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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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June 08, 2017

ACEs and Primal Health

By Mark Sisson
31 Comments

In-line_ACEsIt’s fair to say that I gravitate towards tangible, actionable subject matter when it comes to improving my own and others’ health. Things like nutrition, fitness, sleep, hormonal responses, and supplement science may seem like a lot to chew on for the layperson, but these are my personal passions as well as my long-time profession.

And while these are certainly the big, actionable players in the game of health, I fully acknowledge there may be more lurking behind the scenes than we realize. A body that refuses to heal no matter how Primal you eat. Stubborn health conditions that simply refuse to fully go away, despite all the changes you make in your life. A propensity for disease that defies everything you’ve learned about ancestral nutrition and wellness. An intriguing new angle in the health sphere suggests the hurdle for some people may be embedded deeper than outer changes can access. 

What Are ACEs (Adverse Childhood Experiences)?

Oddly enough, it all began with a weight loss program. Working out of Kaiser Permanente in Oakland, CA, Dr. Vincent Felitti was on a mission to get to the bottom of obesity. The problem was, the patients in his program kept dropping out, and he had no idea why. After a series of rather awkward and unintended questions, an interview with one obese woman provided the answer: Adverse Childhood Experiences (ACEs).

It turned out that the woman had been sexually abused as a kid, and her weight gain was a way of disappearing; of minimizing her risk of further sexual assault. Felitti dug deeper, and discovered that of the hundreds in his weight loss program, at least half of his patients had suffered from some form of ACE. What those people had experienced in their childhoods was somehow systematically preventing them from losing weight. If they did manage to lose weight, they regained all of it in short order.

The findings couldn’t be ignored, and Felitti soon teamed up with Dr. Robert Anda from the CDC to delve deeper. Beginning in 1995 and running until 1997, the resulting ACE study was one of the largest of its kind, encompassing a whopping 17,000+ participants. What Felitti and Anda found not only verified the earlier links between obesity and ACEs, but amplified them exponentially. Adverse Childhood Experiences were a pivotal factor for many of the most common major diseases and health conditions of our time.

The findings were simple yet far-reaching. Through the use of an uncomplicated questionnaire and scoring system, each participant was assigned an ACE score. Each traumatic experience during their childhood would give them a point, with more adverse experiences equating to a higher score. These experiences included sexual, verbal and physical abuse, five forms of family dysfunction (alcoholism, violence, incarceration, divorce, or abandonment), and 2 forms of neglect. Someone who had been verbally abused and had an alcoholic mother, for example, would get an ACE of 2. Those fortunate souls without any adverse experiences sailed through the survey with 0.

How ACEs Affect Our Health

Our heroes at Kaiser Permanente found that, perhaps unsurprisingly, the higher the ACE score, the greater the propensity for certain diseases. But it was the extent to which those ACEs affected the health of participants that had me doing a double take. Compared with people who achieved an ACE score of 0, those who ticked 4 ACE boxes were found to be at a 240% greater risk of hepatitis, and a 390% higher risk of developing chronic obstructive pulmonary disease. As the score went up, Felitti and Anda noted that people were more prone to violence, more broken marriages, more broken bones, more drug prescriptions, more depression, and more auto-immune disease. Thanks a lot, childhood.

As Felitti and a host of other researchers dug deeper in the following years, the picture became even more ominous. In short order, a higher ACE score was linked to greater risk of ischemic heart disease, chronic and frequent headaches, lung cancer and other forms of cancer, and liver disease. Whichever disease or health condition researchers homed in on, inevitably a link was found to Adverse Childhood Experiences. More “minor” but broadly influential conditions like sleep disturbance corresponded with ACEs as well with those people who had an ACE score of 5 or more being up to 2.4 times more likely to have trouble falling or staying asleep. As the ACE count went down, the sleep quality slowly improved.

Taking a step back, it became apparent that ACEs were impacting all areas of health. People with an ACE score of 5 or more had a nearly threefold increase in rates of psychotropic drug subscriptions, while a 2009 study conducted by Felitti and company found that risk of autoimmune disease in general went up significantly with increasing adverse experiences during the childhood or teen years. Breaking it down, they demonstrated that an ACE score at or above 2 meant a 70% increased risk of idiopathic myocarditis (a cardiovascular disease), 80% greater risk for myasthenia gravis (a chronic autoimmune neuromuscular disease), and 100% increased risk for rheumatic diseases. I don’t like those odds.

