My Knee is Killing Me… No, Really.

One of the standard defenses uttered by those who desperately cling to the fast food and couch-potato lifestyle is, “why should I live like a hunter-gatherer? Their average lifespan was only 35 years.” Ipso fatso, if we clearly weren’t designed to live long, why make all those diet and exercise sacrifices?” This common faulty assumption that our hunter-gatherer ancestors lived “nasty, brutish and short” lives has always bugged me. Research suggests that Grok and his family were actually generally healthy (robust is the term), productive – and even so appreciative of their lives that they felt the need to express themselves through art. There are recent studies that suggest there may even have been a selective benefit within tribal units for grandparents – meaning that getting older may have actually had a selective benefit far past procreating. So, if they were so robust and if our genes truly evolved to allow us to live long lives, then why was the average lifespan relatively short? I had always assumed that it was things like deaths during childbirth, infections, accidental poisoning, even tribal warfare that brought the average lifespan down. But then I got a real-life experience of what might have affected the average more than anything else. And it’s really mundane, folks.

I made an unusually bad dive while playing my favorite game “Ultimate Frisbee” last September, slamming my knee hard into the ground and driving my knee-cap down my shin. The result was a torn quadriceps muscle, a ruptured prepatellar bursa and a smashed nerve. An x-ray revealed no other damage and my orthopedist said the soft-tissue injury would heal in 8-12 weeks. He advised me to use pain as my guide and come back slowly. Since I had no pain at all (smashed nerve, remember) I felt like I was recovering fairly quickly – to the point of even resuming my beach sprints in early December. As everything was on track, I decided to go snowboarding six days in Aspen over Christmas break. But despite wrapping the knee every day and taking it fairly easy, (wink, wink – and again no pain) I came home with a very swollen, black and blue knee. By the end of the week, I was unable to bend it more than a few degrees. An MRI revealed a large “organized hematoma” over the quad and kneecap which needed to be removed surgically – otherwise I would carry it with me forever. I went under the knife on January 9. It turns out that the original torn quad muscle had never repaired itself and was leaking blood into the space causing the hematoma. So my surgeon removed the hematoma and stitched the quad back to the patellar tendon. Total recovery time now: 12 weeks.

I tell you all this to illustrate a perfect example of why Paleolithic people may have had such a short lifespan. Here I am 54 years old, with the body of a 25-year-old (and the mind of a 17-year-old) looking forward to living well past 100…but I am effectively incapacitated for over two months now by an injury caused by a random fall. Of course, I have the luxury of modern surgical procedures to repair the damage and get me back on my feet (more on that in a later post) – but had this been 10,000 years ago, my inability to run towards dinner or away from a predator or to stand my ground against an invading tribe might well have been the beginning of the end of me. A small accident that today we take for granted – a fall from a tree branch, off a cliff, a broken arm or a rolled ankle – may have been enough to seriously jeopardize an otherwise healthy older person. The fact that I don’t have the same testosterone levels I had in my 20’s (when I could recover from an injury in two weeks) puts added pressure on my being able to safely afford two or three months of relative inactivity before I am able to hunt and gather effectively once again. The big revelation for me was that our ancestors had all the genetic potential to live to 80, 100 or longer – the lifestyle almost by definition precluded death by any degenerative diseases – but that daily living presented so many obstacles that eventually your number was up. Hence the “average” lifespan dropped and ruined it for everyone.

Alfer22 Flickr Photo (CC)

Further Reading:

Would Grok Chow the Cheese Plate?

What’s All This Talk About Inflammation?

Extreme Exercise: Ultimate Frisbee Included

Medieval Serfs Ate Better Than We Eat

Who Needs Shoes Anyway?

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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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45 thoughts on “My Knee is Killing Me… No, Really.”

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  1. Actually, the short lifetime of Paleo humans isn’t the major problem with your diet theory (though your post above falls short on that too). The bigger issue that you fail to address is that humans have evolved considerably in the past 10,000 years. Just two examples: light skin and the ability to digest lactose are recent developments since the days of Grok. There is now considerable evidence that human evolution has been speeding up even in the past 5,000 years. So basing a diet on peoples that we don’t have much in common with really does not make sense.

  2. Tim,

    I disagree that there is “considerable” evidence human evolution has been speeding up. Regarding your two examples:

    1) Evolution of human skin pigmentation has been ongoing for at least 100,000 years of human migration out of Africa and, if anything, probably ceased or slowed down substantially in the past 5,000 years when clothing and shelter removed most remaining selective pressures.
    2) Lactose tolerance is often submitted as one of the few – if not only – examples of relatively recent genetic adaptation. But there’s a big difference. It’s not as if we adapted a means of digesting a foreign substance or new food. Humans have always had the ability to digest lactose – it is the main sugar in breast milk. What has changed is that some descendants of long-term dairy-based societies seem to have retained the ability to continue to digest lactose well past being weaned.

