“[H]ealth policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status…. For example, [one study] found large and significant lifespan effects: a three year loss for smoking, a six year gain for rural living, a ten year loss for being underweight, and about fifteen year losses each for low income and low physical activity (in addition to the usual effects of age and gender).”
—George Mason University economist Robin Hanson1
“The only field more self-confidently but just as regularly wrong as economics is nutrition, whose recommendations to shun butter/margarine or red meat/carbohydrates regularly reverse themselves.”
—Physicist and Goldman Sachs “quant” Emanuel Derman2
Although we are presenting views in this book that some might describe as “radical,” our mission is educational. We don’t want you to go “do something” except to take steps to promote your own health and that of your family. If you are concerned about the direction of the country, as you should be, then the single best thing you can do for its future is to make sure your household is healthy.
For the vast majority of Americans, staying healthy is far more important than timing the stock market or inflation-proofing your portfolio. Your most productive asset is your body: especially in a sluggish economy, a debilitating sickness is not only expensive directly, but also in terms of lost wages and career advancement. Of course, there are many problems the country faces besides its crippled health care delivery, but if you or your loved ones fall ill, that’s going to dwarf everything else. As we’re constantly reminded in the safety review before a flight, in the event of an emergency, you need to first take care of yourself so that you are able to help others.
In light of the very depressing narrative we gave in the first two parts of this book, we’re happy to report that there is an answer. We can return to a way of eating and living in which we’re genetically, physically, and mentally adapted to thrive. In particular, we’re trumpeting the “primal” lifestyle developed by Mark Sisson, whose work combines modern science with our ancient roots to create a powerfully health-promoting way of living. The tenets of a primal lifestyle—which include centering your diet on the nutrient-rich plants and animals we are evolutionarily adapted to consume, engaging in both low-intensity and high-intensity activity, lifting heavy things, and getting adequate sleep and sunlight—will help safeguard you against preventable illness and modern disease, reducing your chance of needing medical care in the first place.
Ever since the “evolutionary discordance” hypothesis was proposed 25 years ago, randomized controlled trials have begun to confirm the value of hunter-gatherer diets as protective against disease, even as compared to diets routinely recommended by the medical establishment.3 The sheer value of this information for your health cannot be overstated. While nearly all of us will someday require medical care due to forces largely beyond our control—such as infections, car accidents, or unexpected injury—the reality remains that for many Americans, health care is mostly a matter of “chronic disease care.” In modern times, a full 75 percent of the nation’s health care costs stem directly from chronic conditions, with three of the most expensive being heart disease, cancer, and mental disorders.4 To avoid the disease-stricken fate so many will succumb to is to grant yourself freedom from a lifetime of needless pain and expense.
For a full discussion of the primal lifestyle (and guidance for implementing its principles), we refer you to Mark Sisson’s website www.marksdailyapple.com along with his bestselling book, The Primal Blueprint. Although we will be touching upon the most salient parts of primal living as they relate to health care and disease prevention, these resources offer a far more detailed exploration of the primal laws than we can provide in these pages, particularly for readers seeking a clear-cut starting point for their journey to medical independence.
For our purposes here, we will focus on the ways in which health care costs can be substantially reduced—both on an individual and national level—through the adoption of primal diet and lifestyle practices. Furthermore, by protecting yourself and your family from the biggest chronic diseases in the Western world, you can minimize the hours, days, and even years you might otherwise spend entangled in our unwieldy and inefficient medical system. The simple act of eating and living in accordance with your genes can thus save you a resource even more valuable than money: your time.
You may have heard the argument that the “costs” of healthy living—paying more for higher-quality food, purchasing a gym membership or exercise equipment, taking nutritional supplements, investing in a water filter, and so forth—will be offset by having fewer health care expenses later down the road. While true, few discussions put an actual sticker price on these savings. We will use this chapter to examine the most pervasive diet- and lifestyle-related diseases in America, discussing their cost upon the nation and revealing the ways in which primal living may be better “health insurance” than anything you or your employer could ever purchase.
