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A Medical Mystery of the Best Kind: Major Diseases Are in Decline (nytimes.com)
307 points by suprgeek on July 10, 2016 | hide | past | web | favorite | 147 comments



On the other hand, autoimmune diseases have been increasing in prevalence over the last century. While these diseases are rarely immediately fatal, in severe cases they can have a major impact on quality of life. Onset often occurs in early adulthood so the cost of treatment over a lifetime can be extremely high. The usual treatment, immunosuppressive therapy, also has serious risks of its own.

While there has been much progress on finding new treatments, their scope has been limited to new and creative ways of suppressing the immune system. There are a multitude of theories which attempt to explain the causes of autoimmune diseases, but we seem to be quite far from truly understanding them.


Absolutely. I wish this article wouldn't speak so generally when I hear consistent articles about major spikes in:

- Autoimmune issues (especially allergies) - Obesity (particularly in children) and diabetes - Autism - Depression, ADD, and similar disorders


> Autism - Depression, ADD, and similar disorders

My personal impression is that the rise of mental conditions is an increase in diagnosis, not occurrence. An awful lot of people who, just a few decades ago, would have been dismissed as lazy, stupid, whiny, or the all-purpose "crazy" are actually starting to receive recognition and treatment. That's a good thing.


> My personal impression is that the rise of mental conditions is an increase in diagnosis, not occurrence.

Robert Whitaker [1] has looked into the matter, and proposes that standard treatments take an episodic disease and make it chronic.

[1] Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America - http://www.madinamerica.com/product/62043/

My step-brother hates what his psychiatrists did to him. He stopped taking their drugs, and is rather normal now.


I'm sorry for whatever happened to your brother. Psychology is sadly not an exact science yet. But when I stopped taking my drugs, I was basically nonfunctional for months. You can't generalize from one data point.


> But when I stopped taking my drugs, I was basically nonfunctional for months.

The body adjusts to compensate for the activity of the drug in the body, so the original problem frequently gets worse if the drug is taken away suddenly. There are strategies for helping people get off psychotropic drugs, but I don't think they cover this in psychiatrists' training programs.

> You can't generalize from one data point.

I don't know anything about my step brother, other than that my mom mentioned that he'd gotten himself off the pills. It might've taken him a while.


> My personal impression is that the rise of mental conditions is an increase in diagnosis, not occurrence

Do you have a source for this? It goes against much I've read myself recently—for instance, depression has strong links to inflammation—perhaps shitty diets and no exercise are catching up to people.


The problem with some of these conditions unfortunately is that it is only possible to speculate based on behavioral reports, because the term simply didn't exist back then (or if it did, it existed in widely varying terms describing some sort of "insanity" or "neurosis"). So unfortunately I don't think there is an answer to this question.

In reading up on the histories of various classical composers, for instance, several of them appear to have suffered regularly from depressive orders (a very definitive example is Sergei Rachmaninoff). A few of them such as Erik Satie and Anton Bruckner appear to be afflicted with what we now know as OCD. Can we definitively diagnose, though? No, we only have reports to go off of.

Heck, we're still pretty fuzzy with the diagnosis and root cause of some of these mental conditions now. (See: the definition of Aspergers)


The increase in suicide rates seems to be evidence against this hypothesis.


are suicide rates going up overall? all I can find, back to the 1950s, is that the rate has gone up and down with no clear upwards or downwards trend over those years (2010 rates are slightly below 1950s rates)

http://www.infoplease.com/ipa/A0779940.html


For CZ we have stats up-to 1870s: https://www.czso.cz/csu/czso/sebevrazdy_zaj

(link in czech - sorry. First image, brown line is relative suicidal rate that is probably a good metric for comparison.)


Isn't there a connection between anti-depressants and suicide? Basically they give you enough energy to get going, but not enough to break the depression so you have just enough to go and kill yourself.

Basically, you have to watch someone like a hawk when they first go on antidepressants until they get over the hurdle and start feeling good again.


Clinically speaking, perhaps biological evolution had a chance of dealing with this.

