The $35 billion race to cure a silent killer that affects 30 million Americans

[akrasia]

https://www.cnbc.com/2018/12/21/the...or-a-liver-disease-that-affects-millions.html


(from later in the article my bold)
In spite of the large U.S. patient population at risk, the CDC has not addressed the crisis, and there is no FDA-approved treatment available, experts point out.


At the Mayo Clinic in Jacksonville, Florida, the liver transplant group is busy handling an onslaught of patients who have come from all over the country in hopes of a chance at life. For many, a liver transplant is their last hope, after being diagnosed with a deadly disease sweeping the nation at epic proportions. People crowd the unit and undergo scores of testing and evaluation in an effort to get on the hospital’s coveted transplant list. It’s a program with a 94 percent survival rate after liver transplant, one of the highest in the nation.

For many the culprit is a serious form of fatty liver disease called nonalcoholic steatohepatitis, also known as NASH. An outgrowth of the obesity epidemic in the Western world and around the globe, it causes scarring and inflammation that can lead to liver cirrhosis, cardiac and lung complications, liver cancer and death. Yet few people know about it.


Across the United States, millions of people of all ages suffer from this silent killer that slowly morphs from nonalcoholic fatty liver disease, a condition that now affects 89 million in the U.S., according to the Center for Disease Analysis. The National Institutes of Health estimates as many as 30 million people, or 12 percent of U.S. adults, now have NASH....

 

[leokitten]

Again spending billions and billions on lifestyle diseases... and when those who have life destroying disease which is no fault of their own, sadly no money is left for us. Sad and disgusting. NASH didn't even exist 30 years ago, it was rare if someone had something like that in the 80s. Unfortunately it's because of the lifestyle of many people here in the U.S., and I know the food industry makes it very hard for people to have willpower, but in the end it's still usually lifestyle and some responsibility must be shared.

 

[NelliePledge]

I know the food industry makes it very hard for people to have willpower, but in the end it's still usually lifestyle and some responsibility must be shared.

From my perspective as an overweight person if you’ve not been there don’t judge. Especially people with ME who are and have been judged should know better and have more empathy. And my understanding from a documentary I saw recently (will try to find a link) genetics can contribute a substantial part up to 70% I think it was said of why an individual is obese.

 

[Arnie Pye]

in the end it's still usually lifestyle and some responsibility must be shared.

The US dietary guidelines since the late 70s(?) have recommended a high carb, low fat, fairly low protein diet. There is evidence to suggest that Americans have changed their dietary habits to adhere to this. I remember a few years ago being told by an American friend that ordinary milk has sugar in it, as do bread products, and all processed food. Why? Pizza is classified as a vegetable in school meals. Again... Why? My American friend comes from a rural part of the US and sources of food are limited. Fresh vegetables and fresh protein sources of any kind are not easily found. She lives in what is known as a food desert. So, how are people like her supposed to eat healthily? It simply isn't possible! But no doubt if she gets fat she'll be blamed.

 

[Snowdrop]

https://www.wsj.com/articles/SB1023915818486451160

With obesity reaching epidemic proportions in the U.S., some critics say it's the government's food pyramid that should go on a diet.

 

[leokitten]

From my perspective as an overweight person if you’ve not been there don’t judge. Especially people with ME who are and have been judged should know better and have more empathy. And my understanding from a documentary I saw recently (will try to find a link) genetics can contribute a substantial part up to 70% I think it was said of why an individual is obese.

Apologies didn’t mean to judge, tried to make the point that for lifestyle diseases some responsibility should be shared and we should give more than equal weight and funding for diseases where lifestyle isn’t a factor at all instead of leaving communities high and dry.

The documentary you’ve seen is telling a partial falsehood. If 70% of obesity is genetic and completely out of one’s control than why haven’t we had similar rates of obesity even 30-40 years ago?

Also NASH is a specific disease that is not just a side effect of obesity, you also have to be eating all the wrong foods on top of it. There’s been a fundamental change to many American’s eating habits in the last 20 years or so that has brought it on.

