Incidence and prevalence of chronic disease

The last half century has seen a steady increase in the incidence and prevalence of chronic inflammatory diseases with further increases expected. According to the Marshall PathogenesisA description for how chronic inflammatory diseases originate and develop., a number of factors are to blame:

• misuse of antibiotics especially Beta-lactam antibiotics
• vitamin supplementation including folic acid but especially vitamin D
• novel vectors for sharing pathogens including blood donation
• widespread adoption of compulsory mass vaccinations

Manifestations of both arteriosclerosis^{1 2} and cardiac disease³ can be observed in mummies of ancient Egypt. Ötzi the Neolithic Iceman who lived around 3300 BC was found to have arthritis.⁴ Yet, it is only recently that rates of certain chronic diseases have appeared to escalate.

At the beginning of the twentieth century, infectious diseases were the leading cause of death worldwide. In the United States, three diseases — tuberculosis, pneumonia, and diarrhoeal disease — caused 30% of deaths.⁵ By the end of the twentieth century, in most of the developed world, mortality from infectious diseases had been replaced by mortality from chronic illnesses such as heart disease, cancer and stroke.⁶

While many researchers have argued^{7 8} that most chronic diseases are not caused by infection, a broad array of evidence suggests otherwise.

25% of Americans have more than one chronic condition.

In 2000, approximately 125 million Americans (45% of the population) had chronic conditions and 61 million (21% of the population) had multiple chronic conditions.⁹

According to a 2004 report:

In 2004, almost half of all Americans, or 133 million people, live with a chronic condition. … People with chronic conditions account for 83 percent of health care spending and those with five or more chronic conditions have an average of almost fifteen physician visits and fill over 50 prescriptions in a year.

Partnership for Solutions National Program Office, Robert Wood Johnson Foundation

Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases—cardiovascular disease, cancer, chronic respiratory disease, and diabetes—caused 29 million deaths worldwide.¹⁰ Worldwide annual mortality due to chronic disease is expected to increase in real numbers as well as relative to deaths from injuries and diseases traditionally understood to be infectious such as polio, rubella, tuberculosis, etc.

In the United States, the number of people with chronic conditions is projected to increase steadily for the next 30 years.¹¹ Partnership for Solutions National Program Office estimates that it will reach 157 million by 2010 while another estimate says that figure will be 140 million.

• obesity – One team concluded in a recent meta-analysis that if Americans keep gaining weight at the current rate, 75 percent of U.S. adults will be overweight and 41 percent obese by the year 2015. A 2002 paper concluded that “the prevalence of obesity is increasing globally, with nearly half a billion of the world’s population now considered to be overweight or obese.”¹²

A progressive leftward shift in age of onset of the childhood disease has been and continues to be observed in the United Kingdom. This trend in a progressively earlier onset of diabetes is consistent with data from other countries. Source: Gale

Obesity is likely to continue to increase, and if nothing is done, it will soon become the leading preventable cause of death in the United States.

Youfa Wang, MD, PhD ¹³

• diabetes – In a 2002 paper, Edwin Gale concluded that the incidence of childhood diabetes (type I diabetes) began to steadily increase at almost the same time – from the 1950s onwards.¹⁴ This increase had been identified in a range of developed countries including the United States, Sardinia, and Northern Europe.¹⁵ According to a 2009 paper in Diabetes care, the number of people with diabetes in the United States is expected to double over the next 25 years. That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.¹⁶
• pre-term delivery – The U.S. National Center for Health Statistics (Centers for Disease Control and Prevention) has reported a 20% increase (from 10.6% to 12.7%) in the percentage of preterm deliveries during the years 1990–2005.¹⁷

Members of societies that do not supplement their food chains with vitamin D have naturally low levels of 25-hydroxyvitamin DThe vitamin D metabolite widely (and erroneously) considered best indicator of vitamin D "deficiency." Inactivates the Vitamin D Nuclear Receptor. Produced by hydroxylation of vitamin D3 in the liver. (25-DThe vitamin D metabolite widely (and erroneously) considered best indicator of vitamin D "deficiency." Inactivates the Vitamin D Nuclear Receptor. Produced by hydroxylation of vitamin D3 in the liver. ).^{18 19} However when whole populations are given large amounts of vitamin D, the only members of that population who remain “deficient” are those whose immune systems are fighting disease by actively downregulating 25-D. In other words, the more rigorously vitamin D is added to milk, juice, snack bars, and breakfast cereals, the less likely it is that someone has low levels of vitamin D but no chronic disease.

For this reason, data which identifies vitamin D “deficiency” is actually pointing to incidence of disease. In a 2009 paper, Saintonge et al showed that the prevalence of low levels of 25-D - and therefore the rate of chronic disease - is between 2% and 14% among a cohort of 2,955 Americans 12 to 19 years of age.²⁰

Using data from the National Health and Nutrition Examination Survey III, Saintonge et al found that a significant proportion of American adolescents had low levels of 25-D.

