Sunday, November 9, 2014

The Narrative

The Narrative

People make decisions based on costs and benefits.  Given the detrimental effects that poor health has on quality of life, why is it that poor health is so common in western societies?  We are often told that by changing our diet and/or lifestyle we can reduce our risk of disease, and yet despite this many people continue to knowingly make poor diet and lifestyle decisions.  It’s not like we are oblivious to the prevalence and impact of poor health in the community as awareness campaigns by health bodies and the ubiquity of poor health in our social circles tell us that poor health is both common and has an adverse effect on quality of life.  However, this is also a negative, since poor health is so widespread it has become normalised.  We are then exposed to with a far more powerful message, one of hopelessness:

·         ‘That’s the sort of thing that happens when you get older’
·         ‘It’s genetic/runs in the family’
·         ‘No one knows why/these things just happen/just because’
·         ‘Diets (or other lifestyle interventions) are unsustainable’
·         ‘There is no cure’

The narrative is essentially a self-fulfilling prophecy: the narrative promotes hopelessness, hopelessness leads to inaction and inaction on a large scale leads to the ubiquity of poor health the current population faces, that then gives rise to the narrative

Challenging the Narrative

These statements avoid blaming the other person for their poor health (which is often unproductive), but simultaneously reinforce that the other person is powerless.  Also, these statements are often false and intellectually lazy

‘That’s the sort of thing that happens when you get older’

Weight gain, the development of chronic disease and loss of independence is almost seen as an inevitable part of the aging process, but it doesn’t have to be:

·         Hunter-gatherers, who had an average life expectancy of 65-70 at 45 [1], are almost completely free of chronic degenerative diseases [2]
·         Similarly, the traditional cultures studied by Western A Price were almost completely free of chronic degenerative diseases [3]
·         Those living in the mid-Victorian era had a life expectancy at 5 that is similar to ours today and had 90% less incidence of degenerative disease [4] (and the remaining 10% could probably be explained by smoking/poor diet)
·         The incidence of coronary heart disease was very low in the early 20th century, that is not due to shorter life expectancy [5]

‘It’s genetic/runs in the family’

The points above also provide evidence against most poor health being solely due to genetics (some diseases are genetically determined, but most are not).  Chris Masterjohn made a point that one of the strengths of Weston A. Price’s work is that he found among populations free of chronic disease, the most vulnerable and the least vulnerable members are protected from chronic disease.  A saying goes ‘genes load the gun, but the environment pulls the trigger’

‘No one knows why/these things just happen/just because’

This type of statement may be made by the type of academic who waits for all the evidence to come in or by a doctor/layperson who is unaware of current research.  Ideally we would know everything about a particular disease and have multiple RCTs testing the efficacy of various therapies.  But this is the real world, where poor health/chronic disease is prevalent, current therapies aren’t good enough.  We have some understanding about the causes of chronic disease and their underlying pathologies and should use that to develop some logical, low risk, non-dogmatic approaches to preventing and treating/reversing chronic disease.

‘Diets (or other lifestyle interventions) are unsustainable’

In my opinion much of the problem here comes from the popular diet and fitness community where bland, low calorie diets (or highly restrictive diets) and/or grueling, high volumes of exercise are presented the only path to weight loss and subsequently improvements in health, which is often unsustainable.  People try it, but give up because it’s too difficult, then feel powerless to take back control of their health.  The traditional CICO approach to weight loss (simply ‘eat less, exercise more’) is harmful not because it’s wrong, but because it’s so difficult to sustain [6].  It forces people who are only aware of that method of weight loss to make a choice (to some degree) between being overweight and otherwise feeling good or having a normal weight and feeling hungry and tried.
An alternative is to devise a delicious and nutritious diet that improves food quality with the goal to normalise the body fat setpoint.  Recommendations for both diet and lifestyle could also be framed differently: as improving quality of life/making you feel better, rather than something fairly intangible like 20% reduced risk of disease

‘There is no cure’

This implies to some extent that you can’t do anything about it.  The way medicine is currently practiced is about ‘disease management’ and treating the symptoms even when potential cures exist (for example diet and type 2 diabetes).  Similar to the third point this may also be said when someone is unaware of potential cures

An Alternative to the Narrative

The narrative seems to be reinforced by:

·         The ubiquity of chronic, degenerative diseases that few people successfully reverse
·         People saying either 1, 2 or 3 to be sympathetic and avoid blaming the other person
·         Ineffective and/or unsustainable diet and lifestyle interventions that are promoted as ‘cure alls’
·         Doctors and researchers protecting others from the false hope of the latest lemon juice fast

Therefore to shift the narrative we need to:

·         Be sympathetic to those with health problems and avoid blaming the other person without making them feel hopeless
·         Don’t fanatically promote something as cure all with insufficient evidence, poor reasoning and without discussing the limitations, but also don’t be too sceptical about new approaches with some evidence and logical arguments supporting them.  There is a middle ground where the pros and cons of a variety of proposed therapeutic approaches can be discussed in a balanced manner

An empowering thing to consider is that there is an explanation for everything*.  Sometimes the explanation is simple, other times it is very complex, but there is often some level of understanding in even the more complex problems.  If you have a health issue a good place to start is identifying and fixing your weakest link(s), which is/are likely to be an underlying cause.

I think the Paleo community is great for shifting the narrative as many people have great success with Paleo (weight loss, improved metabolic health, autoimmune disease remission, etc) and some the core messages include the very low prevalence of chronic disease in hunter-gatherers and traditional cultures and that ‘humans are not broken by default’.  This is part of what got me interested in health as I’ve always had a pretty optimistic view of the human body (I’m not generally an optimist), and I didn’t identify with the negativity and pessimism in the mainstream health community.

* This is doesn’t mean there is a purpose for everything.  Explanation is to how as purpose is to why.  Science aims to answer the ‘how’ questions, but not the ‘why’ questions.

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