    So I stick with my original argument that the Primal diet and exercise styles are the ones we evolved to thrive on and would do best to stick with today.

    1. I want to add clarification as Bovine Lactose digestion is a mutation over 70% of the population has inherited and which occurred approximately 8000 years ago. Approximately 7400 years ago we have record of consuming it where it seems to have started in what is now Turkey. I only add this clarification as someone may not pickup your two lactose distinctions in your second point. As humans we have always had the ability to digest human lactose, Just not lactose from other species.

  3. Mark,

    Speedy recovery! I’m the same mentality. I messed up my wrist and shoulder playing ice hockey…so I just keep on playing! 😀 Thank god for supermarkets….makes it alot easier to hunt dinner!

    1. I’m not a genielogist (sp,if that word even exists) but I can only take from Mark how his advice has affected me. Since going primal, and only two months ago at that, I feel lighter, fitter, and full of energy. I never feel bloated, or overly full anymore. Nor do I feel like I HAVE to eat every few hours. I have only continued to feel better and look better, aside from those few benefits I look at Mark as a Leader by example. While other leaders of diets “sell” their theories and advice Mark gives it for free and appears to be living a more healthy and happy life style because of it. I think that is what really swayed me toward Grokking, is the fact that someone is only saying “This works great for me and others, give it a try!”

    2. Tim,

      I noticed a couple things about the articles you posted. Number one, the researcher involved in the first one said there were probably other genes that cause paling in europeans. Not that this throws out the point, there may not be other genes, pale skin may truly be that recent. But it’s far from a certainty in either direction.

      The second thing was cool, because I had long believed it even though I hadn’t heard the explanation: human evolution is accelerating because of rapid population growth and massive changes in diet. This clearly means we are still adapting to eating grains and sugars.

      But that doesn’t mean we *have* adapted to it yet, and it is likely going to be a long, slow, arduous process taking place over countless generations. 5000 years may be extremely rapid in geological terms, but it’s still pretty damned long in terms of generations.

      So why bother with the unnecessary pain? Scientific progress will likely make other food cheaper to the point that we don’t need grains. And if you don’t have any health problems with grain consumption, by all means, enjoy your baguettes and english muffins. But if you do have chronic health problems give this a try. Remember that nutrition is still a very inexact science, we don’t know everything about optimal diets yet, and we do know that this level of grain and sugar consumption is unprecedented even in the past century.

      All that said, thanks for the post, it was a very interesting read, and I always enjoy a good debate.

      1. Lol, sorry, didn’t notice the date. I thought this was new. I don’t really expect a response.

    3. I know this is several years after the fact, but it is something that should be noted. Genetics are not the only thing that affects skin color. Diet affects it as well. Certain fruits such a papaya will over time cause your skin to darken a little. If you are outside a lot, your skin will be a darker tan.

      I mention this because I have seen it in action. As a child I ate a lot of tropical fruits, and my skin tone was darker. Due to my Northern European genetics, it had a red tint to it. When out in the sun, my skin would turn a dark brick red, rather than a tan. That is what my genetics at work. Genes play a large role, but remember, our children inherit the changes not us. The next generation gets the benefits, we don’t.

  4. Hi Tim,

    Very interesting links. I’m with Mark on this one though. Just because our genes have changed doesn’t mean we’re all of a sudden adapted to eating grains.

    I do agree that we’ve begun adapting to an agricultural lifestyle. You can look at the duplication of the salivary amylase gene, lactose tolerance, resistance to zoonotic diseases etc. You can also point to the fact that the first generation to go from hunter-gatherer to agriculture is usually very unhealthy.

    But I think we are far from fully adapted. Just look at the obesity/diabetes/heart disease epidemic. And modern humans still have not achieved (on average) the level of skeletal and dental development that paleolithic people had. We accept slight frames and crooked teeth as normal when in reality they have only been common since agriculture, and continue to be common to this day.

    The fact that we’re evolving rapidly means we are being subjected to strong environmental pressures, ie a lot of us are being weeded out. I would argue that most of this selective pressure is being put on us by the agricultural lifestyle. In other words, the fact that we’re evolving rapidly means we aren’t fully adapted to our current environment.

    On another note, I just started a blog:

  5. Tim,

    When you suggest my facts are out of date, you are assuming that there are actually “facts” that all scientists agree on in these fields of paleobiology, evolution, genomics, nutrigenomics and epigenetics. Most would agree that “facts” are very hard to come by in these fields. We all work off of theories, hypotheses and selective data, but that doesn’t mean that there is any real answer to these questions. If there were, everyone would be doing the right thing and agreeing on it.