The foundation of getting out and staying out of the belly of the health care beast is rooted in Mark Sisson’s book, The Primal Blueprint (and elaborated on in his follow-up book, The Primal Connection). This approach offers a collection of ten “laws” that you can incorporate in your day-to-day life to optimize the signals you send to your genes, allowing you to live as vibrantly and healthfully as possible. Although we won’t ask you to walk around with a club and loincloth to reenact the lives of your distant ancestors, we encourage you to see the wisdom of viewing our modern health care crisis from an ancestral and evolutionary lens, which clarifies both the problems we face and the solutions we can choose. A summary of the ten Primal Blueprint laws is as follows.
1. Eat Lots of Plants and Animals. Across the globe, our early ancestors ate diverse diets influenced by their particular climate, geographic location, available plants and animals, and cultural traditions. Although there many combinations of foods and macronutrients could fall under the umbrella of primal eating, a diet based on “single ingredient” vegetables, grass-fed meats, seafood, tubers, fruit, full-fat dairy, nuts, and seeds will provide the fuel necessary for optimizing your health.
2. Avoid Poisonous Things. Some of the substances that are truly harmful to the human body are not found under the kitchen sink, but exist directly in our food supply. In modern times, the toxic items worth avoiding are mostly man-made and include things like soda, candy, and other sugar-laden or heavily processed foods. Others are chemically altered fats used for frying. Less obvious are the things that have been marketed to us as healthy but are anything but—including grains, even in their whole form. Exploring www.marksdailyapple.com will provide more background on how grains and other foods touted by “conventional wisdom” can contribute to modern disease.
3. Move Frequently at a Slow Pace. Anthropological evidence suggests that ancient man spent a lot of time at leisure, but this does not mean he was sedentary. Instead, he moved around a lot, but at a very low level of intensity that most of us would not consider exercise or exertion. This backdrop of activity seems to be a prerequisite for the signaling that leads to ideal body composition and the prevention of chronic disease.
4. Lift Heavy Things. Our ancient past featured plenty of lifting, hauling, carrying, and climbing as part of basic day-to-day survival. For men and women alike, the benefits of strength training are no less powerful now than they were back then: brief, intense muscle contractions help trigger beneficial hormones, increase muscle size and strength, improve insulin sensitivity, and protect against a spectrum of modern diseases.
5. Sprint Once in Awhile. Our early ancestors did not have the luxury of hopping in a car to outrun a threat or chase down their prey: sporadic bouts of sprinting were a normal part of life. Incorporating sprints into your routine—while running, bicycling, rowing, swimming, or doing any other form of exercise that allows for rapid acceleration—can boost fat oxidation (the burning of body fat) and provide neurohormonal benefits.
6. Get Adequate Sleep. We evolved in an environment where our sleep/wake cycles were guided by the rise and fall of the sun. We are forever tied to our circadian heritage. Sleep obtained in accordance with this ancient rhythm promotes the release of hormones and neurochemicals critical to repair and rejuvenation; much of the body’s cellular repair occurs during sleep.
7. Play. Both ancient humans and modern hunter-gatherers generally work fewer hours than the average American and spend more time “playing”—a form of social interaction that encourages physical movement, problem solving, interpersonal skills, and bonding. Engaging in play can help counteract the stress of work by triggering the release of feel-good chemicals called endorphins.
8. Get Adequate Sunlight. Sun exposure is a major part of our nutrition, especially our acquisition of vitamin D, which has powerful hormonal and immunological effects. While vitamin D supplementation can be helpful, there is a growing body of evidence showing that a given vitamin D level acquired by sunlight provides benefits that a given level of vitamin D acquired by supplementation cannot. Exposure to sunlight will improve your immune system and decrease your risk for cancer and cardiovascular disease, helping to shield you from the problems we have discussed in the US health care system.
9. Avoid Stupid Mistakes. Just as many early humans “weeded themselves out of the gene pool” by engaging in risky behavior and dying young, modern humans, too, can end up with severe injury or worse by making what we will call “stupid mistakes.” In modern times, these include texting while driving, diving into pools of water of unknown depth, cutting down trees with a chainsaw when you are not a trained professional, getting on your roof to hang Christmas lights, driving while intoxicated, and a long scroll of other activities that could cause needless harm.
