On chlorophyll extracts, green poo and hogwash

“It will probably give her green poo” said Eric.

Eric had just received an email from his physiotherapist, worried about a friend with Lyme disease who had been told to take chloroxygen.

Realising this was outside his area of expertise, Eric contacted me. We have known each other for a long time.

Chloroxygen? For Lyme disease? Really?

Now I was curious.

Is there something in this or is it just another load of internet promoted hogwash?

So I decided to investigate the scientific literature on chloroxygen and its effect on health, particularly Lyme disease.

What is chloroxygen?

According to the promotional literature of one well-known brand, chloroxygen is an extract of chlorophyll from stinging nettles, suspended in water and glycerine, and free from preservatives and alcohol (1).

This seemed odd to me because the chlorophyll molecule has an oil-loving tail and does not dissolve in water.

I examined the label: Chlorophyll (Sodium Copper Chlorophyllins) 50mg per serving.

Just as I thought.

Chlorophyllin is a semi-synthetic mixture of sodium copper salts derived from chlorophyll. Chlorophyll is chemically treated and the magnesium atom at the centre of the ring is replaced with copper and the oil-loving tail is lost.

Unlike natural chlorophyll, chlorophyllin is water-soluble.

Although the content of different chlorophyllin mixtures may vary, two compounds commonly found in commercial chlorophyllin mixtures are trisodium copper chlorin e6 and disodium copper chlorin e4 (2).

These chlorophyllins are not naturally occurring substances and it is therefore more accurate to describe chloroxygen as a semi-synthetic chlorophyll derivative.

Health benefits claimed for chlorophyll-derived products

As you can see from the picture above, there are some, shall we say ‘interesting’ claims for the health benefits of chlorophyll-derived products, including but not limited to:

1. Anti-bacterial activity
2. Enhancement of the oxygen carrying capacity of the blood by building red blood cells, which boosts energy levels and facilitates high altitude acclimation
3. Deodorant for bodily smells
4. Inhibition of toxins that damage the body

How many of these are supported by scientific evidence, I wondered.

1.  Anti-bacterial activity

Most claims that chlorophyll products can kill bacteria are based on research performed early in the 20th century, before antibiotics were available to fight infections (3). Although many of these studies do not meet the rigorous standards of modern science, there is evidence that chlorophyll can kill certain types of bacteria (4). There is, however, no published evidence that chlorophyll can kill the type of bacteria which cause Lyme disease (more on this below).

Even if there were such evidence, it is unlikely to be a practical choice, because very high chlorophyll concentrations are needed for any positive anti-bacterial effect and modern antibiotics are far more effective.

2.  Increase in the oxygen carrying capacity of blood

Marketing brochures for chloroxygen claim that chlorophyll is the “blood of plants” and “increases haemoglobin’s ability to grab and hold oxygen” (1).

It is true that the chemical structures of haemoglobin and chlorophyll display some similarities but they perform entirely different functions in living organisms and are made via different pathways (5).  One of my friends who is a chemist gets very annoyed about this.  He says that claiming that chlorophyll and haemoglobin are closely related is like saying that a man is like a woman.

Haemoglobin is a molecule in the red blood cells of animals, made from a red iron-containing pigment called haem, bound to a protein, globin. Its primary function is to transport oxygen from the lungs to the tissues and then to transport carbon dioxide back from the tissues to the lungs.

Chlorophylls are a group of magnesium-containing molecules in the chloroplasts of plant cells. Their role is to trap energy from sunlight. This energy is then used, together with carbon dioxide, to manufacture the carbohydrates that all living organisms use as food.

Chlorophyll-a, the most abundant and most important chlorophyll of the family, represents about 75 per cent of the green pigments in plants. It is very susceptible to metabolism in the human gut and little of the chlorophyll-a that is ingested emerges intact (6).

Chlorophyll does not bind or transport oxygen and is not absorbed into the bloodstream. It is therefore biologically implausible that it “increases haemoglobin’s ability to grab and hold oxygen”.

Despite an exhaustive search of the scientific literature, I have been unable to find any evidence that the effect of chlorophyll on oxygen carrying capacity in humans has ever been studied.