    The PNAS paper you cite is interesting, but I disagree with the interpretation of the findings. The authors state “the past 10,000 years have seen rapid skeletal and dental evolution in populations…” to which I have to laugh. I guess it could be called “evolution” in the strictest sense, but when smaller, brittle bones and bad teeth are considered examples of “evolution”, it only builds my case.

    Sasquatch suggests that there has been some “adaptation” to agriculture. Salivary amylase is one example – but again, it’s not as if we didn’t have SA to begin with…just that some individuals have a SNP or two that causes an increase in the amount produced. I would argue that a ready supply of calories (grains and livestock available with advent of agriculture) allowed humans to multiply at a much faster rate without having to migrate. That higher birth rate automatically increased (linearly) the number of random mutations. Those mutations have a better chance of surviving (ie not being selected against) when that same ready supply of calories – however maladaptive – still allows people to achieve reproductive status and pass those genes along to the next generation. However, that doesn’t mean that the random mutation confers a selective or adaptive benefit, even though it may exist in the progeny for generations or maybe even forever. There are some (Jared Diamond, for one) who argue that agriculture, by removing a major selective pressure for food, actually allowed otherwise unfit individuals to pass along non-beneficial genes without penalty. Devo, if you will. Bad teeth, smaller stature and brittle bones being examples.

    Still sticking to my philosphy. Thanks for the references, too.

  6. Hi Mark,

    This is turning into a nice little discussion. I like your idea of accumulating mutations due to a lack of selective pressure. I’ve often thought about that myself. I call it “devolution”. I’m not sure that was happening when we first adopted agriculture and it was making us really sick, but I bet it’s happening today to some extent.

    We live in a climate-controlled world where we can drive and take elevators almost everywhere. If we can’t see, we get glasses and cataract surgery. 20,000 years ago, if you couldn’t get around and couldn’t see, you were dead. With technology and medicine coddling our lives, even the very sick survive, and we don’t “weed out” mutations that would have conferred a disadvantage in the past.

    And about the duplication of salivary amylase and lactose tolerance, I agree that those are crude adaptations. Not the kind of thing you see with true long-term adaptation.

  7. An interesting discussion indeed, and not everything I’m about to say here is completely thought out. Still, I’ll throw it out and see what others can do with it.

    Surely we are also seeing diseases that would be maladaptive in younger people, but are not selected against because they occur either after our reproductive years or so late in reproductive years that we have already passed the genes on to at least one offspring. I’m thinking of things like diabetes and most cancers, of course. I don’t think that particularly supports either Mark or Tim’s point, but it’s fascinating to contemplate whether natural selection cares about the survival of postmenopausal women. I think it was Diamond who suggested that having a grandmother around to care for children was, in fact, adaptive, because offspring in our species are more vulnerable, for longer, than virtually any other species.

    Another thing we have to consider when we try to talk about what would happen to humans in nature is that pretty much anything humans do IS nature. So the fact that we have learned to process grain, allowing more of us to survive (though not necessarily to thrive) to reproductive age means that we are evolutionarily adapted to eat grain, because we evolved big brains and opposable thumbs that helped us grow, store, sprout, grind, and/or cook it. (Sorry, Mark, I think that’s a point for Tim.)

    However (and this is a point for Mark, I think), the problem with natural selection is that it doesn’t “care” whether we thrive, it just cares about whether we survive long enough to reproduce and to rear our notoriously helpless offspring. So evolution may favor the eating of grain simply because it provides enough energy for us to squirt out a few seedlings. That does not imply that we will thrive on grain in the long term, though. That does not mean that we are biologically equipped to eat grains for 80 years.

    One final point – maybe you can argue that 10,000 years is long enough for us to have evolved some adaptations to the agricultural diet. But surely you can’t argue that 150 years (about 5 generations) is enough. And certainly the worst stuff in our diets – highly processed breakfast cereals, artificial flavorings and colorings, trans fats, HFCS – have all appeared in that time frame or even less. So whatever we think about the pace of evolution, surely we can all agree that any processing that our great-grandmothers couldn’t have undertaken in their own kitchens – chopping, grinding, fermenting, cooking – is sketchy at best.

  8. Sasquatch, Tim, Migraineur, Scott, Mike OD,

    I think I may have to do a piece on this. Part of what we are dealing with here is a semantic issue: how is the term “evolved” to be used in the context of the Primal Blueprint? On the one hand, evolution does mean “the changes seen in the inherited traits from one generation to the next”…on the other hand, I have always put evolution in the context of “favorable heritable traits that become more common in successive generations of a population while unfavorable traits are selected out”. And I think here we see the distinction being argued.