Now, biological evolution has been replaced by "social evolution". A trait of physically debilitating condition, that is treatable, is no longer a reproduction fullstop. Those genes carry on. What genes will peter out are the absence of skills that are employable and not being able to find a partner because of that. Of course this is simplifying it to a large extent.

The human population will drop over the next millenia. Whether that is because of waterwars, lack of food, natural calamities, or space colonisation is left as an exercise for the future generations.


Unemployed people have plenty of kids. Not sure what's being selected for, but it's not that


>Not sure what's being selected for

Latex allergy


Do you know if the increase of autoimmune diseases is of the order of magnitude as the decrease of other diseases mentioned in the article?


I always wondered if the removal of lead in gasoline could account for a lot of this. Especially the dementia drop.


It is never one thing; your lead assessment is probably a serious contender among other pollutants. Then there is better hygiene via food handlers, stiffer USDA rules, cleaner water, less smoking and second hand smoke, more people exercising too.


Smoking rates are only decreasing in developed nations. Globally it's increasing by ~1% each year.


The study is talking about wealthy (e.g. developed) nations this doesn't apply.


I was just replying to his comment. It's a "mainstream" idea that people like to repeat, but it's simply untrue.

It's like a stock phrase: "Smoking is actually going down, you know! People really are getting smarter/healthier/happier/whatever."

It's just false.


The article indicates most of the lower disease rates are also in developed nations, so this could be indicative of a correlation.


That's lower than population growth so would still be a global per-capita reduction.


I would imagine a global smoking increase statistic would be per-capita as well but without a citation we won't know.


"In his own studies of smoking, Stebbins has shown how the tobacco industry has turned to markets in the developing worl to make up for loss in sales first in the United States and subsequently in parts of the European market. Governments in developing nations often do not have the ability to limit tobacco marketing and, usually in need of financial help, they are open to introducing taxable commodities to their citizens. As a result of extensive advertising in developing nations, Stebbins notes that worldwide tobacco consumption has increased at the rate of 1 percent per a year, and countries such as Brazil, India, and Kenya exhibit the greatest increases (1990)."

This is from Bryan Page's "Comprehending Drug Use." It's a textbook but it's accurate, well-cited, and well-written.


This is an area where I see the free market causing great harm. How can a population contend with greedy, money-rich corporations who wage huge psychological and legal campaigns? It's very one-sided. In the US, science and the people's own best interest are seldom enough. The government must have some balance of power to regulate corporations that are otherwise happy to abuse their fellow humans and distort culture and consciousness to systematically disempower whole populations.

It's an awful cycle. It's possible that a system built on nurturance and development, one that empowered people with a wide array of tools including compassion and self-realization, would produce corporate leaders who could themselves balance multiple constructive ends. Imagine if the mega-corps who routinely disenfranchise poor communities and third world countries not only sought money and power, growth and impact, but also felt internally compelled to be accountable, admit mistakes, build constructive non-manipulative and non-bullying relationships, empower others when possible, and respect others when not possible even when taking care of oneself, etc.

I'm a big fan of free-will and independence and no human having more authority than another, but I also see a huge importance in nurturing and developing children to bear those responsibilities constructively, for example free from low self esteem and arrogance, and rich with curiousity, support networks, courage and inventiveneess. Unfortunately, nurturing, developing and supporting others are tasks that are largely seen as "feminine" and therefore economically unimportant (stay at home parents are free labor, and teachers, nannies, etc earn very little money, and research in those areas is similarly seen as lesser science to math and engineering). These professions are often shunned by those needing to defend their "masculinity", and in fact nurturance and emotional support is often required of women and people of color as free labor (the classic "mother" and "grandmother" and "POC friend" role). So it's a strange world we live in, where corporations are seen as people under the law, and are of course directed by people in charge, and yet we keep the bar very low for how mature and capable these people-corporations are.


I can safely agree with you on these points, and it's probably the biggest argumentative weapon feminism has: many of the big problems that need to be dealt with require a "retreat" to a more innocent and child-like state of curiosity about our value systems.


