I have both T1D and MS. For MS, one leading idea is that getting exposed to Mono later in life can trigger the disease. There’s solid evidence for this.

For T1D, it’s similar - there’s a notion that you’re genetically predisposed to it and certain types of infections during adolescence can cause it to manifest.

I’ve had discussions with researchers in the space and apparently certain autoimmune diseases happen less often in “grubbier” parts of the world (their words, not mine) even when the population density is high, and an inference here is that >early exposure< to certain infections might not trigger some of these problematic autoimmune reactions.

Side note: these diseases aren’t fun, especially when working in tech. I’m appreciative of those dedicating their lives to researching autoimmune disease.

> I’ve had discussions with researchers in the space and apparently certain autoimmune diseases happen less often in “grubbier” parts of the world

Is that corrected for mortality? It seems like an analysis like that would be quite prone to survivor bias.

For MS in particular there's several EBV mRNA vaccines in clinical trials - not just to prevent mono itself, but also to prevent long term complications (theoretically including MS) for people who already had it.

Has viral pressure really increased? It seems stuff spread globally a few generations ago with things like the flu in the early 1900s. Even in the middle ages you had stuff like the plague.

What has changed is the sterility of our environment. Better bathing, more hand washing, food safety rules, etc. There have been theories that autoimmune diseases might be increasing because we aren't exposed to enough "normal" pathogens.

I'm highly suspicious that higher viral pressures are the cause of increasing dementia rates, as it seems we're exposed to less today.

Bacterial, fungal and parasitic load has lessened, for sure, due to sterility of the environment, because many of those come from exposure to animals and plants. But viral load from viruses that spread from human-to-human and live exclusively in humans has increased because there are more humans and they spread the diseases around the world more effectively than before.

Yes, we probably get way less pathogens overall than we used to, but at the same time we get more pathogens that live exclusively on humans (such as respiratory viruses).

> But viral load from viruses that spread from human-to-human and live exclusively in humans has increased because there are more humans and they spread the diseases around the world more effectively than before.

This seems like pure conjecture to me, and without any actual evidence to support it, I'm disinclined to believe it. My guess is that the number of people any one individual interacts with has gone down considerably since the beginning of the century, and earlier. Before the advent of the car, shared forms of travel were much more common. People do much less forms of basic shopping than they used to given the rise of the Internet. Air travel, while much faster, is much less crowded that the ship travel of earlier generations.

There are significantly more humans in which a human-borne virus could live and/or mutate.

There are significantly fewer humans living in close contact with livestock in which a zoonotic virus could be transmitted. I'm skeptical that there has been a net increase. It's possible but I haven't seen any reliable evidence one way or the other.

But there are significantly more amounts of livestock in contact with those fewer humans.

Think of it this way: more total numbers = more opportunities for viruses to grow or mutate = more chances for runaway or novel infections. Runaway infections are dealt with fairly well by government entities. Novel infections... might be harder to discover because they're, well, novel.

> Before the advent of the car, shared forms of travel were much more common. Air travel, while much faster, is much less crowded that the ship travel of earlier generations.

Maybe in the US. Definitely not in most of the world. For my grandparent 70 years or so ago, the way to travel long distances was riding a donkey. Now travel by bus, train, subway, etc. is really common and something that most people experience often. 100 years ago of course there were trains, stagecoaches, boats, etc. but they were for a tiny minority of society or for special occasions (like to migrate a different continent to not return in decades, etc.). I'm also pretty sure air travel has a much higher penetration than ship travel would have 100 years ago.

As further anec-data points, there are much more massive gatherings now (concerts, sports, etc. - church used to be the major gathering, but churches tend to be ample and ventilated). And every parent knows that daycare and kindergarten are a major vector for pathogens. I used to get like a cold a year with 2 days mild congestion, and since my kid started kindergarten (he didn't go to daycare) we all started getting sick like monthly or so, for a couple of years. Putting dozens of kids in a closed space for hours is something that just wasn't a thing in previous generations either.

So personally, yes, I would bet that chances for pathogen spread have increased greatly.