    Scientists are showing that there is more genetic diversity now than ever before. Agreed. But in my mind, that is NOT indictative of evolution as it relates to natural selection. What they are measuring is/are simple SNPs and gene variants and then calling that “sped up evolution”. In many cases, they are suggesting that there are more harmful SNPs than beneficial. These can add up to thousands of points of difference between races or geographically isolated populations. I see it as a natural effect of having millions of people on earth (and now billions) who have allowed short-term non-lethal mutations to be passed on to their progeny. The fact that there are effectively none of the selection pressures that our ancestors dealt with for the first 2 1/2 million years of human evolution means that any and almost all products of random mutation or genetic drift are incorporated into the genome without penalty. And passed on to the next generation similarly. As a result we have a litany of documented SNPs that predict greater risk for certain diseases…but they certainly do not guarantee that the possessor will get the disease. I really do think it is a form of devolution. I argue that adhering to the same type of diet and lifestyle (environment) that surrounded the original “design” process of the prototypical pre-agricultural human will almost always significantly reduce the disease risk of the offending SNP. But that’s just my theory.

    Furthermore, the concept of epigenetics has not been discussed here, but we may find that, in terms of gene expression, our maladaptive agriculture-based diet not only promotes higher birthrate AND allows an individual to attain reproductive status regardless of “fitness”, but also actually influences outcomes of future generations. You could argue that we are in a mid-adaptation phase in our evolution vis a vis grain for instance, but since we haven’t fully adapted, we still suffer from the ill effects (some are affected far more than others, but all are in some way affected negatively). I say, When in doubt, consult the orginal blueprint.

  9. Mark,
    Epigenetics is a very interesting topic that I’ve touched on a couple times over on my site. Epigenetics is, as you said, why some people can be “susceptible” to a disease genetically, yet not get that disease. Epigenetics is the upper layer of that onion that determines which genes are expressed and which aren’t, the genotype vs the phenotype.

    I recall reading that in one of Jared Diamond’s books as well, that as a whole, we’re allowing maladaptive features to exist because of civilization and our ability to take care of all. I also recall him saying that amongst the tribes he’d met, they were, contrary to popular belief, far from unintelligent. In fact, he argued that on the average, they were more intelligent, though in Western society, their inability to use a computer or do other tasks of “education” would label them as stupid. Just as I and most others here probably have the intelligence to learn to fly a plane, we lack the knowledge. In a hunter-gatherer society, they have to remember the locations of feeding and watering grounds and which of thousands of plants are edible or poisonous; we just have to remember how to get to Kroger. Diamond argued that the less intelligent get weeded out in a hunter-gatherer society because they do something unintelligent. In our society, the less intelligent go on Jerry Springer.

    Anyway, I agree with you that “evolved” is a tough word. The gene to keep lactase turned on is a genetic modification, but on the whole, humans are largely the same as we were 15,000 years ago.

    Scott Kustes
    Modern Forager

  10. I just had my third surgery (meniscus tear) and it looks like my high impact days are over. I tore my ACL at age 18, later needed arthroscopic surgery to remove scar tissue and now this. Not to mention the three on my nose from fighting MMA… I recently switched to a primal lifestyle and I am never EVER going back!

    -Cheers from Panama Mark, keep up the good work!

  11. Back in what I think was grade 8.. maybe 7.. I tried out for the school volleyball team. Made an awesome dive where I literally did a barrel-roll.. like a screw.. hit the ball and scored a point. Didn’t get selected for the team!!

  12. If you watch “The Perfect Human Diet” You will see the explanation of some of the best scientists in the world telling how we have not changed at all (blueprint) just the expression of different genes are what has been happening and that this is due to environmental factors including diet, exercise, level of activity…etc.

    The most interesting part to me was the they explain why so many people have glasses and crooked teeth (as I have both). Not that crooked teeth or poor vision are being passed on from one generation to the next as a form of Devolution, but because our grain/sugar based diet is not allowing full expression of the best genes in us from the second of conception. They go on to say how since grains have so much energy and we are lacking full needed nutrients from lacking of veggies and fruit, in them and we are not using our jaw muscles as much to chew that our body isn’t expressing the genes to let our jaw grow to its full genetic potential while things like number of teeth stay the same so smaller jaw plus same amount of teeth equals crooked teeth. Same goes with head size so many people are nearsighted due to again also relating to the jaw not chewing as much during bone growth, lack of good nutrients (lots of energy from grains not a lot of nutrients) and less using of our eyes to hunt causing smaller head size and not as active eyes thereby causing nearsightedness.

    There are even more examples! Watch the documentary very interesting!