10. Use Your Brain. A hallmark of the human species is our large, hungry, and active brain, and just because we’ve arrived at the top of the food chain doesn’t mean we should stop using it. Parallel to Law 2 of “Avoid Poisonous Things,” we should strive to ration the time spent passively absorbing information from social media, advertising, the Internet, television, the news, and other sources of largely superficial content. We should instead be defending our mental space for meaningful thought, focus, and deeper self-awareness.
In 2012, Diabetes Care published a truly alarming report entitled “Economic Costs of Diabetes in the US in 2012.”5 Between 2007 and 2012, the national cost of diabetes skyrocketed from $174 billion to $245 billion, with $176 billion of the more recent figure coming from direct medical expenses such as office visits, antidiabetic agents and supplies, hospital inpatient care, and prescription medications to treat complications of the disease. Over 29 million Americans currently have diabetes, and the harsh reality for upcoming generations is that an estimated one in three people will have developed the condition by the year 2050. If you become diabetic, you can expect to add an average of $7,900 to your annual medical expenses.6
Although these numbers may seem dismal, a primal diet and lifestyle assaults type II diabetes on multiple fronts and can help eliminate what is truly an unnecessary and preventable disease. A major benefit is the avoidance of refined carbohydrates, which include the breads, pastas, cereals, pastries, sodas, and processed sweeteners comprising much of the modern American diet. Our method of processing grains by crushing them into digestible powder creates a rapidly absorbed form of carbohydrate, in turn overwhelming our carbohydrate-storing capacity and causing an overproduction of free fatty acids. This, combined with our modern lifestyle of chronic energy surplus and sedentary living, makes insulin less effective and forces the body to secrete more of it. Insulin spikes and chronically elevated insulin levels are very foreign to our genes, and result in a signal of energy storage that causes us to be very efficient at fat storage and simultaneously unable to use it for energy. Along with its contribution to obesity (a major diabetes risk factor), this process can progress to type II diabetes for those who are genetically susceptible, with a gradual loss of beta cell function in the pancreas contributing to worsening glucose tolerance. By removing these highly digestible carbohydrates and replacing them with primal sources of slow-digesting starches, protein, and natural fats, you will be abolishing one of the key ingredients in the development of this disease.
Another primal tenet—moving frequently at a slow pace—also has a direct effect on diabetes risk. There is mounting evidence that walking improves insulin sensitivity above and beyond what can be achieved with diet. Researchers demonstrated this by comparing diet alone to diet plus daily walking in patients with adult onset (type II) diabetes. They found that metabolic clearance of glucose, a marker of insulin sensitivity, was improved in the group that incorporated walking but not in the group that relied on diet alone.7
The impact of a primal lifestyle upon diabetes has been corroborated by multiple scientific trials. As early as 1984, a study of diabetic Australian Aborigines showed significant improvements in glucose control, fasting blood sugar, and triglycerides after participants moved from a standard Western diet to a traditional hunter-gatherer way of life.8 More recently, trials on type II diabetics have confirmed that paleo-style diets can elicit improvements in glycemic control and cardiovascular risk factors associated with diabetes.9
Imagine the impact upon the health care system and individual well being if the $245 billion currently syphoned into diabetes care was absolved by simply returning to a lifestyle compatible with our genes.
Cardiovascular diseases—including heart disease, stroke, and hypertension (high blood pressure)—represent the leading cause of death in America for both men and women. As of 2010, the CDC reports that cardiovascular diseases contribute to $444 billion of the nation’s annual health care costs, and that treatment for these diseases amounts to almost 17 percent of total health care spending.10 As a greater proportion of the population ages, those numbers will only climb higher and place an increasingly heavy burden upon the public.
On an individual level, the numbers are equally alarming: in 2011, the average cost of a coronary bypass graft—used to treat severe heart disease—was approaching $40,000; pacemaker insertion or replacement was over $35,000; and heart valve procedures were approximately $52,000.11 Add to this the cost of statins, doctors visits, heart scans, blood work, and blood thinning or hypotensive medications and it becomes clear that developing heart disease (and managing it through mainstream medicine) is expensive on many fronts.
