Customer Reviews

Evolving Health: The Origins of Illness and How the Modern World Is Making Us Sick

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This works as a general introduction to the nascent field of evolutionary medicine. Note well the word "health" in the title. One of the central ideas in evolutionary medicine is preserving health, and in general looking at medicine from the point of view of the healthy instead of from an overweening concentration on the sick. An ounce of prevention in evolutionary medicine is worth a whole ton of cure.

Another important idea is to look, in so far as possible, to our adaptations as evolutionary beings to see what we might be doing wrong today. For example, grasses with plump seeds of carbohydrates were in short supply before the advent of agriculture about 10,000 years ago. There were wheats and ryes, wild oats and such, but their seeds were relatively small and required a lot of labor to harvest. Consequently, our ancestors on the savannahs and in the woodlands ate grain carbohydrates in small amounts. Now, of course, grains--especially rice, wheat and corn--are the staple foods everywhere in the world and we eat massive amounts of them.

Is this a problem? As Professor Boaz points out, evolutionary medicine suggests that it is. We are "carbohydrate intolerant" (Boaz uses the term "glucotoxicity," page 133) and cannot shut down our appetite for all the carbohydrates so tantalizingly available to us. They are especially enthralling when served up with salt and fats.

In the prehistory there were no supermarkets open 24-hours a day. Instead there were freezing winters and droughts that might last for months or more, sure to visit almost every human eventually. So when there was a bountifulness in the land we chowed down big time. And those of us who had the ability to put on fat could live out the times of famine better than any prehistoric runway model. And so our chubby guy- or chubby gal-genes were favored. Boaz calls this the "thrifty genotype."

However that virtue has become a fault. What to do? Boaz recommends exercise, for one thing. In the pre-history our ancestors managed to walk all the way around the world. They had no cars or easy chairs. That we can solve our fat problem by looking at the way our ancestors lived and emulate them, is the somewhat bitter pill of this book. And, by the way, this "medicine" (hard to take, as we all know) also works against heart attacks, gout and other modern diseases.

Boaz has gone to some considerable trouble to associate various "diseases" with 17 evolutionary levels of human structure and function. (There's a table on pages 19-25.) These levels are like the idea that "ontogeny recapitulates phylogeny" in that some of the levels are similar to those stages in the embryo's development from single cell through bony fish and amphibian to mammal, all the way to us. What Boaz is adding here is the idea that certain diseases are associated with each level of development. For example, emphysema is associated with the amphibian level of adaptation while viral infections go all the way back to when our ancestors were just single cells.

This scheme is useful in helping us to understand disease. It is even helpful in treatment. But Boaz's formulation is no magic pill or cure-all. For the chronic diseases that plague those of us in the developed world there is no easy cure. Boaz recognizes a "discordance" between our evolutionary selves and the modern environment that is leading to these diseases. He uses a concept he calls "adaptive normality" that can guide us away from the discordance.

This is a very readable book requiring no prior expertise. It is obvious that Boaz wanted to reach the educated lay person with his ideas. For those of you new to the idea of evolutionary medicine, this will be an exciting book. Boaz does an excellent job of teaching us is how to think from an evolutionary perspective, which is something we all need to do.

Another interesting book on this subject is Why We Get Sick: The New Science of Darwinian Medicine (1994) by Randolph M. Nesse and George C. Williams which I also recommend.

This is a fascinating book, written in clear, lucid, and descriptive prose, and written for the non-specialist and specialist alike, exploring the impact of evolution on health and disease. The book introduces "evolutionary medicine" to help the reader make informed choices about his or her own health. No one who wants to live a long, healthy life can afford to ignore the important insights gleaned from evolution in this book. What worked when we were hunter-gatherers on the African savannas no longer works in modern society, and the changes in our modern environments have caused Homo sapiens to adapt poorly.

One of the key evolutionary concepts is an entity's adaptation to its environment: When all the body's organs and systems are operating optimally under the ideal evolutionary environments, both internally and externally, our bodies are concordant. When our bodies are out of sync with either environment, they begin to fail, and our bodies become discordant. The former is homeostasis and health, the latter is disease and dysfunction.

