Er ernæringsfolk klare for å ta til seg evolusjonsvitenskapen?
En dag i 2018 når jeg satt og tittet etter noe interessant å lese kom jeg over en artikkel som umiddelbart fattet min oppmerksomhet. Artikkelen, med tittelen “Status of evolutionary medicine within the field of nutrition and dietetics”, viste seg å presentere resultatene fra en større kartlegging av evolusjonsvitenskapens posisjon i ernæringsverdenen. Hvis du kjenner litt til meg og hva jeg står for, så skjønner du nok at jeg syntes det var en interessant studie.
Slik jeg ser det er det utrolig uheldig, og egentlig ganske absurd, at evolusjonsbiologi ikke er standard pensum på ernæringsstudier. Det burde være noe av det første man setter seg inn i, ikke bare innenfor ernæring, men også på andre helserelaterte utdannelser, slik jeg ser det. Det at ernæringsfolk generelt vet lite om evolusjon er ikke noe man trenger en stor studie for å finne ut av. Dog kan en undersøkelse bidra til å kartlegge evt. hindringer og muligheter på området, samt kanskje viktigst av alt, rette oppmerksomhet mot problemet.
Just so it happens, så fikk jeg veldig kort tid etter jeg hadde kommet over og lest den tidligere nevnte artikkelen en e-post fra hoveforfatteren Anthony J. Basile, der han gjorde meg oppmerksom på prosjektet deres og tilbudte seg å ta del i et intervju – et tilbud jeg tok han opp på…
1. Please tell us a little about yourself. I’m particularly interested in hearing about your educational background and research work.
Firstly, thank you very much for interviewing me! I’ve been a fan of your work for quite some time, so I really appreciate this opportunity.
I earned my bachelor’s degree in Dietetics, Foods, and Nutrition from City University of New York (CUNY), Lehman College in spring 2014. As an undergraduate, I spent the summer of my junior year as a research volunteer at the New York Obesity Research Center at Mount Sinai St. Luke’s Hospital. As my first exposure to research, I worked on a study looking at high intensity interval training in African American women with obesity. I then earned my Master’s of Science in Nutrition from Columbia University Medical Center from the Institute of Human Nutrition in summer 2015. My thesis work examined the effect of artificial sweeteners on the sweet taste receptor and cephalic insulin release in mice. Also, if you ever have the opportunity to taste pure saccharin, I highly suggest that you decline; it was the most bitter thing I have ever tasted in my life!
After receiving my master’s degree, I went on to earn my Nutrition and Dietetic Technician, Registered (NDTR) accreditation from the Academy of Nutrition and Dietetics. I then worked on The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) at Mount Saini St. Luke’s Hospital before starting my current Ph.D. program at Arizona State University in the fall of 2017.
2. What made you decide to study nutrition?
Almost eight years ago now, I was trying to lose some weight. I was working as a pharmacy technician at the time, and a colleague of mine suggested that I try the paleo diet to lose weight. I first thought that diet was a crazy idea, and outright told her, “No way!” After about a month of mulling it over and her continued encouragement, I caved and tried the diet. It worked wonders for me; I lost close to 70 lbs (~31kgs)! After seeing, first-hand, how powerful nutrition was, I left my job at the pharmacy, went back to school to study nutrition and dietetics fulltime, and never looked back.
3. In 2017, you started on a PhD in Evolutionary biology. Why did you choose this subject for your doctorate, and how did you first become interested in Darwinian/evolutionary medicine?
While I was completing my undergraduate degree, I read Why We Get Sick by Randolph M. Nesse and George C. Williams, and it completely changed the way I thought about disease. I even bought several copies to give to all my nutrition friends that summer. This book supplied me with the evolutionary reason of why I had so much success with adopting the paleo diet.
After completing my master’s degree, I wanted to take a step out from nutrition and dietetics to learn more about the theory of evolution and evolutionary medicine. While I was applying for programs, there were only two Ph.D. programs in the US that would allow me to study evolution and conduct nutrition-related research simultaneously. Naturally, ASU with the Center for Evolution and Medicine (CEM) was my top pick. Luckily enough, I was accepted! I truly couldn’t be happier.
4. Very recently, you conducted a survey with the purpose of assessing what the status of evolutionary medicine is within the field of dietetics and nutrition. Could you briefly tell us a little about that study, as well as what triggered you to look into the matter of inquiry?
After graduating with my master’s degree, I was hooked on using an evolutionary approach when thinking about nutrition. I saw the potential it could bring to the field of nutrition and dietetics and wondered what others in the field think of evolutionary medicine. After gathering a group of researchers interested in this question, we set out, without any funding, to survey an entire field of professionals and students. It was quite an ambitious goal, but we did it!
We surveyed over 2,000 nutrition and dietetics students (undergraduate, graduate, and dietetic interns) and professionals (Registered Dietitians and Dietetic Technicians, Registered) throughout the US. I was surprised, and incredibly happy, with the response rate that we received. I was also excited with how many participants seemed genuinely interested in the study; many of the participants even emailed me to inquire more about the study and requested the results when we had them.
5. As you see it, what were the most important findings of the study? Are nutritionists and/or nutrition students ready to embrace evolutionary science?
The most important finding is that, generally, the participants were welcoming to evolutionary medicine and thought it would benefit the field itself and dietetics education in general (see the paper for more details).
Not surprisingly, the support for evolutionary medicine decreased with religious belief. Overall, the mean was more supportive for participants who believe in evolution without guidance by God, lower for those who believe in God-guided evolution, and lowest for those who believe God made humans in their present form.
Interestingly, the participants were less in favor of brining evolutionary medicine in a clinical setting. We attributed this to the culturally sensitive setting of nutritional counselling.
