How Will We Deal with Five Epidemics at TEOTWAWKI?, by Philip J. Goscienski, M.D.

In One Second After, William Forstchen describes a cataclysmic scenario, a widespread EMP effect that is only slightly less devastating than nuclear near-annihilation. The protagonists in JWR‘s novel Patriots fare better temporarily because the physical infrastructure remains relatively intact for a few weeks after the nation’s economic collapse. In either scenario the five epidemics that are already under way in the United States give new relevance to TEOTWAWKI.

Epidemic (from the Greek: among the people): prevalent and spreading rapidly among many individuals within a community at the same time; widespread.

The five epidemics:
            Type 2 diabetes
            End-stage renal disease (kidney failure)

Although it is the leading cause of death in the United States, heart disease resulting from coronary atherosclerosis is not an epidemic according to the above definition. It is not spreading rapidly but is well established and mortality
is actually decreasing slightly because of modern treatment.

Epidemic #1: Obesity
Obesity is the linchpin for the other four epidemics.
From 2000 to 2010 obesity increased by 80 percent or more in 39 states. The Centers for Disease Control and Prevention estimate that by 2030 42 percent of Americans will be obese, nearly half again as many as currently bear that burden. A study from Duke University indicates that morbid obesity, a weight 80 pounds or more above standard weight, will affect 11 percent of the U.S. population. Obesity is clearly “prevalent and spreading rapidly among many individuals” as defined above.

Inactivity is a major factor in the obesity epidemic. A century ago only about 5 percent of Americans were obese but labor-saving devices and automobiles have reduced the need for physical activity for the average person by nearly 75 percent. The typical American adult or child spends 8.5 hours a day watching television and using a computer or similar devices.
Diet is the other major factor that leads to obesity. Over the past 4 or 5 generations we have replaced whole-grain products with those made from refined flour and we have increased our consumption of sugar several-fold. The average American consumes 40 pounds of sugar in soft drinks alone in a single year. When the SHTF, whatever the cause, our food supply will be severely compromised.            

One might think that the one-third of our population that is obese will be able to live off stored energy and will survive longer but they will not. The reason is that very few of them are free of medical problems. Obesity is simply not compatible with good health. There are no exceptions. To think otherwise is delusion.

Epidemic #2: Type 2 diabetes
Type 2 diabetes is the fastest-growing chronic disease in the world. It affects more than 25 million Americans and 57 million more have prediabetes (defined as a fasting blood sugar between 100 and 125), half of whom are not yet aware of their condition. The CDC projects that one-third of the population will have type 2 diabetes by 2050. Among Hispanic females that number will reach 53 percent.

Type 1, early onset or juvenile diabetes, is a disease in which an autoimmune process completely destroys the insulin-producing cells of the pancreas. A severe reduction in carbohydrate intake will postpone the inevitable in some persons with type 1 diabetes but not for long. They need insulin daily in order to survive. Reduced supplies of all forms of insulin and the lack of effective refrigeration mean that their days are numbered, as described so tragically in One Second After.

Type 2 diabetes was once known as adult-onset diabetes but it has become common in adolescence and it occurs with some frequency among pre-adolescent children. Persistently high levels of blood sugar cause cells to be come unresponsive to the action of insulin. After a period of such insulin resistance the cells that produce this hormone eventually fail.

A lifetime of moderately intense physical activity almost eliminates the risk of developing type 2 diabetes. Experts refer to it as an exercise-deficiency disease. Sometimes it results from a genetic disorder or from prescription medications but these are in the minority. In reality, more than 90 percent of persons with type 2 diabetes are inactive and overweight or obese. Among those who appear to be of normal weight, some fall into the category of normal-weight obese, persons who have gained fat but lost muscle. Although their weight is normal, their waist size reveals the truth because a pound of fat takes up more space than a pound of muscle.

Diabetes is a disease of blood vessels. That’s why its worst complications, heart disease, stroke, kidney failure, blindness and limb amputation are so common. These complications appear faster and earlier among children because those growing bodies are constantly forming and re-forming new blood vessels as they increase in size.

When the SHTF death rates will rise dramatically among those with both types of diabetes. Type 2 diabetics who have mild disease will fare better but most of them have
complications that will worsen without prescription drugs. Lifestyle changes can postpone the need for insulin but when metformin and other drugs become unavailable, complications of the disease and mortality will rise rapidly. 

Survivalists with type 2 diabetes should double down on their efforts to lose weight and to become physically fit. Those who can afford to stock up on medications should do so. Pharmacies will be depleted of stock as rapidly as grocery stores when the SHTF.

Epidemic #3: Osteoporosis
The incidence of this bone-thinning disorder will reach epidemic proportions by mid-century. Like type 2 diabetes, osteoporosis is an exercise-deficiency disease. It is not due to an inadequate calcium intake. Lack of calcium makes bones soft, not brittle. Two examples are childhood rickets and adult osteomalacia. The first is due to a lack of vitamin D that inhibits the absorption of calcium; the second has several causes, including chronic kidney disease. These calcium-deficient bones do not break; they bend, causing extreme bowlegs, for example.

