Myth busting

Chronic disease is not inevitable or natural, even with age

To stem the rising tide of chronic disease, we must alter the elements of our environment.

In the 1830s, British settlers in New Zealand imported European rabbits for food and sport. With no native predators, the rabbits soon took over. Accounts from the period describe thousands of hectares run through with burrows, and huge tracts of arable land destroyed by overgrazing.

In a desperate bid to stem the scourge, the New Zealanders brought in a natural predator of the rabbit – ferrets. Without native predators to pick them off, the new imports did well. But they also played a prominent role in the decline of several endangered bird species, including the kiwi, the weka, and the kakapo. It’s a familiar parable (Mark Twain even riffed on it) about unintended consequences, and the danger of applying reductionist logic to a world that is characterised by extraordinary interdependence and complexity.

As a physician, I can’t help but be reminded of ferrets in New Zealand as I write prescriptions for the drugs we use to manage chronic disease. Hydrochlorothiazide for high blood pressure. Sulfonylureas, a class of medication used to treat Type 2 diabetes. Statins for heart disease.

Don’t get me wrong, these drugs work. They absolutely save lives. But the human body is a precisely interdependent system, and these drugs are like sledgehammers. The ferrets did kill rabbits, but they were such an indelicate intervention that they wrought their own special havoc on the native ecosystem. The kakapo might never again be seen on the New Zealand mainland. How much collateral damage are we inflicting on the human ecosystem with our powerful medicines?

Perhaps more than we think. Hydrochlorothiazide, a widespread treatment for high blood pressure, increases haemoglobin A1C and impairs glucose tolerance. These are indices of insulin resistance, which is associated with diabetes, obesity, cardiovascular disease and dementia. Hydrochlorothiazide raises LDL cholesterol and triglycerides, and lowers HDL cholesterol – a pattern known to confer increased risk of cardiovascular disease.

Sulfonylureas have been shown to increase the risk of cardiovascular disease as well.

And statins, some of the most widely prescribed drugs in the United States, have been found to impair glucose tolerance and increase the risk of diabetes.

While there is no doubt that the collective benefit of these medications currently outweighs their adverse effects, it’s remarkable that many of the drugs we give to treat chronic disease can actually increase the risk of those selfsame diseases. It speaks to the intricacy of human biology, and to the crudity of even our most advanced pharmaceuticals. Twain would have loved the irony.

External forces of chronic disease

The hope of academic medicine is that research ­– especially in molecular biology and pharmaceuticals – will save us. As we zero in on the elusive, primordial mechanisms of disease, we can design ever more precise pharmaceuticals, or even cures.

But rather than producing any outright cures for chronic disease, decades of basic science research seem to have yielded a different kind of truth – that the human body is an incredibly, devilishly complex system. The deeper we dig, the more convoluted becomes the pathophysiology of chronic disease. What has become clear is that these chronic diseases – high blood pressure, diabetes, cardiovascular disease – are manifestations of aberrant metabolisms, rather than a lone faulty switch buried somewhere within our cells.

There seem to be no silver bullets. Causation at the molecular level, deep inside the body, appears to be beyond our current reach. But what about pushing against the ultimate cause – not within us, but in the outside world? Are we fated to follow the New Zealanders’ folly, causing damage with every effort to treat? Or, can we learn what external forces have made us so chronically ill, and push back there?

Perhaps we can. It turns out that traditional cultures across the globe, from hunter-gatherers to pastoralists to horticulturists, have shown little evidence of chronic disease. It’s not because they don’t live long enough – recent analysis has found a common lifespan of up to 78 years among hunter-gatherers, once the bottlenecks of high mortality in infancy and young adulthood are bypassed. We can’t blame genes, since many of these groups appear to be more genetically susceptible to chronic disease than those of European descent.

Evidence suggests it is how they live. Though traditional cultures span an immensely diverse gamut of lifestyles, they share a common denominator defined by the absence of modern banes: absence of processed foodstuffs, absence of sedentary lifestyle, and likely absence of chronic stressors.

The lifestyle factor

Indeed, evidence suggests that lack of chronic disease in these groups flows from how they live, how they move, how they eat. Diet looks to be an especially powerful driver – adoption of a Western diet, rich in processed foods, has mirrored the development of chronic disease worldwide, and prospective studies with healthy and diabetic subjects have documented the powerful influence of food on health. Physical exercise, long touted as merely a means to calorie disposal, turns out to have complex endocrine and metabolic effects on insulin signalling, stress response, sleep, mental health, and even neuronal function in the brain. What the science seems to say is that an ancestral way of life aligns the machinery of our metabolisms toward good health.

Thus it appears that our bodies aren’t, after all, destined for chronic disease as they age – rather, it is the environment we’ve put them in that should bear the blame.

But isn’t this obvious? Yes, physicians and public health researchers have long acknowledged the influence of environmental elements on health, but we remain beholden to a paradigm that places first priority on mastery of molecular mechanisms. The sophistication of our sciences is a triumph, and technological progress must no doubt continue. But we know enough about the environmental determinants of health to act, even if we don’t fully understand the mechanisms.

Our ship is sinking, and the current approach is akin to bailing with a thimble. If we are to stem the rising tide of chronic disease, we must alter the elements of our environment that promote chronic disease. With the global price tag of chronic disease projected to rise to $30 trillion by 2030, we simply can’t afford not to.

