A really pleasant to read story. It's funny because I live in Switzerland and some of my friends debate the "ioded salt", and prefer to consume "natural salt" without the additives. Funny how history can repeat itself.
I'm always impressed with all these doctors that would question the approach, try new protocols, and end up by finding a cure
With the complex supply chains and processed/ready-made food we have nowadays I am wondering how much iodine makes its way into the diet of the Swiss today even without ioded table salt.
I suspect that one of the issues was that most/all food used to be sourced locally, especially eggs and milk, which are good sources of iodine, with seafood probably mostly absent from the Swiss diet.
Edit: apparently nowadays, and taking animal feed into account, Switzerland imports about 50% of its food.
Most processed food uses uniodized salt iirc, which is actually becoming a problem in parts of the USA where populations eat nothing but processed food.
One interesting use of iodine supplementation is during nuclear accidents, where it is given to flood the thyroid and prevent unstable iodine isotopes from being taken up.
"Iodine-131 (usually as iodide) is a component of nuclear fallout, and is particularly dangerous owing to the thyroid gland's propensity to concentrate ingested iodine and retain it for periods longer than this isotope's radiological half-life of eight days. For this reason, people at risk of exposure to environmental radioactive iodine (iodine-131) in fallout may be instructed to take non-radioactive potassium iodide tablets... Ingestion of [a] large dose of non-radioactive iodine minimises the uptake of radioactive iodine by the thyroid gland."
The salt used in processed and prepared foods usually isn't iodized, contributing to declining iodine intake given the increasing consumption of these foods.
I've 100% switched to kosher salt & various sea salts with my own cooking. Not because I'm anti-iodine, but because I like those salts better for cooking purposes. Given how much attention was paid to using kosher salt in cooking by people like Alton Brown over the last 20 years I would expect I'm far from an outlier.
Pretty much the same as against fluorine in water in the States: it’s unnatural/a globalist conspiracy/killing our traditional way of life/a plot to subdue the people for <reasons>.
There is no scientifically sound reason against it.
Depends on the salt, there are few that hardly contain more then dairy, but some salts contain enough to make it make sense.
My main issue with normal salt is the anti-caking ingredient needed to not have it stick together, in general not needed with sea salt and a real grinder.
We just don’t think about it because we’ve defeated it completely by putting iodine in the most popular spice, and also people in the past were afflicted by all sorts of horrible illnesses. It doesn’t stand out from the noise of the past being generally a mess.
> Worldwide, iodine deficiency affects two billion people and is the leading preventable cause of intellectual and developmental disabilities.[1][2] According to public health experts, iodisation of salt may be the world's simplest and most cost-effective measure available to improve health, only costing US$0.05 per person per year
"The interests of people in the thyroid gland have always been immense because of the widespread prevalence of its diseases. Therefore the earliest references to the gland date back to 1st century AD. The Chinese, Egyptian, Indian, Greek and Byzantine medicines are especially rich in their knowledge on the subject."
It was. Cretinism was one of the manifestations of iodine deficiency. The trope of crétin des Alpes (lit. cretin from the Alps) existed for a reason. The manifestation was goitres and stunted development, with people who seemingly stopped growing up around 14. Pretty much the story’s subject. It was a public health problem before iodised salt.
> How come that the disease wasn't widespread earlier?
The article makes reference to the Madonna on the Albrecht Dürer’s Dresden Altarpiece having an obvious goiter. That was produced in the late 15th to early 16th century. That’s evidence from the article that the problem was so common then that it was depicted in sacred art.
It was widespread but has always been particularly worse in inland mountainous regions. To this day, efforts remain to eliminate iodine deficiency worldwide.
In Slovakia, another landlocked country with lack of natural iodine from rainfall or diet, dementia became part of the culture. 30% (!!!) of population suffered from dementia. Iodizing salt raised IQ by 10 point every 10~ years but the damage is irreparable…
I (while not living in Switzerland) am one of those people. I don't want to eat salt with iodine. I don't like the taste. Too metallic, like in baking powder with aluminum.
Lovely article. It reminds me of the relationship of scurvy and Vitamin C. Despite scurvy being largely understood around 1750 the knowledge was forgotten or replaced with wrong theories as late as 1911. https://idlewords.com/2010/03/scott_and_scurvy.htm
With all our popular narratives about the inevitability of scientific progress, it's always refreshing (from a historical point of view) and important (from a personal, ethical perspective) to remember that there's no guarantee that chronologically later developments will necessarily be improvements on earlier conclusions.
