The hungry brain in the 21st century: Challenges and opportunities for health

On October 12, I’ll be speaking at the Evolutionary Nutrition conference and Staffan Lindeberg memorial in Lisbon, Portugal.  I was asked to write a one-page abstract of my talk, which I have reproduced below.

The world is undergoing a striking transformation of health and demographics that has been called the “epidemiologic transition”. This term was coined by Abdel R. Omran in 1971, who wrote “During the transition, a long-term shift occurs in mortality and disease patterns whereby pandemics of infection are gradually displaced by degenerative and man-made diseases as the chief form of morbidity and primary cause of death.” It has been forty-six years since Omran wrote these words, yet our ever-expending evidence base continues to support his hypothesis.

Most notably, the Global Burden of Disease project has documented that people in low-income countries continue to die primarily of infectious diseases, accidents, and violence. These are the scourges of our ancestors. In contrast, people in high-income countries have mostly overcome the threat of infectious disease, accidents, and violence, yet we face a new set of scourges: Omran’s “man-made diseases”, more commonly called noncommunicable diseases. These include obesity, diabetes, coronary heart disease, stroke, most heart failure, kidney failure, gout, some cancers, and many more. Although overall mortality is falling as global economic development proceeds, many people in affluent nations live with debilitating noncommunicable diseases that limit their potential for health and well-being. And low-income countries are severely affected by epidemics of noncommunicable disease as they rise to greater affluence.

Studies of traditionally-living cultures suggest that most common noncommunicable diseases, such as obesity and severe coronary heart disease, are evolutionary mismatch disorders, meaning that they result from poor compatibility between our ancient genomes and the modern industrial diet and lifestyle. Yet what is the nature of this mismatch? It is undoubtedly complex, however I will argue that one element of it is as simple as it is influential: Energy excess. Consuming more energy than one expends is well-established to cause obesity, yet evidence also strongly suggests that energy excess is the primary nongenetic cause of type 2 diabetes, and an important contributor to cardiovascular disease, certain cancers, orthopedic problems, and many other common ailments.

To understand why we engage in behaviors that lead us to energy excess, we must first acknowledge that the brain is the source of all behavior, that it evolved in a specific range of contexts, and that the inclinations we have today are a result of that process. Our ancestors evolved in a context in which they had to acquire energy from an environment that does not easily give it up. As a result, they developed learning and motivation systems that attempt to maximize their energy return rate by seeking calorie-dense foods that require the least time and effort to obtain, and avoiding unnecessary physical activity energy expenditure. In affluent countries today, nonconscious brain circuits continue to implement the rules of this obsolete survival game, and they drive most of us to energy excess. They are extremely persuasive due to the key role they played in the reproductive success of our ancestors, explaining why most of us overconsume food despite understanding the serious long-term consequences.

How do we solve the problem of energy excess when it emerges from human nature itself? I propose that instead of fighting the nonconscious brain circuits that drive our food intake, we understand them and provide them with diet and lifestyle cues that align them with our goals of leanness and health. In this way we may avoid exchanging the scourges of our ancestors for the scourges of modernity.

11 Responses to The hungry brain in the 21st century: Challenges and opportunities for health

  1. I finally read your book. Definitely 5 stars! It’s nice to read a book on diet that actually tells you what is the of added weight (or adiposity 🙂 ).

    I think part of what my problem was/is is that corn would make it so my stool was always on the runny side. I thought it was because I was eating so many vegetables and fruit (when I married my wife she was mostly vegan). But now that I stopped eating corn and I feel much better my appetite has gone way down and I’ve been shedding about 1 lb. per week. My legs don’t get cramped when I go running anymore. I’m not 100% certain that this was all because of me giving up corn though. I went to the doctor and found I needed 1/4 grain hypothroid medicine, but I didn’t start losing weight at that point, so I don’t think that was the main reason. I also started taking vitamin D in the winter.

    So, yes, your book covered a lot of good ground. I think it left some stuff out (since it impossible to have everything in there unless you want thousands of pages). Thanks for writing it. It’s nice to be armed with an anti fad diet knowledge now!

    Do you know if there is a book out there that talks about what we should be eating to maintain a healthy life beyond just the need to lose weight? There are so many people always saying eat this or that it is good for you that I get quite confused. I know we need meat to be healthy but then you get people like Dr. McDougal (sp) who live a long healthy life as vegans with high starch. Part of why I wonder is for my kids. I always worry that we eat too much fruit. One of my kids it seems she skips dinner 75% of the time and just eats fruit. Unless of course it is one of those rare meals that has lot’s of cheese in it (maybe once or twice a fortnight).

