ACEs and Primal Health

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.

Primal Kitchen Mayo

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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