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

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

Is anyone considering poor sanitation as cause of the global diabetes epidemic? What about all the other NCDs (non-communicable diseases) such as autism, Alzheimer's, cancer, heart and lung disease?

Evidence is mounting diabetes is a matter of intestinal microbial imbalance. Indeed, all the major NCDs may be explained in this way, gut origin. Gut-brain connection is a very hot topic.

Given the global scourge that is diabetes, this issue alone may be a very powerful way toward improved sanitation, especially dry compost toilet technology.

Meanwhile, sanitation is not on the NCD agenda guided by the UN and WHO, a lost opportunity.

Here's a Facebook photo I've devoted to the issue. Please feel free to send a friend request as sanitation and health are my focus on Facebook:
www.facebook.com/photo.php?fbid=10153499190915602&l=de2edfe628

Also attached is a poster and abstract I recently presented at a health symposium: "Water-­Based Sanitation and Negative Effect on Flora Balance"

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

Today, November 14, is World Diabetes Day.

The global scourge is strongly related to flora shift. Think sensitive gram-positive bacteria (bifidobacteria, lactobacillus) compromised by pollution allowing gram-negatives (resistant e.coli, clostridium) to flourish along with rampant, opportunistic fungal overgrowth.

Here's a Facebook photo devoted to the issue of wastewater treatment as cause of antibiotic resistance due to horizontal gene transfer in microbes. Antibiotic resistance ranks in the top 3 of all health concerns. It's strongly related to flora shift and diabetes.
www.facebook.com/photo.php?fbid=10153311488915602&l=0f06c38ad0

I'm not sure if toxic chemicals and heavy metal pollution is a greater factor than microbial pollution (sewage) in creating antibiotic resistance . . . or if the human gut is a more important reservoir in fostering horizontal gene transfer than wastewater treatment plants.

But why are UNICEF and the World Bank still building groundwater-polluting pit latrines and wastewater treatment plants? It's time to end the practice of mixing water with waste. Have you heard about the global problem of algae blooms in water fed by nutrients in sewage? Meanwhile, antibiotic resistance genes are studied in the gut microbiota of children:
www.sciencedaily.com/releases/2013/11/131113182425.htm
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  • arno
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Hi Keith
Do include links to some of the papers on this topic.
Thanks
--Arno

Arno Rosemarin PhD
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  • JKMakowka
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

KeithBell wrote: I'm not sure if toxic chemicals and heavy metal pollution is a greater factor than microbial pollution (sewage) in creating antibiotic resistance . . . or if the human gut is a more important reservoir in fostering horizontal gene transfer than wastewater treatment plants.


Could you explain what you mean with the link of toxic chemicals and heavy metals to the creation of antibiotic resistance? I am not aware of any such link and theoretically it doesn't make much sense I think.
Horizontal gene transfer of antibiotic resistance can happen everywhere, but only if there is a sufficient number of vector harboring bacteria and a selection pressure it causes an issue, e.g. only where antibiotics are present in sufficient quantities (human patients, farm animals and habits of the original source organism) a problematically large population of antibiotic resistant bacteria can develop.

KeithBell wrote: But why are UNICEF and the World Bank still building groundwater-polluting pit latrines and wastewater treatment plants? It's time to end the practice of mixing water with waste. Have you heard about the global problem of algae blooms in water fed by nutrients in sewage? Meanwhile, antibiotic resistance genes are studied in the gut microbiota of children:
www.sciencedaily.com/releases/2013/11/131113182425.htm


While I agree that more waste needs to be source separated and recycled, some sort of water borne sewerage makes sense to exist in most cases as water is an important cleaning and hygiene agent.

Microbiologist & emergency WASH specialist
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Amo, thanks so much for asking. Please download the poster linked above where you'll find 96 references. Here it is online, but with watermarks:
f1000.com/posters/browse/summary/1094298