3.  Deodorant for bodily smells

In the 1940’s and 1950’s various claims were made for the deodorant properties of chlorophyll. It was alleged to reduce bad breath, stench from skin ulcers, vaginal odours and bad smells from colostomies. Studies published in the British Medical Journal in 1953 provided no evidence to support these claims (7). According to John C. Kephart, who performed studies at the laboratories of the National Chlorophyll and Chemical Company about 20 years ago, “No deodorant effect can possibly occur from the quantities of chlorophyll put in products such as gum, foot powder, cough drops, etc. To be effective, large doses must be given internally” (8).

The Food and Drug Administration of the United States published a monograph pertaining to the use of chlorophyllin copper complex as a drug entitled “Deodorant Drug Products for Internal Use.” This monograph describes chlorophyllin copper complex as “generally recognized as safe and effective”, and describes the following uses: (i) “An aid to reduce odor from a colostomy or ileostomy.” (ii) “An aid to reduce fecal odor due to incontinence” (9).

4.  Inhibits toxins that damage the body

Chlorophyll and chlorophyllin are able to form tight molecular complexes with certain chemicals known or suspected to cause cancer, including polycyclic aromatic hydrocarbons found in tobacco smoke (10), some heterocyclic amines found in cooked meat (11), and aflatoxin-B1 (12).

Diets high in red meat and low in green vegetables are associated with an increased risk of colon cancer. It has been suggested that haem, the iron carrier of red meat, is involved in diet-induced damage to the cells of the colon resulting in cancer. There is evidence that natural chlorophyll, rather than chlorophyllin, reduces the toxicity caused by haem (13).

Researchers at Oregon State University reported that chlorophyll and its derivative chlorophyllin are effective in limiting the absorption of aflatoxin in humans (14). Aflatoxin is produced by a fungus that is a contaminant of grains including corn, peanuts and soybeans; it is known to cause liver cancer – and can work in concert with other health concerns, such as hepatitis.

Aflatoxin

Studies in animal models have suggested that chlorophyllin may act as an antioxidant (15) but more research is needed to understand the bioavailability and metabolism of natural chlorophylls and synthetic chlorophyllin in humans before conclusions can be drawn (16).

What is Lyme disease?

Lyme disease is a tick-borne infection caused by an organism called Borrelia burgdorferi. This is a type of gram-negative bacterium called a spirochete. Spirochetes look like miniature springs and move in a corkscrew fashion, which enables them to travel more easily through viscous substances like mucus.

Borrelia burgdorferi

The earliest and most common symptom of Lyme disease is a pink or red circular rash that develops around the area of the bite, three to 30 days after someone is bitten. The rash is often described as looking like a bull’s-eye on a dart board.

Early symptoms of Lyme disease

You may also experience flu-like symptoms, such as tiredness, headaches and muscle or joint pain.

If Lyme disease is left untreated, further symptoms may develop months or even years later and can include:

• muscle pain
• joint pain and swelling of the joints
• neurological symptoms, such as temporary paralysis of the facial muscles

Lyme disease in its late stages can trigger symptoms similar to those of fibromyalgia or chronic fatigue syndrome. This is known as chronic Lyme disease. More research into this form of Lyme disease is needed (17).

A person with Lyme disease is not contagious because the infection can only be spread by ticks.

As the causal organism is a bacterium, Lyme disease is medically treated with antibiotics.

Choice of antibiotic varies with stage of the disease but amoxicillin, doxycycline and ceftriaxone are commonly used (18). Treatment is usually required for 2 to 4 weeks.

In the early stages, oral antibiotics are usually effective but if treatment is delayed until later stages, then intravenous antibiotics may be required.

Conclusion

Whilst there is strong scientific evidence that consumption of green leafy plants, rich in chlorophyll and many other nutrients, is beneficial for human health (19) (20) (21), there is limited scientific evidence to substantiate the health claims made for semi-synthetic chlorophyll-derived products such as chloroxygen.

Chlorophyll and its semi-synthetic chlorophyllin derivatives may have some weak anti-bacterial activity, but there is absolutely no scientific evidence for their efficacy against the bacterium which causes Lyme disease.

Furthermore, there is no plausible biological explanation or evidence to support the claim that chloroxygen increases the oxygen carrying capacity of the blood.

This is utter hogwash.

Many of the nutrients which build and sustain the essential elements in blood are found in plant foods high in chlorophyll, but this is the limit of the association between chlorophyll and the oxygen carrying capacity of blood.

