Increasing Incidence of Non-communicable diseases
The cause of an epidemic especially one beginning at an identifiable moment in time has one cause and is usually not multifactorial and complex. Occam’s Razor: "Of competing theories, the simpler explanation of an entity is to be preferred”.
The June 2010 issue of American Journal of Clinical Nutrition highlights growing evidence that nutritional advice provided by governments and health organizations for the past 40 years has been seriously in error. The result has been the exact opposite of that intended and instead these recommendations have created “a perfect storm” of nutritional conditions that has led to an epidemic of the diseases they were intended to prevent. (1) (2) (3) (4) (5) To paraphrase a quote from Winston Churchill “we have sown the wind and we will reap the whirlwind”. The whirlwind we are now reaping was sown in the 1970’s. At that time the cause of heart attacks and strokes was poorly understood but a group of politically influential scientists in America were convinced that eating fat was the cause of these diseases. Although the evidence behind the claims was still highly contentious, nevertheless Senator John McGovern’s Committee on “Dietary Recommendations for the Health for America” created a campaign to reduce fat consumption and most countries in the world followed suit. Industry and the public bought into this belief and more and more low fat foods were produced but the fat was largely replaced with refined carbohydrates (6). Obesity, hypertension and diabetes were serious health concerns in the 1970’s but what has happened since is an extraordinary acceleration of the incidence of all those conditions, increasing 300% between 1980 and 2000 (7). The study in the January 2010 issue of American Journal of Clinical Nutrition no increased risk of heart disease or stroke with saturated fat consumption. They did however find evidence of publication bias where many studies that failed to show a link between saturated fat and heart disease, the politically correct theory at the time, were never published (8). On the other hand there is growing evidence from many different scientific lines of study that carbohydrates and particularly refined or rapidly digested carbohydrates not only cause obesity but increase the risk of death from all manner of diseases through multiple mechanisms that produce metabolic disorders and chronic low grade inflammation (9) (10) (11) (12).
A Universal Metabolic Derangement:
Whilst obesity is the most apparent outward concern it heralds far more sinister issues regarding our internal workings best known as “Metabolic Syndrome”. The hallmark is abdominal obesity along with disorders involving high blood pressure, high cholesterol and high blood sugar. The prevalence of hypertension in African Americans is among the highest in the world. Compared with whites, hypertension develops earlier in life and average blood pressures are much higher in African Americans. This is accompanied by an 80-percent higher stroke mortality rate, a 50-percent higher heart disease mortality rate, and a 320-percent greater rate of hypertension-related end-stage renal disease than seen in the general population. Diabetes is twice as common in black races as Caucasians. Diabetes has had an extraordinary increase in incidence over the last 100 years, between 1935 and 2000 it increased 735%. Between 1970 and 2000 diabetes increased by 300%. In the USA it is estimated that 50 million people are either diabetic or pre-diabetic. Even worse increases have been seen in South India, Mauritius and the Pacific Islands where the prevalence of diabetes exceeds 20% (13).
Economic Impacts
A study in the January-February 2009 issue of the journal Health Affairs concluded that 75 percent of the USA’s $2.5 trillion in health care spending has to do with four increasingly prevalent chronic diseases (14): obesity, Type 2 diabetes, heart disease and cancer (15). Most cases of these diseases, the report stated, are preventable because they are caused by behaviors like poor diets, inadequate exercise and smoking. If virtually all non-communicable and age related diseases have a significant lifestyle component that’s $2 trillion in the USA and another $2 trillion in the rest of the world spent every year on self inflicted diseases.
Works Cited
1. Hu, Frank B. Are refined carbohydrates worse than saturated fat? . s.l. : American Journal of Clinical Nutrtion, Vol. 91, No. 6, 1541-1542, June 2010.
2. David S. Ludwig, Joseph A. Majzoub, Ahmad Al-Zahrani, Gerard E. Dallal, Isaac Blanco, Susan B. Roberts. High Glycemic Index Foods, Overeating, and Obesity . s.l. : Pediatrics 1999; 103(3). URL: http://www.pediatrics.org/cgi/content/full/ 103/3/e26;.
3. A PERFECT STORM OF HEART DISEASE LOOMING ON OUR HORIZON. HEART AND STROKE FOUNDATION ANNUAL REPORT ON CANADIANS’ HEALTH. 2010. http://www.heartandstroke.com/atf/cf/%7B99452D8B-E7F1-4BD6-A57D-B136CE6C95BF%7D/Jan23_EN_ReportCard.pdf.
4. Ageing brain abnormalities in young obese patients with type 2 diabetes: a cause for concern. Nolan, J. J. s.l. : Diabetologia, 2010, Vol. 10. DOI 10.1007/s00125-010-1890-x.
5. A Potential Decline in Life Expectancy in the United States in the 21st Century. S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C. Hershow, M.D.,Jennifer Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D.,Robert N. Butler, M.D., David B. Allison, Ph.D., and David S. Ludwig, M.D., Ph.D. s.l. : n engl j med, 352;11, March 17, 2005.
6. USDA, Economic Research Service. Food Disapperance Data. s.l. : http://www.ers.usda.gov/Data/FoodConsumption/.
7. Katzmarzyk, Peter T. The Canadian obesity epidemic: an historical perspective. . s.l. : Obes Res. 2002;10: 666–674.
8. Patty W Siri-Tarino, Qi Sun, Frank B Hu, and Ronald M Krauss. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. . s.l. : Am J Clin Nutr 2010;91:535–46.
9. Scholl., Johannes. Traditional Dietary Recommendations for the Prevention of Cardiovascular Disease: Do TheyMeet the Needs of Our Patients?. . s.l. : Hindawi Publishing Corporation, Cholesterol, Volume 2012, Article ID 367898, 9 pages, doi:10.1155/2012/367898.
10. Renata, Sousa, Sabat. Dementia: Largest Contributor to Disability Worldwide . s.l. : Lancet. 2009;374:1821–1830.
11. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. s.l. : Diabetes Care22:233–240, 1999.
12. Marianne U Jakobsen, Claus Dethlefsen, Albert M Joensen, Jakob Stegger, Anne Tjønneland, Erik B Schmidt, Kim Overvad. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. s.l. : Am J Clin Nutr June 2010, vol. 91 no. 6 1764-1768
13. Obesity and the Metabolic Syndrome in Developing Countries . Khurana, Anoop Misra and Lokesh. s.l. : J Clin Endocrinol Metab 93: S9 –S30, 2008.
14. Hyperinsulinemic diseases of civilization: more than just syndrome X. Loren Cordain, Michael Eades, Mary Eades. s.l. : Comparative Biochemistry and Physiology, Elsevier, 2003, Vols. Part A 136 95-112.
15. Thomas N Seyfried, Laura M Shelton. Cancer as a metabolic disease. s.l. : Nutrition & Metabolism 2010, 7:7.