According to Dr. Roger Bouillon of the University of Leuven, “over one billion” people worldwide have vitamin D “deficiency.”²¹

The accuracy of this estimate is debatable. If this figure includes those populations that do not supplement with vitamin D, Dr. Bouillon's figure may be an overestimate: healthy people who do not supplement with vitamin D have naturally low levels of 25-D. However, it does seem likely that a large fraction of the world's population suffers from chronic disease of one kind or another.

A study published in 2008, controlling for age and other factors, found that Americans' serum levels of 25-D declined “5-9 nmol/L” in 1988-1994 as compared to 2000-2004 in most males, but not in most females.²² A 2010 study found that 90% of the pigmented populace of the United States (Blacks, Hispanics, and Asians) and nearly 75% of the white population have levels of 25-D lower than 30 ng/ml. This proportion has doubled in these same population within the last 10 years.²³

While it has been widely hypothesized that lifestyle factors, including a poor diet and a lack of exercise, are driving what the World Health Organization has termed “an obesity epidemic,” even the most ambitious obesity intervention programs, which have gone to great lengths to increase rates of exercise and improve eating habits of a population, have been failures.^{24 25}

According to the Marshall Pathogenesis, the primary cause of chronic inflammatory disease is microbes and factors which directly influence pathogens. Indeed, there is growing evidence that chronic diseases are not due to predominantly lifestyle factors. A number of factors have contributed to the creation of an epidemic of Th1 inflammatory diseases.

In a 2004 Science paper, Finch and Crimmins proposed that one of the major driving factors behind mortality at all ages was infection and inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.. The team pointed to studies of historical cohorts in England and Sweden showing that as rates of mortality at younger ages improved in groups born in different years, the adult survivors in those cohorts also had lower rates of mortality and disease. While some have concluded that improvements in sanitation, nutrition, income, and medicine are the driving factors behind historical difference in mortality across all age groups across the last two centuries, Finch and Crimmins argue one of the principal factors, was the difference in “lifetime exposure to infectious diseases and other sources of inflammation,” which they said makes “an important contribution” to the change in disease.²⁶ Early infections, they said, afflicted survivors with a “cohort morbidity phenotype” which they carried with them throughout their lives.²⁷

For example, Costa et al. concluded that the difference in the rate of arteriosclerosis (hardening of the arteries) between older blacks from 1910 and older whites from 2004 was due to the discrepancy in infectious burden between the two populations.²⁸ Early-life infection may also explain effects of the season of birth on longevity. Among birth cohorts of the 19th and early 20th centuries from Northern Europe, those born in the spring eventually lived 3 to 6 months longer than autumn births, with corresponding differences in some later-life diseases.²⁹ Fitch and Crimmins attribute this discrepancy to infections, which tend to be higher during winter months.³⁰

• Availability and widespread use of antibiotics which promote the bacterial transition to intracellular. The Beta-lactam antibiotics, namely the penicillins (e.g. amoxycillin and cephalosporins) foster the growth of l-form bacteria.
• Public policy which frowned upon using secondary antibiotics, such as minocyclineBacteriostatic antibiotic used by Marshall Protocol patients. which could have helped by killing the L-formsDifficult-to-culture bacteria that lack a cell wall and are not detectable by traditional culturing processes. Sometimes referred to as cell wall deficient bacteria. created by the Beta-lactam usage.
• The communication of the L-form bacteriaDifficult-to-culture bacteria that lack a cell wall and are not detectable by traditional culturing processes. Sometimes referred to as cell wall deficient bacteria. through the food chain from animals routinely treated with antibiotics

• Vitamin D supplementation of baby food and also of the general food chain.
• The rise of the sun-loving culture in the 50s. Prior to the bikini, it was not so fashionable for the young to sunbathe excessively
• Supplementation with folic acid

• Routine interference with immune reactions: anti-infammatories, anti-bacterials, corticosteroidsA first-line treatment for a number of diseases. Corticosteroids work by slowing the innate immune response. This provides some patients with temporary symptom palliation but exacerbates the disease over the long-term by allowing chronic pathogens to proliferate., TNF-alpha drugs, etc.

• Widespread adoption of compulsory mass vaccinations may play some role although evidence for this is still preliminary and, in some cases, contradictory
• Blood transfusions especially in elective surgery

War offers a number of circumstances which contribute to the incidence and prevalence of chronic disease as evidenced by epidemiological studies. Circumstances include:

• Acquisition of new pathogens
• Physical trauma and stress
• Psychological stress

Perhaps it is more than coincidence that those diseases for which there is a demonstrated association with war – cancers, hypertension, obesity, and many of the other forms of cardiovascular disease – saw an increase in the aftermath of World War II, particularly in the United States. Given the discrepancy with which the genders have traditionally enlisted, it would be speculative to suggest that war plays a role in the onset of predominantly “male” chronic diseases, but that possibility may be worth further study.