I'd say excessive STRESS.

The fourth horseman is not a nutrient, it's lack of sleep, acronym LoS.

Orthorexia Nervosa. Stop hacking and start living.

• Why are my dumps so smelly on Paleo?
• At what macronutrient ratio does my unit look bigger
• Is polygamy Paleo (yes it is BTW)
• Etc etc

End Hypocrisy...I'll own it. Really, I'm here on PH just to be a jack ass and to score the chicks. Mission accomplished.

Excessive sitting on the ass.

I'm going with cocaine. I think that we are surrounded by it, in a figurative sense.

Sounds dumb, but bear with me. Get ready for a way-too-long answer. Moreso than food reward, I'm looking at our attitude on reward in general. Food reward is an unconventional but excellent answer as to what it is about our diets that is most negatively affecting our health. Aravind and I were talking at AHS about dose-dependent toxins, and wondered if the big 3 (gluten, n-6, sugar) are mostly a big deal because people eat so much now. If packaged foods have more of these three, and people eat way more packaged food and food in general, then oila!

But why do people eat so much packaged food? Lots of reasons, obviously. Convenience, price, palatability, blah blah. But one factor lurking in the background is that there just isn't time for the average Joe to think about food or prepare it themselves. Time is spent doin things that we know temporarily will make us happy-- checking Gmail 10-100 times a day, checking paleohacks 10-100 times a day, facebook, twitter, TV-on-DVD, etc etc.

What if everything had a "Nutrition Label" that showed how it affected your brain? So your smartphone could have a label that says "1 daily dose = 10 mg cocaine". Now I know virtually nothing about neurotransmitters, but I'd bet that the daily dopamine/seratonin/norepinephrine rush from internet/tv/smartphone is mother@#$% huge!

Whenever someone gets on a soapbox and talks about how smartphones might be bad, or checking email a billion times a day might be bad, it can sound smart, but nobody cares. We should care! The NIH funds primarly drug and medical device trials because that's where the research agenda is at. Despite this, we paleos have managed to snoop around and find a good approximation of a healthy diet. The NIH is just never going to be that interested in making us live a more mindful life, and stop deepening these grooves in our brain dedicated to instant reward.

I know that if I see something new and interesting on paleohacks, I'll google the shit out of it in an instant. Screw that, if I see something new and interesting in an episode of Golden Girls, I'll google the shit out of that too. The only reason I don't feel like a helpless drug (technology) addict on a daily basis is that everybody I know is doing it. Currently, 30% of my friends check their smartphones in the middle of conversations. I can only imagine what the percentage will be in 10 years. Personally, I hope to reverse direction a bit and wean myself of technology. That will afford much more time for cooking, chillin', pleasure reading, and doing things that I don't feel I have to interrupt to get an email buzz.

In summary, I'm apprehensive that I am no match for technology. There are so many interesting paleo blogs, and that is just one subject matter. When I see someone like Kurt Harris withdraw for a while, it makes smile a little. But another part of me feels like a vampire who craves more KGH posts. Although the connection is roundabout, I do feel like taming this instant-satisfaction monster must be tied to not craving rewarding foods, as well as creating time to build up activities that don't involve information fixes. In fact, I want to get a before-and-after fMRI to track just how hard this hamster is sucking at the sugar (information) straw, and how much I can improve.

Food reward is the fourth horseman.

I'm thinking nutrient deficiencies for your fourth. They can be huge determiners of health. Deficiencies of copper, selenium, vitamin c, zinc, choline, etc. can raise the risk of chronic disease significantly, and most SAD people aren't getting enough of them.

Big Brother.

You can't eat it, but it ruins everything. Heck, it fluoridates our water (which has been proven to increase complacency), takes away our money (thus, less to spend on grass-fed beef and organic greens), messes with our careers (leading to stress and cortisol spikes), tries to zap our intelligence with TV and useless celebrity babble to distract us from reality (goodbye new neural synapses that could have been formed), uses the FDA 'stamp of approval' to allow toxic chemicals in out food supply (mm .. preservatives and aspartame and all things toxic and lovely), oh how I could go on and on and on ...

The main horseman of the apocolypse: Big Brother.

A cavewoman wouldn't put up with this. I am a cavewoman. I won't.

P.S. Gotta love me some thought police ...

Lack of sleep for sure...

My money's on trans fats - or preservatives, which actually - surprisingly - aren't discussed all that much on PaleoHacks.

