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Ancient Egyptian Atherosclerosis and Diet

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Comparing trends in diet and disease during ancient times to contemporary times, in a meaningful way, can be a very difficult task. Diets present in the past may not be present in the future, or they may have changed. Diseases, however, can sometimes be traced back to ancient times and a mistake can be made when labeling diseases as “modern.” Atherosclerosis is a disease, linked to high cholesterol and diet, in which calcified deposits build up in major arteries and can lead to heart issues such as hypertension (high blood pressure) and myocardial infarction (heart attack). Atherosclerosis, in Egypt, has increased in prevalence from ancient times to contemporary times because of a change in dietary habits of its countries citizens. Examination of ancient diets, contemporary diets, and how the two compare and contrast will help shed light on this argument in order to show how dieting has changed and how it has affected the continuation of this disease process. Because diets are not expected to be completely the same in ancient times as they are in contemporary Egypt, this paper aims to see how trends in diet between the different class systems has changed from ancient to modern times and to see if this can be related to the increased prevalence of atherosclerosis.

Ancient Egyptian Atherosclerosis and Diet

Ancient Egypt contains a vast amount of knowledge about our past that can be applicable to our future. Atherosclerosis is a disease that is being studied in ancient Egyptian mummies. Thompson et al. (2014) describes the disease aby stating, “Atherosclerosis is thought to be a disease of modern human beings and related to contemporary lifestyles.” However, we now know this to not be the case. Bioarcheologists have found evidence of the calcified deposits cause by atherosclerosis in the arteries of many mummies from ancient times. David, Kershaw, and Heagerty (2010) states, “More recent multidisciplinary investigations of mummified remains have provided evidence of arteriosclerosis among elite groups in Egyptian society, particularly those individuals with priestly status and their immediate family members.” Many different types of studies have been completed including computed tomography and tissue sampling. According to these studies, it seems that in ancient Egypt, the higher-class citizens tended to have more of an occurrence of atherosclerosis. David et al. (2010) provides evidence of this stating, “in a selection of twenty-two mummies of Egyptians with high social status, sixteen of these where the hearts or arteries could be identified, nine mummies showed evidence of vascular calcification.” However, although arteriosclerosis has been clearly identified in mummies, it seems to have been fairly uncommon in ancient Egypt. The disease seems to have been more of a risk factor for citizens of the higher class and this can be the case for many reasons including fattier diets leading to high cholesterol and improper exercise.

The link between diet, cholesterol, and atherosclerosis in ancient Egyptians is an important consideration. Mayerl et al. (2006) discusses taking dehydrated tissue samples and plaques from Egyptian mummies in order to evaluate them for atherosclerosis. The scientists determined that the plaques consisted of connective tissue and cholesterol and postulated that, with research done on rabbits, risk factors for this included improper diet, stress, and exercise trends. Cholesterol is an important factor when trying to decipher how this disease has changed. Grundtman and Wick (2011) argues their research by stating, “Our hypothesis is that cholesterol levels of human beings considered ‘normocholesterolemic’ in terms of current medical criteria are still significantly hypercholesterolemic from an evolutionary viewpoint.” Basically, these scientists are looking at cholesterol trends across time. By taking dehydrating tissue samples and testing them they have been able to see that the “normal” cholesterol values in today’s medicine, are actually evolutionary higher than the levels that would have been considered normal during ancient times. The conclusions that were reached in this study are trying to say that we have evolved, culturally, much more quickly than biologically because our trends in diet have changed much faster, even in the last one hundred years, and thus has not given our genome near enough time to keep up with this trend. Western diets have greatly altered the normal levels of cholesterol and of our body composition, in general, and will continue to do so in the future if the world continues to adapt Western diets. Egyptians had a much different diet than we do today, which can help us to understand ancient atherosclerosis.

Hieroglyphs have been instrumental in learning what kinds of diets were utilized in ancient Egypt and how they differed between the class systems in the hierarchy. Randall et al. (2014) discusses these diets from surviving papyri and paintings on the walls of tombs of the mummies that are being researched. Agriculture was advanced during this time and included domesticated goats, cattle, and fowl. There was also an abundance of fish from the Nile and cereal grains. The working-class citizens would have relied on a diet of farmed wheat, barley, fish, and cabbage. Bread would have been one the of the biggest staples, along with fish, in the diet of the lower class. The upper class, along with fattier proteins, would have consumed a large amount of honey, one of the main sources of sugar for them during this time. (Thompson et al. 2013). Because of their importance, priests and royal family members would have consumed the fattier goats, cattle, and fowl that were offered up during sacrificial rituals. Because of the less demanding physical work of these members of the elite class, lack of activity level and exercise would also contribute to the occurrence of arteriosclerosis. David, Kershaw, and Heagerty (2010) also provides more evidence stating:

“Interpretation of the hieroglyphs indicates that the diet consisted mainly of beef, wildfowl, bread, fruit, vegetables, cake, wine, and beer. Many of these food items would obviously have contributed to an intake of saturated fat, and our analyses of the individual meat and wildfowl they consumed would demonstrate that all provided greater than 35% of energy from fat. Goose, which was commonly consumed, contains around 63% energy from fat with 20% being saturated, while the bread that was eaten differed from that consumed today, often being enriched with fat, milk, and eggs. The cakes were typically made with animal fat or oil. Although it is difficult to calculate exactly how much was consumed in terms of portion size, variance in food storage, preparation, and cooking methods, it is still evident from a conservative estimate that the dietary energy was more than 50% from fat with a significant portion of this coming from saturated fat.”

