NOTIONS OF NUTRIENTS AND NUTRIMENTS

238 CHAPTER 22 NOTIONS OF NUTRIENTS AND NUTRIMENTS It is no surprise for historians of science that in any scientifi c fi eld ideas which in one generation seemed to be fi rmly based truths should be overturned in the next. Kenneth J. Carpenter (1994) 1 ALLAYING PUBLIC HEALTH concerns about food quality was a neces- sary step in America’s march toward food globalization. How could one be adventuresome about new and strange foods when even familiar ones were suspect? Moreover, perceptions had to change. For example, throughout most of baking history, white bread has been preferred by the elites; the whiteness signifying purity and refi nement. By contrast, brown and black breads suggested coarseness, so that in racially-mixed Spanish America, skin color was closely associated with the color of the bread consumed. 2 Sylvester Graham had railed against white bread in the nineteenth century but not for the right reasons. He thought white bread was too nutritious to be digested properly. 3 Regardless, Graham’s railing did little to slow white bread production or to improve its yield of nutrients. Quite the contrary. The steel roller mills that came into use in the 1870s made it possible to turn out bread fl our lacking both bran and wheat-germ as well as important vitamins and minerals. Interestingly, it was only after white bread became universally available that the upper classes, at least, discovered the virtues of coarse bread that was high in fi ber, and the coun- terculture of the 1960s found practically anything brown (brown bread, Notions of Nutrients and Nutriments 239 brown rice, brown skin) preferable to white (white bread, white skin, White House). 4 Four decades later, Tufts University researchers discovered that white bread and other refi ned grains are much more likely than whole grains to create an unsightly abdominal region which, of course, increases the risk of heart disease. Graham would also probably have railed against the waterlogged iceberg lettuce, introduced in 1894 by W. Atlee Burpee & Co. Like white bread, it has little nutritional value and not much fl avor. Its sole virtue is that, with reasonable care, it stays crisp. Also, like white bread, it fell from fash- ion among the nutrition-conscious upper classes, yet both have had recent reputation comebacks. Cheap white bread is a partner of pulled pork, and wedges of iceberg lettuce with blue cheese dressing have become standard fare in the new chophouses springing up across the country where only the lettuce is an American development – even chophouses are imports. Food prejudices and taboos are generally constants. The Seventh Day Adventists, for example, always maintain the dietary prohibitions of the Jews found in Leviticus and Deuteronomy, and the Mormons always reject alcohol. 5 In the past we saw Romans frown on everyday meat-eating, believ- ing it to be “barbarian,” and the upper classes of the Middle Ages avoided plebian vegetables. Thus, foods such as white bread and iceberg lettuce that fall in and out of fashion do so because of fads on the one hand and health concerns on the other, with advertisers straining to exploit both. This, in turn, has presented the public with another of what we might call the “perils” of plenty. Advertising, promotions, and packaging are the weapons of choice in a competitive struggle that aims at creating an irre- sistible illusion of quality, no matter what the truth. 6 But any measurable quality, in a nutritional sense, that might have reassured a jittery public remained an elusive concept until vitamins were discovered. 7 The English had been nervous about foods since the 1850s and particu- larly about meat contaminated with tuberculosis. 8 And, by the end of the nineteenth century, quality as measured by purity was another, and serious, matter for a U.S. public now thoroughly alarmed by exposés of food adul - teration and dangerous additives at the hands of “muckraking” journalists – and, especially, by Upton Sinclair’s The Jungle published in 1905. 9 His description of conditions in the meatpacking industry – such as sausages made from spoiled meat, then chemically treated to disguise this fact, and handled by tubercular workers – turned many to vegetarianism, and meat sales in the country plummeted by half. 10 240 A Movable Feast The book, however, did muster support for Harvey Wiley, who, as head of the Chemical Division of the U.S. Department of Agriculture (the USDA), had been campaigning relentlessly for a federal pure food law, while at the same time generating publicity by using his “Poison Squad” of volunteers to test the safety of food preservatives. 11 It was the uproar caused by The Jungle that prompted President Theodore Roosevelt to order an investiga- tion, and Wiley fi nally got his bills passed: 12 the Pure Food and Drug Act of 1906 and the Federal Meat Inspection Act of 1907, which he subsequently erratically and idiosyncratically enforced. 