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

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.

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

Joe, it appears you're not understanding my view, as well as the most recent scientific view, of what diabetes really is: microbial imbalance.
C
There are several peer-reviewed papers detailing this view:
health.usnews.com/health-news/news/artic...d-to-type-2-diabetes
www.medscape.com/viewarticle/808519
articles.latimes.com/2013/may/29/science...etes-europe-20130529

None of these suggest that pathogens from potable water cause diabetes. Correlation does not imply causation.

This is why I believe diabetes is a sanitation issue. Of course, diet is important, but the reason it's important is because diet shifts flora. You're not the only one consuming what you place in your mouth. The latest in health is diet which considers this factor.

You'd need to be able to prove that a) there was a causal link between pathogens in potable water and diabetes and b) that there were forms of sanitation technology that prevented this. You haven't done either.

As stated, this isn't just about the developing world. But to answer your question, water is contaminated in the developing world due to wastewater treatment plants, groundwater-contaminating pit latrines and direct defecation in rivers, lakes and oceans. 60% of the world's population--4.1 billion people--use sanitation systems that simply dump the untreated waste back into the environment.

All sanitation systems we discuss here put human sewage back into the environment. You would have to prove that the treatment had destroyed whatever microbes you claim are causing diabetes.

Have you ever heard the expression "Death begins in the colon" ? This was stated by Hippocrates and is now more true than ever.

Irrelevant.

Are you familiar with the burgeoning science of gut-brain connection as cause of mental illness? This concept is rapidly gaining credibility.

No, but then I wouldn't have, as I am trained as a soil scientist not a doctor. I'm not prepared to take your word for whether it is a credible idea, given what you've written so far is incredible.

It's obvious the world needs to be educated about the relationship of intestinal health to overall health. And it's all about microbial balance. I believe the issue of diabetes is a good way to illustrate the point with hope to steer nations and the World Bank away from building wastewater treatment plants and promote dry compost toilet technology.

I think you're talking drivel.

Joe, it appears you're not understanding my view, as well as the most recent scientific view, of what diabetes really is: microbial imbalance.

There are several peer-reviewed papers detailing this view:
health.usnews.com/health-news/news/artic...d-to-type-2-diabetes
www.medscape.com/viewarticle/808519
articles.latimes.com/2013/may/29/science...etes-europe-20130529

This is why I believe diabetes is a sanitation issue. Of course, diet is important, but the reason it's important is because diet shifts flora. You're not the only one consuming what you place in your mouth. The latest in health is diet which considers this factor.

As stated, this isn't just about the developing world. But to answer your question, water is contaminated in the developing world due to wastewater treatment plants, groundwater-contaminating pit latrines and direct defecation in rivers, lakes and oceans. 60% of the world's population--4.1 billion people--use sanitation systems that simply dump the untreated waste back into the environment.

Have you ever heard the expression "Death begins in the colon" ? This was stated by Hippocrates and is now more true than ever.

Are you familiar with the burgeoning science of gut-brain connection as cause of mental illness? This concept is rapidly gaining credibility.

It's obvious the world needs to be educated about the relationship of intestinal health to overall health. And it's all about microbial balance. I believe the issue of diabetes is a good way to illustrate the point with hope to steer nations and the World Bank away from building wastewater treatment plants and promote dry compost toilet technology.

You don't seem to have understood my point.

Let us say that diabetes is caused somehow by sewage sludge. Explain to me how what technology we could use to prevent that in a developing country context. Most people do not defecate directly into water. What actually do you think it is about the sewage that would cause diabetes and what pathway are you suggesting we use to treat and prevent people from being exposed to whatever-it-is.

Diabetes is obviously a problem, but clearly not as great a problem as diseases caused directly by faeces-contaminated potable water. The former is caused by a range of factors, including diet, the latter is caused directly by microbes. If the 'world's health focus' cannot see (and deal with) a direct relationship between poor sanitation, microbial contamination and diseases affecting a massive proportion of the population of the world, why do you think they're going to do anything about it even if you can link it to diabetes?

I appreciate you are not a scientist, but you don't seem to be making a lot of sense at the moment.

Diabetes and blood sugar imbalances are the centerpiece of all major diseases, physical and mental illness.

And this, my friend, is rubbish.

Because NCDs are currently the world's health focus and sanitation isn't even on the agenda. It's been a lost opportunity. Everyone thinks it's about diet and exercise.

Diabetes epidemics are global. This isn't just about developing nations. The trends are truly frightening, perhaps enough for people to stop defecating in water . . . and actually connect with the web of life via consideration of their intestinal tracts as driver of general health.
blogs.reuters.com/data-dive/2013/11/15/t...-epidemic-in-charts/

Diabetes and blood sugar imbalances are the centerpiece of all major diseases, physical and mental illness.

Given that we can't deal with sanitation even when we've proven that many diseases are directly caused by faeces contaminated potable water, how actually would it help to know that these other NCDs were also caused by it? I don't understand your logic.

I think there is some evidence of harmful effects of hormonal releases, of heavy metals (but then that is not going to be much of an issue in non-industrial releases to water) etc. Even accepting that all of the effect are direct and real, which is again quite an assumption, I don't understand how you think this would act as a 'rallying point for improved sanitation'. How is improved sanitation (as discussed on this website) going to help with 'gender-bending'?

It seems to me that you've linked some fairly random diseases to sewage sludge releases, which might not at all be relevant to most developing country situations and then suggested that low tech improved sanitation would somehow magically solve these problems, when I can't see that it would.

Agreed and thanks so much, Chris. I obviously glanced over the dolphin study in attempt to illustrate sea creatures suffering the same maladies as humans due to poor sanitation. That doesn't help the cause, my apologies.

Here's an interesting 2010 paper about increasing obesity trends in both captive and feral animals:
rspb.royalsocietypublishing.org/content/.../rspb.2010.1890.full

There's plenty of obesity research detailing the problem as a matter of flora imbalance (gut dysbiosis). What's controversial is whether or not children are born predisposed, a matter of poor microbial predisposition. This may also explain dramatic rise in autism:
www.nytimes.com/2013/08/29/science/human...ore-birth.html?_r=2&:

Another health crisis where sanitation has taken a back seat is gender-bending in the environment, especially well-studied in fish. By far, most focus is on endocrine disrupting chemicals such as atrazine. But this is in disregard of natural estrogens in sewage. Everyone excretes cholesterol and its metabolite, coprostanol, from which all steroid hormones are derived. Hormonal pollution is barely on the map.

And I completely agree, associating NCDs with sewage is difficult to grasp. But I believe there's ample evidence to make the case as part of a public education campaign focusing on the global scourge: diabetes.
Evidence is mounting rapidly that the problem is one of gut flora imbalance and it's not such a leap to connect this with poor sanitation:
news.ku.dk/all_news/2012/2012.9/gut-bact...ould-cause-diabetes/

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

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/

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

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

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/