The woman who became pregnant during the Stone Age faced huge risks compared with today's mother-to-be. There was no way to control bleeding or infection; Caesarean section was not an option. That we survived as a species seems remarkable - until you dig a little deeper.
The outcome of pregnancy depends on the underlying health of the mother, nutrition before and during pregnancy and the threat of infection. In all those areas the woman of 50,000 years ago was better off than her counterpart today. How is that possible in an age when there was no plumbing, no medical care and no protection from infectious diseases?
Better diet, better pregnancy
The primitive woman's diet was less likely to be deficient in important nutrients than that of today's young girls. (Ref 1) A study from the University of Cincinnati Medical Center has confirmed earlier reports that adolescent and adult pregnant women take in too little iron, zinc, folate and vitamin E.
A woman who begins pregnancy without sufficient calcium, vitamin D and other bone-building nutrients increases her risk of developing osteoporosis in middle age. But that's not the end of the story. Her infant may also be at greater risk of fracture in the future. Osteoporosis of middle age is at least partly programmed before birth, especially if the mother smokes and has little physical activity. (Ref 2, 3, 4)
Most laypersons believe that Stone Agers were hearty meat-eaters. Anthropologists know that isn't so. They lived on a predominantly meat diet for only about 100,000 years, from the time that Homo sapiens developed keen hunting skills until the advent of farming. Before that time meat came from carrion and small game. The bulk of their calories came from vegetables, fruit, roots and nuts.
Plant foods contain everything that a pregnant woman needs, including vitamins, antioxidants, protein and minerals. Modern vegetarians often become deficient in vitamin B12 but small game, birds' eggs and the deliberate or accidental inclusion of insects in the Stone Age diet provided more than enough of that critical nutrient.
Folic acid deficiency in early pregnancy leads to defective formation of the infant's brain and spinal cord. Those abnormalities are much less likely among the babies of mothers who receive an adequate amount of folate, at least 400 micrograms per day. So few women eat enough green leafy vegetables to boost their folate levels, the U.S. government requires that manufacturers of baked goods add it to their products.
Obstetricians have been prescribing multivitamins for their pregnant patients for decades but it is only in recent years that studies confirmed the wisdom of that practice. In 2002 the American Medical Association reversed a position of long standing and recommended that everyone, with no exceptions, needs a multivitamin/multimineral preparation every day in order to avoid subtle but health-damaging inadequacies of these nutrients. Taking a multivitamin reduces the risk of congenital defects of the newborn, especially those that involve the heart. Preeclampsia is a serious, sometimes fatal complication of pregnancy. Women whose intake of vitamins C and E is low have a threefold greater risk of that condition. (Ref. 5, 6)
Would these mostly vegetarian early Stone Agers have become iron-deficient? Not likely. Their diet was rich in iron as well as in Vitamin C that facilitates iron absorption. Under those conditions iron deficiency would have been rare. Cereal grains interfere with iron absorption, which explains why iron-deficiency is common in societies that subsist primarily on grains. However, one of the main reasons why Stone Age women were unlikely to be iron deficient is that they didn't have nearly as many menstrual cycles as modern women do.
In a primitive society the onset of menses is about 5 years later than that of American young women. Modern hunter-gatherers, like the oldest Stone Agers, are either pregnant or nursing during most of their childbearing years and they only menstruate a few times between weaning one child and conceiving another. In those groups breastfeeding does suppress ovulation because it is literally on demand, i.e., every few minutes, even throughout the night. For a modern breastfeeding mother, on demand often means no more frequently than every couple of hours and perhaps once or twice a night after the third or fourth month. Thus menses return in spite of nursing and monthly blood loss continues.
The fish-brain connection
Beginning about 150,000 years ago our ancestors discovered seafood. The increased intake of fatty acids in fish and shellfish initiated the great advance in brain size and complexity that allowed humans to progress more quickly in the next 100,000 years than they had in the preceding million. Enormous gains in toolmaking and the development of language and group communication followed.
