A RESPONSE TO THE QUESTIONS
ABOUT IODINE DEFICIENCY IN THE
EXTINCTION OF NEANDERTALS,
WITH A NOTE ON MY PART IN SPECULATION
ON A CURRENT MODEL UNDER
OBSERVATION IN MINDANAO:
THE COMPETTION OF IMMIGRANT
VISAYAN IN EXTINGUISHING
TBOLI CULTURAL CLAIMS AND
DISPLACING THEM
FURTHER Into THE MOUNTAINS
AS REFUGEES
AND UNSUCCESSFUL HYPOTHYROID
COMPETITORS
From: Glenn Geelhoed
To: "anthuvic@uvvm.uvic.ca".IA4GW.Harper; "dobson@ku.edu".IA4GW.Harper; "jstanbur@warren.med.harvard.edu".IA4GW.Harper; "jtd@avery.med.virginia.edu".IA4GW.Harper; "jtd@virginia.edu".IA4GW.Harper
Date: 4/10/02 6:16PM
Subject: Re: Indicators of Thyroid Function
I had enjoyed my "linear reading" of the "vertically integrated" text as though through an instrument I once used for speed reading called a "tachistoscope." I had prepared a reply to Jerome's thoughtful conversation, and had held it until I saw the much briefer and pithier statement from john Dunn saying the same thing I had prepared but more elegantly.
First, I would say that I know a lot more about adenosine than about "adrenosin"‑‑but, that is easy, since I have never heard of the latter, and persist in thinking this is a "typo."
Second, iodine is distributed widely through the body‑‑as are almost all halides (if you think of the distribution of chloride, for example)‑‑but only in a few organs is iodine selectively concentrated. Some of those concentration areas are those that have "Halide Pumps" for specific purposes, and iodine gets pulled in as a competitive "false chloride" halide‑‑example, the oxyntic cell mass of the parietal stomach mucosa, where "hydriodic acid" is pumped into the lumen against an enormous concentration gradient, pushed along with the (dare I say "purposeful") concentration of hydrochloric acid‑‑a digestive chemical as proven so elegantly by the long‑term studies of the first really significant physiologic experiments performed in the New World by William Beaumont on Alexis St. Martin's gastric fistula obtained by a musket discharge on Mackinac Island, Michigan.
As clinicians dosing people with radio iodine, we actually DO worry about the random distribution of iodine in the "chloride compartments" of the intra and extracellular body water, before the radiolabel is taken up on second passes through the avid uptake and concentration of the TSH‑primed "hungry thyroid." The way that concern is handled in radio iodine therapy is to first give the patient a dose of "cold" Lugol's Iodine (SSKI —‑saturated solution of potassium iodide) to "load" the gastric mucosa, the choroid plexus and the meningeal CSF pumps, before the hot iodine is given, so that the radio iodine is essentially given directly into this "second pass" redistribution system in which the thyroid compartmentalization of the radiotag is some 128: 1 over that picked up and retained in adjacent lymph nodes‑‑unless metastatic functioning thyrocytes are present in those nodes‑‑the "marker function " of radio iodine scans for metastatic thyroid cancer.
If iodine is scarce, I agree, that there would be little trace of it in the bones or other durable tissues of. say fossil Neandertal‑‑which is the purpose of looking for IDD in them. I use the term IDD rather than "evidence of cretinism", since I agree with John that cretinism is a neurologic (in one syndrome) or myxedematous (in another clinical manifestation) defect from iodine deficiency in utero at critical periods of brain development.
[ This was the subject of the Franklin Institute Philadelphia conference in which a number of those you addressed in your email participated, I among them. Of further interest, a guest speaker is coming here this week, named Basil Hetzel, MD Chairman Emeritus of the ICCIDD, from Adelaide Australia to speak on "ID and Fetal Brain Damage‑‑Report on a Global Prevention Program" at Children's Hospital. I am dispatching my senior medical student Elizabeth Yellen, who has accompanied me to Ladakh and Malawi on which she presented her experiences today at GWUMC, since I will be in Boston on April 16 at noon, having just run the 106th Boston marathon, and will miss this lecture.)
