ALI SAFAYAN, M.D. - Lecture at Georgetown University
Dr. Ali Safayan
During my 21 years of medical practice in Washington, D.C., I have watched as our world has slowly become unglued. More than at any other time in our civilization's history, we are destroying our environment at an unprecedented rate, while asking ourselves why we are unable to beat the modern diseases that plague our societies. I was recently asked to give a lecture at the Integrative Medicine program at Georgetown University. The following are some of the thoughts I shared with that student audience.
The human genome project has created the mapping of our DNA into the human blueprint. From there, scientists have been able to identify human migratory patterns using DNA analysis. Migration allowed genes to evolve as our ancestors migrated around the world, taking with them foods not indigenous to their new regions. Through archeology and the study of contemporary hunter-gatherer groups, we have learned that our Paleolithic ancestors' diet was balanced, and that their cholesterol was normal.
With the development of agriculture 10,000 years ago, our diet changed as our nomadic ancestors became more organized and sedentary. Over the last century, farming techniques have evolved to satisfy the economic pressures of growing modern societies. Factory farms push for higher yields in less time, using less money and less manpower. Although economically this may make sense, it comes at the cost of quality in our food when compared to the food that nourished our ancestors.
For example, our diet contains substantially greater quantities of sugar than that of our recent and distant ancestors. This is called the glycemic load. Our Paleolithic ancestors consumed four pounds of sugar per year. In the nineteenth century the average American consumed 11 pounds of sugar per year. In 2000 the average American consumed 150 pounds of sugar per year. Our genes have never before been charged with processing such levels of a potentially toxic substance.
This is, unfortunately, just the beginning of the bad news. Our modern diet contains a lesser quantity of good fat called Omega 3. There has also been a shift in the acid-base balance that leads to chronic acid loads. This, in turn, burdens our kidneys and skeletal system, whose functions include buffering excess acid loads. Our sodium-to-potassium ratio has also been inverted, which can lead to hypertension, among other problems. There has also been a dramatic decline in our fiber intake. It is estimated that our Paleolithic ancestors consumed over 100 grams of fiber a day, compared to an American intake of 10 grams a day.
Finally, there has been a loss in the micronutrient density of our food through using petroleum-based herbicides, pesticides, and fungicides. Modern fertilization techniques provide plants with only the ingredients to grow fast and large. This allows little time for the few nutrients left in the soil to be absorbed into the plant. Our soil has become deficient in micronutrients because of intensive farming, environmental pollution, and erosion.
Our food supply, unfortunately, is not our only periled resource. Our air, water, and soil are being contaminated at an unprecedented rate. Every second, 750 pounds of toxic chemicals are released into our air, land, and water by industrial facilities around the world. This means that approximately 21 billion pounds of toxic chemicals are released into our environment each year. Of these, over 4.5 billion pounds are recognized as being carcinogenic.
To further complicate matters, our human population is not being contained. Between 1900 and 2000, the average size of the world's 100 largest cities grew from 0.2 million to 6.2 million. Rural population has also reached a peak, and urban slums seem to be absorbing much of the population growth, now representing 32% of the global urban population.
Given that humans capture nearly 40% of the biological productivity of the land, and 70% of the productivity of the seas, this rate of population growth may not be sustainable. The "net primary productivity" of the planet is for our exclusive use. Do the math: In 15 years we will have exhausted our marine productivity, and in 30 years the biologic productivity.
As a direct consequence of industrial civilization, we have begun the sixth great biologic mass extinction in the 4.5 billion-year history of our planet. During the previous extinction events, biodiversity was reduced by 70-90%, and recovery took five million years. In the short span of human history, the collapse of the Sumerians – the first civilization – affected a half million people. The fall of the Roman Empire affected tens of millions. If our civilization was to fall, it would bring catastrophe to billions.
Only in the 21st century has the notion of our genes dictating our health been replaced by our environment regulating our health. This is logical when we consider trying to explain so many bad genes creating heart disease, hypertension, diabetes, and cancer. Our genes are not bad. Rather, the environment in which the genes are placed makes them behave abnormally and lead to disease.
What are the consequences of placing our good genes in bad environments? Our nutrient-poor food supply has resulted in 1.7 billion overweight people worldwide. Currently 65% of Americans are overweight. By 2020 50% of Americans will be diabetic or pre-diabetic and 90% will not yet be diagnosed. The health care cost over the next decade will be $3.5 trillion. The increase in obesity, unfortunately, is not only in adults, but also in children. The United States is the most over-fed and under-nourished country in the world. 56% of our calories today come from three sources that did not exist when our genes were developing: refined sugar, bleached flour, and vegetable oils.
How are we dealing with our health problems? The pharmaceutical industry has led us to believe that they work toward "curing" disease, yet we're not any closer to curing heart disease or cancer than we were 20 years ago. The pharmaceutical model of medicine overlooks the reality that most of our modern diseases are consequences of the toxic environment in which our genes find themselves. While we know a great deal more about disease than in the past, there are today very few cures, and it is unlikely that any will come soon. Consequently, the industry introduces the newest "best" drug for heart disease, hypertension, cholesterol, and cancer. In the end, however, we continue to deal with increasing rates of disease and increasing health care costs.
America spends 17% of its GDP on healthcare, but we are ranked 37th in the world in health care delivery. This is not a good return on our investment, yet we continue to spend in the same way, somehow expecting different results. This is Einstein's definition of insanity. To use this money more wisely will require cooperation from all sectors of the healthcare industry, which is unlikely to happen easily because few are willing to risk their piece of the healthcare cash pie. Certainly not the politicians, lawyers, insurance companies, pharmaceutical companies, medical instrument industry, hospital CEOs, and, yes, doctors and nurses.
Where must the change come from? If we are to avoid Einstein's conditions for insanity, we must stop the top-down decisions, which have failed us for the last 30 years. It's time for the generals to step aside and let the soldiers lead. It is time for the American public's complacency to stop. We have relied too long on the government to direct our healthcare system, and can no longer allow politicians to make ineffective decisions based on their personal interest groups, lobbyists, and PAC money.
It is time for Americans to demand a clean environment and food supply. Industry needs to create healthier work environments, schools need to change their cafeteria menus, and parents need to be more responsible for the food choices they make for themselves and their children. The healthcare industry needs to go back to basics rather than to higher tech. Diet, exercise, and stress reduction should not be the statements made in passing at the end of a ten-minute office visit. They should be the starting point in the discussion with each patient. Physicians must become front-line educators and not gate-keepers. We must become role models of better health.
We must move from a model based on disease to a model based on prevention. Physicians should be rewarded for preventing disease rather than only treating it. The insurance industry must eliminate the roadblocks it intentionally places to health, and embrace prevention rather than treatment. We need tort reform, and we need the medical instrument and pharmaceutical industries to reduce their astronomical profit margins.
It may seem an impossible task to make America healthy again. We are at a crossroads, and have a great opportunity to show true compassion for our diseased healthcare system. There are difficult choices to be made. We need charismatic leaders that will put personal interest aside and not buckle under pressure…and lead. We need to streamline our healthcare system so it becomes affordable, portable, and accessible. It is time for America to take control of its health.