 

[leokitten]

The US dietary guidelines since the late 70s(?) have recommended a high carb, low fat, fairly low protein diet. There is evidence to suggest that Americans have changed their dietary habits to adhere to this. I remember a few years ago being told by an American friend that ordinary milk has sugar in it, as do bread products, and all processed food. Why? Pizza is classified as a vegetable in school meals. Again... Why? My American friend comes from a rural part of the US and sources of food are limited. Fresh vegetables and fresh protein sources of any kind are not easily found. She lives in what is known as a food desert. So, how are people like her supposed to eat healthily? It simply isn't possible! But no doubt if she gets fat she'll be blamed.

This is the U.S. and for those of us who grew up here we know it’s a very harsh and unforgiving place. You have to be willing to go through hell and work your ass off and make sometimes impossible choices for your health or you will be blamed and it sucks but the world isn’t fair. It just isn’t. I know that having ME/CFS in this country.

I emigrated as a child with my parents from Latin America. They only had a high school education and spoke zero English. My father washed cars and worked as a waiter. My mother sewed clothes and then worked as a secretary. We lived in what are known as projects outside of Washington DC when I was a child. I grew up completely poor and my parents had no money until I was an adult.

So I know what it’s like to have limited resources. I do not know everyone’s situation but I do know a majority of that 12% of people who have NASH and likely another 20% who have NAFLD (pre NASH) that there are choices they choose not to make to improve their health. Yes not everyone but the majority. I see it everywhere around me everyday here. People making the wrong choices.

So I’m entitled to say I think we should spend some of that $30 BILLION on people who don’t have a choice. Us.

 

[NelliePledge]

There’s been a fundamental change to many American’s eating habits in the last 20 years or so that has brought it on.

Right which as you said has been brought about by the food industry

And those who would be critical of people with ME say it’s our thoughts and behaviours that perpetuate the illness. We need to think before criticising others for causing/ perpetuating their own illnesses it is a very simplistic attitude that gets you into a minefield. For example if you have ever known anyone with an addiction to alcohol you would understand that overcoming the physical effects is a massive challenge.

 

[leokitten]

Right which as you said has been brought about by the food industry

And those who would be critical of people with ME say it’s our thoughts and behaviours that perpetuate the illness. We need to think before criticising others for causing/ perpetuating their own illnesses it is a very simplistic attitude that gets you into a minefield. For example if you have ever known anyone with an addiction to alcohol you would understand that overcoming the physical effects is a massive challenge.

Absolutely, I didn’t say we should spend $0 on NASH, but it’s frustrating that we can’t even get $20 million per year on ME and NASH is going to get $30 billion over time. It’s insane

 

[Hip]

why haven’t we had similar rates of obesity even 30-40 years ago?

Because quite possibly the global obesity crisis may be caused by a pandemic of adenovirus 36, a virus which infects adipocytes and then instructs those cells to absorb and store fat.

Adenovirus 36 is much more commonly found in those with obesity that it is in normal weight individuals. In other words, obesity may be an infectious disease, not some simplistic notion of a lack of self control in eating. Ref: 1

CDC: Adenovirus 36 DNA in Adipose Tissue of Patient with Unusual Visceral Obesity

Of course, as we all know, there are a lot of medical researchers don't believe in infectious etiologies of chronic illnesses, so don't expect governments or scientists to develop adenovirus 36 antivirals or vaccines anytime soon.

 

[leokitten]

Because quite possibly the global obesity epidemic may be caused by a pandemic of adenovirus 36, a virus which infects adipocytes and then instructs those cells to absorb fat.

Adenovirus 36 is much more commonly found in those with obesity that it is in normal weight individuals. In other words, obesity may be an infectious disease, not some simplistic notion of a lack of self control in eating. Ref: 1

Of course, as we all know, there are a lot of medical researchers don't believe in infectious etiologies of chronic illnesses, so don't expect governments or scientists to develop adenovirus 36 antivirals or vaccines anytime soon.

Could be.

I just want to be clear and I hope I wrote it correctly I do not think obesity is 100% lack of self control. Part genetics, part socioeconomic, part food industry, part government, part lifestyle and self control. That’s what I meant by some shared responsibility.