That's a photo, of a rate of growth, two decades and half ago.

At least in Brazil, smoking rate is much lower than what it was by then.


It just shifts around from place to place.


Where to?

The world is finite, if you are pushed out of enough places, it's game over. All the poor and developing countries together sill don't have as much buying power as the developed countries. If you take the developing countries out, what's left isn't much of a market anymore.


> Smoking rates are only decreasing in developed nations.

Except Japan when selling tobacco is still a very healthy business and there is no cancer prevention whatsoever. Lobby has been super effective down here.


When you say no cancer prevention whatsoever I think you are referring to just lung cancer. I do not know much about their national lung cancer recommendations but I do know that Japan has actually had a very robust GI cancer screening history compared to the US. This is partially due to their incidence of gastric cancer being much higher than in the US.


Yup, and the main reason for having so much GI cancer is basically alcohol abuse. Salarymen going to drink several times a week with colleagues and having always a beer on your table at home certainly does not help. Korea has the exact same problem, and very high Gastric Cancer rates as well.


Cleaner water, foot and environment are proposed causes for the allergy rate increases - the cleaners hypothesis. http://www.telegraph.co.uk/news/health/news/7589193/Excessiv...

Are more people gettin appropriate levels of exercise? Average fitness levels are in steep decline (mainly due to obesity) I thought. http://resmilitaris.net/ressources/10144/31/res_militaris_te...


There have been a number of meta studies which have tried to link the removal of lead from gasoline and the drop in violent crime. The correlate well.


The evidence for a connection between removing lead from gas and reduced violent crime is much stronger than just a correlation: http://www.motherjones.com/environment/2016/02/lead-exposure...


Other sources of lead, such as paint, are still an epidemic in poor neighborhoods. I wonder how much of an impact it's having, and if there's a measurable correlation with the age of houses and violent crime.


I'd heard that the most violent areas in New Orleans are those with high concentrations of lead in the environment, and a quick Google search brought up this piece from February that states that precisely:

http://www.motherjones.com/environment/2016/02/lead-exposure...


Couldn't that be correlation as well? That is - those neighborhoods are the least likely to be rehabilitated and the buildings retrofitted to remove pollutants?


Yes, but unlike for pure correlation we actually have a mechanism that could explain it. So it isn't on the level of "all we have is correlation", but of course it also isn't on the level of "we know for sure".


Also the legality of abortion (Roe v Wade, 1973) could be a contributing reason. The drop in crime came about 18 - 20 years after abortion was declared a constitutional right. Most crime is caused by teenagers and young adults.

What affect started in 1992,1993 that is still happening today?


In my country abortion laws were changed to much stricter 19 years ago, while everything else changed like in most developed countries.

Crime dropped significantly, and is on the low-medium end in European Union, from high-end in early nineties.

So I think abortion is irrelevant, and it's mostly lead and general quality of life issues.


Is it still legal in your country? It was illegal in the US prior to 1973.


Only in saveral cases (rape, threat for the mother's health, I think that's all).


Speculation:

- People have become more aware of the risk factors, and behave accordingly. Awareness would be connected to prevalence but have a lagged effect.

- Deadly diseases cause evolutionary responses. Perhaps a disproportionate number of people with predisposition to these illnesses passed away before having offspring.

- Reporting bias? While an illness looms large in the minds of the medical community, doctors are more likely to either wrongly attribute to the illness (false positive), or do false negatives less often.

- Highly speculative: combined effects are non-linear. I don't know what they use to do these studies, but typically you hear something along the lines of "for every x, there's m*x effect", which makes things sounds nice and linear. Maybe better prevention and better treatment does better than either on its own summed up, and so you won't be able to find the "reason" by splitting into each feature.


I don't think you'd see any significant evolutionary responses in the timeframes the article is talking about (<100 years or 4 generations)


Haven't studies shown that high stress (like concentration camp) has immediate effect on next generation's DNA? That would indicate that it's at least potentially possible for evolutionary adaptation to work pretty fast.