The ACE Pyramid

As Felitti and his team began to piece together the links between current-day health and past adverse experiences, a certain trend started to emerge. That trend is as follows:

  1. Adverse childhood experiences
  2. Disrupted neurodevelopment
  3. Social, emotion and cognitive impairment
  4. Adoption of health-risk behaviors
  5. Disease, disability and social problems
  6. Early death

It looks like a decidedly morbid take on something that happened many years ago during childhood, but if the numbers are anything to go by it’s a very accurate synopsis. This progression, known as the ACE Pyramid, was observed and documented in thousands upon thousands of people.

Demographically speaking, in the original study of 17,000 participants, nearly 75% were white. Almost 40% had a college or graduate degree. Another 36% had some college.

In a 2009 commentary posted in the Journal of Academic Pediatrics, the Godfather (aka Felitti) himself noted that the pathway from ACE to early death isn’t always linear. ACEs can work their destructive ways via two feedbacks: first, disease and early death is the consequence of various trauma-coping mechanisms like smoking, overeating and drug use. In this scenario, the maladaptive behavior brought on by the trauma of childhood could lead to excessive eating and poor diet, for example, which then leads to type 2 diabetes, the culmination of which is coronary artery disease.

Second, chronic stress generated by the trauma (and the brain’s inability to let go of the incident) directly leads to impairment of immunity and chronically elevated inflammation, which in turn paves the way for disease. Even worse, both of these mechanisms can work in tandem, further sealing the fate of the person in their grip.

The Neurobiological Role of Trauma

Where things get interesting indeed is with regards to neurobiology. The trauma of Adverse Childhood Experiences can literally rewire and re-form the brain, changing the way a person develops neurologically for the rest of his/her life without intervention. As this study noted, “the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains [of the brain] increased in a graded fashion as the ACE score increased.” The result of a single ACE, then, could be permanent impairment of multiple brain structures and functions. 

Put simply, the stress of a traumatic childhood event, such as being beaten or constantly belittled, releases hormones that physically damage a child’s developing brain. These children live their lives in a constant state of fight or flight, as the brain begins to perceive everyday places and situations as potentially dangerous. Thus, an adaptation to danger becomes a maladaptation in its permanency. 

With the world either promising danger around every corner or heaping guilt on the developing child, they begin to find solace in diversions. Food, alcohol, drugs, sex, high-risk sports—anything to get their minds off the trauma that is set on rerun in the back of their minds. 

But while this is easy to compute in theory, it’s much harder to diagnose in practice. A neurobiological response to an ACE may remain dormant for years, perhaps not even emerging until much later on in a person’s adult life. A triggering event or phase hits, and latent dysfunction goes haywire, developing into mental illness or morbid obesity, or ruining their marriage (take your pick). So, was it really a midlife crisis gone horribly wrong, or an ACE finally rearing its ugly head?

Add to this the fact that trauma, like many factors, interacts with genetic susceptibility, and we’ve got a very confusing picture indeed. Two people in the same household can go through the exact same experiences but be affected in very different ways, depending on an innate dimension of resilience.

It’s generally assumed that neurobiological markers for PTSD are acquired following a traumatic event. What researchers are finding, however, is that certain PTSD symptoms in a patient may in fact represent pre-existing “upstream” pathological functions that remain dormant until released by trauma. Meaning some of us were hard-wired for obesity, but just needed a supremely unpleasant event to unlock that unhealthy potential.

The Far-Reaching Significance of ACEs 

Rather than trying too hard to convince you why these findings are so important, I’ll refer you to Nadine Burke Harris and her excellent TED Talk. She paints a vivid picture from a practitioner’s perspective, explaining that ACEs essentially provide the missing link to solving head-scratching health cases in many patients.

But if we’re looking for cold, hard facts, it’s hard to ignore the economic viability of integrating ACEs into healthcare. According to a CDC study published in 2012, a single year of trauma during childhood can add up to $124 billion in costs over the lifetime of those children. Of those costs, healthcare and productivity loses account for the lion’s share. If recognizing and treating ACEs could cut those costs by even a quarter, we’re talking astronomical savings down the line.

But what’s the entry point for action here? 

In this case, I’d say it starts with knowledge as power—recognition, self-reflection, and support as needed. Just because someone is consciously healthy now, doesn’t mean they’re living their best life. It doesn’t mean they’re immune to the effects of any latent traumatic childhood events they’ve been unwittingly carrying around. These factors might be responsible for any number of unexplainable things that have and continue to happen in a person’s life, including stubborn health anomalies.

For this reason, the true importance of ACEs lies with you. Recognizing any ACE influence from your own history can provide Burke’s missing link for your own self-diagnosis, enabling you to direct your healing inwards, finally accessing the potential undercurrent of chronic stress and correcting coping behaviors that have been set on repeat. Maybe a strong innate resilience protected you from lasting effects. Maybe that isn’t the case. Unpacking the question may just open up the possibility for a better life, and improved long-term health.