After a very short introduction to the essential Darwinian concepts, excellently and easily recapitulated, the author turns to the seventeen stages of human evolutionary development, beginning with prokaryotes as stage one and ending with Homo sapiens as stage seventeen millions of years later, and describing all the intermediary stages in between. Although not difficult, it's the only place where the reader might become pensive, if not impatient, thinking the author is off course. But the key to understanding the rest of the book depends on understanding the material presented in Chapter Two. Here are some of the insights in columnar outline:

LEVEL OF EVOLUTION, ADAPTIVE FAILURE, CONSEQUENCE

Pre-life, Environmental poisons, Birth defects

Single cell, Viral infection, Cold/Flu/HIV

Morula (sponge-like), Cellular stress, Cancer

Chordate, Physical stress, Back pain

Fish, Excess dietary salt, Heart disease

Amphibian, Tobacco smoke, Lung disease

Lower primate, Excess dietary sugar, Diabetes mellitus

Higher primate, Vitamin C deficiency, Scurvy

Ape, Excess dietary protein, Gout

Homo sapiens, Reduced dietary variety, Allergies

This is a partial list. Each of the seventeen stages co-exist in humans; this complexity is both to our advantage, and can be our downfall. Understanding how each stage of evolution works within us unlocks a wealth of information.

Obviously, the emphasis is on prevention, not treatment, although there are constructive, non-medical, non-surgical options discussed. Some of the ideas are extremely valuable and helpful, others are highly speculative and dubious. For example, one particularly difficult concept advocated by Boaz is a return to a Paleo Diet that is high in animal products (especially gamey meats), while avoiding indigestible beans, grains, and dairy. It might be the "ideal" diet, but it's an impossible one to follow, and even more difficult to find. Still, the insights can help guide one to nutrition from an evolutionary perspective. The chapter on our musculoskeletal system was by far my favorite; I suffer from many of the system's dysfunctions, and now realize why. I knew it was a failure to adapt, but exactly how was new to me.

Nearly every anatomical and physiological system is evaluated in evolutionary terms. I'd run out of space just outlining them. Suffice it to say, this is not the only book on evolutionary medicine. This new field is literally exploding. Certainly an excellent alternative is Randolph Nesse's and George Williams' "Why We Get Sick: The New Science of Darwinian Medicine." Both are equally competent and informative, the only difference is a matter of style and approach. Take a look at both books and find the one that suits your temperament best. I truly enjoyed both. Ignore either to your health's detriment.

The field of evolutionary medicine is starting to take off - and some popular books (for instance: Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease & Why We Get Sick: The New Science of Darwinian Medicine) have highlighted the field for the layman. The field has a long way to go, and many theories are hard to test. However, the 'evolutionary approach' holds great promise for our understanding of both disease and aging - and based on other reviews of this book I was reasonably excited picking it up.

What a disappointment! The central 'idea' is that diseases can be traced to one of 17 'levels' of evolution based on the development cycle of an organism. Each chapter is based on telling about the diseases caused by a defect from that 'level'. Although this seems to make some sense at the outset, it does not provide any deeper insight to the origin of diseases that I could find.

Although some insights are given, I think the job of providing a comprehensive view of evolutionary medicine was too large for this author. Many statements are not referenced, and some are flat out wrong - for instance the claim that betacarotene can prevent lung cancer in smokers.

The chapter on smoking and lung cancer/COPD was a good example of disappointment brought by this book. The causal link between tobacco smoking and lung cancer & COPD is already well described by 'ordinary' medicine. The ill effects of smoking and its addictiveness have been proved convincingly, and I could not see what this book added.

What evolutionary insight came forward here? The author seems to think that we evolved to like fire, thus we want to smoke, and then we are hooked by the unintended addictive effect of nicotine. Why does nicotine have pleasant by-effects for instance?

I believe this exciting field is still awaiting a comprehensive and well-referenced treatment.

This is one of the four or five best books I have ever read. It explains our most important health problems in their evolutionary context, and it explains why diet and lifestyle changes are far superior to pills and surgery. Everyone should read this book in their youth, so that they can prevent the health problems that come with a lifetime of bad choices and bad medical care. Buy this book, and buy more copies for all your relatives and friends --- and buy one for your doctor so that she can do a better job for you.

The book describes the quite natural idea of developing an evolutionarily-informed medicine in order to better understand diseases and health, the causes, origins and possible treatment/prevention of diseases. It is an interesting example of "applied biology" in which theoretical

concepts from evolution, biochemistry, molecular biology and philogeny come together

in order to help our understanding the processes of sickness.