An Energy-Related Reason Why US Healthcare Outcomes are Awful

Back in January 2013, the US Institute of Medicine published a report called U.S. Health in International Perspective: Shorter Lives, Poorer Health. This poor health outcome for US citizens is in spite of the US spending twice as much as a percentage of GDP on healthcare as other high-income nations.

As an example of the problems the US has, the report showed the following exhibit, pointing out that the US has made much smaller advances in life expectancy since 1980 than other high-income nations.  The US is now seventeenth of the seventeen countries analyzed in male life expectancy, and sixteenth out of seventeenth in female life expectancy.

Figure 1-6 Female life expectancy at birth

I am sure I do not know all of the reasons for the US divergence from patterns seen elsewhere, but let me try to explain one energy-related reason for our problems. It has to do with a need to get a wide variety of nutrients at the same time we need to balance (Energy In) = (Energy Needed for Life Processes), in a period of time when the food we eat is increasingly of the “processed” variety. There may also be an issue of eating too much animal protein in our food mix, thanks to today’s ability to ramp up meat production using grains grown and shipped around the world, using fossil fuels.

An Overview of Energy-Related Modifications to Food

If we look at primates in general, it is pretty clear that all of the nutrients such animals need come prepackaged in the food that they gather with their limbs. They get the level of exercise they need from gathering this food and from their other daily activities. They have a pretty good balance between (Energy In) = (Energy Needed for Life Processes), without any special effort.

We humans have been modifying food for a very long time, dating back to the days of being hunter-gatherers. Our earliest changes were successful from the point of making humans more dominant. They allowed us to grow larger brains and allowed human population to grow.

The changes made in recent years, thanks to abundant fossil fuels, seem to be excessive, however. The new processed foods are often missing necessary nutrients and fiber, providing mostly empty calories. It becomes a balancing act to get enough of the right nutrients without filling our bodies with calories we don’t need. Some foods (juices, added sugars, very finely ground grains) are sufficiently different from natural foods that our systems don’t react properly to such food. Also, the exercise our body was expecting is often much reduced.

The way our current system works, the food that is closest to its original form is hardest to ship and store, so tends to be highest-priced. The most calorie-dense, over-processed food tends to be cheapest. As a result, the least-educated people (who tend to be poorest) tend to be most damaged by our poor food supply. According to one study, at age twenty-five, men with less than a high school education have a sixteen-year shorter life expectancy than men with a graduate degree.

Remaining Years of Life_prbOf course, at least part of the problem is the disproportionate lack of health care of less-educated US citizens. There are no doubt effects related to feeling like second-class citizens as well, because of reduced work-opportunities for those with poor educations. But having to work around a poor food system with an inadequate income is an issue that likely plays a major role as well.

How Did Humans Develop Larger Brains?  

There is a popular belief that eating meat made us human. While meat eating may have played a role, there seem to be other factors as well. National Geographic in an article in the September 2014 issue, The Evolution of Diet, observes that modern day hunter-gatherers typically get about 30% of their calories from meat. When meat supplies are scarce, they often live for long periods on a plant-based diet. The article says, “New studies suggest that more than a reliance on meat in ancient human diets fueled the brain’s expansion.”

The point National Geographic mentions is the one I have brought up previously–the theory advanced by Richard Wrangham in Catching Fire: How Cooking Made Us Human. It seems to be the ability to control of fire, allowing humans to burn biomass, which set us apart from other primates. This allowed us to cook food, and in doing so, allowed the food to be more easily chewed and digested. Reduced chewing time freed up time for other activities, such as making tools. Nutrients could be more easily absorbed from cooked food. The fact that the food was easier to chew and digest allowed chewing and digestive systems to shrink, and brains to increase in size. It probably also made it easier for more human children to survive.

Furthermore, we now know that some other primates eat meat, so humans are not unique in this regard. Chimpanzees even hunt animals for their meat. National Geographic reports that baboons eat birds, rodents, and even the young of larger mammals, such as antelopes and sheep. But meat makes up only a small share of their diet. We also know that when monkeys are fed a diet that includes very much meat, they gain weight and experience degenerative diseases like humans.