Time scale. Viral load has increased dramatically over what it was like 1000 years ago. The change over the past 100 years is all lifespan due to antibiotics and the sterility another comment is pointing the finger at. It’s possible that viral load + lifespan = cancer, dementia, autoimmune stuff, etc.

Agreed. We've had this immune system battling stuff non-stop throughout evolution and now we're living in these clinical environments and it's going haywire.

Not to mention we're poisoning ourselves with all sorts of novel stuff, especially poor hi-carb nutrition, ultra processed food and pollution from various sources that act as endocrine disruptors and God knows what else.

Can we take it as proven that the rate of these diseases has increased? I wonder if in the past some conditions we now classify as particular diseases were considered a normal part of aging, perhaps at most getting a blanket classification of “senility”.

And obesity.. there are several adenoviruses associated with it. Example: https://www.nature.com/articles/s41366-021-00805-6

(Although the article takes pains to say that obesity is multifactorial, conflicting evidence in humans, etc.)

Immunocompromisation due to chronic inflammation from dietary issues and stress in addition to the above as well

The frequently cited "stress" thing of modern lives is just eyebrows-raising. Do anyone actually believe that lives of people 100 or 200 years ago have been less stressful?

Physical activity gives an outlet to stress, and people used to get way more of it. Stress and physical effort are supposed to go hand-in-hand; you feel stressed, which gives you a boost of adrenaline, which you need to physically fight back whatever caused the stress. When the physical component is missing, the stress just lingers and wreaks havoc on your body.

Also, sunlight exposure (with limited UV) went hand in hand. Now we have neither.

Careful. Exercise also causes a stress response in-and-of itself.

Work is not the same as stress. People today (especially near the bottom of the ladder) are not in control of their own destiny like they used to be. It's a different kind of stress.

Slaves were more on control of their own destinys than someone working an entry job today?

I was thinking more about farmers.

And they used to be more in control? Epidemics wiping out whole families? Gulags, concentration camps? Religious violence? Persistent threat of starvation death that was just the norm of life? One year of crop failures, and your kids are dead. Two years, and you are dead yourself. And it doesn't depend on you at all, just bad luck (if there was too much luck - like a generation without crop failures - population doubled, then just one year of crop failures meant you were dead). And yeah, the Church that keeps telling people that they were all sinners and will burn in hell, very comforting. Tell me about "control of one's own destiny".

I think there’s something to this. Life in those times was difficult and stressful, yes, but most hardships then were entirely beyond any individual’s control. To a large extent, good times and bad times would come and go regardless of what you did.

Contrast this to the modern day where more often than not, hardships are attributed to personal failings (“You should’ve worked harder if you didn’t want to be stuck working abusive under-compensated jobs!”) and people perpetually teeter on the edge of a knife suspended over a bottomless pit. If anything goes wrong, it’s treated as nobody’s fault but your own, regardless of the reality of the situation. It’s almost a type of psychological torture.

I think the idea is that the cells are stressed due to inflammation due to diet, rather than psychological feelings of stress

Average "healthy" body temperature is down more than half degree exactly because of reduction in inflammation. People used to have very unsanitary lives and were fighting infections nonstop. 37.0C was the "normal" body temperature when the "norm" was first discovered in the early XIX century, now it's considered to be a sickness already.

I'm not an expert but maybe keeping the immuno-army busy with constant infections keeps it from going bored and attacking itself

also not-an-expert opinion, but an average higher body temperature would reduce immune system workload by virtue of killing a lot of stuff dead via inhospitable environment before an immune reaction could ever muster..

Fascinating claim, where did you hear this?

well, you may read & discuss this one? :)

https://en.wikipedia.org/wiki/List_of_common_misconceptions_...

It's possible they had better support systems due to larger families, church being more prominent, etc.

Any form of positive community is helpful, religous or not. Just having caring neighbors is a boon to well-being.

Have you read Dr. Casey Means’ book on this?

Literally every time in the history of the universe when someone has structured a sentence like this, in this context, whoever they're talking about ends up being a giant crackpot. I'm not saying this person is a crackpot, just that the pattern recognition systems are throwing off some alarms.