Being able to break down ancient diets to see how much more fat consumption was used is important in being able to compare it to working class diets to see the difference in nutrition and thus explain why arteriosclerosis was not found in working-class mummies.

The lower class consumed a much different diet than that of the elite class and despite the fact that one might think they would be more prone to this disease, because of their diet, they were often protected and spared. Abdalfattah et al. (2013) examines one case of a mummy that would have been a nurse maid to the elite and compare her diet to the normal diet of lower class citizens. Fish would have been considered unsuitable for the upper class and, because of its overabundance, would have been a staple in the diet of the lower class. Eating fish, because it is a lean protein, would have given the lower class healthy omega 3’s along with a low-fat protein option. Because of these reasons, the lower class have shown no signs of heart disease or arteriosclerosis. Lady Rei, the mummy being researched, would have been privy to the diet of the upper class and therefore would not have received the health benefits of eating the healthy omega 3’s. She had advanced atherosclerosis and probably suffered from symptoms, including myocardial infarction (heart attack).

Learning the diets of the past can help us to understand the current trend of atherosclerosis in the present. Diet trends have not remained the same over time, in most cultures. Adaptations to different ways of cooking will be explored to see if there are any changed in the modern Egyptian diet. Research aims to help us to see if higher class, contemporary, Egyptians are exclusively affected, or if the lower class is now affected as diets have changed throughout time. By doing this we can, perhaps, try to understand the trend in modern Egypt and predict how the future will change the prevalence of this disease.

Atherosclerosis in Contemporary Egypt

In order to make a comparison of the diet trends in Egypt, we must not only look at the past, but also the current trends in modern Egypt. While thought to be a disease that mostly effects men, Egyptian women tend to be equally at risk for atherosclerosis. Abdelfattah et al. (2013) lists the main causes for the disease in women, stating main occurrences in “obese, sedentary, hypertensive, dyslipidemic women with metabolic syndrome, and smokers with advanced atherosclerotic coronary artery disease.” The scientists in this study relate the reason for the increase of incidences of atherosclerosis in modern day Egyptians as a rapid change in diet trends. These trends include the reliance on “high caloric content foods, high in carbohydrates and fat, and low in fiber which is accelerating in contemporary Egyptian society.” A study performed by Allah, Baligh, and Ibrahim (2010) looks as statistics of this disease in modern Egypt stating:

“Atherosclerosis is a major cause of ischaemic stroke, of which thromboembolic phenomena account for a significant proportion. It is estimated that extracranial carotid artery disease is responsible for 20–30% of strokes in developed countries. We conducted a 5‐year survey study of 4733 Egyptians using extracranial duplex, in Cairo University Hospitals. Atherosclerotic carotid disease was detected in 41% of the studied population, of which 17.6% in the form of intimal thickening, and 23.4% in the form of variable degrees of stenosis.”

The study showed that there is a significant prevalence in the number of people developing atherosclerosis in contemporary Egypt. Allam et al. (2014) compared the trend from ancient to modern in a study that bore results stating “Vascular calcification was detected in 108 of 178 (60.7%) modern Egyptian patients versus 26 of 76 (38.2%) ancient Egyptian mummies,” showing that the disease has become more severe in modern Egypt. A deeper look into the modern trends in diet are essential to understanding the increasing number in atherosclerosis victims, which will be discussed in the next paragraph.

The similarity of the modern Egyptian diet to ancient times, is more shocking than one might have believed. Hassan-Wassef (2014) discusses this in great detail in his study of the modern Egyptian diet. He performed numerous participant observations along the Nile, studying the different class systems to see how the diet has changed and how it differs in today’s world. He notices that one thing is not different from the ancient Egyptian diet: bread. He states that:

“Bread, the staple food, enjoys a very special place in the diet. It is still made from high extraction wheat flour or wheat mixed with other ingredients. It is the main ingredient in all meals. Egyptians eat food with bread and not bread with food.”

Bread was one of the staple diets of the lower class in ancient times, as cited before, it is interesting to see that it is still so important in the diet of modern Egyptians. Hassan-Wassef also investigates how the consumption of bread has changed and there is one very important factor that has changed from ancient to modern times: salt. The amount of salt witnessed being added to bread and other foods was excessive and because of the correlation between salty foods and high cholesterol, this is definitely one food practice that is adding to the increasing problem of atherosclerosis in modern Egypt. Because “food is eaten with bread,” the increased usage of honey also needs to be examined. Honey tended to be a food source of the upper class in ancient times but is now readily available to all classes of modern Egyptians, and, it is used heavily in fruit pastries and alongside bread consumption. Hassan-Wassef (2014) also states, “The heritage of ritual food habits and culinary traditions of contemporary Egypt represents an unbroken continuity from ancient habits.” The data, shockingly, shows that many of the same diet trends, with some modification, are still present and therefore would explain why atherosclerosis is still present, and rising, in modern Egyptians.