Drinking green juices and eating green vegetables such as rocket (arugula), broccoli, parsley, kale and spinach, together with other plant foods rich in iron and other minerals, such as pulses and sea vegetables (these are actually algae rather than plants), is likely to be just as effective for strengthening the blood, and maybe more so, than taking supplements of man-made chemical derivatives of chlorophyll.

There is evidence that chlorophyll and chlorophyllin can bind to toxic substances such as aflatoxin and may prevent cancer and other damage to the body. The anti-cancer properties of whole plants are, however, well-documented (22) and the studies reported on chlorophyll products may simply offer potential mechanisms for some of the benefits of eating a plant-based diet.

So my advice to Dave and his friends is not to take promotional literature on dietary supplements at face value.  In some cases, there is little or no evidence to substantiate the claims made for the products.

Consuming a predominantly plant-based diet will help to support the immune system in fighting infections and improve general health, but if Lyme Disease is diagnosed, it is important to seek medical treatment with modern antibiotics.

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References

1. Chloroxygen. http://www.herbsetc.com. [Online] http://www.herbsetc.com/Topics/PDF/chloro_bro_07.pdf.
2. Chlorophyll: Structural Properties, Health Benefits and Its Occurrence in Virgin Olive Oils. İnanç, A. Levent. 2011, Akademik Gıda/Academic Food Journal, Vol. 9 (2), pp. 26-32.
3. PhD, James A. Lowell. Amazing claims for chlorophyll (1987). Quackwatch. [Online] http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/chlorophyll.html.
4. Anti-bacterial activity of chorophyll. Mowbray, Sheila. 2 February 1957, British Medical Journal, Vol. 1(5013), pp. 268-270.
5. Haems and chlorophylls: comparison of function and formation. Hendry, G.A.F. and Jones, O.T.G. 1980, Journal of Medical Genetics, Vol. 17, pp. 1-14.
6. The metabolites of dietary chlorophyll. Ma, L. and Dolphin, D. 1999, Phytochemistry, Vol. 50, pp. 195-202.
7. Assessment of chlorophyll as a deodorant. Brocklehurst, J.C. 7 March 1953, British Medical Journal, Vol. 1(4809), pp. 541-544.
8. Chlorophyll derivatives: their chemistry, commercial preparation and uses. Kephart, J.C. 1955, Journal of Ecological Botany 9:3, Vol. 9, pp. 3-38.
9. Federal Register Volume 55 No. 92 – Chlorophyllin as Deodorant. Food and Drug Administration http://www.fda.gov. [Online] 11 May 1990. http://www.fda.gov/downloads/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Over-the-CounterOTCDrugs/StatusofOTCRulemakings/ucm110925.pdf.
10. Mechanisms of the in vitro antimutagenic action of chlorophyllin against benzo[a]pyrene: studies of enzyme inhibition, molecular complex formation and degradation of the ultimate carcinogen. Tachino N, Guo D, Dashwood WM, Yamane S, Larsen R, Dashwood R. 1994, Mutation Research , Vol. 308 (2), pp. 191-203.
11. Study of the forces of stabilizing complexes between chlorophylls and heterocyclic amine mutagens. Dashwood R, Yamane S, Larsen R. 1996, Environ Mol Mutagen, Vol. 27 (3), pp. 211-218.
12. Mechanisms of chlorophyllin anticarcinogenesis against aflatoxin B1: complex formation with the carcinogen. Breinholt V, Schimerlik M, Dashwood R, Bailey G. 1995, Chem Res Toxicol., Vol. 8 (4), pp. 506-514.
13. Natural chlorophyll but not chlorophyllin prevents heme-induced cytotoxic and hyperproliferative effects in rat colon. de Vogel J, Jonker-Termont DS, Katan MB, van der Meer R. 2005, Journal of Nutrition, Vol. 135 (8), pp. 1995-2000.
14. Effects of Chlorophyll and Chlorophyllin on Low-Dose Aflatoxin B1 pharmacokinetics in human volunteers. Carole Jubert, John Mata, Graham Bench, Roderick Dashwood, Cliff Pereira, William Tracewell. December 2009, Cancer Prev Res 2009;2(12) December 2009, Vol. 2 , pp. 1015-1022.
15. Effect of chlorophyllin against oxidative stress in splenic lymphocytes in vitro and in vivo. Kumar SS, Shankar B, Sainis KB. 2004, Biochim Biophys Acta., Vol. 1672 (2), pp. 100-111.
16. Bioavailability of dietary sodium copper chlorophyllin and its effect on antioxidant defence parameters of Wistar rats. . Gomes, B. B., Barros, S. B., Andrade-Wartha, E. R., Silva, A. M., Silva, V. V. and Lanfer-Marquez, U. M. 2009, J. Sci. Food Agric., Vols. 889: 2003–2010, pp. 2003-2010.
17. Lyme disease. NHS Choices. [Online] http://www.nhs.uk/conditions/Lyme-disease/Pages/Introduction.aspx.
18. The Merck Manual of Diagnosis and Therapy. 19th. s.l. : Merck Manuals, 2011.
19. Global burden of disease study 2010. Murray, C. et al. 13 December 2012, The Lancet.
20. Campbell, T C and Campbell, T M. The China Study. s.l. : Benbella Books, 2006.
21. Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study. al, Anne-Claire Vergnaud et. 3 April 2013, American Journal of Clinical Nutrition.
22. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC : AICR, 2007.

