In a recent article, we discussed how the most prescribed drugs are usually indicated for common noncommunicable diseases. These include chronic conditions like diabetes, heart disease, GERD and mental health issues. Regarding treatment innovation, these prevalent diseases are often underserved when compared to less common, but more profitable, orphan diseases. In this article, we look at some of the underlying factors causing these noncommunicable diseases and what could be done to prevent them.
This article was authored by Ward Capoen from V-Bio Ventures.
According to the World Health Organization (WHO), the top 10 causes of death in high income countries are almost exclusively noncommunicable diseases. Many of them are cardiovascular and metabolic diseases, with cardiovascular diseases along being responsible for 31% of deaths worldwide.
These diseases are not just a burden in their own right: they also predispose people to all sorts of other maladies, including autoimmune diseases, cancer and infections. This vulnerability for infectious diseases has become particularly obvious in the current pandemic, where it has been shown that obesity, hypertension and diabetes are major risk factors for bad patient outcomes. The link between cardiovascular/metabolic diseases and infections is of course not unique to COVID-19. A deranged metabolism is not an asset when battling any disease, be it cancer or the flu.
Changed diets have altered our metabolisms
Whereas there certainly are genetic predispositions that contribute to the development of cardiovascular and metabolic diseases, the main risk factors are lifestyle related. Unhealthy diets, physical inactivity, tobacco and alcohol use are what have led to such a large proportion of the world’s population being diseased. This was not the case less than a century ago.
There are several key metabolic changes that increase the risk of noncommunicable diseases: raised blood pressure, obesity, high blood sugar and/or insulin, elevated blood lipids and low-grade inflammation. Which pathways cause all these symptoms is not entirely understood, but there are hints to be found.
The evidence all points to the Western diet, rapidly spreading around the world with increased globalization and general affluence, as a major contributor to our deadliest diseases.
Plenty of research has shown that a diet high in processed foods, sugar and bad fats directly contributes to the development of cardiovascular and metabolic diseases. Specifically, excessive consumption of carbohydrates, like white flour and refined sugars, may play a major role in the onset of metabolic disorders. Supporting this, diets based on carbohydrate restriction (like ketogenic or paleo diets) and whole-foods, plant-based diets (with less processed foods and animal products) have both been reported to improve overall health. The evidence all points to the Western diet, rapidly spreading around the world with increased globalization and general affluence, as a major contributor to our deadliest diseases.
You are what you eat: unhealthy
What is most striking when considering the high incidence of cardiovascular and metabolic diseases, is that they are such a recent development. Sure, the average life expectancy was lower in the past, but this was largely caused by high infant mortality and death from trauma or infectious diseases. Historically, if you avoided these mortality causes, you were likely to live to a ripe old age free of many of the noncommunicable diseases we suffer from today.
Many of today’s most common diseases are relatively new to the scene, including diabetes, autoimmune diseases and even cancer. Currently, individual auto-immune disorders have a prevalence of about 1-3% of the population, cancer will affect about 30% of people and more than 60% of us will suffer from some form of metabolic disease. Even accounting for longer life expectancies, this is not how it should be, nor how it was in the past.
While there will always be a need for medicines to treat cardiovascular and metabolic diseases, they should only be needed in a minority of people. The high incidence of these diseases is not a given that we simply need to accept: lifestyle changes can make a difference.
In his seminal 1939 book ‘Nutrition and Physical Degeneration’, Weston Price reported on 10 years of research into the diet and health of different populations. He found that people living on their traditional diet were often strong, healthy and athletic. Primarily a dental researcher, his work showed that caries and dental arch deformities occurred in less than 1% of people relying on indigenous foods, whereas villagers that ate a western diet had crippling dental decay due in part to the prolific use of sugar and flour. He also noted a link with mental health issues, even describing crippling arthritis in children with bad teeth.
Since then, the increased prevalence of toothpaste has removed some of the damage done by sugar that Price observed. However, the link between dental and microbial health and noncommunicable diseases like arthritis, Alzheimer’s and autoimmune diseases is under renewed investigation.
The rise in preventable diseases
Reading through ‘The Diet Delusion’ by Gary Taubes, it is clear that Price was not alone in linking diet and diseases. William Osler, the godfather of modern medicine in the US, only found 17 diabetics in 35,000 patients treated at Johns Hopkins in 1892. In 2020, that number would be 3,500. Elliott Joslin, the original diabetologist, collated almost 100 years’ worth of inpatient data at Massachusetts General Hospital in Boston. He found 175 diabetics in 50,000 patients (18 were under 20, so likely type 1 diabetic). Nowadays you can expect 500 type 1 and up to 5,000 type 2 diabetics in such a dataset.
Colonial physicians told similar stories. Albert Schweitzer spent years in Africa and treated many thousands of patients in a remote area. It took him 41 years to encounter his first appendicitis patient and he apparently had a hard time remembering seeing anyone with cancer. In 1902, Samuel Hutton, who treated thousands of Inuit and settlers in Labrador, found no evidence of cancer, asthma, appendicitis or other diseases common today. Scurvy and cancer were only seen in people living on a settler’s diet, heavy in flour, canned goods and sugar. The entirely carnivorous Inuit had no such issues.
While there will always be a need for medicines to treat cardiovascular and metabolic diseases, they should only be needed in a minority of people. The high incidence of these diseases is not a given that we simply need to accept: lifestyle changes can make a difference. If we reduce the number of patients that need to be treated for preventable issues, perhaps we could then focus our resources on creating appropriately priced therapies for the patients who need it the most. And have a healthy and happy population to boot.
