Transcript Diapositiva 1

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Step 2 - (CONTINUED)
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For Urolithiasis:
“Renal stone is rare among persons living in poor or primitive
socio-economic circumstances and is very rare in African Bantu
living under tribal conditions (Modlin, 1969)” [1]
“To summarize, from being virtually unknown in historical
times, renal stone has become significant as a common morbid
condition in the affluent, westernized countries within the last 80
years whilst remaining rare in communities where the people live
in primitive and poor conditions.” [1]
Epidemiological data strongly contrast the possible hypothesis
that the high frequencies of malocclusions and urolithiasis
suffered by modern populations are caused by a recent (in
evolutionary terms) relaxation of natural selection pressures.
On the contrary, they indicate that these diseases are largely due
to alterations of the ecological niche to which our species is
adapted, that is presumable phenomena of mismatch.
[1] Trowell HC, Burkitt DP (eds) (1981). Western diseases, their
emergence and prevention. Edward Arnold, USA.
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… It is essential to compare the ancestral diet with that of
contemporary Western populations [1].
In the table, the factors in the modern diet that increase urolithiasis
risk are highlighted in pink, while those having the opposite effect
are highlighted in green. It is not shown in the table the reduced
intake of calcium in modern diets that is strongly correlated with
urolithiasis frequency.
Total energy intake
Caloric density
Dietary bulk
Total carbohydrate intake
Added sugars/refined carbohydrates
Glycemic load
Fruits and vegetables
Antioxidant capacity
Fiber
Soluble:insoluble
Protein intake*
Total fat intake
Serum cholesterol-raising fat
Total polyunsaturated fat
ω-6:ω-3
Long-chain essential fatty acids
Cholesterol intake
Micronutrient intake
Sodium:potassium
Acid base impact
Milk products
Cereal grains
Free water intake
Ancestral (Hunter-Gatherer)
More
Very low
More
Less
Very little
Relatively low
Twice as much
Higher
More
Roughly 1:1
Contemporary Western
Less
High
Less
More
Much more
High
Half as much
Lower
Less
<1 insoluble
More
Less
Roughly equal
Less
More
Roughly equal
More
Equal or more
More
<1
Alkaline or acidic
Mother’s milk only
Minimal
More
More
Less
Far more ω-6
Less
Equal or less
Less
>1
Acidic
High, lifelong
Substantial
Less
* But, meat from game is lean (wild condition), while meat from breeding is fat (modern
conditions). By considering this, perhaps proteins were not a risk factor in the wild.
[1] Konner M, Eaton SB (2010) Paleolithic Nutrition: Twenty-Five Years Later.
Nutr. Clin. Pract. 25, 594-602.
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It is clear that Paleolithic diet and lifestyle are optimal to
prevent malocclusions and urolithiasis, but it is also true that
the return to ancestral conditions of life is not feasible.
More realistically, it is certainly useful to correct as much as
possible those changes in diet and lifestyle that to a greater
extent show to increase disease frequencies.
Available data suggest the following indications:
- to increase the intake of dietary calcium, potassium and
vitamin D to the levels estimated for the Paleolithic ;
- to increase the exposure to sunlight, so as to increase the
production of vitamin D;
- to increase the intake of foods and elements that reduce
oxalate absorption and calcium absorption (and therefore
urinary calcium: K, PO4, fiber, Alkali Load alias fruits and
vegetables);
- to increase the intake of plain water;
- to reduce the intake of the foods and elements that increase
oxalate absorption and calcium absorption (and therefore
urinary calcium: supplemental Ca, Na, Mg, Carbohydrates,
Acid Load alias animal flesh).
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Price, in his fundamental work [1], not surprisingly called Nutrition and
Physical Degeneration, attributes the high frequency of malocclusions
(and of other dental diseases) to changes in diet and lifestyle compared
with the habits of primitive societies.
A critical factor emphasized by Price is the amount of dietary vitamin D
and of sun exposure for the formation of additional vitamin D. According
to Price, an insufficient intake and absorption of dietary calcium in the
early years of life determines, among other things, insufficient
development of facial bones and an improper development of the set of
teeth.
Konner and Eaton [2] reported that prior to 1990 the recommended
daily intake of vitamin D was 400 IU and that of calcium 800 mg. In
2010, this advice had become 1000 IU of vitamin D and 1000 mg of
calcium. But the estimate for the ancestral population was over 4000 IU
of vitamin D (also by sunlight) and 1500 mg of calcium. It is clear that
with regard to ancestral conditions there is a strongly reduced intake of
dietary calcium and a considerable deficiency of vitamin D, a poorly
understood problem even in scientific circles. …
[1] Price WA (1939) Nutrition and Physical Degeneration. New York – London,
Paul B. Hoeber.