Pope Francis, food and the mystics

Almost every article I have read about the new Pope Francis mentions his humility, the simplicity of his home, his dedication to serving the poor and the fact that he cooks for himself.

This led me to wonder what he eats.

According to an article in the Argentinian newspaper La Nacion in 2009, he chooses healthy frugal food and occasionally drinks a glass of wine. He is said to like fruit, skinless chicken and salads. When in Buenos Aires, he apparently never ate out in restaurants. He would eat by himself and would not even join meals at parish churches in his diocese. On the rarest of occasions, he might break from his routine of eating in his own quarters to visit a nunnery to enjoy bagna cauda – a fondue of anchovies, garlic and olive oil.

The simplicity of Pope Francis’ diet reminds me of the story of Daniel and his friends in the Christian Bible (Daniel 1).

King Nebuchadnezzar of Babylonia attacked Jerusalem and surrounded the city. He captured King Jehoiakim and seized treasures from the Temple.

Nebuchadnezzar then ordered his chief official, Ashpenaz, to select some young men from the noble and royal families of the Israelite exiles to serve in his court. They had to be handsome, intelligent, well-trained, quick to learn, and free from physical defects. Ashpenaz was to teach them to read and write the Babylonian language. The king also gave orders that every day they were to be given the same food and wine as the members of the royal court. After three years of this training they were to appear before the king. Among those chosen were Daniel, Hananiah, Mishael, and Azariah, all of whom were from the tribe of Judah. The chief official gave them new names: Belteshazzar, Shadrach, Meshach, and Abednego.

Daniel made up his mind not to let himself become ritually unclean by eating the food and drinking the wine of the royal court, so he asked Ashpenaz to help him. Ashpenaz was sympathetic to Daniel but was afraid of the king. So he said to Daniel, “The king has decided what you are to eat and drink, and if you don’t look as fit as the other young men, he may kill me.”

So Daniel went to the guard whom Ashpenaz had placed in charge of him and his three friends. “Test us for ten days,” he said. “Give us vegetables to eat and water to drink. Then compare us with the young men who are eating the food of the royal court, and base your decision on how we look.”

He agreed to let them try it for ten days. When the time was up, they looked healthier and stronger than all those who had been eating the royal food. So from then on the guard let them continue to eat vegetables instead of what the king provided.

God gave the four young men knowledge and skill in literature and philosophy. In addition, he gave Daniel skill in interpreting visions and dreams.

At the end of the three years set by the king, Ashpenaz took all the young men to Nebuchadnezzar. The king talked with them all, and Daniel, Hananiah, Mishael, and Azariah impressed him more than any of the others. So they became members of the king’s court. No matter what question the king asked or what problem he raised, these four knew ten times more than any fortune teller or magician in his whole kingdom. Daniel remained at the royal court until Cyrus, the emperor of Persia, conquered Babylonia.

Daniel was not alone in his experience with food. Mystics of all traditions teach that diet influences spiritual awareness.