 

[NelliePledge]

Absolutely, I didn’t say we should spend $0 on NASH, but it’s frustrating that we can’t even get $20 million per year on ME and NASH is going to get $30 billion over time. It’s insane

Ok criticise that disparity I agree but you don’t need to criticise other ill people to get the point across it’s strong enough anyway

 

[leokitten]

Ok criticise that disparity I agree but you don’t need to criticise other ill people to get the point across it’s strong enough anyway

@NelliePledge please when you have a chance read this article

https://www.cnn.com/2019/01/08/health/cardiologist-statin-cholesterol-mission/index.html

As a society we are wasting our time and billions of dollars of money if we think we are going to truly help people with NASH, NAFLD, obesity with research for new drugs and other attempts at magic bullets so that people don’t have to change their poor lifestyle.

So many in America just want a pill to solve their problems. They do not want to face reality and make changes. In the above article about heart disease you can clearly see that the drugs might lower cholesterol numbers and lower risk of heart attack but people just continue feeling like shit and have poor health. Expensive drugs and treatments are never going to be the answer.

It’s because there is no magic bullet, you have to take some responsibility for the food you choose to eat and the lifestyle you choose follow because medicine and science will never be able to give you a simple treatment so you can just continue doing what you are doing without consequences.

Even a significant percentage of people who have invasive bariatric surgery, which effectively resets your hunger centers, gain much of the weight back again because they do not take responsibility to change their lifestyle at all. They expect magic with no work from their part, they expect doctors and pharma to sweep down and save them so they do not have to do much and they refuse to educate themselves and be their own health advocate.

To be clear I’m not speaking about obese and overweight people with ME. We all understand that it can be a side effect of having this disease for obvious reasons and not a lifestyle issue.

 

[Pyrrhus]

In other words, obesity may be an infectious disease, not some simplistic notion of a lack of self control in eating. Ref: 1

I have also seen some interesting hypotheses that chronic refractory obesity may be a neurological condition. Not much data yet, but interesting ideas.

Even a significant percentage of people who have invasive bariatric surgery, which effectively resets your hunger centers, gain much of the weight back again

I have heard the opposite, although I’m no expert in this area:
https://www.ncbi.nlm.nih.gov/pubmed/30293134

For the record, however, I wouldn’t consider NASH to be a ‘lifestyle disease’, any more than I would consider ME to be a ‘lifestyle disease’. Such ‘blame the victim’ approaches are unfortunately commonplace.

 

[leokitten]

For the record, however, I wouldn’t consider NASH to be a ‘lifestyle disease’, any more than I would consider ME to be a ‘lifestyle disease’. Such ‘blame the victim’ approaches are unfortunately commonplace.

You provide zero evidence for that statement. Where’s your evidence that NASH and NAFLD are not predominantly lifestyle diseases?

Diseases that were virtually non-existent since the dawn of humanity until the 1980s. And you are comparing this to ME?

Second I’m not doing a “blame the victim” approach, you are not carefully reading my words. If the public believes they do not have to take any responsibility for any lifestyle changes and they expect society, government, food industry, science, pharma, everything and everyone else to fix the problem they are living in a fantasy world.

It won’t get fixed like that anytime in the next 100 years, if ever. At some point one has to say I need to play a role in my own health and help make things better. I’m not saying only lifestyle change will solve it, yes with help from surgery etc but those by themselves will not work without the permanent lifestyle changes.

NASH and NAFLD are typically one of the end results of decades of poor lifestyle.