The writer is a medical resident at the Massachusetts General Hospital in Boston.

This article was first published on Aeon.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

Modern home design trends that are radically changing living spaces in India

From structure to finishes, modern homes embody lifestyle.

Homes in India are evolving to become works of art as home owners look to express their taste and lifestyle through design. It’s no surprise that global home design platform Houzz saw over a million visitors every month from India, even before their services were locally available. Architects and homeowners are spending enormous time and effort over structural elements as well as interior features, to create beautiful and comfortable living spaces.

Here’s a look at the top trends that are altering and enhancing home spaces in India.

Cantilevers. A cantilever is a rigid structural element like a beam or slab that protrudes horizontally out of the main structure of a building. The cantilevered structure almost seems to float on air. While small balconies of such type have existed for eons, construction technology has now enabled large cantilevers, that can even become large rooms. A cantilever allows for glass facades on multiple sides, bringing in more sunlight and garden views. It works wonderfully to enhance spectacular views especially in hill or seaside homes. The space below the cantilever can be transformed to a semi-covered garden, porch or a sit-out deck. Cantilevers also help conserve ground space, for lawns or backyards, while enabling more built-up area. Cantilevers need to be designed and constructed carefully else the structure could be unstable and lead to floor vibrations.

Butterfly roofs. Roofs don’t need to be flat - in fact roof design can completely alter the size and feel of the space inside. A butterfly roof is a dramatic roof arrangement shaped, as the name suggests, like a butterfly. It is an inverted version of the typical sloping roof - two roof surfaces slope downwards from opposing edges to join around the middle in the shape of a mild V. This creates more height inside the house and allows for high windows which let in more light. On the inside, the sloping ceiling can be covered in wood, aluminium or metal to make it look stylish. The butterfly roof is less common and is sure to add uniqueness to your home. Leading Indian architecture firms, Sameep Padora’s sP+a and Khosla Associates, have used this style to craft some stunning homes and commercial projects. The Butterfly roof was first used by Le Corbusier, the Swiss-French architect who later designed the city of Chandigarh, in his design of the Maison Errazuriz, a vacation house in Chile in 1930.

Butterfly roof and cantilever (Image credit: Design Milk on Flickr.com)
Butterfly roof and cantilever (Image credit: Design Milk on Flickr.com)

Skylights. Designing a home to allow natural light in is always preferred. However, spaces, surrounding environment and privacy issues don’t always allow for large enough windows. Skylights are essentially windows in the roof, though they can take a variety of forms. A well-positioned skylight can fill a room with natural light and make a huge difference to small rooms as well as large living areas. However, skylights must be intelligently designed to suit the climate and the room. Skylights facing north, if on a sloping roof, will bring in soft light, while a skylight on a flat roof will bring in sharp glare in the afternoons. In the Indian climate, a skylight will definitely reduce the need for artificial lighting but could also increase the need for air-conditioning during the warm months. Apart from this cleaning a skylight requires some effort. Nevertheless, a skylight is a very stylish addition to a home, and one that has huge practical value.

Staircases. Staircases are no longer just functional. In modern houses, staircases are being designed as aesthetic elements in themselves, sometimes even taking the centre-stage. While the form and material depend significantly on practical considerations, there are several trendy options. Floating staircases are hugely popular in modern, minimalist homes and add lightness to a normally heavy structure. Materials like glass, wood, metal and even coloured acrylic are being used in staircases. Additionally, spaces under staircases are being creatively used for storage or home accents.

Floating staircase (Image credit: Design Milk on Flickr.com)
Floating staircase (Image credit: Design Milk on Flickr.com)

Exposed Brick Walls. Brickwork is traditionally covered with plaster and painted. However, ‘exposed’ bricks, that is un-plastered masonry, is becoming popular in homes, restaurants and cafes. It adds a rustic and earthy feel. Exposed brick surfaces can be used in home interiors, on select walls or throughout, as well as exteriors. Exposed bricks need to be treated to be moisture proof. They are also prone to gathering dust and mould, making regular cleaning a must.

Cement work. Don’t underestimate cement and concrete when it comes to design potential. Exposed concrete interiors, like exposed brick, are becoming very popular. The design philosophy is ‘Less is more’ - the structure is simplistic and pops of colour are added through furniture and soft furnishings.

Exposed concrete wall (Image Credit: Getty Images)
Exposed concrete wall (Image Credit: Getty Images)

When building your home, it is important to use strong and durable materials. A value-added premium product with high compressive strength, Birla Gold cement is used to make tough, impermeable concrete that sets quickly, lasts long and minimises cracking. Its durability will ensure that your dream home always looks new and the steel structure inside remains protected. Birla Gold offers variants that are optimised for different needs. The unique hydraulic binding properties of the Birla Gold Premium cement variant prevent seepage, making it resistant to even corrosive water, especially important for houses in coastal cities. The Birla Gold Royal cement variant provides very high strength and is perfect for the foundation. As the video below says, with the different varieties of cement that Birla Gold offers, you can build the home of your dreams.

Play

This article was produced by the Scroll marketing team on behalf of Birla Gold Premium Cement and not by the Scroll editorial team.