As with diabetes, cardiovascular diseases are largely a result of diet and lifestyle factors within our own control. You may be familiar with the conventional wisdom stating that heart disease is a product of high cholesterol, and that lowering your levels to within “officially defined” limits—either by eating a low-fat, high carbohydrate diet or by accepting a lifelong course of statins—is the way to treat it. This outdated model fails to incorporate other significant steps in heart disease etiology, such as inflammation and oxidation, that happen to be vastly improved by the application of primal principles.
Generally, LDL (often called “bad” cholesterol) present in the bloodstream is most harmful when it becomes oxidized, a process in which the lipid layer surrounding the LDL particle reacts with free radicals and undergoes modification. Once oxidized, LDL particles can cause tissue injury, trigger inflammatory processes, turn white blood cells into atherogenic “foam cells,” and cause secretion of sticky adhesion molecules that pull those foam cells into the artery walls. This cascade of effects leads to the formation of arterial plaque and a progressive development of heart disease.
Along with smoking and uncontrolled diabetes, a major contributor to oxidized LDL is a high intake of polyunsaturated fats (PUFAs), especially omega-6 fatty acids. This is due in part to their chemical instability. On a molecular level, the fragile double bonds in PUFAs leave them more prone to free radical attack than saturated or monounsaturated fatty acids, which have more oxidation-resistant structures. When excessive PUFAs are consumed and incorporated into the lipid layers of LDL particles, those particles in turn become vulnerable to oxidation. In contrast to omega-3 PUFAs, which provide enough anti-inflammatory properties to counteract their chemical instability, omega-6 fats are pro-inflammatory and may contribute to cardiovascular diseases through pathways beyond just LDL oxidation.12
Here is where a primal diet can provide effortless and automatic correction of a major instigator of heart disease. By avoiding the two most common sources of omega-6 fats for Americans, refined vegetable oils and grains, a primal diet will dramatically lower omega-6 intake and help protect against LDL oxidation and systemic inflammation. The antioxidants supplied by high quality vegetables, fruits, and grass-fed animal products may likewise reduce free radical damage by keeping your LDL particles antioxidant-replete. To date, studies conducted on paleolithic diets confirm they improve cardiovascular risk factors such as blood pressure and lipid profiles, even in the absence of weight loss.13
Although some people are more genetically susceptible to heart disease than others, such as those with familial hypercholesterolemia, the reduction of cardiovascular antagonists and increase in protective nutrients will go a long way to reduce your risk and keep you out of the medical labyrinth. What’s more, your efforts to ward off cardiovascular disease will help decrease the astronomical costs crippling the nation’s health care system.
In the span of a lifetime, approximately 1 in 2 men and 1 in 3 women will develop cancer. For the year 2015, a projected 1.6 million Americans will be diagnosed with cancer and nearly 590,000 will die from it.14 Along with the physical, emotional, and psychological turmoil resulting from diagnosis and treatment, cancer places a significant economic burden upon the country, costing $88.7 billion annually in direct expenses from the disease.15
Only 5 to 10 percent of cancer cases are considered genetic in origin, with the other 90 to 95 percent owing to technically “preventable” causes such as tobacco, stress, obesity, physical inactivity, and food.16 In fact, as many as 35 percent of all cancer cases may be rooted in diet.17 These astounding figures suggest that our national focus on “race for a cure” fundraising and pharmaceutical treatments may be better spent improving the way we live and eat.
To be clear, we are not promoting a “blame the victim” mentality for those who have been diagnosed with cancer, nor suggesting anyone should feel personally guilty for their condition. You have probably heard anecdotes of health-conscious individuals who “did everything right,” avoided smoking, ate pristine diets, exercised daily, and still developed cancer, while others engaged in risky behaviors throughout life and remained free from the disease. Yet for the sake of our discussion on health care, we should embrace the view that cancer has many modifiable contributors and there is much we can do to reduce our risk.