There is a bone-building window between the ages of about 5 and 25 years during which the body completes the formation of almost all of its bone mass. Once closed, that window never reopens. The process requires two elements: moderately intense physical activity and proper nutrition. Today’s young people fail on both counts and will face an epidemic of broken hips and collapsed vertebrae when they are eligible for Medicare (if it still exists then).

Only a couple of generations ago most kids walked a lot, rode bikes, climbed trees, participated in pick-up games of various sports, frolicked on monkey bars and roughhoused. Safety concerns, urbanization, organization of sports, cancellation of Physical Education classes in school and other factors limit those activities now. Computer games and television occupy about half of their waking hours today.

Calcium is important during these bone-building years but children now drink twice as much soft drinks as milk. In the 1970s it was just the opposite. Other nutrients for making strong bones include several vitamins, magnesium and omega-3 fats but children who don’t get many vegetables but eat plenty of junk food get few of them. Nearly half of today’s adolescents are deficient in vitamin D because they spend so much time indoors.

Few people, including those in the medical field, are aware that pregnancy factors will affect the skeleton of the fetus when that infant reaches middle age. A pregnant young woman who exercises little, smokes and has poor nutrition will herself have an inadequate bone mass. Her baby will too, the evidence of that being that the rate of forearm fractures among school-age children has doubled since the 1970s.

Most adults lose bone mass year by year because of their sedentary lifestyle. Without regular, moderately intense physical activity bones become less dense and break easily in a fall. Exercise, especially resistance training, helps to restore some of the bone mass that has been lost during years of inadequate physical activity.

Why is osteoporosis a problem in TEOTWAWKI? A hip fracture almost always requires hospitalization, perhaps surgery. Even with modern medical care about 25 percent of persons with a hip fracture die within a year. Picture the scenario when the SHTF.

Epidemic #4: Dementia.

Dementia consists of two different conditions, Alzheimer’s disease and vascular dementia. Alzheimer’s disease is a disorder whose cause is uncertain. Genetic factors play a major role in about half of its victims. As our population ages it is estimated that Alzheimer’s disease will affect about 25 percent of the population by the age of 85.

Vascular dementia is the result of narrowing of the blood vessels of the brain. Diminished blood flow prevents brain cells from being properly nourished and removing waste products. The result is poor mental function, memory loss and shrinkage of brain tissue. Type 2 diabetes has become the most important cause of vascular dementia.

Persons with dementia require attentive personal care for their nourishment and hygiene requirements. I cannot predict what will happen to them in a TEOTWAWKI scenario but many of them have one or more chronic illnesses that require prescription medications that are likely to be in short supply. In a worst-case scenario they will have a low priority for treatment.

Epidemic #5: Kidney failure (End-Stage Renal Disease)

The kidney is little more than a collection of tiny blood vessels in close contact with equally tiny tubular structures, the combination forming a filtering system that removes waste products in the form of urine. When normal blood vessels within the kidney are replaced by those that have become deformed and scarred because of diabetes or other disease, toxic by-products accumulate within the body. A dialysis machine – what some persons still refer to as an artificial kidney – cleanses the blood in 3 or 4 treatments per week.

When the nation’s power grids fail because of an EMP or a devastating cyber attack it will take the lives of hundreds of thousands of dialysis patients with it. In 1972 there were 10,000 persons on dialysis; in 2010 that number reached 350,000, even as dialysis centers were struggling to keep up with the demand. If the CDC’s projection for type 2 diabetes, the primary cause of kidney failure, is correct that number could soar to more than a million in a couple more decades. The yearly cost of dialysis ranges from $15,000 to $50,000 per year and it will make kidney failure one of our most expensive epidemics.

There is no alternative treatment for kidney failure. Kidney transplantation, which may require a year or two on a waiting list, is not an option for millions of diabetics and it certainly will not be at TEOTWAWKI.

Dialysis units will stop working when the lights go out. Patients with end-stage renal disease will be among the grid failure’s first casualties.

Finding solutions: Genes load the gun; lifestyle pulls the trigger.

All these chronic conditions are lifestyle-related and are not due to genetics or to aging. They were either rare or nonexistent barely a century ago and not because people are living longer and have more time to acquire these diseases. Centenarians in places as diverse as Okinawa and Sardinia are slender and fit and can name their great-grandchildren. They have almost no heart disease and type 2 diabetes is virtually non-existent. Elderly hunter-gatherers don’t develop these diseases either – until they become civilized.

To be sure, if the pharmaceutical industry were to collapse in a SHTF scenario we would again face new threats from old infectious diseases but the thin and the fit would fare best. Obesity and diabetes weaken the immune system but exercise strengthens it.

Scores of posts on SurvivalBlog urge us to maintain a high level of fitness and to keep our weight, i.e., body fat, at normal levels. No one is too old to exercise and eating sensibly (quantity and quality) is not rocket science. It’s not too late to begin a healthy lifestyle. It may be the key that will help you to survive in TEOTWAWKI.

About The Author: Philip J. Goscienski, M.D. is a retired pediatric infectious diseases specialist, CPR instructor, columnist and author. His book, Health Secrets of the Stone Age, Second Edition, Better Life Publishers, 2005 has won three book awards. He has archived more than 400 weekly newspaper columns at