Many spiritual masters of the East, including Hindus, and various schools of yoga, divide foods into three basic categories: Sattvic (pure), Rajasic (kingly), and Tamasic (impure). They teach that this last category of foods, which includes all flesh foods and eggs, is to be completely avoided. A sattvic diet consists of fresh, simple foods including: grains, beans, vegetables, fruits, seeds, nuts, and dairy. Sattvic foods are said to promote mental clarity, relaxation, meditation, and spiritual experience including inner visions. A rajasic diet includes very rich, spicy food, and a tamasic diet includes meat and alcohol. These are said to stimulate passions, promote mental agitation, and have an adverse effect upon concentration in meditation.

Those who take up the practices concerning the lower centres in the body, do take meat … but those who are anxious to rise above body consciousness and go into the Beyond have of necessity to eschew all that. This is the Path I have put before you. Liberation or salvation is something which starts only when you rise above body consciousness. For that reason, vegetarianism is the first essential.

(Kirpal Singh, The Night is a Jungle, published by Sant Bani Ashram of New Hampshire).

Guru Kabir, a great Master from Northern India, loved by Sufis, Sikhs, Jains, and Hindus alike, said:

The man who eats meat is a demon in human form. Keep away from him – his company will ruin your meditation.

(Kabir: the Weaver of God’s Name, Radha Soami Satsang Beas).

According to these teachers, the bad karma and other negative effects of flesh-eating apparently to some degree darkens one’s inner vision, interfering with the quality of one’s meditation, making it more difficult to reach the required deep levels of tranquility, clarity and concentration.

The concept of diet affecting spiritual awareness is not confined to Eastern mystics.

Many early Christians were vegetarian; also Clement of Alexandria, Origen, John Chrysostom, and Basil the Great. In some early church writings, Matthew, Peter and James (brother of Jesus and first leader of the Aramaic-speaking Jerusalem Church) were said to be vegetarian. According to the historian Eusebius, the Apostle “Matthew partook of seeds, nuts and vegetables, without flesh.” Many monasteries in ancient times practised vegetarianism and continue to do so.

Clement of Alexandria wrote,

It is far better to be happy than to have your bodies act as graveyards for animals.

Modern day Seventh Day Adventists, for example, advocate a vegetarian diet.

Most conventional world religions in the West condone flesh-eating, but many esoteric traditions which have practised various forms of mysticism, are consistent in their agreement about the need for contemplative mystics to abstain from the flesh. The list of Western vegetarian paths includes: the Pythagoreans, followers of the Hermetic philosophy of Egypt, the Sethians, Theraputae, Essenes, the original Jewish Christians called Ebionites, the Gnostic religions, Manichaeans, some Catholic monasteries, some monasteries associated with the Orthodox Church – including the great mystery school on Mount Athos in Greece – and the Sufi mystics of Islam.

It may be no coincidence that the predominantly plant-based diet of Daniel and spiritual masters of many traditions, is virtually identical to that advocated by modern science. A diet which is believed to enhance spiritual openness also protects against cancer, heart-disease, stroke, diabetes, dementia, arthritis and the general ravages of aging.

Pope Francis’s simple diet may not only have helped to deepen his spiritual practice but also given him the physical strength to take on this monumental role at the age of 76. May he prove to be as wise, knowledgeable and visionary as Daniel.

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Plant-based diet for treating heart disease

Coronary artery before (left) and after (right) plant-based diet (Esselstyn CB Jr: Preventive Cardiology 2001;4: 171-177)

Few people realise that a plant-based diet not only prevents heart disease but can also reverse it. Choosing whole grains, fruits and vegetables and avoiding simple sugars, and saturated and trans fats, as in meat and dairy products, has been shown to result in regression of coronary atherosclerosis after 1 and 5 years in some studies (1) (2) and to continue for over 12 years in other studies (3).

In contrast, standard medical interventions for cardiac patients, such as coronary artery bypass, bypass grafts, atherectomy, angioplasty or stenting, treat only the symptoms, not the disease.  It is therefore not surprising that patients who receive these interventions alone often experience progressive disease, graft shutdown, restenosis, more procedures, progressive disability, and ultimately death from disease (4).

Caldwell Esselstyn MD persuaded 18 cardiac patients to continue with a plant-based diet for over 12 years. Adherent patients experienced no extension of clinical disease, no coronary events, and no interventions. This finding is all the more compelling when we consider that the original compliant 18 participants experienced 49 coronary events in the 8 years before the study (4).

Some patients believe that there is no need to change their diet if they have had heart surgery, stents inserted and/or are taking drugs like statins and aspirin.