13 These Acts, although amended from time to time by Congress to make them more effective, were routinely circumvented by the food industry and even used by big producers to force smaller ones out of business. Still, the Acts constituted an important acknowledgment by the federal govern- ment that it had both the authority and the responsibility to ensure a safe food supply for the nation. 14 In 1907, an article appeared in the USDA yearbook entitled “Food and Diet in the United States,” in which its author asserted, “in no [other] coun- try is there a greater variety of readily accessible foods of good quality.” 15 But despite such reassurances, the nation’s safe food jitters were far from over. Rather, the appearance of the article coincided with the beginning of the nation’s next food scandal: pellagra, a nutritional defi ciency disease (see Chapter 23), had broken out among people in the south who had little access to either food variety or quality. 16 Not that poverty was immediately identifi ed as the culprit, but corn became a chief suspect, and in 1909 the plant was put on trial for murder by the state of South Carolina. 17 By 1913, it was clear that there were at least 100,000 cases of the illness in the south (in that year it killed 1,192 people in Mississippi alone), and the disease continued to stalk that region until the middle 1930s. In 1934, pellagra was credited with the deaths of 3,602 Americans and it was estimated that there were 20 cases for every death. 18 The persistence of pellagra did nothing to sooth a public worried about the dangers lurking in its food supply, nor did publications like Leon A. Congdon’s Fight for Food (1916). 19 Congdon, Division Chief of Food and Drugs for the Kansas State Board of Health, systematically criticized the food industry for adulterating and mislabeling foods, and for employ- ing unsafe additives. He was especially hard on the milk industry, which he correctly portrayed as responsible for outbreaks of typhoid and scarlet fever as well as diphtheria and tuberculosis. 20 In fact, of the cattle supplying Notions of Nutrients and Nutriments 241 Pittsburgh with milk in 1907, between 10 and 15 percent were found to be tubercular, 21 and in the following year it was estimated that from 20 to 25 percent of all dairy cattle in the nation were affected with the disease. 22 Pasteurization, it was pointed out, was an easy remedy but hardly one consistently utilized, as a signifi cant percentage of samples of milk, butter, and cream for sale in U.S. cities were found to be infected with tubercu- losis bacilli. 23 Another turn-of-the-century problem was lead water pipes, which had come into use with the beginning of canalized water toward the close of the nineteenth century. Fortunately, this danger was quickly realized, and many municipalities abandoned their use when it became apparent that the presence of lead sharply increased infant mortality rates, elevating them from 25 to 50 percent. 24 Congdon was similarly concerned about the safety of new food substi- tutes like oleomargarine and saccharin, and echoes of such concerns have continued to reverberate right down to the late twentieth-century distress caused by the use of other laboratory-produced products such as Stellar, Simplesse, and Olestra. 25 In addition to one alarm after another set off by new food-processing technologies from an industry few relish trusting with their lives, the public has gotten a century’s worth of contradictory, but nonetheless “scientifi c,” advice about what constitutes good nutrition – beginning with the remarkably high recommendations for protein and fat intake that were in vogue at the start of the twentieth century. 26 Such advice has always commanded a wide audience, because in speak- ing to questions about the salubrity of various foods taken into the body, it speaks to concerns that are both eternal and global – as refl ected in the Hippocratic medicine of the ancient Greeks, the Chinese yin and yang, and the Ayurvedic texts of India. But despite the antiquity of the anxiety, little more than theorizing about nutriments could be done until the advent of modern chemistry and the birth of nutritional science. Vitamin A defi ciency and the blindness (especially night blindness) it causes was probably the fi rst nutrient defi ciency to be identifi ed. The prob- lem was known to the ancients – both Hippocrates and Galen wrote about night blindness – and they had a cure for the condition. It was liver, high in vitamin A, although the vitamin and its assignments were not under- stood for another 2,500 years. In fact, the discovery of most of the chief nutrients was a strictly twentieth-century phenomenon, even though the importance of some minerals, such as iron, to human health was at least vaguely understood in the eighteenth century. 