[2] Konner M, Eaton SB (2010) Paleolithic Nutrition: Twenty-Five Years Later.
Nutr. Clin. Pract. 25, 594-602.
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Any change of the ecological niche to which a species is adapted must be
considered potentially harmful until the contrary is proved.
In the case of a new drug, this principle is observed!
[Precautionary principle]
But for other modifications
of the ecological niche, no
precaution is taken.
It is presumed – irrationally
and stupidly, because of
non-scientific evaluations –
that a modification must not
be considered harmful until
the experience proves the
contrary!
[Imprudence Principle]
The correct scientific logic would be to take steps against a
change in the ecological niche on the sole grounds of the
suspicion that this change is bad and BEFORE the sure
demonstration in irreproachable scientific terms.
Afterwards, the results in populations (or fractions of populations), which
pursue - to a greater or lesser extent - the restoration of more physiological
(alias natural) conditions must be compared both to confirm the expected
results and for evaluating other possible measures.
But one should not expect the results of test samples before applying the
aforesaid preventive actions on a large scale.
Step 4 - Study of the mechanisms linking the alteration
of the ecological niche to the pathogenesis of the disease
For malocclusions
The proper development of facial bones and set of teeth is
optimal when the values ​of dietary calcium and of vitamin D
absorption and production are those to which our species is
adapted.
Modernized alimentation has severely altered these factors, and
perhaps others that are more or less important to a correct
development.
The details of these alterations and the mechanisms by which
the correct development is compromised require further
information and explanations, but the correlation between
alterations in diet and lifestyle and the correct development of
facial bones and set of teeth are clear and well documented for a
long time past [1].
[1] Price WA (1939) Nutrition and Physical Degeneration. New York –
London, Paul B. Hoeber.
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Step 5 - Possible restoration of
the normal, alias primeval,
conditions or possible
compensatory conditions
Step 3 - Hypotheses on the possible changes
in the ecological niche underlying the disease
and on possible pathogenetical mechanisms
Step 6 - Analysis of the results achieved and ideation
and proposal of further improvements
Afterwards, it will be indispensable to evaluate the results
obtained with different types of diet more or less suited to these
principles.
Useful indications will be obtained from these results, which
obviously in their application will be influenced by economic
factors, dietary customs, and individual choices.
At the same time, it is essential to continue the deepening of the
study of ancestral conditions of life to which our body is better
adapted.
If these guidelines were not followed, the populations will
gradually adapt to the new conditions of life with known
evolutionary mechanisms, but it is good to point out that this
choice is ethically unacceptable as it would result in countless
cases of illness and death before, over many generations, a good
adaptation will be reached.
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Second Objection
Malocclusions and urolithiasis should be attributed to the
combination of environmental and genetic factors.
This is a misleading way of describing the case.
Certainly, when an individual is exposed to an ecological niche to which
its genes are not adapted, in the diseases that are caused by the altered
ecological niche, his genes, which are more or less resistant to the onset of
diseases, come into play.
But, we cannot and should not consider the genes that are less resistant
to the diseases as pathological: they are entirely normal genes that in new
conditions, to which the species is not adapted, have responses that are
more or less effective against the onset of pathological changes.
For example, our species is certainly not adapted to smoking.
If, in smokers, some suffer respiratory failure, others chronic bronchitis
and others cancer, it is not correct to say that those who develop these
diseases have bad genes that somehow must be corrected, or for which it
is necessary to develop opportune treatments.
The logic says that we must avoid the alteration of the ecological niche
and thus prevent the development of diseases that result from it.
It should be noted that in some cases malocclusions or urolithiasis are
actually due to genetic alterations. In these cases any preventive measure
is not able to prevent the diseases. But, if we refer to data from the study
of populations living under primitive conditions, the incidence of such
cases is rare. Therefore, the attribution of responsibility to genetic
factors should not be an excuse to diminish or avoid to address the most
attention and efforts on prevention.
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… But if malocclusions are largely caused by reduced intake of
dietary calcium and by reduced intake and production of vitamin D,
these factors could seem to cause a reduced frequency of
urolithiasis, a thing that is clearly contradicted by data from
modernized population.