From https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes

Causes of NAFLD
You are more likely to develop NAFLD—either simple fatty liver or NASH—if you

• are overweight or obese
• have insulin resistance
• have abnormal levels of fats in your blood, which may include
  • high levels of triglycerides
  • abnormal levels of cholesterol—high total cholesterol, high LDL cholesterol, or low HDL cholesterol
• have metabolic syndrome or one or more traits of metabolic syndrome. Metabolic syndrome is a group of traits and medical conditions linked to overweight and obesity. People with metabolic syndrome are more likely to develop type 2 diabetes and heart disease. Experts think NAFLD may be closely linked to metabolic syndrome. Doctors define metabolic syndrome as the presence of any three of the following:
  • large waist size
  • high levels of triglycerides in your blood
  • low levels of HDL cholesterol in your blood
  • high blood pressure
  • higher than normal blood glucoselevels
• have type 2 diabetes

Research also suggests that certain genes may make you more likely to develop NAFLD. Experts are still studying the genes that may play a role in NAFLD.

In NAFLD, people have a buildup of fat in the liver that is not caused by alcohol use. If you have a history of heavy alcohol use and fat in your liver, your doctor may determine that you have alcoholic liver disease instead of NAFLD.

All predominantly lifestyle causes!

 

[leokitten]

I have heard the opposite, although I’m no expert in this area:
https://www.ncbi.nlm.nih.gov/pubmed/30293134

I think you failed to read the full details of this review. A significant percentage of patients across all procedure types required reoperations/revisions for all the studies that reported it. This means that they gained weight back and needed to go back under the knife more than once and sometimes multiple times!

 

[Jonathan Edwards]

I have to agree with Leokitten here. Obesity and liver damage are due to eating more than is needed. No research is required to state that. Causation does not add up to 100%. It does not add, it has a different maths although people reporting research often get this wrong.

Obesity must be entirely due (100%) to eating more than needed. There are lots of possible reasons for eating more than needed but that does not alter the fact that the only rational management is eating less. Carbohydrates are not a problem unless there is calorie excess. The recent fad for eating protein has no scientific basis.

Where the 'blame' lies is probably not a helpful question but society as a whole somehow has to make sensible choices. In this case it is eating less and blocking commercial pressures to feed sugar addiction.

 

[richard7]

A) I think it makes sense that a nation's institute of health should spend money on researching things that harm (or help) its citizens health. You could paint sunburn and skin cancer, sexually transmitted diseases, sporting accidents, car accidents, illnesses associated with air pollution, all sorts of things as lifestyle choices. But they are not really choices, and even if they were what interest would the vast number of citizens who had made those choices have in not funding research into healing these things.

B) re @Jonathan Edwards comment that "obesity must be entirely due to eating more than needed." That is hardly the point. The questions are why do people more than they need? Why do they have trouble getting back to their idea weight/why do almost all diets fail? and why do people fail to maintain homeostasis when they do manage to loose weight?

Personally I am of the opinion that it is not the people who have changed but their environment. Well I say personally but I know other people have expressed this opinion too.

 

[Hip]

If you look at biological functioning, it's governed by automatic homeostatic mechanisms that millions of years of evolution have created.

For example, when the body is short of water, we automatically experience thirst, which causes us to drink until the thirst disappears. When we need more oxygen to supply energy for our physical exertions, we automatically breathe faster. If we are hot, we automatically start to sweat to shed off heat. These are all homeostatic self-regulating mechanisms.

So when it comes to food, I cannot believe that evolution somehow forgot to provide us with a homeostatic mechanism regulating food consumption and fat storage; I don't believe that when food is in abundance, humans will eat, eat, eat without any self-regulation and continually accumulate fat. Food consumption must be homeostatically regulated just like everything else.


So I think obesity may involve dysfunction of fat storage, where too much fat is stored in the body; and/or dysfunction of the mechanism regulating food consumption (such as a dysregulation of our hunger hormones leptin and ghrelin).

If there is such dysfunction, and if one believes in the scientific principle of cause and effect, one would have to find some environmental factors that are causing this dysfunction.

 

[Hip]

I should add that the abundance of food is a necessary factor for obesity, just as the abundance of guns is a necessary factor for high levels of gun crime.

But the abundance of guns or food are clearly not sufficient factors, as there are countries like Switzerland which have high levels of citizen gun ownership, but gun crime is virtually unheard of. And you get people living in countries that have abundant food available, but they do not get obese.

So abundance of food I think may be a necessary factor for an obesity epidemic, but not a sufficient factor.