One Billion IQ Points

Hypothyroidism and its effects on intelligence may pose the single most easily curable malady plaguing the world at large today due to the lack of iodized salt, according to Nicholas Kristof in today's NYTimes:

Almost one-third of the world’s people don’t get enough iodine from food and water. The result in extreme cases is large goiters that swell their necks, or other obvious impairments such as dwarfism or cretinism. But far more common is mental slowness.

When a pregnant woman doesn’t have enough iodine in her body, her child may suffer irreversible brain damage and could have an I.Q. that is 10 to 15 points lower than it would otherwise be. An educated guess is that iodine deficiency results in a needless loss of more than 1 billion I.Q. points around the world.

It's sad to think how so many things we take for granted, like iodized salt or chlorinated water, are luxuries in other parts of the world. It frustrates me when people knock government or public health initiatives and completely ignore all the benefits that such efforts have brought us. Hopefully articles like this one will spur philanthropic organizations like the Gates Foundation to pay more attention to this issue. As much as AIDS is a global health issue, one wishes that causes like potable water or adequate nutrition would receive equal attention.

Kidney Stones Increase In U.S. Children

Children are being diagnosed with kidney stones much more often these days, according to a piece in the NYTimes "A Rise in Kidney Stones Is Seen in U.S. Children":

To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6. 

While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics. 

“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.” 

Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.” 

In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones. 

The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt. 

Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated. 

Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine. 

Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

Interesting, but not too surprising, especially when you consider how much soda kids drink, the rise in childhood obesity, inadequate water intake, and the link all of these have with kidney disease.

Outhouses and Obesity?

Steven Dubner at the Freakonomics blog makes an, um, interesting argument for one possible factor in the rise of obesity, outhouses:

Is it possible that the availability of good plumbing has contributed to our national weight gain? This may sound ludicrous, but think about it for just a moment. Very few people have to trek through the night to use an outhouse anymore; furthermore, restroom facilities are readily available just about everywhere — which means you don’t have to worry about getting rid of your waste, which frees you up to consume as much as you’d like.

As a kid, I remember taking a long bus ride to New York City for a ballgame. There was no bathroom on the bus. No one on the bus was drinking anything either. (Yes, this was before you could readily buy bottled water; but there were such things as cans of soda.)

A few times in the recent past, I’ve rented a summer house with no garbage pickup. This meant not only paying for how much waste you produce, but also storing your trash until the one day that the dump is open. During these times, our behavior changed radically: not only did we compost all our food waste to cut down on stink, but we thought about everything we bought before we bought it to make sure we wanted to deal with the waste. As a result, we bought a lot less.

I know of no legitimate research connecting plumbing and obesity, though I would be interested in hearing from anyone who does.

I'm not really sure where to begin on this one. Even if this were a factor, I think the low cost of high density calories through agricultural subsidies would dwarf any effect. Furthermore, this argument could be made about any technological advancement made in the past century. For example, cars have caused people to walk less, therefore consuming less energy daily, thus, cars cause obesity. Clearly, the argument is too simplistic. While an interesting thought, I can't imagine any serious scholarly work has been done on this topic.

Fructose and Lipogenesis

An interesting study from UT Southwestern notes that the rate of lipogenesis is increased when glucose is replaced with fructose:

In the research, six healthy individuals went through three tests where they had to drink a fruit drink mix. In one test, the breakfast drink was 100 percent glucose, similar to the liquid doctors give patients to test for diabetes — the oral glucose tolerance test.

In the second test, they drank half glucose and half fructose, and in the third, they drank 25 percent glucose and 75 percent fructose. The tests were random and blinded, and the subjects ate a regular lunch about four hours later.

The researchers found that lipogenesis, the process by which sugars are turned into body fat, increased significantly when as little as half the glucose was replaced with fructose. Fructose given at breakfast also changed the way the body handled the food eaten at lunch. After fructose consumption, the liver increased the storage of lunch fats that might have been used for other purposes.

Hmm... guess I should lay off the colas, huh?

Second-Hand Obesity Kills

Like second-hand smoke, second-hand obesity is the impact obesity has on others around the obese person. This is a sad story, but I think this just might be the first instance of obesity leading to the death of someone besides the obese person:

LA JOYA, Texas (AP) -- A 2-year-old boy who died with a fractured skull might have been accidentally crushed by a morbidly obese relative, authorities say. Investigators believe that the woman fell on the child, who was pronounced dead Tuesday, said Bobby Contreras, Hidalgo County justice of the peace.

"It didn't look like there was any foul play from what I saw," he said.

An autopsy was scheduled, with the cause of death to be announced Monday. Hidalgo County Sheriff Lupe Trevino, who called the death "suspicious," said he would wait for an announcement on the cause before deciding whether to file charges. The child was believed to have been dropped off by his mother to spend the day with the bedridden relative, The McAllen Monitor reported Friday.

Sad to say, but it's little surprise that this happened in Texas.

Diet Sodas and Metabolic Syndrome

Diet sodas just can't catch a break! Apparently, metabolic syndrome is tied to diet soda. The concept of metabolic syndrome always seems a bit fuzzy to me, but I basically like to think of it as "pre-diabetes." At any rate, given the other recent news about diet sodas possibly leading to increased weight, it seems like there's just no way to enjoy a soda anymore like we used to.

