Each day, 50,000 people die directly or indirectly from undernutrition.
Most of the suffering is borne by children, and survivors are often
brain-damaged. Yet the world currently produces more than enough food.
Right now, all hunger is political. The problems are complex; my
prescription, like Virchow's, is democracy.]
Marasmus ("wasting"): Total-calorie malnutrition. Wasting, ravenous
Kwashiorkor (African term): Protein malnutrition, as when the child is
displaced at the breast by a younger sibling. Hypoalbuminemia, fatty
liver, edema, sluggish mind, depigmentation ("flag sign" in the hair),
pellagra-like paint-chip rash.
Vitamin deficiencies: Hard to find nowadays in their pure forms, except
vitamin A deficiency. Usually seen as features of mixed malnutrition.
Folic acid is relatively deficient in the U.S. "twinkies and diet
pepsi" diet; iron less so. I am not aware of any good study confirming
the popular claim of "widespread subclinical vitamin deficiencies".
Fat-soluble vitamins (A, D, E, K) may get depleted in those with fat
malabsorption (steatorrhea, or any generalized malabsorption).
Vitamin A deficiency: Major world health problem. Metaplasia of
columnar epithelium into stratified squamous epithelium; over-
keratinization of existing stratified squamous epithelium
(xerophthalmia, Bitot's spots, acne). Bad respiratory infections (no
cilia), measles is likely to be fatal. Loss of visual pigments (rods
first, night-blindness). Several million people are blinded yearly
from vitamin A deficiency; the problem is worst in General Khadaffi's
Vitamin A excess: Vitamin faddists, polar-bear liver eaters; you can't
do it with carrots) get increased intracranial pressure ("pseudotumor
cerebri") with headache and nausea-vomiting, a special kind of fatty
liver (vitamin A clogging the "Ito cells"), and desquamation of the
skin (as seen in those taking Accutane, but worse). Remember
retinoids, but not carotenoids, are teratogens.
Vitamin D deficiency: Rare in the developed nations unless you "tea-
and-toast" for all your meals. "Rickets" in kids, "osteomalacia" in
adults; problem is failure of the bone to mineralize. "Rickets"
features Harrison's groove, the "rachitic rosary", bow-legs,
"craniotabes", "frontal bossing", "pigeon breast", "square head",
pelvic deformities (die in childbirth).
Vitamin D excess: Vitamin faddists get hypercalcemia and kidney stones.
Vitamin E deficiency: Malabsorption or total-parental-nutrition.
Ceroid in the gut, damaged sensory pathways in the cord. Animals get
hyposexuality and infertility. Vitamin E therapy helps preemies with
their eye problems and hemolytic anemia.
Vitamin K deficiency: Vitamin K is the cofactor required to add a
gamma-carboxyl group to clotting factors II, VII, IX, X, S, Z, and C.
Required for clotting; your gut bacteria may or may not give you enough
vitamin K. Deficiencies, usually in preemies, are preventable with an
injection of vitamin K; you may want to inject your cirrhotic patients
Vitamin B1 deficiency (thiamine): Polished rice eaters (historical),
alcoholics, women with hyperemesis of pregnancy. Beriberi may be dry
(neuropathy) or wet (congestive heart failure; heart is flabby, yet
vessels are dilated for "high-output failure"). Wernicke's (ataxia,
eye movement problems, damaged mammillary bodies; why you give
drunkards a shot of thiamine before starting the glucose) and
Korsakoff's (can't tell real from imagined memories, damaged
dorsomedian nucleus of thalamus).
Vitamin B2 deficiency (riboflavin): FAD precursor. I doubt its
existence as a distinct disease; the books describe "cheilitis"
(cracked angles of mouth), seborrheic-type dermatitis on the nose,
cheeks, and hands ("glove dermatitis"), and purple tongue.
Vitamin B3 deficiency (niacin, nicotinic acid): NAD precursor.
Deficiency is pellagra, with dermatitis (paint-flakes, especially on
the shins and wherever the sun shines), dementia (schizophrenia-like),
diarrhea, and death (the "D"'s). Maize-eaters (lack of tryptophan, a
niacin precursor, and something that binds niacin).
Vitamin B6 deficiency (pyridoxine): Amino group shuttle. Best way to
get "deficient" is to poison your pathways with isoniazid. Neuropathy.
Folic acid deficiency (Vitamin P): In vegetables. Methyl-group
shuttle. Deficient in many alcoholics, pregnant women, folks with
malabsorption (especially disease of the terminal ileum), bacterial
overgrowth of the gut (including "tropical sprue", vicious cycle) folks
taking phenytoin "Dilantin". Macrocytic anemia, mental changes, neural
tube defects in babies.
