Some of the same key survival traits that have kept us alive for thousands of generations are killing us today.
That is the thesis of cardiologist Lee Goldman, dean of the College of Physicians and Surgeons, chief executive of Columbia University Medical Center and executive vice president for Health and Biomedical Sciences at Columbia University, in a new book aptly titled Too Much of a Good Thing.
Goldman, the author of hundreds of medical articles and the lead editor of a bestselling medical textbook, has not written for a general readership before. But he was inspired to do so after decades of questions from patients, family, friends and even brief acquaintances who asked for medical advice about diet, weight loss and blood pressure and what medications they should be taking.
“As I thought back about the answers to those questions, I realized that many of them linked back directly to our DNA—who we are, and the difficulty of living in the modern world with genes that, by and large, were designed for tens of thousands of years ago,” said Goldman, the Harold and Margaret Hatch Professor for Health and Biomedical Sciences.
Can’t stick to a diet? That’s a holdover from when humans roamed the plains and gorged when food was plentiful, storing the rest as fat for when it wasn’t. High blood pressure? Much of the blame is the excess salt found in today’s diets, a problem that did not exist generations ago, when salt was a precious commodity in short supply.
Anxiety is a descendant of the fight-or-flight response, which kept us alive when faced with a woolly mammoth but is something that we less often need today. And the ability of our blood to clot, which keeps us from bleeding to death, is now a root cause of unneeded clots that block arteries and result in heart attacks and strokes.
“For each of these four conditions, the risks have long since flipped,” Goldman said. “These protective genes that helped keep our ancestors alive now paradoxically account for about 40 percent of deaths in modern America—far, far more than the number they prevent.”
Is there a solution? “I come to the controversial and not very politically correct conclusion that, whether we like it or not, we are going to have to rely to a greater extent on scientific advances to help us,” he said.
Goldman looks to a new kind of science, one that he has helped put into practice at the Medical Center with Columbia’s Precision Medicine Initiative, which Columbia President Lee C. Bollinger announced last year to help treat and even prevent disease by looking at a patient’s genes. “The concept is that you’re different than I am, and there may be a treatment that works better for you and one that will work better for me,” he said.
For example, he points out, there is a range of medications for high blood pressure, but if doctors knew exactly what triggered a particular patient’s condition, they could specifically target that problem. And there are common genes that it might be possible to change.
He cites a study that found a woman whose level of LDL, the bad cholesterol that triggers a build-up of plaque in the walls of blood vessels, was 14. By usual American standards, an ideal level is between 100 and 129, and anything over 190 is considered very high. Even in people who have had a heart attack, the usual treatment goal is 50 to 70. She was apparently missing both copies of a gene that controls low-density lipoprotein, but to no ill effect. “We had never seen that, ever.”
That gene is a leftover from a prior era, thousands of years ago, when it was instrumental to be sure we formed enough cholesterol to create and maintain healthy cell membranes. “But this person is perfectly healthy and proof that we don’t need either copy of that gene anymore,” he said. “If everyone’s LDL was 14, we probably wouldn’t have any heart attacks.”
Unfortunately, we’re not under any survival pressure for these genes to change since the resulting conditions don’t kill us until after we’ve had children who can perpetuate the human species—as well as these now-adverse genes. Another potential treatment approach—using will power—is often worth trying, but typically has relatively little success. “There is a lot of hope and oftentimes hype that we can dramatically change our behavior,” Goldman said. “A lot of health advice focuses on that today, but if it was commonly successful, I wouldn’t have written this book.”
Indeed, if it did, 38 percent of Americans wouldn’t be obese, 14 percent wouldn’t have diabetes, a third wouldn’t have high blood pressure, and heart attacks and strokes wouldn’t be two of the five leading causes of death in America.
“Behavior change is a virtue worthy of an attempt, and I wish I could predict that it would solve these problems. But we shouldn’t feel guilty if we can’t beat our genes, and we shouldn’t look down upon people who can’t beat theirs,” Goldman said. “That’s just not the way we’re built.”
— By Bridget O'Brian