A recently published international study (5) indicated that individuals (more than 31,000 men and women of an average age of 66 in this study) who chose whole grains, fruits, vegetables, nuts, and fish over meat, eggs and refined carbohydrates had a 35% reduction in cardiac death rates over 5 years. That’s a 35% reduction in addition to the decrease from surgery and optimal medical management. And these men and women were older, where you’d expect diet to be able to reverse less.

So it is never too late to make simple changes to your diet and lifestyle to improve your long-term health, whether you have medically-managed heart disease or not.

If you have heart disease, you can eat a wonderful variety of delicious, nutrient-dense foods:

• All vegetables except avocado. Leafy green vegetables, root vegetables, vegetables that are red, green, purple, orange, and yellow – every colour of the rainbow
• All legumes—beans, peas, and lentils of all varieties.
• All whole grains and products, bread and pasta, that are made from them—as long as they do not contain added fats.
• All fruits

You need to avoid:

• Red meat, poultry and fish
• Dairy products
• Oils of all kinds (even olive oil)

 

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References

(1) Ornish, D. et al (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, Vol 280, No. 23, 2001-2007

(2) Ornish, D. et al (1990). Can lifestyle changes reverse coronary heart disease?  The Lancet, 21 July 1990, Vol 336, No. 8708, 129-133

(3) Esselstyn, C. (2001).  Resolving the coronary artery disease epidemic through plant-based nutrition.  Preventive Cardiology, 4, 171-177

(4) Esselstyn, C.  Updating a 12-Year Experience With Arrest and Reversal Therapy for Coronary Heart Disease (An Overdue Requiem for Palliative Cardiology).  Article on Caldwell Esselstyn’s website.

(5) Dehghan, M. et al. Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention: A Prospective Cohort Study of 31 546 High-Risk Individuals From 40 Countries. Circulation, 4 December 2012, 126: 2705-2712

Towards a new paradigm for public health

In 1990, physician and health economist Christopher Murray at Harvard University and medical demographer Alan Lopez at the World Health Organisation embarked on the first ever attempt to measure the global burden of disease and developed the now-famous Disability Adjusted Life Year (DALY) metric that made it possible to combine estimates of mortality and morbidity burden around the world. DALY is the sum of years lived with disability [YLD] and years of life lost [YLL].

Since then, there have been estimates in 1999 to 2002 and 2004. But the latest iteration of the project, Global Burden of Disease 2010, has been on a different scale, involving nearly 500 researchers from more than 300 institutions in 50 countries. It is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors.

Twenty years ago, the project assessed the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions over one calendar year. Now, thanks to advances in technology, the availability of data, and the participation of experts around the world, as well as the leadership of a core group of researchers, the scope has increased to 291 diseases and injuries in 21 regions, for 20 age groups, and an estimation of trends from 1990 to 2010. Global Burden of Disease 2010 also includes an assessment of 67 risk factors.

The results, published yesterday in seven articles in The Lancet, are set to shake up health priorities across the world.

In summary, the analysis shows that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

There were 52.8 million deaths in 2010 compared with 46.5 million deaths in 1990. Of these, 12.9 million were from ischaemic heart disease and stroke, or one in four deaths worldwide, compared with one in five in 1990. Cancer claimed 8 million lives in 2010 compared with 5.8 million in 1990; trachea, bronchus and lung cancer accounted for 20% of these. Twice as many people died of diabetes in 2010 – 1.3. million – than in 1990, which is higher than deaths from tuberculosis or malaria (1.2 million each). Deaths from HIV/AIDS increased from 0.30 million in 1990 to 1.5 million in 2010, reaching a peak of 1.7 million in 2006. The fraction of global deaths due to injuries (5.1 million deaths) was marginally higher in 2010 (9.6%) compared with two decades earlier (8.8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1.3 million in 2010) and a rise in deaths from falls.

The contributions of risk factors to regional and global burden of diseases and injuries has shifted substantially between 1990 and 2010, from risk factors that mainly cause communicable diseases in children to risk factors that mainly cause non-communicable diseases in adults.

