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Gluten, Famine and the Slow Crawl of Medical Knowledge August 20, 2012

Author: Beach Combing | in : Ancient, Contemporary, Modern , trackback

***Beach wants to salute his readers for a couple of days as he is going on his yearly retreat (hermit’s cave etc): he’ll see you on the other side, if the wolves don’t come***

Wheat is the grain of the west. The crop that has followed Europeans wherever they have gone for the simple reason that post 300 AD and prior to the Reformation wheat was needed by Christians wanting to get into heaven. We all sin, we all need to be forgiven and you must have bread and wine to do that. Wine can be a little rheumy red vinegar shipped to Tasmania from Turkey. But bread has to be bread and even if you are in a farmhouse on some good forsaken heath in Labrador you have to grow or have easy access to wheat.

The problem is though that for a small minority  wheat is poison. Those with celiac disease react badly to gluten that is carried in a number of cereals – rye, barley etc – but above all wheat. Gluten provokes their immune system that then turns its incisors on their digestive systems.

Celiac condition has everything to do with ‘the greatest mistake in history’, but the mistake that  allowed our escape from the seasons: the invention of agriculture. A 1981 study suggests that celiac condition is found in higher proportions the further you travel from the starting points of agriculture: i.e. there are more celiacs among populations that have had less time to adapt to the use of cereals in our diet.

All this is relatively well known. What is less discussed is humanity’s reaction to celiac condition. First, celiac disease – save in the case of an unfortunate few – stops when you stop eating gluten. In other words an exclusion diet or a month on a desert island will ‘cure’ you. Men and women who have suffered massive weight loss and compromised digestive tracts suddenly put on weight and stabilise.

The first description of celiac condition comes in a third-century (AD) medical tract. It was then observed in medical discussions, particularly from Europe – a relatively high celiac area – from early modern times. What is extraordinary is that no one cottoned on that cereals were the problem.

In the late nineteenth century Samuel Gee, a British doctor wrote about eating few cereals or ‘farinaceous food’. But the real breakthrough came in the Second World War in the worst circumstances. In 1944 German occupied Netherlands began to starve: with calorie intake falling from 1000 to 500 calories in the spring of 1945 in some areas. In this time children in a celiac ward at Utrecht – many children died of celiac condition – suddenly started to get better as grain vanished from their diets.

The man justly credited with the breakthrough, Willem-Karel Dicke was a doctor responsible for these children. However, Dicke had already seen evidence that wheat and other grains might be part of the problem. As early as 1936 – and his suspicions perhaps went back even further – he found dramatic improvements in celiac children who were put on fruit and vegetable or even on special banana diets. He also saw some patients get notably worse when they went home where such diets were difficult to follow.

Dicke clearly has every right to be proud of his achievement: his publications in the early 1950s finally identified gluten as the cause and saved tens of thousands from unpleasant deaths and added years and quality to the lives of millions of others. However, it is surely extraordinary that no one else had stumbled onto this through trial and error ten or twenty centuries before. In fact, some sufferers (or their wards) must have done so, but the knowledge never became general. Beach offers up this as an example of the limits of medical progress. Any other examples of slow-learning doctors? drbeachcombing AT yahoo DOT com