27 242 A Movable Feast In 1789, Antoine-Laurent Lavoisier published the fi rst modern chemical textbook that used the term “calorie” and showed that all animals, humans included, were machines that burned food for energy, thereby demolishing the millennia-old theory of the “four humors.” A half-century later, Justus von Liebig, a 39 year old German chemist, argued that this combustion produced animal heat and he founded the science of biochemistry while introducing the concept of proteins. These, he argued, were the only true nutrients, even as science was going about disproving him. 28 At the beginning of the nineteenth century, it was known that blood contained iron and, by its end, numerous other minerals were understood to be vital to life itself. 29 But important as such mineral research was in advancing nutritional knowledge, it was only with the discovery of vita- mins that the fi eld of scientifi c nutrition experienced a truly spectacular birth. This occurred as disease descriptions in earlier texts were matched with modern counterparts suspected of being caused by nutrient defi cits. Vitamins came to light in the ensuing search for their causes and cures. THIAMINE AND BERIBERI Illustrative is beriberi, caused by a dietary defi ciency of thiamine (a B- complex vitamin). Historically those that consume a diet centered too closely on rice, and one that excludes thiamine-rich foods, particularly animal foods, have been especially susceptible to the malady. In Asia dur- ing the latter part of the nineteenth century, the disease achieved a new virulence when new steam-driven mills were applied to processing rice. In stripping away the husks and hulls of the grains (polishing them) they also stripped away their thiamine. The cardiac symptoms of “wet” beriberi, as well as the paralytic symptoms of “dry” beriberi, became widespread, as did those of the invariably fatal “infantile” beriberi that mothers passed on to their babies in thiamine-defi cient milk. 30 Recognition that beriberi was a defi ciency disease began with the work of Christiian Eijkman, a Dutch military surgeon in Java, who showed dur- ing the 1890s that a diet of polished rice caused beriberi-like symptoms in chickens, but symptoms that vanished when the diet was switched to crude (unpolished) rice. 31 In the fi rst decade of the twentieth century, the Malayan government instituted programs to warn of the dangers of con- suming polished rice and to encourage the production of unmilled rice. Both programs dramatically lowered beriberi incidence. Notions of Nutrients and Nutriments 243 After learning of these developments, the United States launched similar programs in the Philippines during the 1920s that were overseen by W. E. B. Vedder and colleagues. It was Vedder who encouraged R. R. Williams, a scientist at the Bureau of Science in Manila, to begin studies that led in 1933 to the isolation of the substance protective against beriberi, a substance that Williams named “thiamine.” 32 Thiamine was a “vitamin,” the word coined in 1912 by Polish chemist Casimir Funk, who proposed that an absence of a dietary substance he called vitamine was responsible for scurvy, pellagra, and rickets as well as beriberi. He was simultaneously right and wrong, but with Funk’s notion of a “vita” (life) “amine” (any chemical compound containing nitrogen) the vitamin age leaped into the twentieth century. Research during that cen- tury, however, carried us well beyond vitamins to an understanding that all nutrient defi ciencies, if suffi ciently severe, can either produce disease or lower disease resistance. 33 VITAMIN C AND SCURVY Scurvy, caused by vitamin C defi ciency, is probably the nutritional defi ciency disease that has caused the most human suffering. 34 It was infamous as a scourge of seamen, who regularly turned yellow, developed purple spots all over their bodies, had gums grow over teeth, teeth fall out, and old wounds open up. Such symptoms were prominent among the crews of the expedi- tion led by Vasco da Gama that rounded the Cape of Good Hope in 1498, crossed the Indian Ocean to Calicut, and returned to Lisbon the following year. 35 In that not so tender-hearted age, it was declared a successful (and enormously profi table) venture even though scurvy and other ailments had claimed 100 of the 160 Portuguese seamen who had begun the voyage. Progress in shipbuilding and navigation technology had reached a point where humans could remain at sea for indefi nite periods of time, and con- sequently, away from the vitamin C contained in those fresh fruits and vegetables found ashore (many sailors also developed night blindness since the same circumstances produced vitamin A defi ciency). 36 It was, there- fore, “progress” with a price. Scurvy would ultimately kill substantially more than a million sailors – claiming more of them than all other diseases, shipwrecks, naval warfare, and nasty storms combined. 