By the way, Sanitation Circle is an organization still forming with goal of promoting dry compost toilet technology. I'm attempting to transition my 25 year career in the recycling industry to sanitation and health. I'm not a trained scientist, more a social technologist with a marketing degree and a keen interest in science. In the 80s I was a UNICEF radio spokesperson for the annual release of State of the World's Children Report, so now marrying interest in environment and health. Here's a recent essay regarding non-communicable diseases (NCDs) and sanitation. Sanitation is not yet on the NCD agenda, a lost opportunity.
www.climateandhealth.org/magazine/read/t...ate--health_289.html
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Julius, those are great questions. The reason toxic pollution may increase antibiotic resistance is due to flora shift where sensitive gram-positive bacteria (lactobacillus, bifidobacteria) allow resistant gram-negative bacteria (E. coli, clostridium) to flourish along with rampant, opportunistic fungal overgrowth seen in all major diseases. Indeed, toxic air and soil pollution are both associated with diabetes, but the same cannot be said for sanitation.
www.scientificamerican.com/article.cfm?i...-dirty-soil-diabetes
www.loe.org/shows/segments.html?programI...13-00036&segmentID=3
blogs.windsorstar.com/2013/07/25/study-f...s-related-mortality/
Gut-lung connection is a two-way street: www.scientificamerican.com/article.cfm?i...ole-in-bowel-disease
China leads the world with a fierce diabetes and obesity epidemic because of air pollution, heavy metal pollution in soil and a highly polluted water supply. It's not about white rice and being sedentary. www.ncbi.nlm.nih.gov/pmc/articles/PMC3485276/
www.sciencedaily.com/releases/2013/06/130603092328.htm
news.ku.dk/all_news/2012/2012.9/gut-bact...ould-cause-diabetes/

It's these gram-negative bacteria most associated with antibiotic resistance, so by sheer numbers we're increasing potential to create antibiotic resistant superbugs, see here:
www.ncbi.nlm.nih.gov/pmc/articles/PMC2391261/

Here's an exploration about wastewater treatment plants as major source of antibiotic resistance including references:
www.facebook.com/photo.php?fbid=10153311488915602&l=0f06c38ad0
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  • arno
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Thanks Keith
See the entry I did on this topic some months back.
forum.susana.org/forum/categories?func=v...6&id=2758&limit=1000

Antibiotic-resistant enterobacteria are being spread in sewage systems in India. NDM-1 producing bacteria were found in water supply and sewage seepage samples in New Delhi in a study from May 2011 in The Lancet. Go to above link to get the paper and other reports.

What I find somewhat alarming is that this is being dealt with almost entirely as a medical problem centering on improper use of antibiotics. And the first line solutions remain to be more sophisticated antibiotics. But these are not forthcoming and probably won't be for at least 10 years, if ever. An integrated preventative approach involving water, sanitation and hygiene experts and practitioners has still yet to be initiated. Containment of faeces and reduction of associated pathogens should be the top priority for all cities at risk. Waterborne sanitation systems were never designed to eliminate these sorts of superbacteria and now that they are even turning up in the chlorinated water supply system we can see what sort of monster this can develop into.

See also the ECDC paper from our World Water Week Workshop Sept 2013
programme.worldwaterweek.org/sites/defau..._water_week_2013.pdf

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

Yes, Amo, I understand your frustration. Thanks especially for the World Water Week Workshop document. Quite disturbing is the photo of the coastal algae bloom. This is a global problem and one that I'm working on here in South Florida USA where the Indian River Lagoon is in peril, North America's most important marine estuary where dolphins and manatees are dying at record levels.

Toxic algae is another issue yet to be associated with poor sanitation, especially wastewater treatment plants releasing treated effluent. Over 300,000 leaking septic tanks are being blamed for the Indian River Lagoon decline. By far, most focus regarding algae blooms is on nutrients (nitrogen, phosphorus) from agricultural runoff.

Toxins from algae blooms (cyanobacteria) are associated with neurodegeneration, a gut-brain connection.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3295368/
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  • F H Mughal
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Dear Keith,

Thanks for your interesting posts. Here in the Sindh province of Pakistan, we have significant pollution of the surface water bodies by indiscriminate, untreated municipal and industrial wastewater discharges. Agrochemicals are widely used here in the rural areas, in excess. During rains, they wash down to the surface water sources, causing algal blooms in some slow-moving water bodies.

While resistance to antibiotic in sewage is a far-fetched aspect here, the water treatment plants have these surface waters as raw water source. Since the conventional water treatment plants do not remove these toxic pollutants, they end up in the finished water supply.

F H Mughal

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

It should be no mystery China leads the world in diabetes and suffers a fierce obesity epidemic due to toxic air, soil and water pollution, shifting gut flora in the wrong direction. It's not about diet and exercise, though diet can shift flora back in the right direction. These are sanitation issues. It's no accident the most diabetic and obese nations are also least sanitary, but I've yet to see a study connecting the two.

