Among agrarian societies there is considerable variation both in time and place in the prevalence of diseases of affluence 6 7 8 . The cause behind the initiation and progression of diseases of affluence are most certainly multi-factorial and probably several factors need to be present to a sufficient degree for these diseases to appear clinically. Among agrarian societies some diseases of affluence, such as obesity and type 2 diabetes, are associated with increasing westernization and urbanization, although some less westernized countries such as China and countries in sub-Saharan Africa did have more cases of diabetes in rural than urban areas in 1995 6 7 . Several risk factors for obesity and diabetes type 2, such as low physical activity and a sedentary lifestyle with prolonged TV watching, are thus associated with westernization and urbanization, which perhaps explain their association with these diseases 9 . However, for other diseases of affluence, such as stroke and CHD, some of the varying prevalence among agrarian societies is puzzling with no consistent association with westernization, urbanization or rise in risk factors 8 10 . Indeed, CHD was reportedly rare in developed populations until the early 1900s with major increases in the occurrence and mortality rate from the disease in the 1930s, but with as much as five-fold differences in CHD mortality rates between European countries such as Poland and Spain 8 . Some of these differences in time and place may be explained by variation in known risk factors 11 12 . A few agrarian societies, like the Amazon-dwelling Brazilian Indian tribe Amondava, reportedly lack diseases of affluence, which possibly is due to a recent and small shift in diet incorporating small amounts of cereals in an otherwise non-agrarian diet 13 . Such a pattern of differentially delayed onset of the various diseases of affluence has been described 2 . However, the global epidemiological pattern suggests that almost all agrarian societies have some prevalence of diseases of affluence. In contrast, diseases of affluence have been virtually absent among many non-agrarian societies in Melanesia, Malaysia, Africa, South America and the Arctic 2 5 14 . One such traditional population are the horticultural Trobriand Islanders with a mortality from atherothrombotic circulatory diseases which apparently is close to zero, even though they have access to abundant sources of food, smoke heavily and have a fair share of elderly people 2 14 . These disproportionate differences between agrarian and non-agrarian societies are even larger with regard to the incidence of non-infectious stroke 10 15 . Moreover, when people living in non-agrarian societies migrate to an agrarian society or when their own society becomes agrarian they contract diseases of affluence 2 14 , which illustrates the general rule that there is no genetic protection against diseases of affluence, only genetic variation in degree of susceptibility 2 .

The global epidemiological pattern of varying prevalence of diseases of affluence thus suggests that some environmental factors specific to agrarian societies could initiate these diseases. There are many such candidate environmental factors, and in this paper we study cereals, the clearest defining dietary difference between an agrarian and non-agrarian diet. Since nothing in biology makes sense except in the light of evolution 16 , we look at the cereal component of human diet from an evolutionary perspective.

The grasses emerged between 65 and 55 million years ago 17 . Since the last common ancestor of living primates, including humans, emerged before this time, some 90 to 65 million years ago, it cannot have had a diet consisting of seeds from grass 18 19 . Subsequent evolution of our primate ancestors up until 4–8 million years ago is thought to have taken place in the trees 20 21 22 23 , where almost all potential plant food comes from dicotyledonous species 24 and the monocotyledonous grasses are absent 17 . The archaeological evidence during the last four million years of evolution towards Homo sapiens suggests that if grass seeds were being incorporated into the diet of our ancestors, they probably only contributed a small part 25 . Homo sapiens emerged about 200,000 years ago 26 27 , and seeds from grass were probably not key dietary staples of Homo sapiens hunter-gatherers 28 . About 10,000 years ago (e.g. 500 generations) some populations invented agriculture 28 , and their descendents possibly have some genetic adaptation to an agrarian diet such as lower prevalence of celiac disease and related HLA genotypes 29 30 . However, many populations shifted to agrarian diet more recently, between 1–100 generations ago, which from an evolutionary perspective is a very short time to admit any measurable sign of adaptation 31 . Thus, when examining human diet from an evolutionary perspective, it makes sense that humans with an evolutionary novel agrarian diet could suffer from diseases of affluence due to insufficient adaptation 31 . Many metabolic factors and pathways are important in the onset and development of diseases of affluence. When looking for metabolic signs of such insufficient adaptation, one of the more relevant associations is that between diseases of affluence and leptin resistance, an acquired insensitivity to high levels of leptin 32 33 34 35 36 37 38 .

Leptin acts as a signal to the brain to inhibit food intake and enable the storage in adipocytes of surplus calories while simultaneously protecting peripheral non-adipose tissue from toxic effects of intracellular lipid overload 39 . Leptin also affects the growth of blood vessels and bone; the immune system; glucose- and fat metabolism and the reproductive system 32 40 . Leptin administered peripherally in animal models such as rodents promotes weight loss and satiation, but peripheral administration of leptin in obese human does not promote significant weight loss 32 41 . This difference in effect together with the observation that most obese humans have high levels of leptin suggest that leptin resistance causes human obesity 32 41 . Sometimes end-organ resistance can be caused by mutations in hormone receptors, which has been described for several hormones. The pathophysiology of acquired forms of end-organ resistance to hormones such as insulin and leptin has been elusive 42 . The differing results from leptin administration implies that the detailed actions of leptin in energy metabolism are different in humans versus experimental animals such as rodents 43 . This difference could be genetically based and possibly an adaptation of the human or experimental animal leptin system to some environmental factors affecting their respective ancient ancestors. But this difference could also be due to an insufficient adaptation to some environmental factors, which are now affecting the leptin system of humans or experimental animals. To address these different possibilities we turn to recent studies on the molecular evolution of the leptin gene.