Healing with ACEs 

It might seem a bit cliche, but recognizing that you might be harboring a traumatic event or experience from your childhood can be an incredibly productive, even “freeing” step. There’s plenty of people within the Primal community who have had to work ridiculously hard to get their health back on track—harder than the average person should have to work, it seems. They might occasionally wonder why eating this way or living that way promotes healing in others but doesn’t have any effect on them, or why they always seem to gain weight with but the slightest of dietary tweaks. Or why the penchant for self-sabotage is so powerful….

With this in mind, maybe you’d be interested in taking the quiz. It’ll force you to cast your mind back and analyze your childhood from an objective viewpoint, highlighting experiences that you might formerly have brushed over. Take it seriously—this might just change your life.

The amygdala part of your brain can be relaxed, the hippocampus can restore proper memory function, and the nervous system can rewire itself back to a semblance of normalcy. Ever-present stress can be banished, and widespread inflammation can dissipate.

There’s also a link between gut dysbiosis and stress, and even a single traumatic event can shift your microbiome. We’re familiar with this by now, and recognize that a healthy gut microbiome and a healthy intestinal lining is critical to both physical and mental health. Use this knowledge—it’s a powerful weapon against PTSD and other accumulated symptoms from buried ACEs.

But this is just the start. Your pathway will need to be one of calm consideration and deep inflection. Here’s a quick set of suggestions for moving through it.

  • Write it down. Writing about traumatic or emotional events in one’s life has been directly correlated to improvements in both physical and psychological health. Studies generally indicate that 20 minutes a day is a good amount for this kind of traumatic digging. Examine the event(s) from every angle. It’s up to you what you do with the writing afterwards, but burning it is always cleansing (provided you don’t burn the house down in the process).
  • Practice mindfulness meditation. We keep coming back to meditation as a form of mental rewiring, and it’s not without reason. The research is there to back it up time and again.
  • Find a skilled therapist. Sharing your experience with an impartial third party can help you to find resolution, along with acceptance of a past you can’t change. There’s no reason this should be work you make yourself do alone. Community heals. The right therapist might be part of the breakthrough you’ve been looking for.
  • Look to embodied therapiesTop experts in the field of trauma consider this the new standard for healing because effective embodiment therapies uniquely access parts of the brain most severely distorted by trauma. This could include (particularly trauma-sensitive) yoga (which in one study offered more sustainable resolution to trauma than talk therapy did).

Final Thoughts…

Developments in ACEs represent one of the rare forays of “mainstream” medical thinking into something resembling a more holistic, less reactive style of healthcare. Clearly, it’s only one small offshoot, and as the CDC has cut virtually all funding to this area of research it’s got many roadblocks ahead of it, but it shows some serious promise.

More importantly, it forces us to examine our history in a different light. We are the culmination of a lifetime of experiences, and not all of those experiences are positive. A Primal approach to health should be open-minded and even fearless. In treading where we’re wary to go, we may discover the circumstances that got us stuck in the first place. Loosening old burdens means a freer life and more expansive health. 

Thanks for reading, everyone. I’d love to hear your thoughts on this one. Take care.

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31 Comments on "ACEs and Primal Health"

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HealthyHombre
HealthyHombre
19 days 8 hours ago

Fascinating. Just adds more credence to the field of epigenetics, that our environment affects our genes / health much more than our inherited genes in most cases.

Anna
Anna
19 days 8 hours ago

I notice this years ago watching those weight loss surgery reality shows. The subject would often speak of a death in the family, sexual assault or other trauma that sent them spiralling into grief-fuelled comfort eating, leading to obesity. I have long known about this factor and wonder why it has not been explored more.

Dana Leigh Lyons
19 days 8 hours ago

Food and eating are always about more than *just* food and eating.

For many, many of my clients, their relationship with eating and their bodies is intertwined with past trauma, abuse, heartbreak or loss.

Bringing mindful, gentle, compassionate curiosity to these connections is often pivotal to healing – and to embracing a nourishing way of eating and living.

Jenny
Jenny
19 days 8 hours ago

Excellent post. We all have experiences. The reality versus the perception of the event that can also cause ACE response. The pyramid explains a lot. Thanks.

Jed
Jed
19 days 8 hours ago

EFT. Emotional freedom technique. (tapping) We’ve never talked about that here, but it works on internal trauma and stress that’s trapped in the body. I’ve been doing it for years, but I only use it when I remember to do it. It’s powerful.

yorik
yorik
17 days 20 hours ago

It turns out that EFT tapping points on the face correspond to branches of the 5th cranial nerve. Stimulating that must help somehow. The nerve does trigger some serotonin release (as does chewing!) so maybe there’s some reward in that.