Of course, there are other factors such as vaccination where no comprehensive studies exist about collateral damage to flora by vaccination. Poor agricultural choices and antibiotic abuse are also large parts of the problem. But sanitation associated with diabetes is not on the map. India, for example, once led the world in diabetes and they still absurdly believe it's about poor diet and being sedentary. India also suffers a full 60% of the world's heart disease due to 4% of the population carrying genetic mutation. When will we acknowledge microbial dysregulation of host genes to the point of mutation?

Like the rest of the world, Pakistan also suffers diabetes and obesity epidemics. Cost of healthcare for diabetes and related illness is projected to cripple economies of nations.
tribune.com.pk/story/630527/world-diabet...pakistan-every-year/
www.brecorder.com/general-news/172/1253640/
www.thenews.com.pk/article-83095-Obesity...increase-in-Pakistan

United Arab Emirates (UAE) is a stark example of diabetes and obesity as caused by poor sanitation. They believe it's about McDonald's while generations pour raw sewage into the Persian Gulf and create inland sewage lakes such as those well-known in Saudi Arabia:
www.saudigazette.com.sa/index.cfm?method...entid=20130528167588
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Happy World Toilet Day, first annual as designated by the UN.

In 2011, the UN held its first General Assembly meeting about health is a decade. The focus was non-communicable diseases (NCDs such as diabetes, cancer, Alzheimer's, autism, heart and lung disease). The last such meeting was 2001 about AIDS. In 2011, sanitation was not on the agenda. People are apparently blind to the simple concept that defecating in water leads to imbalanced intestines as principal driver of NCDs. www.un.org/en/ga/president/65/issues/ncdiseases.shtml

You'd think the World Health Organization may have caught the glitch: www.who.int/.../noncommunicable_diseases_20110919/en/

2013, sanitation still not on the agenda. Harvard still believes lung disease is about smoking. "Tobacco use, excessive alcohol consumption, poor diet, and lack of physical activity contribute to the development of noncommunicable diseases." www.nejm.org/doi/full/10.1056/NEJMra1109345

NCDs such as diabetes are now the world's health focus. When will sanitation be on the agenda?
lifestyle.inquirer.net/131749/noncommuni...ses-kill-more-people

WHO says "The main risk factors for NCDs—tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol—are avoidable." www.taimionline.com/articles/8456

If diabetes is all about diet and exercise as nations currently believe, then why are we seeing diabetic dolphins? Are they exercising less and eating more refined carbohydrates, or are they swimming in "sick seas" filled with terrestrial pathogens and chemicals? www.ncbi.nlm.nih.gov/pmc/articles/PMC3793200/
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  • canaday
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Re: Diabetes and NCDs (non-communicable diseases) as rallying point for improved sanitation

Hi Keith,

Thanks for raising this issue. Water pollution certainly goes beyond the matter of communicable disease and with UDDTs we simply abstain from contaminating water with human excrement.

Nonetheless, the connections you imply between water pollution and non-communicable diseases are diffuse and hard to study (which does not mean they might not also be true), and the research may likely not have been done yet. I suggest we try to be more careful about the citation of scientific studies.

The study of dolphins you mention does not state that dolphins have gotten sicker with diabetes over time (and contamination of the oceans). Instead, it shows that a captive population had higher indices of related metabolic disfunction, as compared to a wild population, but could not pinpoint what had caused this difference. Nor did it state that any of the dolphins were clinically sick with diabetes.

Microbiome studies are just starting to find many unsuspected affects of gut microbes on a wide variety of ailments, beginning with (more obvious) digestive problems, but there is also growing (mostly anecdoctal) evidence that diabetes and other, more systemic disorders, like diabetes, can be affected and that Fecal Microbiota Transplants (FMT) from healthy donors seem to help correct this.

www.mayoclinic.org/medicalprofs/fecal-transplants-ddue1012.html
en.wikipedia.org/wiki/Fecal_bacteriotherapy

So the best overall strategy might be dual:
(1) Keep water clean and free of random fecal microbes, pharmaceuticals, etc., and
(2) Promote the presence of good microbes in people's guts.

Best wishes,
Chris Canaday

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