It brings to mind our current replication crises in science.
Depends what you mean by "development", as the article does not describe developments on treating scurvy, but rather somehow random actions based on wrong assumptions (ex: limes are the same as lemons; acidity is all that matters).
And even if in this case the initial solution was correct, it was still observing a correlation, as they had no clue why lemons do the job.
My conclusion based on the article is that just experimenting is not enough, you also need to develop and test a complex understanding of the system. We probably don't cherish enough as a society, that some of us (as in: trained researchers, etc.) have a mindset that expects both replication and understanding, even if being humans we don't always reach this ideal.
It's worth noting the critical details: how to prevent scurvy was understood, but the underlying mechanisms were not. This mattered because it meant why the treatment worked was not understood, with the result being a resurgence when a supposedly effective treatment turned out to be ineffectual.
Basically, it's easy to think we understand something when we have a solution to it, but the two should not be automatically conflated.
Before the internet I was like "how could we lose information like that and replace it with junk", but now I'm like "oh, I see exactly how that happens"
Maciej has a real gift for writing. His three part travelogue of visiting Yemen has been on my mind a lot recently. He published the first installment just a few months before the civil war started. https://idlewords.com/2015/05/ta_izz.htm
My father told me that goitre's were quite common when he was growing up as a boy in Detroit in the 1920's. In my generation it was totally unknown. Yet I remember people affected by polio as a boy quite well. But I bet that millennials have no personal experience with it at all. Each generation moves forward and I can only hope there is a day when no one has any first hand experience with either cancer or Alzheimer's.
Only if sensible people continue to run the public health authorities.
You now have people that refuse to vaccinate their children against measles, COVID vaccine hesitancy is a widespread phenomenon with some people resorting to heresay remedies like horse dewormers instead, an anti-vaccine conspiracy theorist is running for US president and polling with double digit numbers.
Health-related insights are particularly susceptible to targeted misinformation. And in an era of social media, this can quickly become a majority opinion.
A large number of people have refused the COVID vaccine for completely valid reasons. The vast majority of that group absolutely vaccinates their children against polio, measles, etc.
They aren’t the anti science luddites your comment paints them as. They are (rightly) skeptical of “the science” which often isn’t very scientific at all.
As we’ve seen, the medical science community is heavily motivated by profit and prestige, but unfortunately not always truth.
New discoveries in that field are often revealed to be bullshit. They deserve skepticism, not blind compliance.
I had some elderly neighbors with this condition and I think they lived long enough (1990 maybe?) that my two next younger brothers might have visited them too. (Why I don't know: they were not relatives or anything, my mom and aunt just used to visit them to be nice to them, so I suspect when I started school they might have taken my place.)
I think, outside Europe, this afflicted lots of places away from the coast, right? Like the middle part of the US.
I’ve always wondered if the iodine in the air is part of the allure of the seaside.
Coastal areas of course have produced a huge number of successful countries. Most of that must be the trade and logistics advantages. I wonder if getting the iodine right out of the air was another hidden major advantage though.
There are health resorts here in Poland where the whole reason is for them to exist in these particular places is because air there has a lot of iodine and other minerals from sea salt. I've been to one in Kołobrzeg as a child because of my asthma.
There are also inland health resorts where they build huge salt evaporation walls so that people don't have to drive all the way to the sea to breath sea air- for example in Ciechocinek. And it's not modern technology - they have been built in early 19th century already.
Sounds similar to many parts of eastern Europe and Russia. People go to health retreats to drink water from specific natural springs that are high in minerals.
> I think, outside Europe, this afflicted lots of places away from the coast, right? Like the middle part of the US.
That's exactly where it afflicted people in europe as well, mountainous regions tend to be inlands, and from their remoteness don't have the opportunity for incidental iodine through trade, so they worsen the odds, but historically distance from the sea (and thus lack of sea products) has absolutely been the primary issue. CIDS was also endemic to the english midlands for instance.
> I’ve always wondered if the iodine in the air is part of the allure of the seaside.
But, intake from air is how the soil & plants get it, over long time scales…
It’s always possible that a simple indirect selection is at play, e.g. people who simply love the sea breeze (for no particular reason) are more successful because they get enough iodine. Then, the next generation is more likely to love the sea breeze.
It is not. This kind of ideas is the remnant of the “bad air” theory of diseases propagation, which is not actually a thing and was displaced by germ theory at some point in the 19th century. People clung on to this belief because why not (and there was money to be made bringing rich people to countryside or seaside resorts) but there is no real rational justification. That’s not to say that the atmosphere cannot be harmful locally, but the seaside is not particularly healthy.