That isn'y evolution if it is epigenetic, it would be another type of adaption, Lamarckian really: https://en.wikipedia.org/wiki/Lamarckism#Epigenetic_Lamarcki...


This is incorrect. Evolution is simply change over generations by natural selection. the mechanism by which that happens, be it DNA or epigenetics or whatever, is not strict


Yes/no... It has to be heritable beyond a single reproductive cycle. Which isn't the case with all epi markers.


Yeah, I was curious about that as well. I wonder if the internet and the resulting increase in spread of knowledge about diseases, symptoms, etc. has played a statistically significant part? I'd wager that at the least, it has helped people to realise they need more of an experts opinion when certain symptoms arrive that are linked to more serious illnesses.


> People have become more aware of the risk factors, and behave accordingly.

I wonder how this could be properly measured. My impression based on rising obesity rates and decrease in overall physical activity levels is that we are terrible at making sacrifices in the present for our future self.

Sure, we all avoid trans-fats, leaded fuel, and other similar choices; but all of these are largely forced on the entire population.


wow - I have no clue (obviously) but possible reasons :

- better home heating (less open fires, more heated bedrooms)

- increased time from atmospheric nuclear bomb testing (and the various dispersals of plutonium in the 60's and 70's)

- better nutrition in general

- higher genetic diversity in breeding populations; not many peoples grandparents all come from the same village in the developed world now

- less pollution in the west; import of finished goods rather than local manufacturing


> increased time from atmospheric nuclear bomb testing (and the various dispersals of plutonium in the 60's and 70's)

Ambient radioactivity, under a certain threshold (which is disputed) has actually shown some positive effects. If I remember correctly, folks living in naturally more radioactive areas have been showing lower cancer rates vs the average.


This is a great big citation needed. Come on, you can't "if I remember correctly" a statement like "some radiation is good for you."


OK, I'll supply a citation, which argues the opposite. See the Wikipedia page on "radiation hormesis". Scroll down to "cobalt 60 exposure".

TL,DR: Many apartments in Taiwan were radioactive, because the steel in the structure had been mixed in with 60Co. Residents got big doses of gamma rays. And yet they didn't get much cancer! It turns out that no, gamma rays are not good for you; rather, most residents were young, biasing the sample (few young people get cancer). The study didn't account for this bias.


What? Source?


You beat me to it. My guess would be increased time from those atmospheric nuke tests.

Those were crazy days! The Tsar Bomba. What was the world thinking?


I can't find any evidence that nuclear testing causes any form of global health risks. The amount of material dispersed is negligible on the global scale, and while I've found a few sources that state this material can cause thyroid cancer, it's so small on a worldwide scale it won't really affect anyone.

Gasoline, lead, poor living conditions on the other hand all have well proven links with bad health.


We might actually benefit from some amount of radiation, rather than assuming that increased amount of radiation equals higher cancer risk.

It's called radiation hormesis. Though I don't think there's a scientific consensus on this issue.


It's probably more beneficial for evolutionary 'creativity' than the complex pathways in biology you depend on; and that's gotta be the only reason a quirk like that is still around.


Unlikely, we've evolved with ever present background radiation and have a dna repair mechanism to counter act it but that does not mean radiation makes us stronger.


IIRC genes related to DNA replication are highly conserved; thus our DNA repair mechanism was probably evolutionarily "optimized" for conditions a long time ago. Have background radiation levels remained constant on timescales of hundreds of millions of years? I don't know, but I wouldn't be surprised if it varied significantly considering that cosmic radiation is a significant source and the strength of the Earth's magnetic field fluctuates significantly.


This is weird:

  >Until the late 1930s, stomach cancer was 
  >the No. 1 cause of cancer deaths in the 
  >United States.


In countries which still practice wide-scale pickling, curing and fermentation -- stomach cancer rates are still very high.

http://www.reuters.com/article/us-salty-diet-idUSTRE62N4KX20...

