Ubiquities and other chronic confounders

When looking at health and chronic disease, there is a never ending confusion. The most powerful yardstick is to find the root cause of a chronic disease. The root cause of most diseases has eluded science thus far, despite intensive research. Therefore we sit in hope, waiting for breakthroughs. Medical science often uses large population studies and powerful statistical methods, however even these methods often fail to produce results. One reason is that they cannot penetrate the smokescreen of common things- we “cannot see the forest for the trees”.

This reminds me of Geoffrey Rose’s classic paper on the limits of epidemiology. Sick Individuals and Sick Populations.  “If everyone smoked 20 cigarettes a day, then clinical, case-control and cohort studies alike would lead us to conclude that lung cancer was a genetic disease; and in one sense that would be true, since if everyone is exposed to the necessary agent, then the distribution of cases is wholly determined by individual susceptibility.”. The moral being that UBIQUITIES cannot be detected by clinical, case-control or cohort studies. This is very noticeable in hypertension research due to the effect of salt- in industrialised countries it is universal/ ubiquitous for people to consume excessive amounts of salt.

In our case of Paleolithic diet- we must realise that Neolithic diet is ubiquitous. Therefore researchers will NEVER identify that it is causative of most diseases, unless they compare to a Paleo eating cohort. Because almost everyone eats a Neolithic diet, this will continually confound researchers.

Just as Dr Rose said regarding a population where everyone smoked, medical research often indicates that certain diseases are genetic when in fact they are are related to the ubiquitous Neolithic diet. For example, suppose that a particular gene gives you absolutely no risk of disease if your folic acid intake is the Paleo intake of the last 2 million years, but puts you at increased risk of disease if you have a lower intake of folic acid, such as commonly found in many Neolithic diets. Some people would say that you have a genetic disease, but it is obvious that it is also a nutritional disease, as with the right intake of folic acid you  are well. This is a gene-nutrient interaction. In this case the gene is not defective, it really is not a genetic disease per se, it is a case where the gene is a risk factor for the illness, the defect is that it is a susceptibility gene. Unfortunately it is probably a similar situation with many alleged discoveries of genes that “cause this” or “cause that”. If a gene puts you at risk of disease if you eat junk food is that a disease or just karma?

The example of folic acid given above in fact refers to one of the most common “mutations” the C677T mutation of the gene which codes the MTHFR enzyme. The MTHFR enzyme is important in the metabolism of the vitamin folic acid. 20% of the population have 2 copies of the “mutation”, and around 1/2 of the population carry one copy (Hardy-Weinberg equilibrium). It is well researched that in populations with a high intake of folic acid, people with this “mutation” are perfectly healthy, but of they live in areas with low folic acid intake, they are at increased risk of diseases such as DVT, pulmonary embolism, stroke, heart attack, spina bifida, and other diseases which can relate to folic acid metabolism. If you carry a mutation of MTHFR, you are one of 50% of the population, or 2 copies, then you are one of 20% of the population.

There are a number of other ubiquities and we should also add to the list chronic infections, some of which are almost ubiquitous.
Lead poisoning- until the massive EPA lead campaign began in 1990, 88% of American children had lead exposure sufficient to be called lead poisoning (and most of the other 12% with levels which have also been proven to have harmful effects). Lead has profound effects on many tissues of the body, via various mechanisms, particularly involving its similarity to calcium and magnesium, such as the important enzyme protein kinase C, and vitamin D. Lead is a known risk factor for hypertension cancer and heart attack.

Trace mineral deficiency, such as iodine deficiency
Glutamate exposure
Salt intake
Dietary acid load
Another important group is lifelong or prolonged infection, many of which are very common:

EBV CMV Toxo Herpesvirus family HS HVZ Chlamydia Mycobacterium-tb-avium.
Helicobacter infection
SIBO (small intestinal bacterial overgrowth)

EBV (Epstein-Barr Virus infection, commonly known as infectious mononucleosis or glandular fever) affects around 90% of people by age 30 in urbant populations, and it invades T-cell lymphocytes and remains in them forever, permanently affecting your immune system. Retinol (the animal form of vitamin A, found in cod liver oil, or any other liver or kidneys) knocks out EBV but not many people eat liver or kidneys etc.

CMV (Cytomegalovirus) is a close relative of EBV and is also knocked out by retinol.
Chlamydia is interesting. Around 8% of birds are infected, and have it for life. The more I test for it (pneumonia cases) the more I find.

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