I remember it from my grand-grandparents. It wasn't common-common like in late 19th century Switzerland, but there was at least one case close enough to come across yourself.
I'll always be grateful to the doctor who just noticed my throat being very slightly enlarged, even though I wasn't complaining. I had my TSH tested and found that I needed the synthetic thyroid hormone. It's cheap and you just take it once a day.
Iodine deficiency is ONE cause of goiter, but not the only one.
This seems to be a slightly shortened version of an earlier article by the same author. The swiss weekly magazine "Das Magazin" published a german translation of this longer version in 2019 [1]. It is an absolutely fascinating read.
Since the article from OP is relatively short on images, the following are links to more images from the german article, with captions translated into english. Warning: images contain depictions of the medical condition discussed in the article. YMMV, but i don't consider them 'gross' or NSFW.
For German speakers there's also this 'Geschichten aus der Geschichte' Podcast episode on the matter which does a fairly good job telling the story IMO.
https://www.geschichte.fm/archiv/gag368/
A fascinating story overall and a reminder of just one of a number of everyday sicknesses we (as a society) have been able to overcome through science and understanding, despite the occasional step backwards.
For anyone interested in this area, I would highly recommend following the work of Iodine Global Network (and donating if possible).
They work with politicians and industry in a very targetted way to increase the use of iodised salt in food production where it is most needed in the world. They don't directly fund any of the activities, but create the relationships, conditions and understanding for it to happen - meaning they are an extremely effective charity, creating population scale change with very modest funding.
They also do lots of work to try to map the global picture of iodine intake from the very varied data available. Some of the results might surprise you - https://ign.org/scorecard/
I am increasingly convinced that the "thyroid hormones" T1, T2, T3, and T4 are simply a place to store iodine. When iodine is needed somewhere in the body it can be taken from T4, converting it to T3. But it's not the case that "T3 is the active form" as you'll read in the literature, it's that the removed iodine is the active or useful thing.
Changing the ratio of T3/T4 does cause a change in TSH (thyroid stimulating hormone) but that's IMHO simply a signal that the iodine is getting used, so please send us more.
There are other tissues in the body that need iodine, as evidenced by the sodium-iodine symporter present on those cells, so to set the recommended daily iodine intake based solely on what the thyroid can use is IMHO a huge mistake.
Some things with interesting iodine research: skin cancer, breast cancer, type 2 diabetes, asthma, polycystic ovaries, fibrocystic breast disease, other cancers. But yeah, it cures goiter...
But it's not the case that "T3 is the active form" as you'll read in the literature, it's that the removed iodine is the active or useful thing.
Supplementation with T3 yields a rapid correction in bradycardia and hypothermia caused by hypothyroidism. We treat with T4 because it has a longer physiological halflife and thus yields more consistent serum levels; but the evidence is incredibly clear that it's T3 which is having an effect, not T4.
How does the T3 produce the result? Is it possible that conversion to T2 - liberation of iodine - is what does it? I have not head of this condition so I'll do some reading. Also, does simple iodine supplementation help?
For some symptoms it may be true, for others not? Some hypothyroidism can be fixed by supplementing iodine. Some are due to other causes. Also, some of the things thyroid hormone seems to do can also be achieved by iodine supplements, and some not. It's very complicated.
> Some things with interesting iodine research: skin cancer, breast cancer, type 2 diabetes, asthma, polycystic ovaries, fibrocystic breast disease, other cancers. But yeah, it cures goiter...
When I search for breast cancer and iodine, I find links that suggest iodine may help prevent that disease - and Japan’s low rate of the condition is potentially related to high consumption of iodine.
Are you saying that all those conditions are due to excess iodine?
The thyroid is by far the largest consumer of iodine. It stores iodine in thyroglobulin, which is the precursor to thyroid hormone. I don't know the numbers, but I wouldn't be surprised if the thyroid released more iodine by breaking down thyroglobulin than breaking down thyroid hormone.
Readit News
I'm always impressed with all these doctors that would question the approach, try new protocols, and end up by finding a cure
I suspect that one of the issues was that most/all food used to be sourced locally, especially eggs and milk, which are good sources of iodine, with seafood probably mostly absent from the Swiss diet.
Edit: apparently nowadays, and taking animal feed into account, Switzerland imports about 50% of its food.