When examining the differences between class systems of modern day Egyptians, Hassan-Wassef (2014) summarizes the differences stating:

“The higher social classes were much more readily influenced by the food habits of the foreign ruling elite. The simply prepared foods of the traditional diet gave place to elaborate dishes requiring complex, lengthy preparation and generous amounts of clarified butter, with less attention to the consumption of fresh vegetables. Deep-frying, the use of rich, composite sauces and the growing popularity of rich sweet meats and desserts containing nuts and soaked in heavy syrup considerably raised the overall intake of sugars and saturated fats. White bread, in many instances, replaced the traditional high extraction local bread. Many of the nutritionally valuable traditional food associations were ignored. For people living in poverty or those with limited in- comes, changes were more related to the need to cope with rising food costs and to making nutritionally correct choices. By necessity, they depended on the cheaper traditional foods and the subsidized local bread.”

There is a marked difference between how the higher and lower-class citizens prepare their food, but there is still a heavy reliance on bread in both diet trends.

The higher-class citizens have tended to follow popular dieting trends from around the world. As different trends became more popular, they have tried to adapt these trends into their diet, abandoning ancient dieting practices, except for the continued use of bread as a staple in their diets. Because of the change in not only ingredients, but in preparation, the new diets of the higher-class citizens would have definitely been a factor in the increase in prevalence of atherosclerosis in Egyptians. The lower class, because of their heavy reliance on bread, but also the need to rely on less nutritious foods because of cost, have now become victim to the disease as well, which is a change in the trend from what was seen before in ancient Egyptians, in terms of atherosclerosis.

A Comparison of Atherosclerosis in Ancient and Contemporary Egypt

When looking at these diet trends, the researcher expected to see a flip of affliction tendencies of atherosclerosis. When thinking about modern Western diets and how the poor tend to have less nutritious foods, because they are cheaper, while the rich can indulge in healthier foods that are more expensive, one would think to see this same trend in Egypt. Making the connection between atherosclerosis and diet from pharaonic times to modern times may seem to be a difficult task. One scientist, before starting a particular study regarding this comparison, Adel et al. (2014) states that “Atherosclerotic vascular disease is a major health problem with the highest rate of morbidity and mortality worldwide. Atherosclerosis is often thought of as a “modern” disease, a product of lifestyles and diets much different than that found in ancient civilizations.” With the research presented, and even this scientists conclusion, we now know this is not the case. There has been a shift in those afflicted by this disease and in dieting trends.

In ancient times, the lower-class citizens were protected from this disease by their, so called, “poor man’s diet” of mainly fish and bread. The healthy omega 3’s provided these citizens with a way to equalize the high carbohydrates in the bread that they would have been eating. The higher class, because of their desire to indulge in all of the luxuries life had to offer, would have existed on fattier proteins and cakes. Thomas, Wann, and Nerula (2014) state that “Modern risk factors were already emerging with the changes in agriculture and animal husbandry, which led to the development of atherosclerosis.” He is referring to a comparison between modern husbandry trends and ancient and that they were not much different, at least when it comes to Egypt. A shift can be seen in contemporary Egypt because while the higher-class citizens continue to indulge in the more popular and luxurious diets that continue to be high in fat and sugar, the lower-class citizens are relying on less nutritious foods. Because of the changes they have implemented in their diet and cooking behaviors, such as the increase use of salt and honey, they are now being subjected to having higher risk of atherosclerosis when they were protected before. Because they are still eating fish, they may have some help that the omega 3’s provides, but because of the change in economy and heavy reliance on less nutritious foods due to cost, they are afflicted with this disease when they were not in ancient times.

Conclusion

When examining the changes of diet from ancient times to contemporary Egypt, we can see that the same trend in this country has not been the same trend as seen in other countries. While we would hope that the higher-class Egyptians would have a lower rate of atherosclerosis because of their ability to purchase healthier foods, it seems that the luxurious mind frame of the elites in pharaonic times has lasted through the centuries and they continue to rely on fatty, sugary diets. Sadly, this does not mean that the lower-class citizens are still not being affected, as in ancient times. They are showing the same trends as citizens in other countries that cannot afford the benefits of a fully nutritious diet. Atherosclerosis, in Egypt, has increased in prevalence from ancient times to contemporary times because of a change in dietary habits of the countries citizens. Even though the trends are not what was expected, they are different and the subtle changes are adding to the incidence of this dangerous disease process. While we can hope that some of the world’s providers of unhealthy foods will one day stop relying on the money of the poor to increase their revenue, it is still up to the individual to try to make healthier choices when choosing what to eat.

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