These biologists faced a challenge, and prairie restoration, then and now popular in the American Midwest, was a good example. They encountered a plowed, fertilized, sprayed farm field and wondered how to restore the complex array of plants, animals, and microbes that once made it succeed so magically as prairie, with literally hundreds of species of plants working in concert.
They often would start out by simply cataloging the species of plants that they knew should be there; then they would get seeds and start planting the desired species, often discovering that target species would not grow. A prairie is a complex ecosystem and cannot be so straightforwardly engineered. What they got after planting, it turned out, was highly dependent on initial conditions and the unimaginably complex interplay of all the species in question. Often they found, for instance, that they needed fire, roaring, scorching fire, and often they found that they didn’t need seeds. Once conditions were right, dormant seeds, some dormant for centuries in the soil, sprouted and flourished.
We face something like this in understanding how we restore our personal ecosystems, and, in fact, all the leading health-food stores are perfectly happy to offer you “probiotic” supplements, designed to replace this bacterium or that. There is no evidence that these work, that the species being sold is absent in you, or that this species will flourish, given existing conditions in your personal ecosystem, your microbiome. This is a more complex matter. Just as with prairie, it is not a simple matter of having the right seeds.
And yet we can’t help but think that appreciating the complexity of the task at hand is itself enlightening, not just in matters of bacteria and autoimmune diseases but in everything we have to say about restoration of your body and mind. Above all, you are complex—too complex not to suffer some ill effects from all the tinkering civilization has wrought on your body. This nicely frames the task at hand.
3
Food
Follow the Carbs
These days George Armelagos can be found as often as not in a first-floor office of Emory University’s Anthropology Building, although it does not look exactly like an office—more a wonderful mess. The place is strewn end to end with layers of books, papers, and generations’ worth of academic accretion of near-archaeological proportions. A large, square plastic wall clock advertising Coca-Cola (we are in Atlanta, after all, corporate headquarters of the empire of sugar water)—the sort that one would expect to find hanging on the wall of a burger joint—stands on a desk. It doesn’t work.
Armelagos’s walker is parked to one side and the man himself has eased into a low chair behind the desk. He wears a weathered purple polo shirt two sizes too big, with no attention paid to the buttons. A pile of long black hair with strands headed in most directions rings his bald spot. He’s seventy-eight and has a bit of a struggle getting around, but he carries a teaching load and commands the long view of the topic at hand. Years of thinking about what we ought to eat rests on some of the work he did in the 1970s, back when no one had really thought seriously about these matters, when no one challenged our most deeply seated prejudice about the manifest blessings of civilization. Back then, Armelagos thought civilization was a blessing, too.
Armelagos is an anthropologist but only deflected in that direction after signing on to the University of Michigan’s medical school, a solid path for a Greek kid from Detroit in the 1950s. His academic pathway made him interested in bones, and he has been a bone guy ever since. Once he was in anthropology, med school gave him something of a leg up, in that there was bone work to be done. And, in fact, his colleagues were engaged in intriguing questions about mortuary practices, such as the detailed study of the angle of the head and the curl of the leg in ancient North American burial mounds. He had the notion, though, that bones might also offer some guidance on what were then viewed as less pertinent questions, such as about the health and well-being of the living.
In the late ’70s, Armelagos set his sights on the Dickson Mounds, the leavings of a Native American culture that once lived along the Spoon River in Illinois. The mounds themselves were surviving evidence of a culture of about fifteen hundred years ago, in a period of transition. That is, they recorded a crucial event, the transition to agriculture—the corn and bean agriculture that was the mainstay of pre-Columbian North America, from Mexico northeast along a broad band stretching to the Atlantic coast and north into what is now Ontario. The Dickson Mounds held the bones of these people, but also nearby were remains of the hunters who had lived in the same area, the primitives who preceded the farmers. The working hypothesis of the day was that people around the world, not just in North America, grew in numbers to the point of decimating game supplies, and so suffered famine, famine that sent them to agriculture and its greater productivity. And then they got healthy again, or so Armelagos and everyone else at the time thought. That assumption was also a testable hypothesis, given the bones at Dickson, so Armelagos set out to test it.
He began by looking at infectious diseases and expected those to be a negative effect of civilization. The more closely people live together, the more likely they are to become infected with disease, and even then, science acknowledged this as a cost of civilization.
“We expected to find an increase in infectious disease rates, but we didn’t expect to find an increase in nutritional deficiencies. That was really counterintuitive,” he said.
The evidence, though, was clear. The farmers were less well fed, more deformed, and shorter than the hunters who had preceded them.
To be fair, Dickson was probably an extreme case. Early farmers there probably had only corn, and later adopted the beans that provided some of the nutritional balance in this system of agriculture. Still, there has been a broad repetition of this line of inquiry ever since. Similar sites worldwide tell a story of the transition to agriculture that’s consistent with the overall picture at Dickson. The record does indeed show that there were hunter-gatherers who suffered health problems from nutritional deficiencies, but these are exceptions. The overall record, the broad story, says civilization was a mixed blessing. It came with enormous costs to our health, and at the beginning, most of those costs were directly tied to a decline in nutrition. Agriculture brought malnourishment.
