting.<p>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.<p>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.

<i>The women, when they want to be particularly biting about their men, complain that “he doesn’t even own a gun anymore.”</i><p>Oooh, that enchants my imagination. I do hope I someday get a chance to live in a world where <i>everyone</i> hunts, no matter how small that world is, even if only for a little while.