Vitamin B12 deficiency (cobalamin, cyanocobalamin): In all foods of
animal origin. Deficiencies in the strictest vegetarians, those with
fish tapeworm, those with resected ileum or Crohn's disease here, or
antibodies again / lack of intrinsic factor ("pernicious anemia").
Macrocytic anemia, demyelinized posterior columns ("subacute combined
degeneration of the cord"), later brain dysfunction.
Biotin deficiency: Remember that "avidin" in raw eggs is very effective
at blocking absorption of biotin ("Rocky Balboa" take note).
Vitamin C deficiency (ascorbic acid): Redox cofactor, required for
making and maintaining collagen and for other stuff. Deficiency is
"scurvy". In kids, osteoid is deficient, mimicking rickets.
Regardless of age, capillaries weaken, with bleeds and general misery
(the worst is bleeds under the periosteum), old wounds reopen, bleeding
Vitamin C megadosing: Surprisingly safe; uremics die of oxalic acid
poisoning, normals get increased iron absorption and false-negative
blood and glucose tests in urine. The Linus Pauling story, if you care
to learn it, is sad.
Iron deficiency: From diet ("twinkies and diet pepsi", milk-only),
disease of duodenum (where it's absorbed), kooky diets
("macrobiotics"), rapidly-growing youngsters, heavy blood loss (heavy
periods, GI bleeders notably those with ulcers, cancer, or hookworm;
hematuria, overzealous blood donors), starch-eaters. Rampant in our
world. Anemia (hypochromic, microcytic) appears late. The story about
"esophageal webs" just isn't true -- these are problem-drinkers with
scars from ripping their esophagus during the dry-heaves. Serum
ferritin tells your iron stores ("zero" in symptomatic deficiency);
other techniques include looking at zinc protoporphyrin (porphyrin
molecules building up waiting in line for iron) and transferring
Zinc deficiency: Malabsorption, breast-milk-only, etc. "Acrodermatitis
enteropathica" and loss of senses of smell and taste.
Copper deficiency: Preemies, starvation. Copper oxidizes iron, cross-
links lysine side-chains, oxidizes melanin.
Selenium deficiency: "Keshan disease", a deadly heart-failure syndrome
in Red China (a bureaucrat forget to add selenium to the fertilizer).
You need selenium for glutathione reduction.
Iodine deficiency: A world scandal. Hypothyroidism, goiter (extra
TSH), several million kids permanently brain-damaged each year.
Manganese poisoning: Simulates Parkinsonism.
Fat: In the U.S., even the beggars ("Will work for food") are often
fat. Those who are genuinely hungry are mostly the children of
substance abusers. Yet our women, on the average, are leaner and far
more physically fit than women, on the average, in many of the poor
nations. Your bodyfat is calories-in (food, alcohol) vs. calories-out
(malabsorption, work of living, work of carrying-your-body-weight,
exercise, heat given off from your skin, vomiting, tumor burden,
uncoupled mitochondria). Hunger ("I'm hungry") vs. appetite ("Mmmm,
that looks good!"). Appetite uppers: Hypothalamus (brain injury,
Froehlich's, peptides), anabolic steroids, marijuana. The Ob gene
product (discovered 1995), leptin, suppresses appetite in the presence
of adequate or excess bodyfat. [The "ideal weight charts" are
subscience at it stupidest (the whole track team is "underweight", the
steroid-free weightlifters are "obese"); your best weight is what looks
and feels right for you, and which enables you to be athletic. Despite
all the sub-scientific chatter, I am not aware of any reason to believe
that a man needs any measurable bodyfat; women do best with a few
pounds, helps with the estrogen. "Measuring bodyfat" by dipping you in
water is also bunk (a bit of gas in your intestines will....)]
Obesity: Causes problems, but how serious? Think: (1) un-aesthetic,
(2) bad back; (3) sore knees; (4) sore hips; (5) exacerbates
hypertension maybe; (6) exacerbates type II diabetes somehow; (7) helps
form gallstones somehow; (8) makes surgeon's job harder; (9) airway
problems during sleep; (10) uterus cancer by making extra estrogens;
(11) slight fatty change in the liver but nothing serious; (12) slight
elevation of uric acid; (13) hard to keep your skinfold area clean
(crotchrot, etc.), (14) varicose veins.... Beyond this, it's probably
not an independent risk factor for anything. Are you thinking what I'm
thinking, i.e., that obesity is over-rated as a health problem? Fun to
know: fat cells divide if you're overfed before age 1; they only
Malnutrition in America: malabsorption, don't feel like eating, child
abuse. Alcoholics: folate and thiamine deficiency, protein-calorie
malnutrition, later scurvy.