37 Nor did the disease limit itself to sailors. Soldiers – such as the Crusad- ers in 1250 – engaged in prolonged warfare and under siege (along with 244 A Movable Feast civilians) developed it. So did inmates of prisons and asylums, who had lit- tle choice about what they ate. Scurvy dogged explorers searching out the North and South Poles, and others who ventured into remote places like the goldfi elds of California or into deserts (the onion was recommended in ancient Egypt as a cure for a disease resembling scurvy.) 38 And mild symp- toms were displayed by practically everyone in northern climes during the winter months. Early spring found them scratching under the snow for the fi rst shoots of “scurvy grass” (any number of plants with antiscorbutic properties) to heal their bleeding gums. In fact, winter was yet another reason scurvy was particularly hard on sailors. Although the body stores upwards of a thirty-day supply of vitamin C to fall back on, this supply was already pretty well exhausted for those who generally began their voyages in the spring. 39 In the eighteenth century, experiments in the British navy by James Lind (1854) – some would also credit the observations of James Cook during his voyages of the 1770s – and later, advocacy by Gilbert Blane and Thomas Trotter, fi nally convinced the Admiralty that citrus juice could both cure and prevent scurvy. One says “fi nally” because it was only at century’s end (1795), some forty years after Lind’s observations were published, that lime or lemon juice became a regular part of the rations of a Royal Navy sailor (hence the term “limey,” not generally an endearing one). Moreover, although cit- rus juice was demonstrably successful as a scurvy preventive, unaccount- ably, another half century elapsed before citrus rations were extended to the Merchant Marine. 40 Nor did other navies follow suit, let alone armies. Scurvy was rife during the Napoleonic Wars, the American Civil War, and the siege of Paris during the Franco-Prussian War. In short, the British example did not galvanize many medical decision- makers to follow suit. Most remained skeptical of any theory linking nutri- tional defi ciency with disease causation, theories that were almost totally derailed by the advent of germ theory, which sent investigators scurrying off on wild goose chases for a scurvy-causing pathogen. Yet, the skeptics made some good points, among them that Eskimos who consumed no fresh fruits or vegetables did not suffer from scurvy. 41 Fortunately, Casimir Funk’s proposal that diseases like scurvy were caused by some crucial (but missing) dietary substance was never totally forgotten, especially by vitamin researchers of the 1920s. And in 1932 the missing substance was isolated and identifi ed by the Hungarian scientist Albert Szent-Györgyi and American researcher Glen King. It was called Notions of Nutrients and Nutriments 245 “vitamin C,” and with this discovery many scurvy riddles were resolved. In the case of the Eskimos it turned out that they derived the vitamin after all, by eating their meat raw (cooking destroys vitamin C) and, in addition, they ate the stomach contents of caribou and other herbivorous animals. Finally, the Eskimos had long before learned to doctor any scurvy-like con- dition with an extract of evergreen needles. 42 NIACIN AND PELLAGRA Since 1937, science has known that pellagra is associated with a defi ciency of niacin – another of the B-complex group of vitamins. It was a disorder known to present with unlovely, and generally protean, symptoms, like severe dermatitis (hence the Italian pelle agra or rough skin), diarrhea, and dementia, with death the ultimate symptom of this “disease of the four D’s. ” 43 Historically, pellagra has dogged the heels of heavy maize consum- ers but it was only in the middle 1950s that we learned why. Maize con- tains plenty of niacin, but contains it too well, in a chemically-bound form that makes it unavailable to consumers without special treatment. 44 Yet, other questions remain. We now know that a little fresh meat or milk in the diet permits human bodies to manufacture tryptophan (an amino acid and niacin’s precursor) and be pellagra-free no matter how much maize is eaten. 45 However, science continues to puzzle over the importance of other amino acids and proteins in pellagra’s etiology. And for the longest time investigators had wondered how maize-dependent Native Americans managed to elude the disease for millennia. 46 It turned out – as mentioned earlier – that they perfected the “special treatment.” Called nixtamalization, it is a complex process of soaking maize grains, then cooking them with lime (or campfi re ashes). When this is done, the pericarp of the grain – a transparent skin – can be removed, and this releases the niacin, improves the quality of maize protein, and also contributes to an intake of calcium. 