Deleted Comment
"Iodine-131 (usually as iodide) is a component of nuclear fallout, and is particularly dangerous owing to the thyroid gland's propensity to concentrate ingested iodine and retain it for periods longer than this isotope's radiological half-life of eight days. For this reason, people at risk of exposure to environmental radioactive iodine (iodine-131) in fallout may be instructed to take non-radioactive potassium iodide tablets... Ingestion of [a] large dose of non-radioactive iodine minimises the uptake of radioactive iodine by the thyroid gland."
https://en.wikipedia.org/wiki/Iodine#Other_formulations
https://www.klartext-nahrungsergaenzung.de/wissen/lebensmitt...
https://www.medicalnewstoday.com/articles/iodine-rich-foods
There is no scientifically sound reason against it.
My main issue with normal salt is the anti-caking ingredient needed to not have it stick together, in general not needed with sea salt and a real grinder.
We just don’t think about it because we’ve defeated it completely by putting iodine in the most popular spice, and also people in the past were afflicted by all sorts of horrible illnesses. It doesn’t stand out from the noise of the past being generally a mess.
https://en.wikipedia.org/wiki/Goitre#History
https://en.wikipedia.org/wiki/Iodized_salt#In_public_health_...
> Worldwide, iodine deficiency affects two billion people and is the leading preventable cause of intellectual and developmental disabilities.[1][2] According to public health experts, iodisation of salt may be the world's simplest and most cost-effective measure available to improve health, only costing US$0.05 per person per year
"The interests of people in the thyroid gland have always been immense because of the widespread prevalence of its diseases. Therefore the earliest references to the gland date back to 1st century AD. The Chinese, Egyptian, Indian, Greek and Byzantine medicines are especially rich in their knowledge on the subject."
https://en.m.wikipedia.org/wiki/Congenital_iodine_deficiency...
The article makes reference to the Madonna on the Albrecht Dürer’s Dresden Altarpiece having an obvious goiter. That was produced in the late 15th to early 16th century. That’s evidence from the article that the problem was so common then that it was depicted in sacred art.
Maps with goiter prevalence can be found on the WHO's website: https://www.who.int/teams/nutrition-and-food-safety/database...
Deleted Comment
With all our popular narratives about the inevitability of scientific progress, it's always refreshing (from a historical point of view) and important (from a personal, ethical perspective) to remember that there's no guarantee that chronologically later developments will necessarily be improvements on earlier conclusions.
It brings to mind our current replication crises in science.
And even if in this case the initial solution was correct, it was still observing a correlation, as they had no clue why lemons do the job.
My conclusion based on the article is that just experimenting is not enough, you also need to develop and test a complex understanding of the system. We probably don't cherish enough as a society, that some of us (as in: trained researchers, etc.) have a mindset that expects both replication and understanding, even if being humans we don't always reach this ideal.
Basically, it's easy to think we understand something when we have a solution to it, but the two should not be automatically conflated.
Apparently Michigan helped normalize the ionization of salt in the US: https://www.michiganradio.org/show/stateside/2022-05-12/once...
You now have people that refuse to vaccinate their children against measles, COVID vaccine hesitancy is a widespread phenomenon with some people resorting to heresay remedies like horse dewormers instead, an anti-vaccine conspiracy theorist is running for US president and polling with double digit numbers.
Health-related insights are particularly susceptible to targeted misinformation. And in an era of social media, this can quickly become a majority opinion.
They aren’t the anti science luddites your comment paints them as. They are (rightly) skeptical of “the science” which often isn’t very scientific at all.
As we’ve seen, the medical science community is heavily motivated by profit and prestige, but unfortunately not always truth.
New discoveries in that field are often revealed to be bullshit. They deserve skepticism, not blind compliance.
Mass vaccination started in the late 50s and especially early 60s (with Sabin’s oral vaccine).
Millennials start in 1981, so they would / could well have known affected adults.
It is hard to understand for me how people can intentionally increase risks of deadly diseases for their children.
I had some elderly neighbors with this condition and I think they lived long enough (1990 maybe?) that my two next younger brothers might have visited them too. (Why I don't know: they were not relatives or anything, my mom and aunt just used to visit them to be nice to them, so I suspect when I started school they might have taken my place.)
I’ve always wondered if the iodine in the air is part of the allure of the seaside.
Coastal areas of course have produced a huge number of successful countries. Most of that must be the trade and logistics advantages. I wonder if getting the iodine right out of the air was another hidden major advantage though.
