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:
onlinelibrary.wiley.com/doi/10.1002/hep.23567/abstract

"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."
www.wgofoundation.org/wdhd-2013.html

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.”
well.blogs.nytimes.com/2014/06/13/threat...rue&_type=blogs&_r=0

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:
www.ncbi.nlm.nih.gov/pmc/articles/PMC2641468/

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.

Today is World Digestive Health Day. This year's focus is microbes:
www.wgofoundation.org/wdhd-2014.html

Do you think people in that community understand digestion as a sanitation issue? And does the sanitation community understand digestion as an NCD issue?

It's hardly a simple matter of diet per the United Nations in the news last week:
www.ohchr.org/EN/NewsEvents/Pages/Displa...ewsID=14617&LangID=E
time.com/104999/u-n-official-says-junk-f...s-bad-as-cigarettes/
www.sfgate.com/default/article/Obesity-t...l-health-5493392.php


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

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.
www.ncbi.nlm.nih.gov/pmc/articles/PMC1419796/

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:
www.nytimes.com/2014/05/18/opinion/sunda...-heres-why.html?_r=0

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:
www.sciencedirect.com/science/article/pii/S1570677X07000263
nutrition.highwire.org/content/144/1/87.short
www.tandfonline.com/doi/abs/10.1080/1040....594914#.U3eMn-ZdV9s
www.nature.com/ejcn/journal/v62/n2/abs/1602727a.html
epirev.oxfordjournals.org/content/29/1/62.full
onlinelibrary.wiley.com/doi/10.1111/j.14...sAuthenticated=false

It's time we view obesity as environmental issue and not just a simple matter of diet.

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
www.nytimes.com/2011/11/01/health/scient...d-obesity.html?_r=1&
www.omicsonline.org/blog/antibiotic-abus...eveloping-countries/

2) Cesarean section
healthland.time.com/2012/05/24/are-cesar...o-childhood-obesity/

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.
www.theatlantic.com/health/archive/2012/...sity-vaccine/262487/

4) Lack of breastfeeding
healthland.time.com/2013/08/13/understan...ing-affects-obesity/
www.asianscientist.com/health-medicine/u...ndia-mortality-rate/

“the clearest evidence to date that gut bacteria can help cause obesity.”
www.nytimes.com/2013/09/06/health/gut-ba...-slim-mice-down.html

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.
www.nytimes.com/2013/08/29/science/human...ed-before-birth.html

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:
theweek.com/article/index/240604/the-dis...-very-young-children

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.

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.
www.odi.org.uk/future-diets
healthland.time.com/2014/01/03/study-obe...in-developing-world/

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:
forum.susana.org/forum/categories/96-inn...ience-and-technology

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.

Regards,
Elisabeth

Speaking of diabetes, it's now been found artificial sweeteners are polluting water supply due to WWTPs unable to handle these chemicals.
www.latimes.com/science/sciencenow/la-sc....story#ixzz2o88c76iF

Water-based sanitation is a disgrace to Earth. It's quite surprising that even progressive sanitation professionals still believe flushing toilets are the solution when they are actually the major source of pollution. Moreover, the technology, along with drinking water treatment, denudes our microbial heritage akin to deforestation.

Please find me ONE (1) study correlating poor sanitation with obesity, diabetes and other NCDs in the Pacific Islands where these problems are rampant. Everyone believes it's about poor diet and being sedentary.

Should I spare you all the links regarding obesity and diabetes in the Pacific Islands blamed on diet and lack of exercise? It's about the water leading to microbial imbalance.

And it has become generational:
www.nytimes.com/2013/08/29/science/human...fore-birth.html?_r=0
www.sltrib.com/sltrib/news/53116932-78/h...-department.html.csp

This thread may just as well be about the global obesity epidemic instead of diabetes. Obesity and diabetes are like brother and sister, though there are also millions of thin diabetics. In fact, thin diabetics are more vulnerable to death by the disease than fat diabetics:
www.cnn.com/2012/08/09/health/obesity-pa...-thin-diabetes-time/

Again, diabetes and obesity are matters of microbial imbalance. Why this is not associated with poor sanitation is beyond me. Joe Turner says it's "rubbish," "nonsense" and "drivel" without doing his due diligence in understanding how the body works and doesn't work. At least he admits he's not a medic. Thanks for considering, Joe. I appreciate the dialogue.