So, cretinism would leave no neurologic fossil, but has a number of other stigmata, some of those durable, those of neurologic cretinism being from IDD in an earlier uterine non‑development than the myxedematous form, with both of them likely to come up to background population iodine rates in life and in skeletal remains.
I had a recent "post‑epiphany" if I may use this term following the earlier epiphanies I had exchanged when JED read GWG and vice versa. I have recently returned from two severe iodine deficient goiter and cretinism endemias‑‑‑the mountains of Southern Mindanao in the Philippines and the Western border of Malawi adjacent to Zambia. I operated on scores of goiters and saw several cretins in our medical mission. I had forwarded to you the text of this experience and a few of very many pictures in a complete photojournalism account of each of these medical missions. Besides clinical data, photographic documentation and a wealth of other measurements, can any of you suggest some use to the large quantities of tissues I remove from large goiters that are otherwise simply buried?
(I will be doing the same next week, as I leave after the Boston Marathon, coming to the UVA Charlottsville to give the Medical Ethics Symposium there in discussing the humanitarian consequences ‑‑and perhaps, dysbenefits, of treating hypothyroidism in remote impoverished populations. I leave the following day for Dharamsala to treat the refugees of Tibet in His Holiness, the XIVth Dali Lama's monasteries for two weeks, and then go on to Kathmandu and Lukla Nepal, again, to run clinics for two weeks along the Everest Trek Route. I will be looking out for the IDD in each venue, as I have been in the last two missions mentioned above, and will be repeating later Himalayan excursions five more times this year and eight next year..)
While in Mindanao, I heard the repeated complaints from the advocates of the local Tboli people, who had always been in these foothills of the volcanic mountains: that they were being pushed further into the mountains by an invasion of much more clever Visayan immigrants. The Philippine government had rewarded the Visayan populations of peoples nearer the capital, much more savvy, ambitious, and aggressive coastal peoples, who had been active in WWII service against the invading Japanese (seafood‑eating coastal island peoples), by giving them the "empty lands" of Southern Mindanao‑‑"12 hectares and a carabao" for homesteading‑‑right on top of the isolated, roadless, gentle, agrarian mountain‑dwelling Tboli people. Within very short order, the Visayan had so outcompeted the slower "less developed" Tboli people that they had bargained with them for petroleum‑based imported fertilizer at a cost higher than the crop yields could support, holding their land titles as collateral. Now the Visayan have nearly completely bought up the defaulting Tboli lands, pushing these Tboli still higher into the mountain jungles. (See the attachment referring to this social dislocation and economic extinction.)
It is from these mountain peoples that I am getting the majority of the huge goiters you may have seen in the forwarded photo access (and for which there is abundant further documentation available in the several medical missions in which I have operated there.)
What have I been doing in this new millennium, but witnessing a replay of the invasion of the coastal Cro‑Magnon into the mountain refuges of the Neandertal, outcompeting them in every way toward near extinction of the Tboli as a culture, and as a non‑competitive economic unit and, eventually, as an extant people?
Think about it! I have another theatre as a laboratory for the culture clash with a metabolically predetermined outcome based in differential iodine utilization!
GWG
An addendum note as "an anthropologist en passant" from observations recorded in Feb‑A‑9 in Tboli‑land, Mindanoa
Last time I was fascinated by the "necklace veil" that I had seen many of the women wear, which I had considered an ideal piece of body ornamentation or jewelry here, since it was a "goiter veil." They made most of the beads by collecting colored glass from old bottle or plastic jugs and making the beads by recycling the waste products of a more affluent world. The use of these cast offs made it possible to wear as jewelry other people's trash. The name of the "necklace veil" as I call it is "Hanumbu" in Tboli, and is a high art from, which is appreciated even by the young women who do not have goiters, but is ideal for those with large and unsightly swellings in the neck.