In somewhat related news, a diabetes study was partially halted after deaths when it was noted that patients with tighter glucose control actually had more deaths than the group with less stringent control. In some sense, this is a much more disturbing piece of research. Even if the cause of a disease is unknown, as long as it can be treated, there is not as much concern. But if the cause of metabolic syndrome/diabetes becomes more convoluted and the treatment becomes less clear, medicine's ability to care for the increasing ranks of diabetes patients is much more limited.


Bring back New Coke! Or not: read more about how sodas are associated with gaining weight as well as chronic kidney disease.

Noooo! Not Diet Sodas!

I have a weakness for sodas. I wouldn't go so far to call myself an 'addict,' but perhaps that is my own denial kicking in. I used to drink Cokes like there was no tomorrow. Over time, I switched over to Pepsis, and eventually Diet Pepsis. I think I rationalized my habit by thinking that the 'diet' part made it okay. It's just flavored water! Right?

Sadly, articles like Can Sugar Substitutes Make You Fat? seem to imply that diet soda isn't as benign as I once thought it to be. The article argues that when one drinks diet soda, the body is expecting to see calories, but does not get them, requiring the person to eat even more later on to make up the perceived deficit. It's an interesting argument, and one I'm willing to buy. However, it raises two issues: first, does this mean that drinking Cokes/Pepsis is relatively better than their diet versions, since the body will receive the calories it expects and not overcompensate? Somehow, I doubt this and just assume the article means that diet sodas are not as innocuous as advertised but still better than the alternatives. Second, the article merely notes a correlation but does not really explain why the mice described would overeat to compensate. If anything, you'd expect the mice to consume more calories, but then stop once they reached the amount their bodies thought was required. Also, the mice's bodies had adapted to the decreased caloric intake, so perhaps the real issue here is not the overeating later to compensate, but rather the repression of their metabolism.

Couple this study with other concerns over sweetners (aspartame -> cancer?) and my diet soda just got a lot less appealing.

Still unconvinced? Read about the possible link between diet sodas and chronic kidney disease.

The Great Pellagra Epidemic of 1915

You're thinking, "What? Pellagra Epidemic?" Yea, I did too, but apparently, this epidemic is what lead to the discovery and identification of pellagra as a disease caused by vitamin deficiency, specifically Vitamin B3. Pellagra was found to be a vitamin deficiency by Dr. Joseph Goldberger:

The puzzle of pellagra was solved by Dr. Joseph Goldberger. Dr. Goldberger was assigned in 1914 by the US Public Health Service to the South to deal with pellagra. After inspecting Southern orphanages, mental hospitals and prisons, Goldberger made the pivotal observation that the malnourished inmates of those institutions often developed pellagra while the better-fed staff did not. Pellagra, he deduced, did not arise from germs, as was commonly believed, but rather from a nutritional deficiency. To prove this, Dr. Goldberger, his assistants and even his wife engaged in experiments called "filth parties." They injected themselves with blood or ingested the scabs, feces and body fluids of patients. None developed pellagra. He also did decisive experiments with Mississippi prison inmates (who "volunteered" in return for a full pardon). Dr. Goldberger fed them a poor diet that he believed caused pellagra and within months, many developed the disease. He then added meat, fresh vegetables and milk to their diet and reversed all of the signs and symptoms of pellagra. Dr. Goldberger never identified the dietary principle that had this extraordinary effect. He died in 1929 (of kidney cancer). Eight years later, the factor was found to be niacin. This discovery was made in 1937 at the University of Wisconsin. Niacin is abundant in red meat, fish, poultry, and green leafy vegetables. Niacin can prevent pellagra (and can cure it).

Another point of interest: the name "pellagra" comes from the Italian "pelle", skin + "agra", rough = rough skin, referring to the skin problems in pellagra.

Want to read more? Italians also were involved with atropine, as well as pretty women.

Colas and Chronic Kidney Disease

Does drinking colas increase one's risk of chronic kidney disease (as compared to non-cola carbonated drinks)? According to this article, it does. A group from the NIH did a case-control study looking at about 500 patients with chronic kidney disease (CKD) compared to normal patients. They found that the odds ratio of having CKD if one drank more than two colas per day to be around 2, after controlling for other factors. However, the same effect was not found if subjects drank non-cola sodas (Sprite, I presume?).

Apparently, there was anecdotal evidence that this was the case prior to this study (see image at left). However, the summary of the paper left me with a few questions. First, I happen to like a carbonated cola drink myself, so perhaps I am biased, but this study merely links CKD to poor diet, rather than proving anything. If the researchers are serious about this, they should do a randomized, double-blind, placebo-controlled, yada-yada trial and prove that cola causes CKD. That is probably harder to do in practice, but still, it must be done for the results to really say anything.

Second, why is the NIH spending money on this? While CKD is an important cause of morbidity and mortality in this country, did we really need to spend this money proving that Coke is bad for people with kidney disease, most likely due to diabetes? I would hope CKD patients would know to abstain from such things (unless I guess if they are on dialysis, but that's another story). Since in an abstract sense federal funding is fungible, this money could have been better spent raising awareness about diabetes and CKD and improving diabetes education. Maybe I am wrong, but that is where the real need is.