While gastric cancer is declining, it is still the most common cancer in Korea. Past studies have yielded conflicting results as to whether a salty diet causes gastric cancer, though most found an association between salt use and gastric cancer.

Here's another piece of information: https://en.wikipedia.org/wiki/Refrigerator

The introduction of Freon in the 1920s expanded the refrigerator market during the 1930s. Home freezers as separate compartments (larger than necessary just for ice cubes) were introduced in 1940.


That's a good point, but it's probably the organic acids rather than the salt (which the media report you've linked to blames). Bacteria which produce lactic acid are primarily used for traditional fermentation, I think, whereas distilled vinegar is made from ethanol by bacteria that produce acetic acid...

Hmm:

"Compared to acetic acid, [lactic acid's] pKa is 1 unit less, meaning lactic acid deprotonates ten times more easily than acetic acid does. This higher acidity is the consequence of the intramolecular hydrogen bonding between the α-hydroxyl and the carboxylate group." - https://en.wikipedia.org/wiki/Lactic_acid (emphasis added)


I found a chart showing the prevalence of multiple forms of cancer over time: http://i52.tinypic.com/r9euci.jpg.


Not sure what the source is on that chart, but I'll assume it's credible. If that's the case, then despite what the article says, it's hard to believe that most of this decline is not accounted for by the decline in smoking. Surely the decline in smoking accounts for the vast majority of the lung cancer decline, and the peaks for colon and prostate cancer are very close to the same time.


Smoking also increase the time it takes to recover from surgery fwiw


Weird. Why would lung cancer go the opposite direction as smoking prevalence? I understand the dynamic of "cancer only kills people who outlive every other cause of death", but for the discorrelation to be that strong?


If I were to guess, the results lag behind the prevalence. It takes many years for someone to get cancer. If you were to push back the graph by 20 years it may correlate strongly.

Edit: Also, the U.S. banned asbestos in 1989. That's the turning point of the graph.


The correlation is one of the strongest there is, and indeed, causal -- there's a almost perfect lag time of ~20 years [1].

[1] https://en.wikipedia.org/wiki/Lung_cancer#/media/File:Cancer...


The graph stops at 1970.


Are you suggesting that some post-Nixonian mechanism is in play here.


People die from lung cancer when they are a bit older, so it's shifted to the right relative to the prevalence of smoking.


smoking rates was dropping quickly since 1945, during the period lung cancer rates were going up significantly.

death is a bad stat to look at; incidents would be more useful


Wooow! That's lot of lung cancer deaths, counterintuitively coupled with air pollution elimination.

I wonder how this correlates not with tobacco smoking, but especially with smoking of factory-made cigarettes? Because as I understand those contain virtually no tobacco and you end up smoking garden fertilizer-soaked paper.


Widespread refrigeration removed the need for cured and salted meats. This is widely thought to explain the discrepancy.


In the later 50's the FDA also put strict limits on the amount of sodium nitrite allowed in cured meats. And required the addition of ascorbic acid. The latter supposedly neutralizes the nitrite when the meat is heated/cooked.


Does that take into account refrigeration? Maybe it's totally unrelated --but prior to refrigeration a lot of meats were cured.


The article suggests several possibilities, including increasing use of antibiotics, and less consumption of salted/cured meats, but the actual answer is unknown.

And actually that is the crux of the article: it's not that doctors aren't thinking of possibilities to explain the reduction in disease, they just don't know for sure which of the possibilities they are.

Basically, if we've thought of a possibility in the last 20 minutes since reading the article (or headline), a doctor has probably already thought of it, too.


True enough. One other thing is also the decline of "elixirs" with unknown ingredients, chemicals of then unknown toxicity.


stomach cancer was spiked due to h-pylori. water treatments put a huge dent in that


A comment like this could be very insightful, but you didn't mention what h-pylori is, or why water treatments help reduce it.


It was mentioned in the article: "H. pylori, the bacteria that can cause stomach cancer"


It's the bacteria that causes stomach ulcers.