Armelagos started publishing his findings in the late ’70s, leading to a couple of pivotal books, including Paleopathology at the Origins of Agriculture (coedited by Mark Nathan Cohen), long out of print but republished by popular demand in 2013. Colleagues of his at Emory University—Melvin Konner, Marjorie Shostak, and S. Boyd Eaton—cited Armelagos’s work in The Paleolithic Prescription in 1988, which is the genesis of the current paleo diet trend, the line of thought that carries forward to today’s popular diet books by authors like Loren Cordain. Along the way, the idea has become a movement of sorts, complete with schisms, disciples, true believers, and dogma. Today there are even “paleo” sections in supermarkets and a magazine dedicated to the whole business.
And to compound matters, paleo does not stand alone as the sole thread of this idea. A second strain follows the low-carbohydrate banner, beginning with the Atkins diet and extending through prescriptions like the Zone and fat flushing. The unifying idea of these two strains was to shun carbohydrates, especially the refined sort that arrived with agriculture.
Armelagos has watched all of this transpire with some bemused fascination and has commented in one paper: “A number of these studies follow rigorous scientific methods and have been highly influential in shaping what we know about variety, change, benefits, and costs of prehistoric diets. Unfortunately, these scholarly works have been used to create numerous popular publications that claim some degree of scientific validity.”
He cites a reductio ad absurdum of this trend: a volume popular in some circles titled What Would Jesus Eat?
So what would Armelagos eat? He has a couple of ready answers to this, answers he believes properly reflect his original findings but also everything we have learned since. And his prescription
is a lot simpler than you might think, boiling down to two crucial points. We cite them here because we agree. One is obvious, though it is not at all trivial: low carbs. The second is less talked about, but in Armelagos’s thinking and ours, the second is even more important: variety. But understand first that these problems did not end with the demise of the people at the Dickson Mounds.
CASE STUDY
By the strangest of coincidences, our hunting and gathering for this book led us to a story of a young woman in Alpena, Michigan, who had suffered a remarkable string of health problems. And unremarkable in a way, because Mary Beth Stutzman, it turns out, had a lot in common with a lot of us—not just in her problems but in her encounter with our health-care system. So we tracked her down and let her tell her story in her own words. What follows is a transcript of a conversation recorded on May 29, 2013. It has been edited only for length. We wanted you to hear her story in her words, because of its relevance to the topic at hand, but also for the underlying themes that will recur throughout the book.
MARY BETH STUTZMAN
I am thirty-four right now, so going back to when I was about nineteen or twenty is when I first started noticing that I was having some issues. I was always a skinny kid. I never worried about weight. I could eat a whole bag of Hershey’s Kisses and I did not gain an ounce. I grew up on a farm, so we would always eat good and fairly healthy.
I was getting ready to move away from home and go to school at Michigan State [University]. I started having bad stomach pain. It felt like my stomach was cramping. It lasted for weeks. It was really painful, like something inside was being twisted. I went to the doctors, and they said they were not sure what was happening. They said maybe you have an ulcer.
I started to not be able to sleep at night. I developed really bad acne. There were things that were unusual, but looking at them individually, I was a college student. I was very driven and ambitious. I was working while going to school. It is not uncommon that college kids have trouble sleeping, so I didn’t think a whole lot about it.
I started having other problems with my stomach. I couldn’t digest any food. I would start eating and feel bad. This was independent of the other stomach pain. All of a sudden, I would feel so bloated I couldn’t take it anymore, and I would just vomit everything I had eaten the whole day fully undigested.
It was really hard to sleep at night, and some days I would just never fall asleep. I would have to go to work the next day, and it would make me feel like I had the flu for the whole day. After about five days of that, I would have to take a day off from work, go home, rest, and hope that I would fall asleep. It was getting to the point where one night Casey [her husband] and I were watching TV. A documentary came on about insomnia, and I started crying because I was so frustrated with myself [for] not being able to sleep.
I had tried all the home remedies, I had gone to a therapist, and people thought I was just a highly depressed person. I didn’t think so, but that was what people were saying, so I thought, oh, I have to do something, so I tried meditation. I exercised regularly. I was running about three to four miles per day and lifting weights so I wasn’t out of shape. It was really strange. So I went to the sleep clinic and I did the study. They said you don’t have sleep apnea or anything like that. Your brain is hardwired to always be active.
After that, I tried maybe six different sleeping pills and an antidepressant to try to find something that would help me sleep, and nothing worked. This was over the course of another five years. I tried all these different things. I would try one for six months. It wouldn’t work. I had bursitis in both of my hips. I was twenty-five when I went to the doctor about that. It is like an arthritic condition. What twenty-five-year-old gets arthritis?
So now we come up to the point where I’m pregnant. I had a whole lot of problems with pregnancy. I gained about seventy-five pounds. This was the first time in my life I gained any real substantial weight [in] more than a five-pound increment. I had postpartum depression. More problems with my stomach. I went in and had a CAT scan, and they said that parts of my intestines were becoming paralyzed. They put me on a liquid diet for three days, and then after that I could eat soft foods like mashed potatoes.