47 Unfortunately, Native Americans neglected to pass along this little secret to their European conquerors who carried maize back to Europe where it became a subsistence food for the peasants of northern Spain, Italy, south- ern France, and the Balkans. The life of a peasant was always precarious, and when their economic situation deteriorated, many could afford to eat little else but cornmeal mush. By the fi rst decades of the eighteenth cen- tury, pellagra had become common among them. 48 246 A Movable Feast The disease also accompanied maize into Africa, then erupted in its home hemisphere, in the southern United States among slaves in the nineteenth century, and prisoners, sharecroppers, and mill workers in the twentieth century, all people with circumscribed diets they could do little to change. 49 The U.S. Public Health Service launched a quest for both cause and cure, and progress was made after Joseph Goldberger’s 1914 investigation that involved experimenting with the diets of eleven prisoner volunteers at Mississippi’s Rankin prison farm. Six of the volunteers were fed grits, cornbread, and fatback, while the other fi ve had milk, butter, eggs, and lean meat added to this regimen. It was an elegant experiment in which none of the latter fi ve developed pel- lagra but all six of the fi rst group did. The experiment tied the disease to the kind of poverty that permitted little or no relief from the monotony of a “3M” diet of meat (mostly fat which contains no niacin), meal, and molasses. And in further experiments with dogs, Goldberger came close to discovering the pellagra-preventive by showing that yeast (loaded with niacin) prevented “black-tongue” (canine-pellagra). 50 But the concept, let alone the importance, of vitamins, just then being discovered, lay in the future, and few of Goldberger’s colleagues were willing to concede that a circumscribed diet might actually cause disease. Fortunately, the American Red Cross did make the concession, and dur- ing the Great Depression distributed yeast to southern sharecroppers and encouraged them to grow vegetables. 51 Finally, in 1937 at the University of Wisconsin, nicotinic acid was discovered. Later renamed “niacin,” this vitamin was pellagra’s long-sought preventive and cure. 52 VITAMIN D, RICKETS, AND OTHER BONE MALADIES Rickets, the last of Funk’s defi ciency disease suspects, is actually young peoples’ osteomalacia. Symptoms appear when growing bones are not suf- fi ciently calcifi ed. They become deformed, with the characteristic bow- ing of the long bones of the legs and deformity of the rib cage, especially noticeable. The ancient Chinese wrote of such pronounced skeletal abnor- malities, as did the Romans and Europeans during the Middle Ages. 53 Their cause stems from a lack of vitamin D, which is crucial to the utiliza- tion of calcium. 54 But the only signifi cant food sources of vitamin D (actu- ally not really a vitamin but rather a pro-hormone) are egg yolks, animal livers, fatty fi sh, and fi sh oils. Consequently, most, if not all, of the vitamin Notions of Nutrients and Nutriments 247 D required by the human body has to be produced by that body, which introduces another variable. Ultraviolet rays from the sun are required for vitamin D production – rays that, in refl ecting off of the skin, stimulate the production of a cholesterol-like substance, which is the natural form of vitamin D, called alternatively cholecalciferol, calciol, or vitamin D 3 . 55 Humankind originated in, and adapted to, a region of the world where abundant sunlight ensured vitamin D production, which made rickets an unlikely event. Skeletal evidence indicates that trouble began when our rest- less, ancient ancestors wandered into northern climes with frigid and overcast winters that not only shut out sunshine but also made considerable cloth- ing necessary, shutting out even more sunshine. 56 Physical adaptation to this newly adopted region would have included a lightening of the skin (another variable), because pigment has an important effect on vitamin D synthesis – the darker the skin, the less synthesis, and vice versa. In fact, because black skin absorbs rather than refl ects ultraviolet rays, it receives only about a third of the stimulus to produce natural vitamin D that white skin receives. 57 Another adaptive mechanism involved acquiring an ability to utilize the calcium in milk and milk products by developing what most of the world’s peoples do not have – the lactase enzyme that makes milk digestible by breaking down lactose (milk sugars). Lactose-tolerant individuals (who maintain high levels of the lactase enzyme into adulthood) are assured a regular source of calcium. 58 But even Charles Darwin might have been startled at the speed with which natural selection must have hastened this process of evolutionary adaptation. This is because women with dark skins and limited sources of calcium in northern latitudes would have been much more likely than their milk- drinking, fair-skinned sisters to have their pelves deformed by rickets or osteomalacia which, in turn, would have sharply limited successful births. Conversely, women with light skins who could drink milk were much less likely to have birthing problems. Not only did they enjoy a satisfactory cal- cium source, but the lactose in milk could also substitute for vitamin D. 59 The tradition of June weddings in northern climes has been linked with rickets, because a couple’s fi rst baby was likely to be born the following spring and bask in plenty of spring and summer sunshine during its rapid growth phase. By contrast, fall babies were much less healthy because they lacked vitamin D during this phase. 