The cool thing about the internet is there's a whole universe of information at your fingertips: https://en.wikipedia.org/wiki/Helicobacter_pylori


I read an blog entry by a retired surgeon. He said when he started a lot of his bread and butter business was surgically fixing ulcers. Then came drugs to reduce stomach acid, followed by the discovery of Helicobacter pylori, and that business mostly went away.


Currently, South Korea and Japan have the highest incidences of stomach cancer. It's typically attributed to cured foods and processed meats. Prior to refrigeration, wide consumption of these foods were out of necessity.


I bet it's related to smoked fish and other smoked food products.


What about widespread use of painkillers? Aspirin, paracetamol and ibuprofen have become common place over this period. Calming the body's immune response might have a beneficial effect on overall health.


cancer is caused by swelling, thus anything that reduces it will reduce cancer incidents.


Cancer is caused by swelling?


Perhaps he means inflammation. Inflammation has been linked to certain types of cancers.


yes, I meant that, and no - nearly all cancers are linked to inflammation. the differences are in what causes the inflammation.


"linked to" does not mean "caused by".


The cancers that involve "lumps" are not swelling, but performing angiogenesis [1]. Not sure about the blood cancers because, well, I'm not an expert, but I believe that all cancers involve unrestricted cell division of some kind, at least some of the time as a result of a DNA or RNA error.

I believe swelling is typically caused by individual cells or tissues (or even pockets in the body) building up fluids of one kind or another. Unfortunately cancer can cause this kind of swelling when your liver and/or kidneys shut down. Source: My mom died of breast cancer, and things were not pleasant near the end.

If OP is talking about systemic inflammation...then there may be a link between the two, but it's certainly not the only cause. [2]

[1] https://en.wikipedia.org/wiki/Angiogenesis

[2] https://en.wikipedia.org/wiki/Systemic_inflammation


This helps to understand the scope of cancer in laymen's terms. http://www.phdcomics.com/comics/archive.php/archive_print.ph...


I wonder if all the benefits may be coming from people having kids later in life. You'd think this would lead to more disease, but maybe we are actually evolving to be longer living and the kids later in life is what is causing it.


Research does show that having kids is correlated to having a longer life expectancy:

https://www.psychologytoday.com/blog/iage/201410/having-chil...


Maybe because the kids born in later in life are born to more educated, and more well-off parents?


It mentions statins as something obviously good but is there any evidence they're actually beneficial? I thought cholesterol was good now?


LDL cholesterol and triglycerides are harmful. Higher values of those cause higher risk of coronary artery disease and earlier death. HDL cholesterol ("good cholesterol") appears to have no effect, at least the scalar quantity that we measure with current lab tests.

Statins reduce risk of death in proportion to their reduction of LDL cholesterol, so most likely this effect is a consequence of decreased LDL cholesterol.


Not sure why you say HDL has no effect. Ratios of "bad" to "good" markers have been shown to be much better predictors of risk than any one number on its own, even LDL.

https://www.youtube.com/watch?v=YRFRRqe0vrE&t=924s

You should also take a look at the latest risk calculator derived from the Framingham Heart Study. It's basically a multivariate regression of various risk factors against CVD risk. Total cholesterol and HDL are inputs, while trigs and LDL aren't used. They do of course factor into total cholesterol, but the researchers specifically stated that "The use of low-density lipoprotein cholesterol did not improve model fit or performance."

http://circ.ahajournals.org/content/117/6/743.long


Some doctors and researchers believe the benefit from statins is more to do with the decrease in inflammation caused by them. Possibly widespread use of statins has beneficial effects on other disease processes too.


Yeah I think there was a large study done comparing a newer cholesterol lowering drug with statins. The result was the new non-statin drug wasn't effective at all even though it lowered cholesterol levels.