I struggled to take the weight off. I did boot camp after boot camp. I only lost two pounds. I cut back on crap in my diet. I hadn’t eaten chips in forever. I didn’t drink a lot of pop. I was following a very healthy diet. I had whole grains at every meal. I was eating vegetables and having meals plus snacks to keep my metabolism going. I was working out hard, at least an hour a day at least five days a week, and I was not losing a single pound.
Oh, and then the asthma. Asthma all of a sudden became a problem, and I had to carry an inhaler, and bursitis was still an issue.
No one suggested these things were connected, and no one suggested that I should look at my diet. No one ever mentioned it. I went to my family doctor, who had been seeing me since I was a kid. I went in with a list, and I had handwritten notes, both sides of pieces of paper covered with notes. I said I have been dealing with a lot of stuff, and I have been coming in individually for things, and they are not really getting any better. They are actually persisting, and I think all I am doing is learning how to cope with them.
I took in two pictures of myself. I said look at these two pictures. I know I look kind of the same [in each], but when you look at my face, right now my face looks bigger, and it looks like it’s changing. I know your face changes as you get older, but mine looks longer, doesn’t it? He looked at me, and he said, “Have you ever seen a therapist for your problems?” It was said with a tone that I am surprised I didn’t start crying right there. But I was like, oh my God, I don’t know who else to go to.
So he left the room to go and schedule an MRI with the nurse, and he didn’t close the door all the way, and I heard the nurse say, “What? You want what? For heaven’s sake, have you seen the list that girl has? It’s two pages long. We are going to be here all night. I don’t have time for this.”
I was feeling like maybe I was making a big deal out of nothing. Maybe I’m too whiny. Maybe everybody feels this way, and I’m not handling it well. It was just frustrating, and I kind of gave up a little bit for a little while.
I never felt rested. I started waking up, like, three times in the middle of the night having seizures, but with my whole body convulsing. I would wake up in the middle of them, and after a few minutes, they would go away, and I was conscious. It was very strange. I didn’t go see the doctor about them because I was busy, and other stuff was happening, and I was so sleep-deprived, I was just trying to make it through every day. I had no energy to do anything, even though I was forcing myself to work out. I thought: Maybe if I could work out more. I’m not doing it enough. This is supposed to give you energy. Maybe I’m not doing it right. My husband is a personal trainer and he was helping me.
I remember sitting on the toilet one day, trying to have a bowel movement and nothing was happening, and this was after about five days. This was normal. I would go seven times in one day, and then I wouldn’t go for a week. I remember I had the feeling it was growing [worse]. It was not anything that I noticed right away, but then it became really clear that something else was happening.
I made an appointment with a new doctor. I said stuff was going on, and I didn’t really know why, and I talked with her about it. I said I would really like to start exhausting my possibilities. I told her, if you’re willing to work with me, I want to have every test done because something is going on, and I don’t know what, but I can’t live like this anymore. She said, “Okay.”
I started getting a migraine headache during the appointment, and within about ten minutes, I couldn’t talk because the headache was so bad. It turned out it was just a normal migraine, and they sent me home with pain medication for the headache. After a day or two I recovered, and I just got back to my normal making-it-through-the-day routine.
A few days later, I have another migr
aine coming on. I get my daughter in the car, and I’m driving her, and it’s getting worse and worse by the second. It had never come on so fast before. I’m starting to get worried. I go through the busiest intersection in town. The light is green, and I have to throw up. I couldn’t stop. I didn’t want to cause an accident, so I open my door and throw up on the street. I get through the light, and I have to stop and throw up again. I threw up all over my steering wheel, my seat, my lap, the floor, and the radio.
A couple of days after that, I’m not doing too bad, and we had plans to go on this cross-country ski trip. I hadn’t been cross-country skiing since I was a kid, so I was excited. I was looking forward to it. We go skiing, and everyone leaves me in the dust. I was the slowest person there, despite the fact that I exercise regularly. I was behind everyone.
That night my stomach hurt like it had never hurt before. I just couldn’t take it anymore. I had been getting up at night. I wasn’t able to sleep, so I was getting up out of bed and trying to walk. I remembered growing up on the farm and having horses with colic. I couldn’t walk without poking my fingers into my side where my colon was; it hurt so much.
Finally, about two or three in the morning, I woke Casey up, and I said, “I don’t know what is going on but it never hurt this bad before. I have to go to the ER.” I got there, and they put me in a room. They had me drink some stuff, gave me a CAT scan, and they took an X-ray. It comes back, and they said, “Your intestines are paralyzed in three different areas,” and they showed me: here, here, and here. “Your colon is not working at all. We are not sure what is causing this, but you have stool backed up all the way to your small intestine.” The doctor said, “You are one sandwich away from a ruptured bowel, which can be deadly. We need to get this out of you right now.” In the X-ray, my colon was extended all the way up into my rib cage below my heart.
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