As for the other names in the area, the name "Tboli" itself means "mountain people", or Montanyards. They were less confined to the mountains than they had been to the whole area of South Cotabato. But when the resettlement of the Visayans from their crowded areas after the war, when the government gave the returning war veterans a "carabao" (the Lusophone name of the water buffalo) and several hectares of land that they considered "unclaimed" in the underpopulated areas of southern Mindanao, the central government was displacing the less aggressive Tboli who had inefficiently farmed those lands that the government gave away a second time, and the Tboli were forced further up the mountain. This did two things as far as my interest in them as a hypothyroid endemia at risk for goiter and cretinism (as opposed to my other anthropologic interests in their hunter/gatherer culture and art forms)‑they moved into mountain slope marginal lands and cassava country, and further away from the readily available sources of seafood‑the largest product of the port of the also newly expanded city of General Santos City. Hence, the areas of the highest goiter incidence, are among the Tboli peoples displaced into the more remote mountain diasporas. I had wanted to go on trek up there into the mountains, and last time that request was made known to them and the outreach fellow who walks through these remote villages "drumming up" patients for me had mapped out the trek I would have taken this time‑but for the security risk. I would be there this trip, climbing up and around Mount Apo, the highest peak in the Philippines, or at least Mount Mitchell (where a US pilot had crashed so the mountain bears his name) or the peak up around the state of Bukidnon (="mountainous region")‑each high mountain places where I might trek and see, besides the Tboli mountain men, the Tasaday people living in the clefts of the tree roots (="Tsaday" = "the clefts in the roots,") and, hope against hope, I might even be able to spot the "monkey eating eagle the Philippine Eagle," emblem of the nation.
The other term from which the term Tboli may be derived is "Tagabili" = "the people who buy from merchants." This means that the mountain people have to come down to the roads every once in a while to get items for which they are not self‑sufficient. These included much the same trade goods as I had seen among my jungle‑dwelling Zairian hunter/gatherers‑‑‑salt and soap. Later the outside world items they had need for were batteries, tee shirts and flip‑flops, and kerosene fuel and marches. Then they had graduated to needing chemical fertilizers and bicycle parts.
But, these careful plans for a naturalist's/anthropologist's dream field trip in participant/observation will have to be modified for the presence of Abu Sayyaf‑‑‑the "Sword of Allah." I cannot carry the whole security regiment on a mountain trekking camp out, any more than I could run with them here. So, this is another item for "next time."
>>> "John T. Dunn" <jtd@virginia.edu> 04/10/02 02:56AM >>>
REPLY FROM JOHN DUNN: Thanks for your note. The heart, along with many
other organs, is sensitive to thyroid hormones, and many subjects have
symptoms, mostly from too much thyroid hormone, but occasionally from too
little. The effects are from thyroid hormone receptors in the heart
muscle. ATP is closely involved with many biochemical reactions throughout
the body, prominently in muscle (like heart). I know of no direct relation
to cretinism. Remember that many cretins who survive are close to
euthyroid when seen as adults, and the cretinism is the result of
hypothyroidism (from iodine deficiency) at a critical period in fetal
development, from their past. Regards, John
At 09:39 AM 4/1/02 ‑0600, Jerome E. Dobson wrote:
>Greetings. I'm now at the University of Kansas and still pursuing my
>research on Neandertal thyroids.
>
>As we discussed some time ago, it would be wonderful to have an objective
>indicator of thyroid function that could be measured in ancient
>bones. Now, an intriguing possibility has been raised by a perceptive
>grad student at Murray State University. Read the exchange below if you'd
>like more background.
>
>I turn to the four of you with two questions:
>
>1. Is excessive adrenosine production characteristic of cretinism?
>
>2. Are any other conditions known to cause excessive adrenosine production?
>
>Jerry
>
>
>>To: D Slemmer <dslemmer@apex.net>
>>From: "Jerome E. Dobson" <dobson@ku.edu>
>>Subject: Re: Pre‑Neanderthal certinism?