However, it has been shown that urolithiasis frequency is inversely
related to dietary calcium intake [1-3], even though supplemental
calcium may increase the risk [2].
Dietary calcium reduces oxalate absorption and the urinary excretion of
oxalate and this lowers the risk of kidney stones of calcium oxalate, the
prevalent type of stones [1]. This “may be due to increased binding of
oxalate by calcium in the gastrointestinal tract” [1].
Other factors correlated with a lower frequency of urolithiasis are
potassium intake [1] and fluid intake [1].
The intake of fiber and plant foods reduces urinary calcium excretion
and thus the frequency of the stones, while carbohydrate intake has the
opposite effect [3]. A higher protein intake is associated with a moderate
increase of urolithiasis risk [1]. …
[1] Curhan GC et al. (1993) A Prospective Study of Dietary Calcium and Other
Nutrients and the Risk of Symptomatic Kidney Stones. New Engl. J. Medic. 328,
833-8.
[2] Curhan GC et al. (1997) Comparison of dietary calcium with supplemental
calcium and other nutrients as factors affecting the risk for kidney stones in
women. Ann. Intern. Med. 126, 497-504.
[3] Heller, HJ (1999) The role of calcium in the prevention of kidney stones. J.
Am. Coll. Nutr. 18, 373S-378S.
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…
For urolithiasis
There is hypercalciuria in 95% of patients with nephrolithiasis
[1].
The mechanism by which hypercalciuria causes an increased
risk of renal stones is known [2].
There are foods that reduce calcium absorption, and therefore
the urinary calcium - K, PO4, fiber, Alkali Load alias fruits and
vegetables - and others that have the opposite effect –
supplemental Ca, Na, Mg, Carbohydrates, Acid Load alias
animal flesh - and the mechanisms that cause these effects are
quite known [2].
But an increase in dietary calcium reduces oxalate absorption
and oxalate excretion in the urine and thus reduces the
frequency with which they form calcium oxalate stones, the
most common type of calculations [3].
[1] Levy FL et al. (1995) Ambulatory evaluation of nephrolithiasis: an
update of a 1980 protocol. Am. J. Med. 98, 50-9.
[2] Heller, HJ (1999) The role of calcium in the prevention of kidney
stones. J. Am. Coll. Nutr. 18, 373S-378S.
[3] Curhan GC et al. (1993) A Prospective Study of Dietary Calcium
and Other Nutrients and the Risk of Symptomatic Kidney Stones.
New Engl. J. Medic. 328, 833-8.
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First Objection
Before applying these measures of prevention on a large
scale, observation of controlled groups in order to confirm
their validity is necessary.
But this objection would be generated by a contradiction of current
Medicine.
In fact, when a new drug is proposed, we rightly expect a series of
experiments, in several stages, before its use is authorized. Meanwhile,
the NON-use of the drug is considered to be due and NOT subject to
preventive experimentation.
On the contrary, in the case of a new habit of life, alias a change of the
ecological niche, the new habit is introduced and accepted WITHOUT
any trial that demonstrates its safety. Now, If a new NOT tested habit
of life is suspected of causing illness, the indication to stop this habit of
life is rightful and proper.
Why, before its suspension, should we demonstrate its harmfulness
and the benefits resulting from its suspension?
Such an absurd principle has been used for decades to extend the use
of smoke without that smokers were at least warned of the deadly
risks they were running. Again, a new habit (smoking) was introduced
without any evidence that proved its safety and for decades it was
claimed that its harm should be proved before taking action against it.
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Conclusion
Malocclusions and urolithiasis involve significant costs and causes
sufferings, reduced quality of life and even death.
Current Medicine is directed to pursue means of correction that are
increasingly sophisticated and refined.
But the best goal would certainly be to minimize new cases of
malocclusions and urolithiasis, reserving the cures to exceptional
cases.
This would limit the degradation of quality of life, a lot of suffering,
and - last but something to be reckoned with - rising costs.
This is possible with the correct application of trivial principles of
Evolutionary Medicine.
Modern doctors, largely unaware even of the most basic principles of
Evolutionism, do not know these possibilities.
At the same time, evolutionary biologists are unaware of the extreme
importance of these possibilities for a rational organization of a health
system that should primarily prevent diseases.
It is therefore essential the integration of the knowledge of
Evolutionism in the active body of current Medicine, transforming it
in Evolutionary Medicine.
This poster is on my personal pages too: www.r-site.org/ageing
(e-mail: [email protected])