The human brain is composed mostly of water but the solid portion is mostly fat. The body can't manufacture the omega-3 and omega-6 fats that make up so much of the structure of the brain and eye so we need them in our diet. Maternal deficiency of these nutrients, especially omega-3s, prevents the newborn brain and eyes from reaching their full potential. The best source of omega-3 fats is fish; nuts and leafy green vegetables are also good sources.
Omega-3 and omega-6 fatty acids are found in every cell of the body. They allow efficient flow of nutrients, regulate nerve impulses and keep inflammation in the right balance. In a proper diet there is an equal amount of omega-3 and omega-6 fats. That allows the immune system to fight infection, a real threat that humans faced from the Stone Age until the age of antibiotics, a mere 70 years ago.
The advantage to the baby of a diet that is rich in omega-3 fats is obvious but mothers need it, too. Nature protects the unborn infant by tapping into the mother's stores of omega-3 fats. A woman whose intake of omega-3 fatty acids is low during the months and years preceding pregnancy will develop a deficiency of her own. This becomes worse with succeeding pregnancies if her intake of omega-3s remains low. Postpartum depression affects about 10 percent of women following delivery and it is associated with a deficiency of omega-3 fats. (Ref 7, 8)
The newest epidemic
There is one complication of pregnancy that never occurred in the Stone Age: type 2 diabetes. No disease in modern times has risen so fast. It has increased several-fold since the 1950s; between 1990 and 2001 it rose by 61 percent. Gestational diabetics (Ref. 9) are those who do not yet have the full-blown disease but they cannot process blood sugar (glucose) properly during pregnancy. About half of them will develop frank diabetes in the years following delivery of their infant.
Most of us know type 2 diabetes, which was once referred to as adult-onset diabetes, as the disease that our grandparents developed in their later years. It's no longer uncommon to find it in adolescents, even in grade-schoolers. As it has dipped into the younger generation it has alarmed - but not surprised - physicians to find that it is no longer a rarity in obstetric practice.
How can we be so certain that the pregnant Stone Ager didn't have diabetes? This is a lifestyle disease that has three major associations: a low level of physical activity, a diet that is high in refined grains and sugars, and obesity. Those conditions simply didn't occur during the Stone Age. Their lifestyle demanded strenuous effort. Grains of any sort were not part of their diet because they require tools and controlled heat. Sugar as we know it simply didn't exist and honey was an occasional lucky find. Obesity would have been non-existent, as it is today among the planet's dwindling populations of hunter-gatherers.
Diabetic mothers have more complications of pregnancy than normal women do. Their babies are 5 times as likely to die and are 3 times as likely to be born with abnormalities of various organs.
They kept germs at bay
Common wisdom states that Stone Age people were an infection-ridden lot but that simply isn't true. They had powerful immune systems because of high levels of physical activity and a remarkably varied diet. Between the protective antibodies that a mother passed across the placenta and those that she conferred on her newborn via breastmilk, Stone Age babies had more protection against the germs of the day than modern infants do.
Sexually transmitted diseases don't spread very far or very fast when people live in small isolated bands as they did during the Stone Age. The likelihood that today's pregnant female will have at least one of these infections is more than 50 percent (Ref. 10). The impact on babies can be severe; some die, some will be brain-damaged.
Choice and consequences
Tobacco, alcohol and illicit drugs have produced a generation of infants with problems that Stone Age babies never faced. Mothers who smoke have infants that are smaller than the norm and whose brain development may be compromised. Alcohol or cocaine use by the mother during pregnancy results in stunted growth, congenital defects and other severe problems.
Given a choice, none of us would want to live in a Stone Age world but we have neutralized the almost miraculous medical advances of the last century. We have allowed our daughters to be less physically active and to subsist on a marginal diet. If we could reverse those two factors alone there would be a dramatic decline in prematurity and other complications of pregnancy.
The lessons that we can learn from the Stone Age are not subtle, obscure or beyond our capacity to imitate them. We can produce the healthiest generation ever by making better choices for our children and for ourselves.
Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him via his web site at http://www.stoneagedoc.com.
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