Food Processing: A Little of a Good Thing vs. Too Much of Good Thing

The experience with cooking some food back in hunter-gatherer days shows that a little help in getting more nutrition from foods can be helpful. Plant cell walls are made of cellulose. Cooking vegetables helps break down these cell walls, making nutrients more accessible. There are other ways of processing food–pounding meat to make it more tender or using a blender to chop it into fine pieces. Humans have been milling grains for a very long time.

But it is easy to overdo the processing of food, especially with the help of fossil fuels. Grains can be ground very finely, far more finely they would have been ground, years ago. Sweeteners of various types can be derived from sugar cane, sugar beets, and corn, and added to products of many types. Parts of fruits and vegetables that are deemed “less desirable” such as skins can be removed, even if these parts have a disproportionate share of the nutrients in them.

There is even a second order kind of change to the food supply that can be put in place. For example, before recent “improvements,” cattle ate a mixture of grasses and digested them in their four-part stomachs that are designed from that purpose. Now cattle are being fed all kinds of foods that are not suitable for their digestive systems, including corn and dried distillers grain, a byproduct of making ethanol from corn. There are many other shortcuts taken, from hormones to antibiotics, so as to produce more meat at less expense. Our bodies aren’t necessarily adapted all of these changes. For one thing, there is much more fat in the beef, and for another, the ratio of Omega 3 fatty acids to Omega 6 fatty acids is badly skewed.

There is the additional issue of whether plants actually contain the nutrients that they did years ago. Many of us have learned Liebig’s Law of the Minimum, which states that plant growth is not controlled by total amount of resources available, but by the scarcest resource. In other words, a plant needs all of its nutrients–just adding more of the most abundant nutrient isn’t good enough. But Liebig’s Law of the Minimum doesn’t remove all deviations in nutrient quantity. Plants will still grow, even if some of the trace elements are present in smaller than the usual quantities. Adding fertilizer (or even crop rotation) does not entirely fix this situation. We still end up with soil that is deficient in some micronutrients. This situation tends to get worse with time, as our sewer systems send human wastes out to sea.

In recent years, we have been hearing more about the role intestinal bacteria play. The processing of our food is especially likely to remove the less digestible portions of our food that these bacteria depend on for their nutrition. This adds yet another dimension to the problem of food that deviates from what our bodies are expecting us to eat.

Thanks to fossil fuels, processing of all kinds is cheap. So is adding sugar, artificial colors and artificial flavors to help cover up deficiencies in the original crop. The shortcuts farmers take, including heavy use of fertilizers and pesticides, are ways to produce food more cheaply. The food we end up with is inexpensive and convenient, but doesn’t necessarily match up well with what human digestive systems are adapted to.

What Kind of Exercise Do We Need? 

The story I keep reading is that we need a certain amount of high-intensity intermittent exercise to help our bodies operate as they are intended to. Running for even an average of five or ten minutes a day is said to reduce cardiac causes of death by 30% to 45%, and to increase overall life expectancy by three years. We can easily imagine that hunter-gatherers quite often needed to sprint from time to time, either to avoid predators or to catch potential prey. The finding that human beings need short bursts of high intensity exercise, such as running, would seem to be consistent with what our ancestors did. We also can’t sit for long periods–something our ancestors didn’t do either.

How about strength training? One thing that occurred to me when I visited India is how unnatural it is to have chairs to sit on. Much of the world’s population, even today, sits on the ground when they want to sit down. Needless to say, people who don’t sit on chairs get up from the floor many times a day. This is a type of fitness training that we in this country miss. We in the West also don’t squat much–another type of fitness training.

Even with the beneficial effects of exercise, some researchers today believe that food plays a more important role than exercise in obesity. (Obesity is linked to ill health and shorter life expectancies.) A recent study by Herman Pontzer and others compared the energy expenditure of the Hazda hunter-gatherers to Westerners. The study found that average daily energy expenditure of traditional Hazda foragers was no different from that of Westerners, after controlling for body size. The body seemed to compensate for higher energy expenditure at times, with lower energy expenditure at other times.

Conclusion

It seems to me that our appetites don’t work correctly when we fill ourselves with overly processed foods that are lacking for essential nutrients. We often don’t stop eating soon enough, and then we quickly feel hungry again. In part this may be from eating highly processed foods that would never be found in nature; in part it may be because the foods are missing the micronutrients and fiber that our bodies are expecting. Low-income people especially have a problem with such diets, since diets rich in fruits and vegetables are more expensive.