I'll propose insufficient sunlight, leading to massive Vitamin D deficiencies. Or, put another way, too much time spent indoors.

Economics. The drive to make everything cheaper destroys food quality. It's what led to vegetable oils, factory farming, food additives, and grain based commodity agriculture. Stress is huge too.

Reduced proprioceptive feedback and increased nociception.

Ok, I'm going with a preservative/pesticide combo and calling it: Food Additives

Stress is big tho.

I'll go with the sunshine/outdoors. Does that make it a two-headed horse or a fifth horse? And I wouldn't go with gluten on the other horse, but switch it with wheat.

Soy is terrible!

I voted for three. Could we simply have two sets of four? I'll leave the rest of you to haggle that out.

I'm too tired from lack of sleep, Vit D deficiency, and too many damn calories. Although it is seeming that any calories are too damn many.

grouse complain bitch kvetch whine carp grumble bellyache

Human kind is responsible for a helluva lot more than four horsemen. We've created a Budweiser Clydesdale team of health challenges to contend with.

There could be nine horsemen, if the metaphor were switched to the Ringwraiths (Nasgul) from The Lord of the Rings. http://www.games-workshop.com/MEDIA_CustomProductCatalog/m680117a_P1Mb1.jpg

Under that rubric I'd add (in no particular order) cortisol, overpopulation, technology, soy/legumes, veganism. and greenhouse gases.

If I had to pick one and stick within Kamal's type of categories . . . cortisol.

Jack Kruse .

Trans-fats.

Health: Healthy cells require healthy cell membranes in order to efficiently absorb nutrients and eliminate metabolic waste.

Happiness: A toxic cellular environment puts someone at risk for cancer and other degenerative diseases that will make you sad :(

Longevity: When you're cells can't eat and breathe, they weaken and die. Tissues die, then an organ, body system and you.

processed food

it's a catch all for the worst stuff not fitting under the first three

Elevated Cortisol!?

Mercury in our teeth! I had my amalgams removed one years ago and just finished my third five day round of chelation with oral ALA and oral dmsa and I'm very pleased with the progress. Energy up, mood better, better results in gym and bedroom, less calories consumed (better food absortion I feel.). Only negative, short term memory loss while "on round". Memory gets solid again when "off round". This is where I have to differ with the Quilt and Harris . (They seem to poo-poo the toxicity of Mercury in amalgams) There is something going on. Granted the Ala can be doing this with its antoxidant effect ,rather than with it chelation effect, but I feel pretty bad the first day "off round" ,as well as if I don't dose "on round" close enough to the ALA half life. Feeling lousy would be due to a redistribution of the Mercury. Coming off any other antioxident never has this effect for me. And even more telling, why the memory loss. No other antioxidant gives me short term memory loss. Stirring up Mercury and redistibuting it would be such a cause though.

Lead...........

ALEs...........

• Lack of exercise
• Lack of Sleep
• Lack of sunshine
• Too much stress

??

Wait that's four. Okay trans fats? And then those 4 up there can be... another set of four horsemen I guess. Meh. I can't say I know exactly what I'm talking about.

I would say "Trans Fats or Hydrogenated Fat" and in fact, that should be the first one

GMOs in food and in the feed of the animals most people eat.

And sure all the other toxins from the air, the water and the chemicals we put on our skin.

I'm going with car culture. Car culture contributes mightily to many of the problems that vex us, particularly in a built environment that practically ensures we all participate in that culture. Problems include:

• crashes as a leading cause of death, and the top cause of child death
• no sidewalks in many communities
• diminished access to healthy food, limited to big-box supermarkets that dominate food production with a focus on cheap, mass-marketed processed food
• increased reliance on the convenience of drivethru restaurants, almost none of which offer food worth eating
• ability to obtain food from farther and farther away, leading to reduced access to locally grown food
• children who never walk to school, and thus grow up not recognizing their own bodies as efficient, healthy transportation machines
• reduced exposure to the outdoors and the sun (driving from garage to garage, barely setting foot outside to go from our homes to the office, to the store, back home, etc.
• reduced opportunities to benefit from the exertion of lifting and carrying things over distances
• diminished sense of community, and healthy social contact with others
• increased stress and anxiety caused by traffic
• near constant exposure to pollutants, and toxins released from the car itself from its exposure to heat and UV ("indoor air quality" worse in cars than most anywhere else)
• ...and many more

I don't have a car, but even I have significant dependance on them. One can hardly help it these days, and car culture works very well at encouraging our complicity in the food environment which we struggle against.