Diseases of Affluence | Hacker News Reader

Diseases of Affluence

maisonneuve.org

97 pointskareemm32 comments

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.

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-...

:-)

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. :-)

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...

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.

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.

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. :)

That is an astounding thing to say. I can not think of anyone that I know personally who thinks that death is a good thing. Can I ask what country you are in, and what religion and/or spiritual tradition, or philosophical tradition, are you arguing from?

I'm in the US, was raised as a Christian, and I'm talking about the mainstream view as reflected in the reaction of people whenever the possibility of preventing aging comes up. If you ask, "Do you think death is a good thing?", most people will say, "Of course not!", but when you ask about the possibility of extending life well into the second century, or living for millennia, suddenly objections are all you hear. In fiction, people who live for a very long time are mostly portrayed as being depressed about it -- "I wish I could die" is a common theme in vampire fiction, for example. People seem to want to live another year, but to think that living for another hundred years would be an awful fate.

There's a whole industry of people who try to convince people not to attempt to extend their life another year or another six months, but instead just die "with dignity", as though it's not dignified to live longer.

It's startling to me that you haven't seen at least the edges of this if you've been paying attention to "bioethics" (a too-self-congratulatory name, in my opinion) and similar debates.

I get far worse treatment for such views elsewhere, so I'm not terribly concerned. I was basically posting in the middle of the night, unable to sleep. I felt it was a bad time to try to make such comments. Short version (fwiw): I think a lot of this has to do with body chemistry and (unrecognized) infection rather than calories per se.

I'm probably the stereotypical "woman driver" and was happy to let my husband drive when I was married. I currently live without a car and am happy to not have to deal with the issue of driving. Though, honestly, I have difficulty imagining how this particular navigation technique could contribute to such prejudices concerning women. Still, it was interesting that men were (apparently) literally better equipped for this than women.

That sentence is interesting:

"They are certainly the longest-lived mammals on the planet. Indeed, they may be the longest-lived complex animals of any sort."

I wish I had the money to follow up on that. Of the long-lived vertebrate species (I mean the ones that can live in excess of 200 years) most seem to be at least occasionally exposed to high pressures in the deep sea (off hand, the only exception I can think of is land-based turtles, who also live a long time yet, as far as I know, never face deep sea pressures).

At this point there is a substantial literature suggesting health benefits, to humans, from hyperbaric oxygen therapy. Certainly, HBO seems to be an effective treatment for insulin resistance. This raises the question, is it the pressure, or the oxygen, or both, that creates the health benefit?

I can imagine arguments in both directions. Possibly the pure oxygen creates oxidative stress which then brings forth a response, as Wikipedia writes here (on a page about calorie restriction):

"Although aging can be conceptualized as the accumulation of damage, the more recent determination that free radicals participate in intracellular signaling has made the categorical equation of their effects with "damage" more problematic than was commonly appreciated in years past. It was previously proposed on a hypothetical basis that free radicals may induce an endogenous response culminating in more effective adaptations which protect against exogenous radicals (and possibly other toxic compounds).[49] Recent experimental evidence strongly suggests that this is indeed the case, and that such induction of endogenous free radical production extends life span of a model organism and mitohormetically exerts life extending and health promoting effects. Sublethal mitochondrial stress with an attendant stoichiometric augmentation of reactive oxygen species may precipitate many of the beneficial alterations in cellular physiology produced by caloric restriction."

http://en.wikipedia.org/wiki/Calorie_restriction

But pressure can lead to the increase of a wide range of chemical reactions, and probably increases the activity of various enzymes. This is the angle that I think has not seen much research, and which I wish I had money to dive into myself. For instance, does resveratrol become more efficient when under pressure? Or when in a pure oxygen environment?

Thank you. I read the article in large part because of my medical condition, which typically leads to lung damage and also puts one at high risk for a form of diabetes (as I understand it, neither "type 1" nor "type 2" -- something unique to the condition I have). I have done a lot to get healthier and I now live without a car and do a lot of walking as it is my main mode or transportation. I have read that inflammation may be at the root of diabetes. Inflammation is a major issue with my condition and there is much drug research which indicates you can reduce incidence of infection in people like me by controlling inflammation. I chose to control inflammation by making dietary and lifestyle changes rather than pursuing drugs as a primary defense.

I think the reduced lung function (over time) that my condition leads to, and thus reduced oxygenation is also a major factor in infection, even though I haven't really seen anything which states that per se. So I no longer believe that the primary benefit of exercise is "burning calories". I believe the primary benefit is oxygenation and other chemical changes it causes, which reduces infection and generally improves the body chemistry. I also think I survived my health crisis in part from having lived 3000 feet above sea level at one time, thereby forcibly expanding my lung capacity (I used to have a really narrow rib cage for someone my height and I look more normal since living 3000 feet above sea level).

Anyway, no real point here. Just rambling. But thank you for your thoughts.

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=...

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)

> 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...

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...

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.

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!

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.

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.

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.

http://crossfit.com/

Run, jump, lift heavy things. It's fun as hell and your body will thank you.

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.

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.

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.

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.

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.

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.

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.

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...

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

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.

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.]

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

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