OnTheBayou
OnTheBayou
17 days 11 hours ago

My best friend swears by tapping.

Geranium
Geranium
19 days 7 hours ago

Thank you, thank you for addressing this topic so frankly and kindly.

Jonathan Locke
Jonathan Locke
19 days 7 hours ago
I read a book earlier this year on ACEs called Childhood Disrupted, and it is no exaggeration that it had as profound an effect on my life as reading The Primal Blueprint. Perhaps more so. I have an ACE score of 4, and that meant that for my entire adult life, I’ve struggled with mental health issues. You reach a point, a decade after the trauma, where you think “Why am I still battling? What’s wrong with me? I’ve been through all the therapy, I’ve made lots of self discovery, and yet life is still so difficult.” And the answer… Read more »
Liver King
19 days 7 hours ago
Our biology is truly remarkable as it relates to our ability to heal… we just need to create the right environment for healing to take place. Bruce Lipton’s work regarding The Biology Of Belief demonstrates that we are indeed the architects of our experience. We can, and we do, create cell signals (perceptions) with our thoughts. It may even be possible to become an optimist… even if you’re a firm non-believer, you can do and say things that shift your perceptions and all the downstream goodies that come with. For instance, go outside, connect to the earth… put your hands… Read more »
Katie
19 days 7 hours ago

I am so glad you are bringing this research to the blog, Mark. I am a teacher and my school district has recently been focusing on ACEs research in regards to helping our students. I will be teaching high school Health this fall and I am so excited to incorporate yoga, meditation, journaling and time outdoors into our curriculum. I love that you advocate for the incorporation of these practices into the primal lifestyle.

grey
grey
19 days 6 hours ago
Yeah there are these stubborn bits of ill health here and there–for me, teeth–that don’t conform to my otherwise excellent narrative of primal recovery and health. I’m pushing sixty and think nothing of sprinting up a long hill, leaping into a tree (pretending the dog’s a tiger) and swarming up the tree. I walked forty miles in forty hours the other day for no reason, carrying a weight about the size of badger. Mark once mentioned a study linking dental problems with c-sections, and later I found out from my mother that after my c-section [yes, we male boys have… Read more »
Clay
Clay
19 days 6 hours ago
I experienced ACE in real time. I was stalked and beaten by a much older and bigger bully in our neighborhood. It lasted from 2nd grade until 5th grade when we moved away. I would bite my nails until they bled. I couldn’t stop. We tried that bad tasting nail polish, bribes, rewards…nothing worked. I couldn’t figure out why I was so weak that I couldn’t stop destroying my nails. Then we moved away and I stopped without even thinking about it. It then hit me, I was biting my nails in response to violence that I could not control… Read more »
Grant @ Life Prep Couple
19 days 5 hours ago

Never heard this laid out so clearly. I think it is fantastic to be getting this message out. Never hurts to spread a little empathy along with some suggestions for healing.

Ion Freeman
Ion Freeman
19 days 5 hours ago

Speaking as the father of two young children, I have to say it’s very validating of my decision to avoid incarceration

Clay
Clay
18 days 10 hours ago

Hah! I too have decided to avoid prison. What are the odds?

shasha
shasha
19 days 4 hours ago

What a great and informative post! I can’t remember meeting too many people over the years who didn’t experience at least some of these traumas. Its great that they are finally being addressed and reported on. I hope more research will be done and innovative ways to help will be developed. Thanks Mark, really enlightening and helpful.

davebeas
davebeas
19 days 42 minutes ago

Thank you for another great post discussing mental health in the overall picture of wellness. You mentioned EMDR earlier this week in your post about depression. EMDR is also a very effective therapy for ACEs and trauma.

Groktimus
18 days 22 hours ago

After watching enough weight loss shows my girlfriend once commented, “Can’t any one be just fat? They all seem to be sexually abused.” I admit I lumped most of them into the “just making excuses group” or thought things along the lines of yes it’s horrible but you’re 40 years old get over it category but perhaps I was just being too harsh and ignorant. Well you never know unless you walk in their shoes so assumptions don’t work well. Just like I can’t make people understand carb addiction but it almost killed me.