Several elements of the primal lifestyle can lower your exposure to carcinogens as well as boost your body’s innate defense system. Getting sufficient sleep, sunlight, and exercise all independently contribute to a reduction in cancer risk.18,19,20 As with cardiovascular disease, a balanced omega 3/omega 6 ratio, easily obtained by the primal tenets of avoiding vegetable oils and grains, may help suppress cancer progression. In particular, the unique effects of omega-3 fats—which include inhibiting cell growth, halting the transformation of normal tissue into malignant tumors, and counteracting the inflammatory effects of omega-6—may be protective against breast cancer, colon cancer, and potentially prostate cancer.21
In animal models, many additives used in processed foods have been shown to cause precancerous DNA damage, and the effects in humans may be similar. Even at low doses, food dyes can damage gastrointestinal organs, while certain fungicides, preservatives, and artificial sweeteners appear to do the same—leading some scientists to call for more targeted research on the safety of such additives for human use.22 Although reading endless ingredients labels on packaged foods in attempt to avoid known or likely carcinogens would be laborious, simply adhering to primal dietary principles—eating plants and animals as they more or less appear in nature—eliminates these harmful additives by default.
You may have heard fear mongering about red meat raising cancer risk. However, studies that differentiate based on cooking method and meat type suggest it is mainly processed meat and meat cooked at high temperatures that are involved in this link.23,24 Chemicals called hetero-cyclic amines (HAs) and polycyclic aromatic hydrocarbons (PAHs) are formed by exposing meat to high temperatures or open flames; these chemicals appear to be mutagenic (causing DNA damage) and could plausibly contribute to cancer risk.25 Using gentler cooking methods allows you to reap the benefits of high quality animal products without creating dangerous compounds.
Moreover, many plant foods embraced by the primal philosophy have known anti-cancer properties, most notably alliums (including garlic, leeks, scallions, and onions) and cruciferous vegetables (including broccoli, cauliflower, kale, and cabbage). Alliums are believed to owe their effects to organosulfur compounds that modulate enzyme activities, support free radical scavenging, inhibit cancerous mutation, and suppress tumor growth.26 Likewise, crucifers are rich in glucosinolates, which can block chemical carcinogenesis and reduce susceptibility to environmental carcinogens—particularly after the glucosinolates are converted into isothiocyanates by gut flora.27 These foods could be thought of as “edible health insurance” due to their powerful impact on immunity and cancer prevention.
Although there is no guaranteed way to cancer-proof yourself or your loved ones, the elements of a primal lifestyle should be considered the first line of defense in preventing this physically and financially devastating disease.
By the year 2025, the cost of osteoporosis-related fractures is estimated to surpass $25 billion—growing rapidly from its current $19 billion as the American population ages.28 Yet despite its prevalence and high economic burden, osteoporosis remains shrouded in mythology. Conventional wisdom continues to shout at us to “drink your (skim) milk for stronger bones,” a message created and propagated by a powerful dairy lobby that offers little help for those actually suffering from the disease. Far from sporting a milk moustache, living primally may be the best defense.
Among the many ways in which primal living benefits bone health, one of the biggest involves vitamin K2, a little-known nutrient critical for protecting against osteoporosis. Studies on vitamin K2 suggest it helps stimulate bone formation, suppress bone resorption (the breakdown of bone tissue), and sustain bone mineral density at critical points in the body.29 It also works synergistically with vitamins A and D to ensure calcium is deposited into bone tissue instead of arteries, where it may further contribute to heart disease.30
Vitamin K2 is found abundantly in liver, butter, high-quality cheeses, egg yolks, and a variety of meats. As a result of national dietary guidelines calling for a reduction in saturated fat and cholesterol, many foods highest in vitamin K2 have been categorically eliminated from the American menu, leaving many people with insufficient intake to support optimal bone health. Fortunately, these nutrient-dense animal foods are wholly embraced by the primal lifestyle, which encourages “nose to tail” eating and reintroduces many products that have been stigmatized by mainstream dietary advice.