The hominoids (gibbon, orang-utan, gorilla, chimpanzee, early human and modern human) emerged 25–30 million years ago 19 . Studies on the molecular evolution of leptin have shown a significant increase of non-synonymous to synonymous changes 31 in the ancestral line of primates giving rise to hominoids, and this significant increase is also relative to descendant hominoid species such as humans 43 . This implies that the ancestral line of primates giving rise to hominoids probably acquired several positive non-synonymous changes of their leptin gene due to adaptations, and that the leptin genes of humans have not changed much since the emergence of hominoids. Thus, based on findings from previous section on human diet and evolution, it is very unlikely that human leptin could be specifically adapted to an agrarian diet. Furthermore, similar studies on molecular evolution have shown high similarity of leptin genes in such diverse species as mouse, rat, chicken and turkey, which was ascribed to convergent or parallel evolution 44 . Since many mammals, which share the same distant common ancestor with these species, do not have similar genes, it seems plausible that this high similarity is due to convergent evolution and not parallel evolution 31 . This implies that natural selection has caused the leptin genes of these bird and rodent species to be highly similar by adapting them to some similar factor(s) in the environment of their ancient ancestors. Diet is an important environmental factor, as exemplified by primates, where it affects basal metabolic rate, size, reproduction and locomotion 19 . Since leptin is a regulator of appetite, energy metabolism and reproduction it could well be subject to forces of natural selection due to diet. Except for a diet containing seeds from grass, it is hard to discern an environmental characteristic shared by diverse rodent and bird species which is sufficient to explain such high similarity of leptin genes 45 46 47 . Thus, it is possible that leptin of these rodent and bird species are specifically adapted to a diet including large amounts of seeds from grass. It follows that such a diet possibly imposes problems to the human leptin system, which we have concluded is not specifically adapted to such a diet. The studies on molecular evolution of leptin thus indicate that the differing results from leptin administration in humans and experimental animals could be due to adaptation of mouse and rat leptin and insufficient adaptation of human leptin to a diet including large amounts of seeds from grass. When looking for constituents of seeds from grass explaining these differences, we find the properties of lectins interesting.

Lectins are proteins abundant in the virus, bacteria, animal and plant kingdom, which bind reversibly to specific sugar structures (for most references and background see 48 49 ). Different classes of plants, such as mono- and dicotyledonous, have different classes of lectins with differing biochemical properties, and there is a subclass of lectins only found in grasses like cereals. Many plant lectins are thought to play a role in the plants defence against being eaten. Accordingly, plant lectins have an obvious preference for binding to sugar structures of animal, fungal or microbial origin, and are usually at highest concentrations in plant parts essential for reproductive success such as seed germs. The intensively studied lectin wheat germ agglutinin (WGA), which protects against insects and fungi 49 , is present in wheat seed in both the germ and the gluten part of endosperm 50 . Peptides behaving in a lectin-like manner have also been obtained upon cleavage of gliadin in gluten 51 . Sourdough lactic acid bacteria hydrolyse gliadin peptides and inhibit their lectin-like behaviour 52 , which perhaps explains some of the unexplained health effects of probiotics 53 . White flour consumed by humans contains a high proportion of gluten and has agglutinating activity suggestive of lectins 54 55 56 57 . Thus, lectins are present in our food, they are heat-stable and resistant to breakdown in the gastrointestinal tract, they bind to the surface epithelium of the digestive tract and they can lead to anti-nutritional, mild allergic or other subclinical effects in humans and animals 48 49 . Lectins can also be transported through the gut wall into the blood circulation, where they directly influence peripheral tissues and body metabolism through the binding to glycosylated structures, such as the insulin receptor, the epidermal growth factor receptor and the interleukin 2 receptor 57 58 59 60 61 62 63 64 65 . WGA have effects on activation of the epidermal growth factor receptor 61 , mitogenesis 66 , agglutination of red blood cells 48 , activation of platelets and cell adhesion molecules 67 and vascular permeability 68 69 70 . WGA also have several effects related to autoimmunity, allergy and inflammation 57 71 . WGA binds to several types of mammalian cells including pancreatic duct epithelial cells 72 , prostatic cancer cells 73 , arterial macrophages and smooth muscle cells 74 75 , glomerular capillary walls, mesangial cells and tubules of human kidney 59 . Human serum contains antibodies against WGA and lectins of soybean and peanut 76 . Hence, lectins have sufficient properties to affect the leptin system indirectly, through effects on metabolism central to the proper function of the leptin system, and possibly also directly through interaction with leptin or the leptin receptor. The intriguing possibility of a direct interaction between lectin and the leptin system is worth some additional comments.

The studies on molecular evolution of leptin indicated adaptation of rodent leptin and insufficient adaptation of human leptin to a diet including large amounts of seeds from grass. This adaptation and lack thereof could also involve the leptin receptor, since leptin and leptin receptor coevolves due to interdependency for signalling. An adaptation of the leptin gene could thus be to avoid disturbed function of either leptin or the leptin receptor. It would be interesting to see results from studies on molecular evolution of the leptin receptor, but such studies are unfortunately lacking. However, when considering direct lectin interaction with leptin or the leptin receptor, this interaction could be with either or with both. Lectins binding to sugar structures of a membrane receptor can mimic or block the effect of the physiological ligand 48 61 62 65 77 78 79 80 81 82 . Leptin is not glycosylated, but the leptin receptor is and lectins binding to different leptin receptor glycosylations might explain different leptin binding affinity 83 84 , as observed by Livingston and Purvis in their study on WGA and the insulin receptor 63 . Thus, dietary lectins could possibly bind to the leptin receptor and affect its function, which could translate into diseases of affluence as indicated by studies on effects of single nucleotide polymorphisms on the function of leptin and the leptin receptor 85 86 87 88 89 90 91 .