If you end up dealing with a chronic disease that medical doctors completely fail in dealing with, you naturally get driven to look at “alternatives”. There’s a lot of nonsense out there - but some of it works. As a former skeptic I’m now much less dismissive of these things due to my own circumstances. Particularly when I can see that poor medical treatment over the years actually exacerbated my condition and being less skeptical could have improved my quality of life significantly sooner.

First sentence from wikipedia says:

Casey Means is an American functional medicine/holistic medicine physician, entrepreneur and author.

https://en.m.wikipedia.org/wiki/Casey_Means

I'm more influenced by this passage:

Means withdrew from her medical residency at age 30. She has attributed this decision to the lack of training she received about nutrition and the underlying causes of chronic disease. Means dedicated her practice to functional medicine, which focuses on the root causes of disease.

As one comedian said: “Do you know what they call alternative medicine that works? Medicine!”

that's cute but how much alternative medicine eventually finds a way into real medicine?

in other words : someone telling someone to practice yoga to relax and reduce their heart rate 200 years ago was a quack right up until the point that modern doctors decided to include it in their repertoire?

it's a cute joke but it skips over the fact that there seems to be an 'alternative medicine -> real medicine' pipeline, even if a lot of it turns out badly.

The actual quote (from memory, but I just listened to the monologue a minute ago): "Do you know what they call alternative medicine that's been scientifically proven to work? Medicine!"

In other words, the quote is exactly referring to your "pipeline."

Tim Minchin's "Storm" monologue: https://www.youtube.com/watch?v=KtYkyB35zkk

Medicine as a science didn't exist 200 years ago.

Breath exercises, and physical therapy for relaxation were mainstream in 1960-s.

> it's a cute joke but it skips over the fact that there seems to be an 'alternative medicine -> real medicine' pipeline

Not really. Most of the non-medicine (I refuse to call it "alternative") stays non-medicine: acupuncture, homeopathy, all the "energy meridians" nonsense, ayurveda, alkaline foods, etc.

And even with activities like yoga, it's not more effective than other types of similar physical activity. There is some very weak evidence that yoga _with_ physiotherapy might be more effective than just increased levels of physiotherapy.

Tim Minchin! (about 4 minutes in): https://www.youtube.com/watch?v=KtYkyB35zkk

Well that red flag versus the immediately-preceding passage listing a Doctor of Medicine degree at Stanford Medical School.

I looked into one of the links and apparently she pushes fairly mainstream preventive medicine stuff, diet, exercise, and screening tests. The only questionable thing I saw was the continuous glucose monitoring thing which the jury may still be out on when it comes to non-diabetics.

I haven't tried a continuous glucose monitor myself but those non-diabetics who have generally claim that it gave them interesting insights into how their blood glucose level reacted to different foodstuffs and timing of meals. There is a lot of individual variation there due to genetics, lifestyle, gut microbiome, etc. We'll probably never see a large-scale, long-term randomized controlled trial to show that CGM use improves health outcomes for non-diabetics. But for healthy people who already have the basics dialed in, a CGM can probably help them eke out some additional marginal gains.

Now that you mention that pattern, I can’t say I disagree with your comment. However, the information I can find about Means seems to be fairly…non-controversial. Or at least I don’t understand the controversy (which is very likely).

Bacterial infections can also trigger autoimmune diseases - it's not just viruses.

Realistically immune systems are extremely complex and I suspect there are probably lots of environmental triggers beyond viruses and bacteria as well

My girlfriend has Crohn's disease that can be directly correlated to food poisoning while on vacation. Now years later I can't even count the times I've read and heard exactly the same story from other people with Crohn's disease. A simple search for "Crohn's food poisoning" turns up hundreds of results. I can't believe this is not being investigated with higher priority

most of those with crohn's would likely have developed it at some point - 99% of those with food poisoning won't develop crohn's

Another comment in this post mentions reactive arthritis and HLA-B27; there's some evidence suggesting "permanent" autoimmune conditions in HLA-B27+ people also might come from viral triggers.