Here the primal law of “get adequate sunlight” confers more than just a nice tan. The role of vitamin D in supporting bone health is undisputed, and keeping your levels in the optimal range can help prevent bone loss and subsequent breaks.31 Additionally, the primal guideline to “lift heavy things,” which we will discuss in more depth towards the end of this chapter, is imperative for maintaining bone mass, as well as for developing the balance and strength needed to prevent falls that could lead to fracture.32
Although bone density naturally decreases as we get older, osteoporosis need not be an inevitable part of aging. Optimal nutrition and exercise habits, as guided by our ancient roots, can help safeguard against the physical and financial repercussions of thinning bones.
US obesity statistics are nothing short of staggering, with approximately two-thirds of adults considered at least overweight and a full third qualifying as obese.33 These astronomical rates are reflected in America’s health care burden: costs directly related to obesity have surpassed $147 billion annually, encompassing nearly 10 percent of total medical spending.34 That number is anticipated to reach $344 billion in 2018 if the trends set in motion over previous decades continue into the future.35 With obesity sitting at the root of many other chronic conditions, curbing the crisis is imperative.
The primal philosophy offers a novel—or perhaps more accurately, ancient—approach to fighting obesity. Rather than attempting to override the body’s hunger signals through counting calories, relying on packaged “diet” foods, or embarking on unsustainable quick fixes that rapidly shed water weight, the primal lifestyle tackles obesity from the inside out. The focus on modulating insulin production, becoming a “fat burner” rather than a carb burner, and eating nutritionally dense foods ultimately helps to mobilize fat stores and reduce excess body weight. In contrast to the modern American menu filled with rapidly digesting grain products and sugar, primal eating embraces satiating protein, fat, and slow digesting carbohydrates from whole plant foods. The simple advice to “eat lots of plants and animals” results in a cascade of changes that support a return to a healthier body composition.
Of course, primal eating involves not just the content of the diet, also but the pattern with which it is consumed. Our ability to store and mobilize body fat is rooted in the fact that our ancient ancestors ate sporadically, a stark contrast to the frequent eating and snacking habits of today. This intermittent eating pattern was one of necessity. Because of food scarcity related to seasonal and climatic variation, we evolved the capability to store body fat during times of abundance and to tap into these energy stores during times of scarcity. This adaptation has proven harmful in our modern environment of food novelty and abundance, which has eliminated the “famine” part of the feast-famine cycle that helped sculpt our genome. By eating in a pattern more in line with that of our ancestors, we become capable of skipping meals without hunger and tapping into our fat stores to reduce body weight.
The evidence for primal-style eating as a boon for weight loss extends beyond just theory. In 2007, a short-term trial of paleolithic eating led to spontaneous calorie reduction, as well as improved blood pressure, BMI, and waist circumference.36 Likewise, a 2010 trial confirmed that on a per-calorie basis, a paleo-style diet is more satiating than a Mediterranean diet, leading to effortless reductions in energy intake.37
A primal way of moving can also benefit body weight and composition. This includes the simple but important activity of walking. Anyone who takes up a walking program will experience the positive benefit of fat loss and improved insulin sensitivity, and this may occur not only because of the activity burning off calories, but also because it is sending a familiar signal to our ancient genes that are accustomed to a large amount of low intensity activity. When we engage in frequent low intensity movement, there is a signal that favors leanness, because there is now a diminishing marginal utility to fat storage. Gypsies travel light for a reason: having numerous possessions in storage is of little value if you have to drag it along with you every time you pull up stakes. In a similar vein, even in an environment of food scarcity, the advantage of stored energy in the form of body fat may become less valuable if you have to expend energy hauling it around during frequent daily movement. The signal of repeated low intensity activity reinforces behaviors that optimize body composition. It’s not about calories burned versus calories consumed; it’s about correct signaling, and this process is key in the fight against obesity.
In 2006, each obese American averaged $1,429 more in medical spending than normal weight individuals.38 Every effort made to live in accordance with your genes and achieve a healthy weight and body composition will result in less money out of your own pocket as well as that of the nation, not to mention a lifetime of reduced disease risk.