There are also inland health resorts where they build huge salt evaporation walls so that people don't have to drive all the way to the sea to breath sea air- for example in Ciechocinek. And it's not modern technology - they have been built in early 19th century already.
https://en.wikipedia.org/wiki/Ciechocinek_graduation_towers
https://pl.wikipedia.org/wiki/Ciechocinek#/media/Plik:Teznie...
That's exactly where it afflicted people in europe as well, mountainous regions tend to be inlands, and from their remoteness don't have the opportunity for incidental iodine through trade, so they worsen the odds, but historically distance from the sea (and thus lack of sea products) has absolutely been the primary issue. CIDS was also endemic to the english midlands for instance.
> I’ve always wondered if the iodine in the air is part of the allure of the seaside.
No, intake from air is considered insignificant.
But, intake from air is how the soil & plants get it, over long time scales…
It’s always possible that a simple indirect selection is at play, e.g. people who simply love the sea breeze (for no particular reason) are more successful because they get enough iodine. Then, the next generation is more likely to love the sea breeze.
Iodine deficiency is ONE cause of goiter, but not the only one.
https://www.healthline.com/health/hypothryroidism/hashimotos...
Since the article from OP is relatively short on images, the following are links to more images from the german article, with captions translated into english. Warning: images contain depictions of the medical condition discussed in the article. YMMV, but i don't consider them 'gross' or NSFW.
Image 1: https://cdn.unitycms.io/images/EzdPT4pM4HAAzsQiwi_L2d.jpg Caption: Woman with goitre in Frienisberg, 1921.
Image 2: https://cdn.unitycms.io/images/5PhByWEba4W8L0W1EnHXiE.jpg Caption: Woman with cretinism, 1928. (Today the word has a derogatory connotation, but primarily describes an illness of great cruelty).
Image 3: https://cdn.unitycms.io/images/Bu0SX8WY4gK8jMZgebpyss.jpg Caption: Six women with cretinism, ca. 1920.
Image 4: https://cdn.unitycms.io/images/8qBQEgsuqq-BMdsEAPN63U.jpg Caption: Found the solution to Switzerland's original curse: Heinrich Hunziker from Adliswil ZH, drawn by Marianne Zumbrunn in 1977.
Image 5: https://cdn.unitycms.io/images/7tdlChuPq-3AIeFiSvh5U1.jpg Caption: Experiments with the snow shovel: the Valais country doctor Otto Bayard, 1937.
Image 6: https://cdn.unitycms.io/images/5JGFFaXN48BA4xOsHXf0Zu.jpg Caption: Sun-tanned outdoorsman: the Herisau general practitioner and later chief physician Hans Eggenberger, undated.
[1] https://www.tagesanzeiger.ch/wie-drei-heldenhafte-aerzte-die... or https://archive.is/rHzSV
edit: formatting, removed german caption texts
A fascinating story overall and a reminder of just one of a number of everyday sicknesses we (as a society) have been able to overcome through science and understanding, despite the occasional step backwards.
They work with politicians and industry in a very targetted way to increase the use of iodised salt in food production where it is most needed in the world. They don't directly fund any of the activities, but create the relationships, conditions and understanding for it to happen - meaning they are an extremely effective charity, creating population scale change with very modest funding.
They also do lots of work to try to map the global picture of iodine intake from the very varied data available. Some of the results might surprise you - https://ign.org/scorecard/
Changing the ratio of T3/T4 does cause a change in TSH (thyroid stimulating hormone) but that's IMHO simply a signal that the iodine is getting used, so please send us more.
There are other tissues in the body that need iodine, as evidenced by the sodium-iodine symporter present on those cells, so to set the recommended daily iodine intake based solely on what the thyroid can use is IMHO a huge mistake.
Some things with interesting iodine research: skin cancer, breast cancer, type 2 diabetes, asthma, polycystic ovaries, fibrocystic breast disease, other cancers. But yeah, it cures goiter...
Supplementation with T3 yields a rapid correction in bradycardia and hypothermia caused by hypothyroidism. We treat with T4 because it has a longer physiological halflife and thus yields more consistent serum levels; but the evidence is incredibly clear that it's T3 which is having an effect, not T4.
When I search for breast cancer and iodine, I find links that suggest iodine may help prevent that disease - and Japan’s low rate of the condition is potentially related to high consumption of iodine.
Are you saying that all those conditions are due to excess iodine?
No, the opposite. I'm suggesting they are due to low iodine intake.