The proportion of overall disease burden attributable to childhood underweight – the leading risk factor worldwide in 1990 – had more than halved by 2010, making childhood underweight the eighth risk worldwide, behind six behavioural and physiological risks, and household air pollution from solid fuels. Other risks for child mortality, such as non-exclusive and discontinued breastfeeding, micronutrient deficiencies, and unimproved water and sanitation, have also fallen. However, child and maternal undernutrition risks collectively still account for almost 7% of disease burden in 2010, with unimproved water and sanitation accounting for almost 1%.

Of the non-communicable disease risks, high blood pressure, high body-mass index, high fasting plasma glucose, alcohol use, and dietary risks have increased in relative importance. This overall shift has arisen from a combination of the ageing population, substantial achievements in lowering mortality of children aged younger than 5 years, and changes in risk factor exposure.

These broad global patterns mask enormous regional variation in risks to health. In sub-Saharan Africa, risks such as childhood underweight, household air pollution from solid fuels, and suboptimal breastfeeding continue to cause a disproportionate amount of health burden, despite decreasing. The shift to risk factors for non-communicable disease was clear in east Asia, North Africa and Middle East, and Latin America.

For people aged 15 to 49 years, the leading risk factor worldwide was alcohol use, followed by tobacco smoking including second-hand smoke, high blood pressure, high body-mass index, diet low in fruits, drug use, and occupational risk factors for injuries. Risk factor rankings in this age group stayed broadly similar between 1990, and 2010, with the exception of iron deficiency, which dropped from the fourth leading risk factor in 1990, to ninth in 2010.

High blood pressure, tobacco smoking including second-hand smoke, alcohol use, and diet low in fruits were all in the top five risk factors for adults aged 50 to 69 years and adults older than 70 years, in both 1990, and 2010, accounting for a large proportion of disease burden in both age groups. Globally, high blood pressure accounted for more than 20% of all health loss in adults aged 70 years and older in 2010, and around 15% in those aged 50 to 69 years. Tobacco smoking including second-hand smoke accounted for more than 10% of global disease burden in each of these age groups in 2010.

Globally, the sum of years lived with disability and years of life lost (DALY), was influenced most by dietary risk factors and physical inactivity – together these were responsible for 10% of the global disease burden in 2010.

Of the individual dietary risk factors, the largest attributable burden in 2010 was associated with diets low in fruits (4.9 million deaths), followed by diets high in sodium (4.0 million deaths), low in nuts and seeds (2.5 million deaths), low in whole grains (1.7 million), low in vegetables (1.8 million deaths), and low in seafood omega-3 fatty acids (1.4 million deaths). Physical inactivity and low physical activity accounted for 3.2 million deaths.

This impressive analysis of global health issues by Christopher Murray and colleagues provides much reason for hope but also challenges the current medical paradigm and global healthcare system.

It shows clearly that the focus of global health authorities in recent decades on reducing infection and malnutrition has paid off – life expectancy has increased almost everywhere. This focus needs to continue to minimise incidence of diseases like tuberculosis, malaria and HIV/AIDs.

It also reveals, however, that the leading causes of death in the modern developed world are conditions which cannot be controlled by vaccinations, antibiotics, improved sanitation or insecticides. The data provide evidence that the risk factors for non-communicable diseases like heart disease, cancer and diabetes, are predominantly related to poor diet and lifestyle.

The large attributable burden for dietary risk factors such as diets low in fruits, vegetables, whole grains, nuts and seeds, and seafood omega-3 fatty acids might come as a surprise to some. The large burden is caused by both high exposure, e.g., low intake of fruits and vegetables in many regions – and large effect sizes.

Given the crucial role of dietary and lifestyle factors in determining long-term health, the answer to alleviating the suffering created by these chronic non-communicable diseases does not lie in the current medical model, with its preoccupation with drugs and surgery. Our doctors are trained to relieve symptoms not to address the underlying causes of chronic disease. Powerful commercial interests in the food, pharmaceutical and health sectors drown out the voices of those who can see that the solution is really very simple.

Widespread consumption of plant-based diets, rich in vegetables, fruit, whole grains, beans, nuts and seeds, together with not smoking and more physical activity, would transform people’s lives and radically reduce healthcare costs. It is not rocket science.

Dr Murray, I salute you and your colleagues for a first rate piece of work. May the truths you have exposed become part of mainstream understanding as quickly as possible and lead to a sea change in our approach to health and well-being.

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References

Murray et al (2012). Global Burden of Disease 2010. The Lancet, 13 December 2012.