As you may quickly discover, following primal tenets can impact conditions you never expected were related to diet or lifestyle, but that together contribute significantly to your health care needs. These include everything from eczema to migraines, asthma, sleep disorders, slow healing and recovery time, pain, and other issues that range from minor nuisances to true disturbances, and which often result in drug prescriptions and time-consuming doctor visits. Upon adopting the ten primal laws, some people see improvements in conditions such as these and find that many of their “minor” health care needs suddenly dissolve. Eye and reproductive health may improve as a result of the higher retinol content of many primal foods—particularly the liver, egg yolks, and full-fat dairy shunned by conventional wisdom but embraced by an ancestral approach to eating. The primal diet’s lower glycemic load, a result of excluding rapidly digesting carbohydrates, may potentially benefit acne.39 The avoidance of inflammatory foods can improve joint health and a spectrum of other issues.
In addition, some people see improvement in mental health as a result of simple changes in diet and lifestyle. In the context of our discussion of health care, this issue deserves extra attention: over 18 percent of American adults suffer from some form of mental illness, and pharmaceutical treatments contribute significantly to annual health care costs.40 For instance, as of 2011, the CDC reported that 11 percent of Americans above the age of 12 take antidepressant medication, with 254 million prescriptions written annually and national spending nearing $10 billion per year for these drugs alone.41 Although the causes of mental illness are complex and not always physical or nutritional in nature, there is little doubt that diet and lifestyle can play a role in both the progression and treatment of these disorders. For people with celiac disease, symptoms of anxiety tend to decrease with the avoidance of gluten, a natural consequence of grain-free primal eating.42 Exercise interventions have long been used as treatment for depression and anxiety, lending credence to the primal laws of “Move Frequently at a Slow Pace,” “Sprint Sometimes,” and “Lift Heavy Things.”43 The endorphin release triggered by positive social interaction and “play” may also boost mood, as can reduced fructose intake for individuals suffering from fructose malabsorption.44
We realize it is unrealistic to expect an entire nation to take upon the diet and lifestyle changes necessary to reduce America’s health care burden, just as it is unrealistic to expect sudden change in a health care system that has spent decades in a state of decline. We can only hope to convince you that living in accordance with your genes will greatly reduce your likelihood of needing health care, and may save you from the painful and expensive medical fate that has tragically become accepted as the norm.
A WORD ON EXERCISE
Throughout this chapter, we have mentioned exercise as a powerful way to reduce disease risk and ultimately slash preventable health care costs. Although we are directing you to www.marksdailyapple.com for more information on implementing the primal laws, exercise is an area where one of us (Doug McGuff) holds an approach that in some ways diverges from that of Mark Sisson and the primal community in general. Here we will switch off to McGuff’s perspective to discuss his approach to exercise as it relates to fitness and disease.
IN DOUG’S WORDS …
If I could give only one message to every man and woman that would most impact their health, it would be this: Just Lift Weights. My main area of expertise and interest is in high intensity exercise. Mark Sisson became aware of me through my work in this area, and we first met at a high intensity exercise seminar. I co-authored a book, Body by Science, which discusses in great detail the science behind the benefits of high intensity strength training, as well as the particular protocols that are recommended to reap the maximal benefit from this form of exercise. I would refer any who are interested in the deeper aspects of my work to read the book or visit its website at www.bodybyscience.net.
Having shamelessly plugged myself, let me say that I do so also because there are so many benefits to be obtained from this form of exercise, including direct reduction of chronic disease risk and potential protection against some consequences of severe injury or illness. Lifting heavy things aggressively recruits muscle fibers and fatigues them quickly. This recruitment and fatigue produces several downstream benefits, including the rapid use of glycogen, the stored form of glucose. Glycogen is kept in the muscle for on-site emergency use. When needed for high exertion, it is broken down through an enzymatic amplification cascade. One enzyme triggers thousands of secondary enzymes, which in turn trigger thousands of tertiary enzymes, and so forth. This ensures the ready availability of energy for the muscles to use in an emergency.
The result is the ability to quickly use up stored glucose. When this is done, it needs to be replaced. This is accomplished by increasing the number and the sensitivity of insulin receptors on the surface of the muscle cells, which decreases circulating insulin. When circulating insulin (a hormone with many pro-inflammatory effects) is decreased, you will have much less systemic inflammation and reach a state more permissive for fat mobilization, since insulin inhibits hormone sensitive lipase—the enzyme that must be triggered to allow fat mobilization from your fat cells. Other beneficial hormonal cascades, such as HGH and testosterone, are triggered. Increased lean mass raises your basal metabolic rate, protects you from injury, and correlates with organ mass in general.
