Abstract: It is increasingly recognized that certain fundamental changes in diet and lifestyle that occurred after the Neolithic Revolution, and especially after the Industrial Revolution and the Modern Age, are too recent, on an evolutionary time scale, for the human genome to have completely adapted. This mismatch between our ancient physiology and the western diet and lifestyle underlies many so-called diseases of civilization, including coronary heart disease, obesity, hypertension, type 2 diabetes, epithelial cell cancers, autoimmune disease, and osteoporosis, which are rare or virtually absent in hunter–gatherers and other non-westernized populations. It is therefore proposed that the adoption of diet and lifestyle that mimic the beneficial characteristics of the pre-agricultural environment is an effective strategy to reduce the risk of chronic degenerative diseases. Keywords: Paleolithic, hunter–gatherers, Agricultural Revolution, modern diet, western lifestyle and diseases. 

Health status of pre-agriculture traditional populations: The idea that modern Homo sapiens are still adapted to an ancestral environment is reinforced by data showing that hunter–gatherers, and other populations minimally affected by modern habits, exhibit superior health markers, body composition, and physical fitness compared with industrialized populations, including:

1.  Low blood pressure in hunter–gatherers and horticulturalists (Table 2) 26,67–69 when compared with current optimal values defined by health institutions (120 mm Hg and 80 mm Hg for systolic blood pressure and diastolic blood pressure, respectively)70

2.  Lack of association between blood pressure and age in hunter–gatherers (Table 3)69 and horticulturalists68 compared with in North Americans and Swedes26, 68,70

3.  Persisting excellent insulin sensitivity among middle-aged and older individuals in non-westernized traditional populations that maintain their ancestral lifestyle26, 71–81

4.  Lower fasting plasma insulin concentrations and higher insulin sensitivity (measured by the Homeostatic Model Assessment [HOMA] index) in the horticulturalists of Kitava (Papua New Guinea) compared with in healthy Swedes (Figures 1 and 2, respectively) 74

5. Lower fasting plasma leptin in the horticulturalists of Kitava and the Ache hunter–gatherer Indians of Paraguay compared with in healthy Swedes82 (Figure 3) and North American male distance runners 83 (Figure 4), respectively

6. Lower body mass index (BMI) in hunter–gatherers, traditional pastoralists, and horticulturalists26 compared with in westerners.26,84 For instance, as observed by Lindeberg, 26 in Kitava, 87% of men and 93% of women aged 40–60 years had a BMI below 22 kg/m2 and not a single individual in this age group was overweight or obese. 26

9. Greater maximum oxygen consumption (VO2 max) in hunter–gatherers and traditional pastoralists compared with in average Americans 67 (Figure 7)

10. Better visual acuity in hunter–gatherers and other traditional populations minimally affected by western habits compared with in industrialized populations 85

11. Better bone health markers in hunter–gatherers compared with in western populations and even traditional agriculturalists. 26, 86–98

12. Lower fracture rates in non-westernized populations compared with in western populations. 26, 96–99

Another line of evidence supporting the superior health markers of hunter–gatherers and other traditional populations comes from the historical records of explorers, adventurers, and frontiersmen, which invariably described the populations they encountered as being healthy, lean, fit, and free of the signs of chronic degenerative diseases.26  But perhaps even more important than these observations are the medical and anthropological reports showing a low incidence of chronic degenerative diseases such as metabolic syndrome and type 2 diabetes, 26,67,73,74,100 cardiovascular disease (CVD), 26 ,65, 67, 68, 100–112 cancer, 26 ,67, 113–118 acne, 119 and even myopia 85 in hunter–gatherers, traditional pastoralists, and horticulturalists compared with in western population s 26, 65, 67, 85, 100, 108, 109, 113, 114, 119, 120 and even ancient Egyptians, 67, 114, 121–123 and medieval Europeans.

Counter arguments:

It has been argued that traditional populations may have been genetically protected against the chronic degenerative diseases that occur in industrialized countries, yet when non-westernized individuals adopt a more contemporary lifestyle, their risk for chronic degenerative diseases is similar or even increased compared with modern populations. 26, 67, 78–80, 108, 109, 124–144  Further, when they return to their original traditional lifestyle, many disease markers or symptoms return to normal. 81, 145 ….  These studies also indicate that few or no genetic adaptations have occurred to protect any population from chronic diseases that are elicited by modern diet and lifestyles. Indeed, two different individuals when exposed to the same modern environment (e.g., western diet, physical inactivity, insufficient and inadequate sleep, chronic psychological stress, insufficient or excessive sun exposure, use of recreational drugs, smoking, pollution) will probably express a suboptimal phenotype 27, 65, 146, 147/. . . .

Table 1:  Historical milestones in human generations  ^{14, 63, 65}

Table 2: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at age 40–60 years in hunter–gatherers and horticulturalists (mm Hg) ^{26, 67–69}

Table 3:  Systolic blood pressure and diastolic blood  pressure in Yanomamo  Indians ⁶⁹.     

Figure 1, Fasting plasma insulin (IU/mL) in Kitava horticulturaists (first number) versus healthy Swedes (second number).⁷⁴  Transposed from graph by JK

Figure 3,  Fasting plasma leptin (ng/mL) in Kitava hoticultalists versus healthy Swedes. ⁹²

Figure 7,  Maximum oxygen consumption in various populations (mL/kg/min). ⁶⁷