Many people believe doctors can fix our health problems. Looking across countries, diet and public health issues tend to be much more important than the medical care system in the health of a population. With most chronic health conditions, doctors can only take bad health situations and make them somewhat better. High rates of illness and increased mortality remain, similar to what we see in the United States.

Many of us have heard about the so-called calorie restriction diets of monkeys. This is a misnomer, in my view. In at least one version of it, it is a comparison of monkeys fed a low calorie diet that provides a wide range of nutrients found in vegetables, with a diet typical of Americans. If, in fact, we humans also need a wide range of nutrients found in vegetables, we should not be surprised if we have similarly poor health outcomes.

NYT 31aging_graphic_lgAccording to the graphic, Owen, 26, is affected by arthritis. His skin is wrinkled and his hair is falling out. He is frail and moves slowly. His blood work shows unhealthy levels of glucose and triglycerides. Canto, 25, is aging fairly well.

I personally have been eating a diet that is close to vegetarian for twenty years (heavy on vegetables, fruits and nuts; some fish and diary products; meat only as flavoring in soups). I also cut way back on processed foods and foods with added sugar or corn by-products. When I first changed my diet, I had a problem with arthritis and was concerned that I was at high risk for Type II diabetes. I lost weight, and my arthritis disappeared, as did my blood sugar problems. In fact, I rarely have reason to visit a doctor. In many ways, I feel like Owen on the right.

As I pointed out at the beginning of the post, we need to get a wide variety of nutrients at the same time we need to balance (Energy In) = (Energy Needed for Life Processes). Back in hunter-gatherer days, this was easy to do, but it is increasingly difficult to do today. Besides cutting back on processed foods, eating a diet that is low in meat may be a way of doing this. Studies of people who eat mostly vegetarian diets show that they tend to have longer life spans. There is also direct evidence that diets that are higher in animal protein tend to shorten life spans. These findings don’t necessarily correlate with studies of what works best for losing weight, which is what most people are concerned about in the short term. Thus, we are deluged with a lot of confusing findings.

Food and health problems are issues that tend to strike a nerve with a lot of people. I can’t claim to be an expert in this area. But stepping back and looking at the issue more broadly, as I have tried to do in this article, can perhaps add some new perspectives.

About Gail Tverberg

My name is Gail Tverberg. I am an actuary interested in finite world issues - oil depletion, natural gas depletion, water shortages, and climate change. Oil limits look very different from what most expect, with high prices leading to recession, and low prices leading to inadequate supply.
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658 Responses to An Energy-Related Reason Why US Healthcare Outcomes are Awful

  1. Paul says:

    A little humour….

    Apple’s software updates are like changing the water in a fish tank. I’d rather let the fish die
    The all-new iPhones and Apple Watch can be easily avoided but there’s no escaping iOS 8

    Apple Watch The Apple Watch: only an unhealithily devoted Apple fanatic could bear to wear one.

    The past few weeks haven’t been great for Apple. First they were implicated in the stolen celebrity nude photo disaster, which reminded everybody how easily clouds leak. Correct me if I’m wrong, but I don’t think the iPhone is generally marketed as a diabolical timewasting device with the potential to wreak a grotesque and devastating invasion of your personal privacy. They tend to focus more on all the cool colours it comes in.

    Then they launched the horrible-looking Apple Watch, which does everything an iPhone can do, but more expensively and pointlessly, and on a slightly different part of your body. Only an unhealthily devoted Apple fanatic could bear to wear a Apple Watch, and even that poor notional idiot would have to keep putting their iPhone down in order to operate the damn thing. It’ll scarcely be used for telling the time, just as the iPhone is scarcely used for making calls. It’s not a watch. It’s a gaudy wristband aimed at raising awareness of Chinese factory conditions. Or a handy visual tag that helps con artists instantly identify gullible rich idiots in a crowd.

    Apple also unveiled the all-new bigger iPhone 6, and the all-new even bigger-than-that iPhone 6 Plus, which is the size of the Isle of Man and aimed at people who literally have deep pockets. By releasing two differently sized rectangles, which in turn differ from its previous range of differently sized rectangles, Apple has selfishly exhausted the global supply of differently sized rectangles. From now on, all rectangles, no matter what context they appear in, will have to be the same size. Wars will be fought to decide which dimension becomes the standard. And when mankind finally settles on a compromise, Apple is going to start on ovals.