    Anyways, thanks again for taking the time to write this much needed book!

    • There goes my illogical brain again. I’ve most likely started losing lots of weight because of what was said in the book. My brain connected corn with feeling ill. So, I was finally able to stop eating foods like ice cream (when they have corn syrup in them). Instead of having a large 800 calorie bowl of popcorn with a movie I now normally don’t eat anything or maybe a banana chopped up with a peach. Also, I haven’t gone out as much to social events in the last few months which means I’m eating my wife’s meals which typically consist of bitter greens and other foods that are not as tantalizing. So, I eat less, which makes it so I’m not as hungry. So, pretty much everything in the book. Thanks again for writing The Hungry Brain it’s invaluable!

  2. Our longevity is greatly increased compared to our ancestors. We are confronted with a completely different paradigm.

    A few months ago I looked at the correlation between sugar consumption and longevity for the 10 highest sugar consuming nations. There is a slight correlation between the two, but not a very strong one. The nations that consume the most sugar are among the highest longevity nations in the world.

    Sugar is certainly not a health food. But it is not the devil either. Macronutrient optimization yields longevity benefits but there are other factors of higher importance.

    • Been thinking so too, and even more after reading about the very positive results with Kempner´s rice diet, which was basically 250-350 gram white rice (dry weight), 700-1000 gram fruits/fruit juice and 100-500 gram sugar/dextrose per day, plus some vitamins. See: http://www.actiononsalt.org.uk/Docs/32276.pdf. It was low in protein, phosphorus, calcium, salt and fat, but high in potassium, i.e. 3-5 grams/day. Remarkable improvements in blood pressure has also been seen on water only fasts (https://www.ncbi.nlm.nih.gov/pubmed/12470446, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684131/
      ), and so a 2 week water fast may give better results than following a DASH diet for 2 years. During a water fast the body is running on mostly fat, so it is in practice a very «refined» diet.

    • I just watched the film Yamato. Best line, from the mess officer to a young cadet,

      “Ever learn to cook rice?”

      as all around them huge buckets of steamed rice were being loaded into tins.

  3. Stephan as always, what you write is very impressive. But as always, you are missing the most important point. I don’t think you have ever discussed oxidative stress, and if I might make a suggestion, it would be to do some homework on it and write an article or even a book about it. Nothing is more urgently needed right now and there is nobody on earth who could do a better job than you.

    • Jane as always, your comment is very insightful. But as always, you are missing the most important point. If I might make a suggestion, rather than trying to convince people of things in blog comments and emails, it would be a good exercise for you to do some homework and write down some of your thoughts about nutrition and biology in a clear and coherent manner with references, and put them somewhere that they are accessible via the internet. It could be a few paragraphs, a whole article, or maybe even a collection of articles. Nothing is more urgently needed right now, and you are the only person who has read all of the relevant literature in detail, but is still able to see how all the different pieces fit together to make up the big picture.

  4. Bill Gates recently suggested that some devastating pandemic could hit humanity in the next 10 years and kill off 30 million people in less than a year.

    I am wondering if a somewhat higher BMI, like 25-27, rather than 21-23 could be advantageous in this case. While it has been suggested that both being obese and underweight increases risk of infections, being slightly overweight may actually be beneficial. We also know that while calorie restricted rodents may generally live longer, they live shorter if exposed to influenza virus.

    In 1900 in the US, the rate of death from infections may have been as high as from cancer and heart disease combined today. Maybe we have gotten too complacent, having too much faith in modern science and medicine, forgotten that 50-100 million people died as the result of the Spanish flu after WW1, about 10-20% of those infected. Did anyone predict this could have happened five or ten years earlier? – People may have been aware of the 1890 flu pandemic that killed a million people, and some of the cholera epidemics that also killed a million people, however. But it wasn´t much in comparison. Most of the Spanish flu deaths occured in people aged 20-40. Low body weight and lack of calories played a role in this. It surely wasn´t caused by obesity and a lack of «exercise». It was also attributed to an excess of aspirin supplements.

  5. I just turned up an interesting 2011 study on appetite and hunger after rapid weight loss dieting (550 kcal a day for 8 weeks).

    http://www.nejm.org/doi/full/10.1056/NEJMoa1105816#t=article

    The study patients were followed for a year after their diet ended. Figure 3 shows hunger and desire to eat. A year later, hunger returned to preprandial level in about half the time (compared to pre diet), from 4 hours to 2 hours.

    I noticed the same thing after rapid weight loss. I have maintained most of the weight loss (40 of 50 lbs), with much of the regain in muscle mass and not in waistline. The early onset hunger effect persists 10 years after the diet ended.