Creating a Culture of Health, Part 1

On Chronic Disease


The disease profile of the world is changing at an astonishingly fast rate, especially in low and middle income countries. Long-held notions about the nature of chronic diseases, their occurrence, the risk factors underlying them and the populations at risk are no longer valid. The great epidemics of tomorrow are unlikely to resemble those that have previously swept the world, thanks to progress in infectious disease control. The risk of outbreaks – a new influenza pandemic, for example – will require vigilance. But it is the looming epidemics of heart disease, stroke, cancer and other chronic diseases that for the foreseeable future will take the greatest toll in deaths and disability. It is vitally important that the impending chronic disease pandemic is recognized, understood and acted on urgently. – World Health Organization ( Chronic Disease Report)

The prevalence of chronic diseases is a relatively new phenomenon in human history. People have always encountered acute disease and injury in the population. But the increase in longterm impairment and debilitating symptoms lasting from 3 months to years is crippling our healthcare system.  Chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems. From the CDC website:

Health Risk Behaviors that Cause Chronic Diseases

Health risk behaviors are unhealthy behaviors you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions.

  • In 2015, 50% of adults aged 18 years or older did not meet recommendations for aerobic physical activity. In addition, 79% did not meet recommendations for both aerobic and muscle-strengthening physical activity.7
  • More than 1 in 3 adults (about 92.1 million) have at least one type of cardiovascular disease.8
  • In 2015, more than 37% of adolescents and 40% of adults said they ate fruit less than once a day, while 39% of adolescents and 22% of adults said they ate vegetables less than once a day.10
  • An estimated 36.5 million adults in the United States (15.1%) said they currently smoked cigarettes in 2015.11 Cigarette smoking accounts for more than 480,000 deaths each year.12 Each day, more than 3,200 youth younger than 18 years smoke their first cigarette, and another 2,100 youth and young adults who smoke every now and then become daily smokers.12
  • Drinking too much alcohol is responsible for 88,000 deaths each year, more than half of which are due to binge drinking.13,14 US adults report binge drinking an average of 4 times a month, and have an average of 8 drinks per binge, yet most binge drinkers are not alcohol dependent.1516


The Numbers

1 out of 2 Americans is affected by chronic disease; 1 in 4 has multiple chronic diseases.
27 percent of kids now have a chronic disease, up from just 13 percent in 1994.
7 of 10 deaths in the U.S. are caused by chronic disease.
50 million Americans (approximately 1 in 6) have an autoimmune disease (more than cancer and heart disease combined).
Nearly 1 in 3 Americans have either prediabetes or diabetes. (100 Million)
At any given moment, roughly half of the adults in the U.S., including 9 out of 10 adults over age 60, are taking at least one prescription drug.
Almost a third of adults take two or more drugs.
Almost 30 percent of all teens are now on a prescription drug, as are 20 percent of young children.


The Cost

80% of the cost burden from chronic disease is due to lost productivity, 90% of which is presenteeism (at work but not at full productivity because of preventable health issues) and absenteeism (due to chronic health issue). – Almanac of Chronic Disease.
 America spent just under $310 billion on pharmaceutical drugs in 2015 (IMS Health 2016)
This generation is the first in which kids are expected to live shorter lifespans than their parents.
1 in 5 Americans struggles to pay medical bills, and three in five bankruptcies are due to medical expenses.
Medical care is the third-leading cause of death in the US., according to analyses published in BMJ in 2016 and JAMA in 2000.
Chronic disease will generate $47 trillion in healthcare costs globally by 2030 if the epidemic is unchecked (Duff-Brown, 2017). That’s more than the annual GDP of the six largest economies in the world.


In Part 2 we will delve deeper into the behaviors of health. Until then, here are a few studies linking gut health, what we eat, and how we live with chronic diseases . . .

Links Between Diet/Lifestyle and Disease: What the Research Shows

On B12 deficiency: Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range—a range at which many experience neurological symptoms. (1)

On Vitamin D deficiency: According to the lower boundary of the U.S. lab range of 30 ng/mL, as many as 70 percent of Americans are considered deficient (2, 3).

On diet: One study of obese postmenopausal women found that a modified Paleo diet improved several metabolic markers, including weight, waist circumference, blood pressure, blood sugar, cholesterol, and kidney function (4).

On exercise: Low physical activity is correlated with cardiovascular disease, obesity, insulin resistance, and all-cause mortality (5, 6). Just one additional hour in a sedentary posture per day is associated with a 22 percent greater risk of type 2 diabetes and a 39 percent greater risk for metabolic syndrome (7).

On carbohydrates: A meta-analysis of 17 low-carb diet trials including more than 1,000 patients found that low-carb diets improved CVD risk factors, including decreases in triglycerides, blood glucose, BMI, abdominal circumference, plasma insulin, C-reactive protein, and HDL cholesterol (8).

On sleep: The negative effects of sleep deprivation are serious: sleep durations that are consistently shorter than seven hours in a 24-hour period are associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, learning and memory problems, and an overall increase in mortality (9). Some may argue that poor sleep can even undo the benefits of a healthy diet and exercise routine (10, 11).

On the gut: The microbiota plays a key role in the development, maturation, and function of the immune system. As such, gut microbes are key mediators of inflammatory signaling. A recent study pinpointed the microbiome as a key player in age-associated inflammation. This age-associated dysbiosis and the accompanying inflammation may in part explain the age-associated increase in the incidence of cardiovascular disease (12).

On leaky gut: Chronic heart failure patients have also been shown to have reduced gut bacterial diversity and lower abundance of key bacterial genera (13) and increased intestinal permeability compared to healthy controls (14, 15)

On probiotics: Several studies have reported that probiotic-containing yogurts significantly reduce total serum cholesterol and LDL cholesterol and improve the LDL-to-HDL cholesterol ratio (16, 17, 18).

On depression and the gut/brain axis: One study examined the specific differences in the bacterial make-up of the microbiome in patients with major depressive disorder in comparison with healthy individuals (19). Significant differences were identified between these two groups. Additionally, the severity of depressive symptoms was related to the amount of a specific bacterium. A lower relative abundance of Faecalibacterium was associated with more severe depression.

On bowel diseases and diabetes: Dysbiosis is associated with a growing number of diseases such as Crohn’s disease (20), ulcerative colitis (21, 22), irritable bowel syndrome (23), and both type 1 and type 2 diabetes (24, 25).

On the microbiome and the thyroid: A 2014 study found that individuals with hyperthyroidism had significantly lower numbers of Bifidobacteria and Lactobacilli and significant higher levels of Enterococcus species compared to healthy controls (26).


The next major advancement in health for people is not going to be technological, it is going to come from individuals taking responsibility for their own health by making significant lifestyle changes. If we change course right now, toward preventative care (lifestyle-based intervention programs, health coaching, etc.), by 2023 the US could avoid 40 million cases of chronic disease and reduce the economic impact by 27%, or 1.1 trillion annually. Lifestyle-based interventions are the key to reversing chronic disease costs. – The Milken Institute, Oct. 2007







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