You might be thinking of CETP inhibitors. This class of drug modifies cholesterol levels to numbers associated with better health, but so far none of them have conclusively improved health outcomes:

https://en.wikipedia.org/wiki/CETP_inhibitor

Anacetrapib is still in stage III trials so it's too early to consider the concept a failure, but I think the bad results so far are evidence that hyperlipidemia is a symptom not a cause of cardiovascular disease, and that statins have some mechanism of action beyond just modifying cholesterol levels (eg. anti-inflammatory, as some people have suggested).


Yes those drugs. Hard to say conclusively, but the failure of most of CETP inhibitors is troubling news for the hyperlipidemia theory. Meaning possible hyperlipidemia has multiple causes and in and of itself isn't bad.

AKA

Cause A results in hyperlipidemia.

Cause B results in hyperlipidemia.

Cause C results in hyperlipidemia and arterial plaques.

Cause D results in hyperlipidemia.


Numerous lines of evidence, including randomized controlled trials, single gene studies, and Mendelian randomization studies, are not consistent with your interpretation.

Multiple agents that reduce cholesterol, including ezetemibe and statins, reduce cardiovascular disease outcomes and death.

Multiple cholesterol-related genes, including HMGCR, LDLR, APOB, PCSK9, and ANGPTL3, contain variants which influence both LDL cholesterol and the risk for coronary artery disease, myocardial infarction, and death.

And Mendelian randomization studies that rely upon a dose-response relationship between genes that influence cholesterol and the cardiovascular outcomes that they cause have also demonstrated a link between genetically driven cholesterol levels and hard endpoints.

So, one set of drugs (CETP inhibitors) that don't seem to follow the story are more likely to be the exception, rather than the rule. Interesting biology awaits us in the explanation of why the CETP inhibitors don't do what we imagined they would with hard outcomes.


> reduce cardiovascular disease outcomes and death.

Only in small selected populations.


However, non-steroidal antiinflamatories are linked to cancer.


LDL is still "bad" and HDL is still "good", but that means in your blood, not your diet. The evidence linking dietary cholesterol and saturated fat to cardiovascular disease is weak.

Dr. Peter Attia provides an excellent summary of the topic here: https://www.youtube.com/watch?v=nhzV-J1h0do


Citation?


The question I guess is not what diseases are in decline, but which ones are going up


Apparently Parkinson's disease has been on the rise over the past several disease, some say due to the decrease in smoking. Which is fascinating, as smoking has been shown to be actually protective against Parkinson's.


Or maybe you die from something smoking related before getting Parkinson's.


Or maybe both.


Ans: Diabetes


Any idea if that includes Type I, or only Type II?


Type II.

Type II is insulin resistance. Which is probably caused by our industrial diet and maybe other factors. The rate is increasing dramatically.

Type I is an autoimmune disease. I think it's not increasing. (no idea)



its less caused by diet than lack of mobility. we spend most of our waking day sitting down now. active over weight people with 'bad diets' are healthier than skinny inactive people. but its hard to legislate that, and much easier to pound the shoe on the table about sodas than it is to tell people they need to get up and move


No... It is absolutely caused by diet. Exercise is a factor, but only because you're expending the calories you brought into your body in the first place.

https://www.niddk.nih.gov/health-information/health-topics/D...

I hope you're not a doctor!


Hunger should be correlated with calories expended, our metabolic system is homeostatic. the unnatural consumption of refined carbohydrates, and in such large quantities, is what is causing the Diabetes II epidemic and widespread obesity, both likely symptoms of the same disorder.


"Going up" usually just means in percentage, as more serious diseases decline below that percentage.


Is it possible that medical advances in the last couple of decades have simply delayed the deaths of many sufferers? Heart disease and cancer survival rates are usually qualified with a number of years, given that they are difficult to fully cure. With a larger aging population just barely hanging on, perhaps an upswing is just around the corner but hard to see now. i.e. the rate of death has not actually dropped, the average survival time is longer.


Put bluntly: All of these 'little increases" are starting to add up in big ways. I'm not that surprised that a decline in one disease is leading to declines in others. As we all live a little longer, we make each other healthier as well, being better able to cope with the expanded safety net.

As someone who's seen her grandparents suffer with a cacophony of diseases right before death? Sometimes, one thing really DOES lead to another.