If for some tragic reason, you wind up in the Intensive Care Unit (ICU) after an illness or injury, your main countdown timer to death is your organ mass at the time you begin. Once this mass is catabolized beyond a certain point, you will die from multi-system organ failure. As your muscles go, so goes every other organ in your body. Increased muscle mass correlates with not only increased organ mass, but also increased bone mass and brain mass.
More organ mass is money in the bank for periods of illness, injury, or prolonged catabolic states. Along with potentially saving your life, this could greatly protect you against the after-effects of illness or injury that would otherwise keep you entangled in the health care system for longer than necessary.
Even more recent evidence shows that skeletal muscle is not just a tissue that produces movement, but rather, is a very active endocrine organ. As we’ve touched upon in this chapter, exercise— especially that of high intensity—offers protection against type II diabetes and cardiovascular disease, along with multiple cancers and dementia. These effects are mediated by hormone-like substances called “myokines” that are released by contracting skeletal muscle. Myokines have a direct anti-inflammatory effect, as well as inhibitory effects on visceral fat (the fat located in your internal abdominal cavity). Other myokines work locally in the muscle to increase fat oxidation and glucose uptake, as well as counteracting TNF-driven insulin resistance.45 As the overarching goal of this book is to help you take control of your health amidst the deteriorating health care system, it should now be clear why I am urging you to Lift Heavy Things.
Some proponents of evolutionary based exercise might balk at the recommendation to use machines, pointing out that Grok would never have used a machine, and that it is not “functional.” To me this is akin to the recommendation to eat grass-fed meats. The benefit comes from the healthy elements in the meat (omega-3s, CLA, etc.), not in how it was acquired. The argument against machines is like saying that grass-fed meats are only beneficial if we acquire it the same way Grok did, by running it down with a spear. If we chased a buffalo into a ditch and killed it with spear and knife, we would greatly increase our risk of injury or death and not increase the healthful aspect of the meat. Much in the same vein, there is no need to heave and jerk unstable objects, or perform Olympic lifts to exhaustion, or WOD yourself into an unstable delirium. The benefit comes from the aggressive recruitment and fatiguing of skeletal muscle, not by re-enacting the primitive way Grok had to go about it.
In summary, I recommend picking five basics exercises. (I like the Leg Press, Pulldown, Chest Press, Compound Row, and Overhead Press.) Lift and lower the weight in a slow-controlled fashion, trying to keep the muscle under constant tension. Keep doing this until deep fatigue sets in. This will be recognizable by a degree of discomfort that forces you to stop, or an inability to keep the weight moving without cheating. Do only one set. A workout should take between 12 and 30 minutes, depending on how quickly you pace things. Once you get started, you will be almost immediately hooked, because results come quickly. More importantly, you will be living with the knowledge that you are contributing to your own form of “health insurance” for the future.46
Apart from some divergence of opinion where weightlifting is concerned, my exercise philosophies align with that of the primal laws. I encourage you to browse www.marksdailyapple.com for a fuller discussion on the topics of sprinting, slow movement like walking, and avoidance of “chronic cardio.”
At this point, we are going to make a temporary switch in the narration. The material in the rest of Part III derives almost exclusively from the medical training and work experience of the ER doctor, Doug McGuff. Consequently, Chapters 10 to 13 will be written in the first-person singular (“I”) to make it easier for McGuff to relate personal observations and anecdotes, as well as to offer educated opinions on medical topics.
Next we will discuss the specific details of how to extract yourself from the health care monstrosity, and how to engage the system for those times when you simply cannot avoid being pulled in. There is much that is great about modern health care. We hope to show you how to get everything good from the health care system as it currently exists, while avoiding as much of the bad as possible. Let’s get started!
“I’m proud you’ve become a Doctor, son. You owe me $200,000 for medical school.”