    Edit: Read the rest of the article from this link:

    http://www.theguardian.com/commentisfree/2014/sep/22/apple-software-updates-iphone-watch-ios-8

    • Jan Steinman says:

      “That little rectangular screen is so hypnotic, so omnipresent, I feel lost and sick the moment mine’s tied up doing something as uninterruptable as an update.”

      What is this “iPhone” you speak of?

      (This is coming to you from an eight-year-old computer, that can’t run more software than most i-thingies can run… but it does email and the web just fine, thank you!)

  2. Paul says:

    Totalitarianism, American Style – Chris Hedges

    Understanding the subtle ways democracy has been undermined in the US.

    We have undergone a transformation during the last few decades—what John Ralston Saul calls a corporate coup d’état in slow motion. We are no longer a capitalist democracy endowed with a functioning liberal class that once made piecemeal and incremental reform possible. Liberals in the old Democratic Party such as the senators Gaylord Nelson, Birch Bayh and George McGovern—who worked with Ralph Nader to make the Clean Air Act, the Clean Water Act, the Mine Safety and Health Act, the Freedom of Information Act and the OSHA law, who made common cause with labor unions to protect workers, who stood up to the arms industry and a bloated military—no longer exist within the Democratic Party, as Nader has been lamenting for several years. They were pushed out as corporate donors began to transform the political landscape with the election of Ronald Reagan. And this is why the Democrats have not, as Bill Curry points out, enacted any major social or economic reforms since the historic environmental laws of the early ’70s.

    We are governed, rather, by a species of corporate totalitarianism, or what the political philosopher Sheldon Wolin describes as “inverted totalitarianism.” By this Wolin means a system where corporate power, while it purports to pay fealty to electoral politics, the Constitution, the three branches of government and a free press, along with the iconography and language of American patriotism, has in fact seized all the important levers of power to render the citizen impotent.

    The old liberal class, the safety valve that addressed grievances and injustices in times of economic or political distress, has been neutered. There are self-identified liberals, including Barack Obama, who continue to speak in the old language of liberalism but serve corporate power. This has been true since the Clinton administration. Bill Clinton found that by doing corporate bidding he could get corporate money—thus NAFTA, the destruction of our welfare system, the explosion of mass incarceration under the [1994] omnibus bill, the deregulation of the FCC, turning the airwaves over to a half dozen corporations, and the revoking of FDR’s 1933 Glass-Steagall reform that had protected our banking system from speculators. Clinton, in exchange for corporate money, transformed the Democratic Party into the Republican Party. This was diabolically brilliant. It forced the Republican Party to shift so far to the right it became insane.

    By the time Clinton was done the rhetoric of self-professed liberals was a public relations game. This is why there is continuity from the Bush administration to the Obama administration. Obama’s election did nothing to halt the expanding assault on civil liberties—in fact Obama’s assault has been worse—the Bush bailouts of big banks, the endless imperial wars, the failure to regulate Wall Street, the hiring of corporate lobbyists to write legislation and serve in top government positions, the explosion of drilling and fracking, the security and surveillance state as well as the persecution of government whistle-blowers.

    This audience is well aware of the Democratic Party’s squalid record on the environment, laid out in detail in a new Greenpeace report written by Charlie Cray and Peter Montague, titled “The Kingpins of Carbon and Their War on Democracy.” The report chronicles what it calls “a multi-decade war on democracy by the kingpins of carbon—the coal, the oil, and gas industries allied with a handful of self-interested libertarian billionaires.”

    The Obama administration, in return for financial support from these kingpins of carbon, has cynically undermined international climate treaties, a fact we discovered only because of the revelations provided by Edward Snowden and WikiLeaks. It uses its intelligence agencies, these revelations revealed, to spy on those carrying out climate negotiations to thwart caps on carbon emissions and push through useless, nonbinding agreements. The Obama administration has overseen a massive expansion of fracking. It is pushing through a series of trade agreements such as the TPP and the TAFTA that will increase fracking along with expanding our exports of coal, oil and gas. It authorized the excavation of tar sands in Utah and Alabama. It approved the southern half of the Keystone pipeline. It has permitted seismic testing for offshore drilling in the Gulf of Mexico, the East Coast and in parts of Alaska, a process that kills off hundreds of sea mammals. It authorized drilling within four miles of the Florida coastline, violating one of Obama’s 2008 campaign promises. This expansion of offshore drilling reversed 20 years of federal policy.

