Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Dear Keith,

I would say there is wide consensus nowadays that the flush toilet also has many drawbacks (apart from its positive sides for which it was invented). That's precisely the reason why Bill Gates started his "Reinvent the Toilet Challenge" to find something better - from a technological point of view (yes, we know technology is not the only issue here but it is part of the puzzle). The research projects funded under that scheme are being discussed in great detail in this category on the forum:

I would like to advocate against the term "water-based sanitation", and to rather replace it with either "water-based excreta management" or "sewer-based excreta management". Why do I say that? Well, sanitation is more than just toilets, it is also about all the activities that produce greywater (as well as rainwater drainage and solid waste management).

Therefore, even if we all had UDDTs or composting toilets, we would still generate wastewater from having showers, taking baths, doing laundry, cleaning activities, plus then there is still all the industrial wastewater of course, dairies, abattoirs, tanneries, breweries, etc. In densely populated areas you could not infiltrate all this, so you still need sewers and treatment plants of some sort, even if you had much less excreta in it.

And pathogens as well as micropollutants from greywater would still go into this wastewater, just think of all the additives that are in soaps, shampoos and shower gels. Also think of washing underpants, nappies (if washable nappies are used), washing babies' bottoms, washing people who have had diarrhoea, caring for elderly, cleaning your own bum etc.

So we will always need water for sanitation (=water-based sanitation), even if we had no flush toilets.

Don't get me wrong, I am a huge fan of non-flushing toilets (I have a Separett toilet in my house for years, and I do my fair bit to advocate them where they fit). I just don't like statements about sanitation that are overly simplified.


Dr. Elisabeth von Muench
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Last Edit: 03 Jan 2014 10:54 by muench.
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Elisabeth, I completely agree. Please forgive my simplification. Though the word sanitation does normally connote toilets, it means so much more. Of course, I'm not advocating waterless bathing. :side:

Have you heard today's news about obesity more than tripling in the developing world? All the reports focus on diet and exercise, of course. But obesity in the developing world is not a simple matter of diet. It’s about toxic air, soil and water pollution damaging intestinal flora balance over generations.
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Per the new study, obesity in the developing world has nearly quadrupled from 250 million to 904 million between 1980 and 2008. It's not a simple matter of diet. But I believe poor sanitation is the sleeping giant behind NCDs (non-communicable diseases) including diabetes and obesity.

Here are some additional factors aside from toxic industrial air, soil and water pollution, all related to microbial imbalance as cause of the obesity epidemic:

1) Antibiotic abuse

2) Cesarean section

3) Vaccination
Why is no one asking if vaccines cause obesity? Instead, vaccine scientists create vaccines for the very problems vaccines may cause. There are no comprehensive studies about collateral damage to flora balance by vaccination.

4) Lack of breastfeeding

“the clearest evidence to date that gut bacteria can help cause obesity.”

And the problem is now generational as the developing fetus receives flora in the womb. The womb is not sterile as commonly believed and was never meant to be sterile. Adding insult to injury, I've read 12% of UK newborns receive antibiotics.

Is the obesity epidemic really just a simple matter of diet? Or is it really about pollution, antibiotic abuse, lack of breastfeeding, poor sanitation, vaccination and cesarean section? All these things damage flora balance responsible for obesity as well as the diabetes epidemic. Children are now born predisposed to obesity, diabetes, anorexia . . . that's right, anorexia is commonly viewed as being of psychological origin, but evidence reveals it's actually a matter of gut dysbiosis. Eating disorders are on the rise in very young children, born imbalanced:
Last Edit: 05 Jan 2014 17:44 by KeithBell.
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

So, why should obesity be viewed as sanitation issue? Because it's a matter of malabsorption syndrome akin to environmental enteropathy. This ironic world is filled with literally starving fat people. Obesity is a condition known to include micronutrient deficiencies, a matter of flora imbalance of the small intestine including villous atrophy.

Today's New York Times article is about how people eat because they are fat, not how they eat and become fat. The article focus is about food, particularly types of carbohydrate, but it's a sterile article linking sterile studies not factoring flora balance:

What's more interesting and where the focus should be is on flora balance, particularly in the small intestine and how microbial free fatty acids may "train" our livers to utilize fat. The liver receives 80% of its blood flow from the small intestine. The newly published paper the article is based on talks about "nonesterfied fatty acids" (free fatty acids) without mention they are products of microbes: jama.jamanetwork.com/article.aspx?articleid=1871695

Free fatty acid, butyrate, product of clostridium bacteria means weight loss: diabetes.diabetesjournals.org/content/58/7/1509.long

But you can have too much of a good thing such as high levels of clostridium and butyrate known in autism, born imbalanced or perhaps result of vaccine injury and toxic pollution (there are no studies about how childhood vaccines affect flora balance). High levels of free fatty acids combine with glycerol, another product of microbes, to form high triglycerides, clogging insulin receptors, raising blood sugar, driving the pancreas to produce more insulin leading to insulin resistance. www.sltrib.com/sltrib/world/57942914-68/...tism-adults.html.csp

Here are some papers about the ironic nutrient deficiencies associated with obesity in the developing world, not a matter of malnutrition, but malabsorption:

It's time we view obesity as environmental issue and not just a simple matter of diet.
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

It's hardly a simple matter of diet per the United Nations in the news last week:

Obesity and diabetes epidemics are environmental issues associated with poor sanitation, toxic pollution and poor medical choices such as antibiotics and vaccination. Children are born with imbalanced flora, a matter of microbial predisposition; predisposed to lives of obesity and diabetes, a matter of malabsorption syndrome and micronutrient deficiencies where this ironic world is filled with literally starving fat people.

The U.N. is missing the target. Things like sanitation and toxic pollution aren't yet on the NCD (non-communicable diseases) agenda. They still believe cancer, diabetes, Alzheimer's and obesity are about diet, exercise and smoking. The General Assembly held their first meeting in a decade about Health in 2011, completely missing the microbial target. The last such meeting was in 2001 about AIDS. www.un.org/en/ga/president/65/issues/ncdiseases.shtml
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Today is World Digestive Health Day. This year's focus is microbes:

Do you think people in that community understand digestion as a sanitation issue? And does the sanitation community understand digestion as an NCD issue?
Last Edit: 29 May 2014 15:03 by KeithBell.
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Liver cancer is called a "hidden epidemic" poised to become the #2 form of cancer. The liver receives 80% of its blood flow from the small intestine via the portal vein. So, if there's microbial imbalance in the small intestine, it is translocated to the liver. Fatty liver is strongly associated with obesity, diabetes and cancer.

But one does not have to be obese to be diabetic or have a fatty liver. Nor does one have to live in a developed nation. This paper is about fatty liver prevalence in the non-obese in India where diabetes rates are high:

"World Health Organization reported that there were still approximately 700,000 deaths worldwide from primary liver cancer in 2008. More than eight out of 10 (84%) cases occurred in developing countries."

Here's a recent NYT article on the subject where one doctor states "I’m really afraid that the explosion of this condition is going to overrun the resources available to the transplant centers around the country.”

And I've always found this 1959 paper about protozoal infection of the liver important, especially considering we purposely multiply ciliate protozoans in activated sludge wastewater treatment:

Improving sanitation is not just about prevention of acute illness via infectious disease. It's about chronic, non-communicable disease (NCD), now the world's health focus. Yet sanitation is not on the NCD agenda.
Last Edit: 21 Jun 2014 20:38 by KeithBell.
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