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31 August 2012: Mike Z has this thought on an illness that comes through: It took centuries for scientists to discover that pellegra, a disease caused by niacin deficiency, could be cured by adopting the Indian method of preparing maize with an alkali.  Thousands of poor people in the southern U.S. who ate little else but maize died of pellagra every year. KB writes Slow to learn: That deliberately bleeding patients did not cure infectious diseases. That insects bites caused (transmitted) disease.That trepanning (drilling holes in the skull) did not cure migraines, epilepsy or insanity. That foul odors did not cause disease. That putting sewage into rivers was not a good option for better public health. That common folk who knew the uses and doses of herbs were better at prescribing than most “trained” doctors. That diseases could be transmitted via sex. That frequent baths were not bad for your health. That being out in the cold does not expose you to colds, but being inside in a crowd might. That spoiled or undercooked foods can cause dysentery and death. That what you catch today might not actually cause symptoms or kill you until years later. That persons can be carriers of disease without being symptomatic themselves. That fresh air does not cure consumption (tuberculosis.) Quick to learn: That people will pay for quackery, especially when presented as science. That a fast and large return on quack medicines far outweighs later lawsuit costs. That selling health insurance is extremely profitable, especially when insurance companies set the health care rules. That an ounce of preventive medicine is worth a small fortune: treat the well until you make them sick, and you will have a repeat patient.’ The Count has a bone to pick: Medical science slow to catch on to the bleedin’ obvious? Surely not! Yet it is in fact true that until well into the 19th century, European medicine was so awful that it’s easier to list every method of treatment they had that actually worked than to catalogue their failings. So I’ll do just that. Digitalis, derived from foxgloves, is an effective heart stimulant that’s still used today. Opium didn’t cure anybody of anything, but made them feel much better about being ill. And latterly, the New World wonder-drug quinine did actually cure fevers in general and malaria in particular very effectively (though they wouldn’t have known about it if they hadn’t asked a bunch of Stone Age tribesmen). And that’s it. Seriously! All other medical treatments were either useless or positively harmful. I think it was Galen who, while making an honest attempt to assess medical practices purely on their objective merits, concluded that weapon salve actually worked. This was one of the silliest medicines ever devised – the idea was that, if you’d been injured by a weapon, you smeared this gunk on the weapon, not on the wound. You also had to keep the wound clean and lightly bandaged in order to allow the mysterious influences to get to it. The more conventional alternative was to smear any old random concoction the doctor happened to think might work on the injury, bind it as tightly as possible, and just hope your leg didn’t mysteriously go all black and smelly. Obviously, with medical science this dire, applying the cure to an inanimate object rather than yourself greatly reduced the risk of infection, and thus seemed to work. Homeopathy gained its reputation in France in the late 18th century for precisely the same reason – medicine consisting entirely of water that did exactly nothing visibly resulted in far more cures than the conventional muck. One of the later King Louis – I forget whether it was XIV, XV or XVI – had a peasant nurse who doted on him more than any of his siblings, and for some inexplicable reason didn’t think doctors were all that good at their job, so whenever the royal babies had a childhood illness, she’d hide little Louis. Therefore he was the only one who got no medical treatment at all. He was also the only one who survived. There was even an 18th century French physician whose fame rested on one miraculous pill he’d concocted, which was basically a lump of gold, and could thus pass through the human digestive system completely unaltered. Since it had no effect at all, it was better for you than seeing a real doctor. And when it came out as things eventually do, he’d give it a wash and administer it to the next patient – the price steadily went up as it passed through more and more aristocratic digestive tracts. Sort of like “I’ve danced with a man who’s danced with a girl who’s danced with the Prince of Wales”. All of this was ultimately the fault of the Ancient Greeks. Although the cleverest of them were superb mathematicians, they had an irrational prejudice against experimental science, which they viewed as a plebian getting-your-hands-dirty sort of activity. Also, it was assumed that the truth of a scientific theory could be judged purely by its perceived elegance (a prejudice shared by Albert Einstein, who ruined his chances of a second Nobel Prize when he fudged his own results to prevent the Universe from doing anything as messy as expanding because he intuitively felt that it shouldn’t, and never accepted that quantum physics really worked, even though he’d helped to invent it). This completely barking mad “scientific” results entered the canon, and weren’t challenged for 2,000 years because the Ancient Greeks knew everything (including the fact that you don’t see swallows in the Winter because they dive into ponds and hibernate in the mud). Thus doctors were burdened with the theory of the four humours, which had precisely zero to do with actual biology, but seemed like an elegant idea to the Greeks, on account of the world being made of four elements (they didn’t do much practical testing of that one either). It was beautifully simple. The human body is in perfect balance if the quantities of four crucial substances – blood, bile, phlegm, and black bile (which, by the way, doesn’t even exist) are equal. If one predominates, then you are at best sanguine, choleric, phlegmatic, or melancholy. If one predomites more than that, you get ill. The treatment therefore relies on restoring the balance by removing the excess quantities of whatever substance is supposed to be over-abundant. Hence blood-letting, cupping and leeches. It would seem to be pretty obvious that people who lose a lot of blood become weaker and eventually die, therefore deliberately draining blood from people who are already ill is unlikely to improve their chances. Yet within the last 200 years, blood-letting was still being used in this country to treat almost everything, including anaemia. Dosing seriously ill people with violent emetics and laxatives also tends to weaken them, especially if the doctor keeps on doing it until the substances emerging from one or both ends of the patient are in his opinion the non-existent black bile, or a reasonable substitute. But nobody noticed that either. Even herbalism was seriously compromised by peculiar beliefs which should have been self-evidently wrong. There’s a verse in Genesis in which God gives Adam dominion over all plants, which have been created especially for his use. This was taken to mean that God had helpfully made each plant in such a way that its medicinal use was indicated by the shape of its leaves or whatever. Obviously this is not so, and if you have kidney disease, eating a plant with kidney-shaped leaves is unlikely to help you, and may be seriously harmful. But since it was literally taken to be gospel truth, the idea wasn’t questioned, let alone experimentally evaluated. It should be noted that, in peasant communities, the local wise woman or cunning man was the only doctor they had, but he or she had to be very careful indeed. Disease and poison were very poorly understood, and the Ancient Hebrew word for “witch” in the Biblical phrase “Thou shalt not suffer a witch to live” was literally identical to “poisoner”. Such people, assuming they weren’t suicidally insane, would have been keenly aware of any direct consequences resultant upon taking one of their potions, because any suspicion that they were causing harm could very well have gotten them burnt at the stake. Thus it’s a safe bet that their herbal nostrums had been tested either on themselves, or on an ancestor who had proved their point by not being burnt at the stake. So in all probability, a village wise woman was not only a better physician than the best city doctor, but knew more about the scientific method, even if she didn’t know that’s what she was doing. And then of course there’s mercury. It looks special and mysterious, therefore it must be good for you. Since ingesting large quantities of it inevitably kills you in a horrible way after first driving you completely insane, you’d think that cause and effect would be screamingly obvious. Apparently not. An early emperor of China, whose name escapes me, but he was the fellow responsible for all those terracotta warriors, was advised by his court physicians that the best way to become immortal, and ultimately a god, was to eat as much mercury as possible. Were they able to quote case histories of previous patients who had lived to be, at the very least, 150? I very much doubt it! Fortunately he was a horrible person who was never very sane to begin with, and thoroughly deserved his inevitable fate. Ironically, his tomb supposedly contains dioramas of his kingdom that include rivers and lakes of mercury. This is almost certainly true, since the mercury content of the soil around his tomb is abnormal to say the least. They haven’t dug it up yet for several reasons, the most bizarre being that equally reliable legends speak of Indiana Jones-style booby-traps involving crossbows and the like, and it’s just conceivable that they might still work. Who said archaeology was boring? Thanks KB, Count and Mike!!