60 Still another variable in the etiology of rickets came with industrial- ization. In the cities, smokestacks spewed smoke and smog blotted out [...]... margarine (which many do not use) with vitamin D, and considerable evidence has accumulated to indicate that rickets (and osteomalacia) is now common among Asian groups in both England and Scotland Other examples of women suffering from osteomalacia include Muslims and Hindus with a strict tradition of keeping the female skin out of public view and, thus, out of the sun.67 248 A Movable Feast In addition,... deficiency of the ultra trace mineral iodine Iodine deficiency has usually (but not always) been associated with elevated regions where soils have been leeched of iodine by glaciation, floods, Notions of Nutrients and Nutriments 249 melting snow, and high rainfall By contrast, peoples living close to the sea have historically seemed immune to goiter Their diets were rich in iodine because of seafood and algae,... (enlarged thyroid glands) and cretinism (the physically and mentally retarded condition suffered by individuals born of iodine-deficient mothers) are easily spied in the ancient literature of China, India, and Greece.74 During the Middle Ages, the Alps Mountains were a notorious stronghold of the disease, and it was apparently also present in the interior of Britain However, there is no way of knowing how... intakes of the mineral can produce the twitching and convulsions of tetany (especially in the very young), and a lack of magnesium has also been implicated in coronary artery disease Where the water is soft (meaning a low mineral content) and the arable soils are magnesium-deficient, cereals (a major source of the mineral) will have a low magnesium content, and the population will suffer an elevated rate of. .. those of northern European ancestry – than it is among those of Asian or African ancestry.72 There is no satisfactory explanation for this as yet but it does raise questions about the nutritional adaptation of various peoples to various environments and foreshadows some of the queries we make later on about exactly who the “Recommended Dietary Allowances” of nutrients are intended for IODINE AND GOITER... the story of scurvy and its citrus cure, it is, because the discovery of a bacterial cause of diseases sidetracked the search for nutritional causes, in this case sending investigators racing off to find a goiter-causing pathogen.76 But the iodine-deficiency hypothesis was finally substantiated on the iodine-leached soils of Ohio and Michigan close to the Great Lakes David Marine, at Cleveland’s Lakeside... speaking) like anorexia and bulimia are discussed later on But another, pica (a craving for and consumption of non-foods) has been observed and described since ancient times – since Socrates and Aristotle wrote about earth-eating (a form of pica called geophagy or geophagia).81 Children and pregnant women are the most visible non-food eaters in pica literature In sixteenth-century England both groups had... radicals during a heart attack, may be protective against heart attacks, and, perhaps, some forms of cancer.82 Notions of Nutrients and Nutriments 251 Vitamin K is another fat-soluble vitamin known to be essential – vitally so because it works to prevent bleeding Its deficiency is rare in adults but its administration to mothers before birth and to their infants shortly after delivery has been recommended since... middle-aged and older women because estrogen loss and aging intensifies the loss of calcium in bones Research indicates that a lifetime intake of sufficient calcium could cut the world’s burden of osteoporosis by around 50 percent (the other 50 percent is caused by non-nutritional factors).68 The diets of our hunter-gatherer ancestors were extremely rich in calcium because of their consumption of leafy... efficacy of iodine was ignored until after the death of dictator Francisco Franco, and many continued to suffer from goiter.78 In Africa, where the soils south of the Sahara frequently lack iodine, incidences approaching 100 percent have been observed, although part of the problem may lie in goitrogenous agents such as heavily consumed manioc.79 And globally, the International Council for Control of 250 . outbreaks of typhoid and scarlet fever as well as diphtheria and tuberculosis. 20 In fact, of the cattle supplying Notions of Nutrients and Nutriments. that was high in fi ber, and the coun- terculture of the 1960s found practically anything brown (brown bread, Notions of Nutrients and Nutriments 239 brown