The other interesting finding is that it appears that students are currently more open to using an evolutionary perspective in the field of nutrition and dietetics than professionals. Our results also suggest students may be learning more about evolution compared to their professional counterparts, which could be a good sign for the future of evolutionary medicine!
6. Over the most recent decades, evolutionary science has started making its way into certain sections of mainstream medicine; however, there’s still a long way to go before Darwinian medical methodologies are built into the foundation of medicine, which is arguably where they belong. In your view, what’s keeping evolutionary science from permeating medicine (including nutrition)? What are the main obstacles that impede its entry? Are these obstacles being worn down? Is a breakthrough on the horizon?
This is a great question. This past summer I attended the annual conference for the International Society of Evolution Medicine and Public Health (ISEMPH), and a recurring theme was: Is evolutionary medicine just medicine, or is it separate from medicine? I lean more toward the idea that you can’t try to better understand any aspect of biology without thinking about how life came to be. So, I would argue that evolutionary medicine is medicine, just incorporating an evolutionary perspective.
Something that also came up at ISEMPH was the need for evolutionary medicine to prove itself as important to the medical field. The conversation mostly centered on how we, as researchers and physicians, can illustrate evolutionary medicine’s application and benefit to medicine. However, all I could think about during these discussions was the numerous paleo diet studies that demonstrate how beneficial adding an evolutionary perspective is for preventing nutritionally related disease. I wondered where the disconnect was between the paleo diet community and the ISEMPH attendees.
I would say that the main obstacle for evolutionary medicine would be the field of medicine itself. Currently, it’s set up to treat people who are sick instead of preventing people from getting sick in the first place. An evolutionary perspective lends itself to both treatment and prevention, however, funding for medical research is more likely to go to treatment versus prevention.
One thing that could speed up the process of bringing evolutionary medicine to the medical field would be through education. If we began teaching an evolutionary perspective to premed or medical students, then, over time, it would better integrate into the field. This is the main goal of CEM here at ASU, and I would suggest reviewing the evmeded.org website for more information and resources. Hidaka et al. 2015 has shown that the coverage of evolutionary medicine in medical schools has increased, however it is currently lower than the perceived importance reported by medical school deans. So evolutionary medicine education may be increasing, but it still has a long way to go. However, our recent paper showed that there is interest for evolutionary medicine education in the field of nutrition and dietetics, illustrating an opportunity for growth in the field.
In terms of evolutionary medicine and nutrition science, I think it’s a completely different story. I think the focus of nutrition research is finally shifting away from the reductionist approach (e.g., specific nutrients or foods) and moving toward a whole dietary pattern approach (e.g., diet quality). That being said, there’s no one diet (in terms of food groups) that works best for everyone, which could be for a number of reasons (e.g., cultural preferences, adherence, access, etc.). But there are dietary pattern themes that are universal for health (e.g., nutrient density, minimally processed, anti-inflammatory). I believe an evolutionary perspective lends itself more to the dietary pattern perspective than the specific food group perspective; which will actually be the focus of part of my dissertation. Therefore, I think an evolutionary perspective supports much of the current mainstream nutrition advice, and that this perspective may help refine how we define dietary patterns.
7. You’re very active within the field of Darwinian/evolutionary medicine. You’re on the board of the Ancestral Health society, a fellow at the ASU Center for Evolution and Medicine, and an editor for the Journal of Evolution and Health. Is there anything in particular about this work that you feel people need to know about, think is particularly fascinating, and/or want to draw attention to? If so, please provide a concise description of the thing(s) you want to highlight.
As a board member for the Ancestral Health Society, we host an annual symposium that provides a forum for sharing scientific theories about how diet, lifestyle, and the environment can shape human health. All the presentations from the conference are freely available on YouTube. Also, the society’s interdisciplinary journal, the Journal of Evolution and Health, is a peer-reviewed, open access, and free to submit to! The journal’s goal is to bring together academic researchers and clinical practitioners to cultivate an evolutionary perspective on health, and we’re always looking for new submissions!
Through my fellow position in CEM, I’m working with Dr. Karen Sweazea to better understand physiological mechanisms of nutrition-related disease. We use a comparative physiology perspective and use birds as a natural animal model of hyperglycemia without mammalian-like complications to better understand diabetes. Birds have the highest blood glucose levels of any animal, but do not develop diabetes or any complications from the high blood glucose concentrations. We’re conducting some really interesting dietary studies in birds to better understand their physiology.
8. What do you consider to be the most important things Darwinian/evolutionary medicine has to contribute to the conventional health care system?
The most important thing that evolutionary medicine offers to the conventional healthcare system is the evolutionary perspective of why a disease exists in the first place. Causality in biology can be either be a proximate or ultimate cause. An evolutionary perspective supplies the answer for the ultimate cause. Therefore, an evolutionary perspective allows for a deeper understanding of disease which can hopefully reveal novel therapeutic or preventative measures.
9. What are your plans moving forward? Are you planning to conduct more research related to Darwinian/evolutionary medicine?
I’d like to continue my academic career using an evolutionary perspective to improve human health. I still have four more years in my Ph.D. program. After I receive my doctorate, I’d like to move on to a postdoctoral position where I focus solely on clinical nutrition research. Then, I’d like to obtain a faculty position that allows me to teach nutrition science and conduct evolutionary medicine and clinical nutrition research. I am also very interested in education, specifically, developing the resources needed to teach nutrition and dietetics from an evolutionary perspective.
10. Any last thoughts?
I have greatly appreciated the discussion and the opportunity to contribute my thoughts on the benefit of an evolutionary perspective to the field of nutrition and dietetics! Thank you very much again!