    If we appeal to self-identified liberals in the establishment who have no capacity or desire to carry out the radical reforms, we will pour energy into a black hole. And this is what the corporate state seeks. It seeks to perpetuate the facade of democracy. It seeks to make us believe what is no longer real, that if we work within the system we can reform it. And it has put in place a terrifying superstructure to silence all who step outside the narrow parameters it defines as acceptable.

    The Democratic Party speaks to us “rationally.” The party says it seeks to protect civil liberties, regulate Wall Street, is concerned about the plight of the working class and wants to institute reforms to address climate change. But in all these areas, and many more, it has, like its Republican counterpart, repeatedly sold out the citizenry for corporate power and corporate profits—in much the same manner that Big Green environmental groups such as the Climate Group and the Environmental Defense Fund have sold out the environmental movement.

    To assume that Obama, or the Democratic Party, because they acknowledge the reality of climate change, while the lunatic fringe of the Republican Party does not, is better equipped to deal with the crisis is incorrect. Republicans appeal to one constituency. The Democrats appeal to another. But both parties will do nothing to halt the ravaging of the planet.

    If Wolin is right, and I believe he is, then when we begin to build mass movements that carry out repeated acts of civil disobedience, as I think everyone on this panel believes we must do, the corporate state, including the Democratic Party, will react the way all calcified states react. It will use the security and surveillance apparatus, militarized police forces—and, under Section 1021 of the National Defense Authorization Act, the military itself—to shut down all dissent with force. The legal and organizational mechanisms are now in place to, with the flip of a switch, put the nation effectively under martial law. When acts of mass civil disobedience begin on Monday morning with Flood Wall Street and later with Occupy the U.N., the face of the corporate state will, as it did during the Occupy movement, reveal itself.

    If the response of the corporate state is repression rather than reform then our strategy and our tactics must be different. We will have to cease our appealing to the system. We will have to view the state, including the Democratic Party, as antagonistic to genuine reform. We will have to speak in the language of … revolution. We will have to carry out acts of civil disobedience that seek to cripple the mechanisms of corporate power. The corporate elites, blinded by their lust for profit and foolish enough to believe they can protect themselves from climate change, will not veer from our path towards ecocide unless they are forced from power. And this means the beginning of a titanic clash between our corporate masters and ourselves.

    http://www.alternet.org/activism/totalitarianism-american-style?akid=12281.312354.hBpFE4&rd=1&src=newsletter1020319&t=11&paging=off&current_page=1#bookmark

    • Daddio7 says:

      Remember Romney’s 47%? They will not benefit from your revolution. You want to destroy the fossil fuel wealth of this nation. The poor will not get richer, most everyone else will get poorer. Get ready to make your jaunts to Bali by clipper ship. For your 1820 utopia to happen we will have to impose virtual slavery on most people. 50% of the population will have to return to the plantation, most will not want to go. Half the world depends on the excess food produced by subsidized Western farmers.
      I just read a Market Watch posting about how the world’s climate problem is because of it’s human population problem. Rich people have less children but use more resources. We have to eliminate the rich and control the poor’s reproduction rate.
      Well coordinated attacks can destroy the rich but that does nothing for the poor, you will just have even more people hating you. I have yet to see a plan that describes the effects of total war on climate change and what daily life will be for the average person who survives.
      Our modern economy is unsustainable but most corporate wealth is magnetic bits on a hard drive, it can not be extracted and passed around like a big sack of coins. It might feel good to try but there is no solution.

      • Paul says:

        I agree with you. Hedges doesn’t get it when it comes to the economy – he thinks socialism will solve everything… My take on socialism and communism vs capitalism is that the former simply burns through the earth more slowly – because they are less efficient at doing so.

        That said if it is all going to hell in a hand basket then why shouldn’t the poor get a seat at the last supper too?

        I only post Hedges to point out that the US is headed down the road to a totalitarian nightmare.

        NSA + 1.6 Billion Rounds + Attacks on Occupy Movements + Ferguson War Zone + Heavily Armored Police = Imminent Nightmare.

        Funny how those living in this are unable to see what is coming — the Germans were like that in the 30’s… ‘that could never happen here’ — it’s happening…

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