I've always found it curious that island nations lead the world in obesity. Nations such a Tonga labeled "world's fattest nation," but is it really a matter of diet? Or have they been consuming their own waste for generations?

"Almost 20% of the adult Tongan population suffers from diabetes and the death rate from nutritional conditions is 10 times that of the UK's."
www.theguardian.com/lifeandstyle/2006/au...handwellbeing.health

What is it about small islands which makes people so fat and diabetic? It looks like Tonga will be receiving UN funding for sewage treatment:
english.yanjian.com.cn/Article/ShowArticle.asp?ArticleID=120

What a big, fat mess:
pidp.org/pireport/2013/March/03-07-01.htm

books.google.com/books?id=SPsX9nqw6uUC&p...nga%20sewage&f=false

Joe, PCBs is just an example of how pollution causes diabetes. I wasn't inferring anything about PCBs in sewage. The mechanism is via gut flora shift.

Are you saying diabetes is not a problem in the developing world? See here:
www.intechopen.com/books/diabetes-mellit...ries-and-case-series
www.who.int/mediacentre/news/releases/2003/pr86/en/
www.nejm.org/doi/full/10.1056/NEJMp068177
www.ottawacitizen.com/business/Ottawa+wi...t/9193765/story.html
link.springer.com/journal/13410
www.ngrguardiannews.com/index.php/featur...st-health-risk-today
www.iom.edu/~/media/Files/Activity%20Fil...ioDisease/Brown.ashx
care.diabetesjournals.org/content/34/6/1249.full
www.scientificamerican.com/blog/post.cfm...-developi-2009-06-16

Given the enormity of the problem, it's truly surprising sanitation is not on the NCD agenda, nor are NCDs on the sanitation agenda. Both industries appear blind.

Diabetes, by the way, is a leading cause of blindness in the world: diabetic retinopathy, a problem which dwarfs trachoma as cause of blindness:
health.india.com/diseases-conditions/bew...n-make-you-go-blind/
articles.timesofindia.indiatimes.com/201...ion-loss-visual-loss

Relatedly, we might construe now mysterious glaucoma as a sanitation issue. "Massive" South-East Asian eye damage is strongly associated with insulin resistance (diabetes), yet the excruciating problem is now blamed on studying and lack of sun exposure:
www.bbc.co.uk/news/health-17942181

Amputation is another diabetes-related issue:
www.thenews.com.pk/Todays-News-6-214406-...amputations-per-year

Speaking of sun exposure, are these children in Bangladesh suffering rickets (vitamin D deficiency) because they're using too much sunblock? Of course not. They were born imbalanced from imbalanced mothers, a matter of poor microbial predisposition and high rates of gestational diabetes:
www.irinnews.org/report/85703/bangladesh...n-could-have-rickets

KeithBell wrote: Completely agreed, research needs to take place to demonstrate microbial pollution in water as source of gut flora imbalance/shift associated with diabetes. And that's half the reason I've been posting here in attempt to create interest.

As a soil scientist, you'll be interested in this study about PCBs in soil associated with high rates of diabetes:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3346783/

An article about the study:
www.scientificamerican.com/article.cfm?i...-dirty-soil-diabetes

PCBs are not found in faeces. If they are found in sewage sludge it is from industrial sources. Even if they are found in a particular sewage sludge, the types of improved sanitation we discuss here are not going to destroy PCBs.

Similar studies are about air pollution as cause of diabetes. Yet no one seems to be considering sewage and water pollution, an obvious connection. The reason is that people still don't understand what diabetes really is . . . how interesting that gastric bypass surgery rapidly halts diabetes by removal of infected section of small intestine.

Clearly it is not an obvious connection. Even if there is a connection, it is not clear that there would be person-to-person infection from faeces. Even if there was, it is not clear that any of the technology we discuss here would prevent it. Even if it did, there would be little point in focussing on diabetes given the number of complexity of diseases we know for a fact are caused by faecal pathogens.

How is it that a developed nation such as Germany is experiencing a fierce diabetes epidemic? 600,000 people suffered from diabetes near the end of World War II compared to eight million now. It's not about diet and exercise, but pollution. The same is true of the obesity epidemic.
www.welt.de/gesundheit/article13716752/D...e-vor-15-Jahren.html

I am not a medic, but that sounds like nonsense. But even allowing that there might be an element of truth, there does not seem to be much relevance in this paragraph to the sanitation situation that we discuss on this website forum.