The largest extrinsic factor (causally effective), should be the environment's physiological interaction with cells that have accumulative exposure: the alimentary system. Lower incidences of alimentary cancers should be the hallmark result of bans on various carcinogenic additives. The question should be how low the rates can inherently go based on diet alone, and to then proceed to narrow down the scope of any further factors.



Is it simply, that fewer people can afford insurance/visit a doctor? So they die of 'natural causes' and never get diagnosed?


Curious, if the cause is the decline in cigarette consumption; here's a graph showing roughly 100 years of data for the topic:

http://4.bp.blogspot.com/-p4ECPyex_cY/TzSalazW2XI/AAAAAAAAA2...


The lines do seem to correlate. In the case of stomach cancer, I'm wondering if there's a similar correlation between the decline in chewing tobacco and the decline in stomach cancer. Chew is full of fiberglass and other stuff, and if you swallow any of the juice you're swallowing that stuff. It's impossible to clear it all from your mouth after you finish chewing, too.


OT: I'm pretty sure fiberglass in chew is a myth.


When smokers give up smoking they start to clear their lungs. They cough up phlegm. many people swallow that, not spit it out. That increases risk of mouth, throat, stomach, bladder, and penis cancer.

Tobacco is already pretty harmful.

> Chew is full of fiberglass

No, it isn't.


Thank god, because I chewed a lot when I was younger.


Why don't active smokers cough up phlegm?


Many reasons.

Smoking coats the lungs with a layer of tar and heavy, chronic smokers have coated their lungs to such an extent where there is drastically reduced lung area in contact with the environment (and irritants/allergens). The tar acts like a shield in this case and prevents immune response that can lead to constriction in the lungs and phlegm production.

Moreover, active smokers have destroyed the cilia in their lungs (which start to regenerate when one quits smoking) and it's the cilia that do most of the cleaning and phlegm expulsion. When one quits smoking, he goes through weeks or months of coughing and increased phlegm production as the cilia start growing back.

Finally, a lot of active (and ex) smokers do cough up phlegm. The co-factors of phlegm production are simply too many for a definite answer. You also have asthmatics and those who suffer from COPD/emphysema.


Don't they? What then is the origin of the term, "smoker's cough"?


One explanation can be expanding criteria and/or earlier diagnosis. Earlier diagnosis, even with the same treatment efficacy, will lead to records of improved survival, and expanding criteria of particular diagnoses will often identify borderline cases that likely don't have the same morbidity and mortality.


Of course hundreds of probable individual causes can be attributed to this phenomenon. The Galileo of medicine will be the one who can unify and make the data sensible without pretending one or two factors caused it all.


Better home food (popularity of brown bread vs white bread), better take out food (not just McDonald's and diners anymore), and more indoor working conditions (less exposure to pollution) likely play a big part.


Our genes are somehow improving in quality (survival longevity, quality of life, IQ), and this effect is cascading over generations. I don't know if it can be explained using pure epigenetics, and natural evolution is certainly too slow to explain this, so there might be mutagens in our everyday environment that directly modify the DNA sequence. We recognize cigarette smoke, heavy metals as mutagens, but are there more subtle mutagens that lead to better DNA?


Coffee?


Interesting about the stomach cancer. Makes me wonder if we should be careful about limiting antibiotic usage too far? Perhaps everyone should take a course every five years or so?


That sounds a bit extreme, I would eat a couple tablespoons of Coconut Oil every day.

On another note, I wonder if the probiotic trend is going to pay off. We'll see in 20, 30 years I guess


What does one have to do with the other?


From the article: "Until the late 1930s, stomach cancer was the No. 1 cause of cancer deaths in the United States. Now just 1.8 percent of American cancer deaths are the result of it. No one really knows why the disease has faded — perhaps it is because people stopped eating so much food that was preserved by smoking or salting. Or maybe it was because so many people took antibiotics that H. pylori, the bacteria that can cause stomach cancer, have been squelched."




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