James Moffett
James Moffett
18 days 15 hours ago
Thank you hugely Mark!. ACE is fundamental to our understanding of our Selves and how we live in our world. I have been in conflict within (as all people are) for as long as I can remember and at 53 years old was about to throw the towel of research in when I came across a book “Freedom” by the brilliant Australian biologist and researcher, Jeremy Griffith, who in his extraordinary writings describes our Human Condition dilemma and the solution. Part of our problem as neurotic and psychotic humans, is our universal experience of ACE as children, from birth to… Read more »
Angie
18 days 13 hours ago
Yep, fascinating…. and at the same time none of it surprises me. We’re complex creatures, we human beings. The mind/brain being our most powerful tool, it’s impossible not to consider that any and every experience hasn’t left an indelible mark. The physical body is a road map for all experiences ever lived. You can see it in a person’s posture – whether they walk tall and proudly, or hunched over in fear. In cases of trauma, I don’t think there’s a magic point at which ‘healing’ occurs. That part that was traumatized doesn’t conveniently go away. You need to keep… Read more »
Deano
18 days 13 hours ago

Interesting post Mark. I’m going to take the quiz now. Cheers, Deano 🙂

Gypsyrozbud
18 days 10 hours ago
As a retired social worker, thank you so much for bringing this issue to the forefront!!!! It is indeed a HUGE problem for our society. So many of my clients had multiple health (and substance abuse) issues which I felt were related to a traumatic childhood experience. However they were so focused on surviving….i.e. Getting enough food to eat, a roof over their heads (see Maslow’s hierarchy) that there was not enough energy (or funds from their scant welfare check) left to improve their health. As a social worker, I often felt powerless to help them, although once in a… Read more »
Caitlin Lee
Caitlin Lee
18 days 8 hours ago

I don’t think you went back far enough. Yes, it’s working on the problem of helping adults with current ACE’s that they don’t recognize, but maybe preventing ACE’s might be a worthwhile discussion? Okay, maybe that discussion isn’t for this blog with it’s mandate, but I think even mentioning it would have been nice.

More funding for all kids can prevent a lot of issues. Ask yourself, are you doing enough to help future generations prevent the issues of today?

Sonrie
Sonrie
18 days 7 hours ago
I’m a therapist and I’ve worked at a community counseling center (re: mostly chronic mentally ill, on medicaid). I struggled to figure out why almost all of my clients had schizophrenia, bipolar disorder, major depression, PTSD, etc AND diabetes, HBP, cancer, arthritis, and other serious physical health issues. Eventually I put it together that almost all of the people I worked with had some form of trauma in their early life, even if it was “normal” for them (they didn’t call it trauma – the professionals did). I only found out when I asked the right questions. I’ve been hearing… Read more »
P3Squared
P3Squared
18 days 6 hours ago

Thanks Mark, it was a very timely article. I’ve been stuck in a place where eating primal just isn’t enough to make a difference to my health. It’s very discouraging to see all these success stories and constantly research and tweak my diet yet not see any positive results nor that boundless energy that others speak of. The ACE’s interaction makes a ton of sense to me. I’m definitely going to follow up further on this.

yorik
yorik
17 days 20 hours ago

Something that might help people is “self authoring”, in which you review your personal story, including your ACEs, and rewrite the story for the future. https://selfauthoring.com It takes a while, but I’m having some significant revelations from it.

Chloe
Chloe
17 days 14 hours ago
Thank God for everybody involved in this study, and thank Mark for writing the article. This has both touched and changed my life, and I cried all of the way through. Not only for myself, but for the deeper understanding and empathy I now have with my friends and family who are effected, and for the millions of people out there who must underdog tremendous suffering – physically and emotionally. This aligns with everything I have researched into psychology (Jean Liedloff comes to mind – The Continuum Concept) and nutrition. I have forwarded this to dear friends already, and I… Read more »
Jeb
Jeb
17 days 11 hours ago
I do believe that a percentage of these underlying issues are probably caused by this “ACE”. I also think this article is also the perfect example of correlation not always equaling causation. I’d have to read all of the ACE studies, and most importantly, see what they controlled for before deciding that ACE was the main or only underlying issue. Because there are also a lot of people out there that are verbally/emotionally/physically/sexually assaulted out there that DO heal, so what is making the subpopulation that has trouble healiing more susceptible/less resilient/less physcially capable of accomplishing their health goals. Did… Read more »
Val
16 days 19 hours ago

Fascinating thought provoking post as always Mark. I’m going to try the quiz as I’m really intrigued by what the result will be.

Margaret
Margaret
16 days 10 hours ago

There is a great book on this topic called “Childhood Disrupted,” by Donna Jackson Nakazawa. She so clearly describes the impact of trauma on the developing brain.

I have an ACE score of 4 and definitely suffer from health problems. It seems overwhelming at times to try to fix everything that’s wrong with me … it’s a slow process, and some days are definitely better than others.

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