>>
>>At 07:56 AM 3/30/2002 ‑0600, you wrote:
>>>Me again,
>>> Just a quick P.S. When my thyroid medication gets out of
>>> adjustment, my heart starts to skip. After generations of thyroid
>>> malfunction, could the body have made something to aid or protect the
>>> heart function? Dottie
>>
>>Now, that's an intriguing possibility.
>>
>>Many people have suggested that we need to check for iodine in the
>>bones. That won't work because iodine doesn't collect there. The
>>thyroid is so powerful in capturing iodine that no other organ gets a
>>respectable share. How do we know this for certain? Because physicians
>>routinely treat thyroid cancer with radioactive iodine without risking a
>>buildup of radioactivity in the bones or any other part of the body.
>>
>>Now, you raise the possibility of a secondary residue that would be
>>detectable. The next step, of course is to find out whether excessive
>>adrenosine production is a characteristic of cretinism (and to do so
>>without bias).
>>
>>I know three people who may have the answer: John Dunn, Glenn Geelhoed,
>>John Stanbury, and Susan Crockford I'll send them a note.
>>
>>Jerry
>>
>>>"Jerome E. Dobson" wrote:
>>>> Dottie,
>>>>
>>>>I hadn't heard the statement, but I'm struck by the term as you
>>>>are. The word itself suggests a possible connection to the thryoid,
>>>>but it could be any adrenal gland. It appears to be part of the
>>>>process that stimulates adrenaline production in times of strenuous activity.
>>>>
>>>>I found: "The enzyme adenosine kinase (AK), which is a key enzyme in
>>>>the metabolism of adrenosine, a potent cadioprotective and
>>>>neuromodulating agent. (And yes, that's not a typo, the two words are
>>>>identical except for an "r.") Most references say "adrenosine
>>>>triphosphate," but there's also "adrenosine diphosphate.'"
>>>>
>>>>Elsewhere, I found: "Adenosine kinase (AK), the most abundant
>>>>nucleoside kinase in mammals, catalyzes the phosphorylation of
>>>>ribofurnosyl‑containing nucleoside analogues at the 5'‑hydroxyl using
>>>>ATP or GTP as the phosphate donor. We determined the structure of human
>>>>adenosine kinase by X‑ray crystallography using MAD phasing techniques
>>>>and refined the structure to 1.5 Ĺ resolution. The overall structure is
>>>>similar to the recently reported structure of ribokinase from
>>>>Escherichia coli (Sigrell et al. (1998) Structure 6, 183‑193)."
>>>>
>>>>Every reference seems to connect it with phosphates, rather than
>>>>iodine. I suspect the term "cadioprotective" does not imply "io" as in
>>>>iodine, but really is a misspelling of "cardioprotective" referring to
>>>>the heart.
>>>>
>>>>In short, adrenosine residues sound intriguing, but there's no obvious
>>>>connection to thyroid function, vis a vis iodine, thyroxine, or
>>>>tri‑iodothyronine.
>>>>
>>>>Jerry
>>>>
>>>>
>>>>
>>>>At 02:28 PM 3/29/2002 ‑0600, you wrote:
>>>>>Dear Dr. Dobson,
>>>>> Me again. I was just re‑reading an article from Nature Genetics
>>>>> (2000) in which Matthias Krings, et al, of Max Plank Institute
>>>>> describe the differences that his team found in the mtDNA of modern
>>>>> humans and the 17 Neanderthal mtDNA samples that were used. One thing
>>>>> struck me: "...the Neanderthal sequences differed from a universal
>>>>> sampling of 663 modern humans by 34.9 +/‑ 2.4 substitutions and by
>>>>> the insertion of an adenosine residue shared by the Neanderthals." I
>>>>> don't know what adenosine residue is, but could it by any chance be
>>>>> indicitive of someone who was cretinous?
>>>>> Dottie
>>>>>
>>>>>"Jerome E. Dobson" wrote:
>>>>>> Dottie,
>>>>>>
>>>>>>Answers below.
>>>>>>
>>>>>>Keep it up.
>>>>>>
>>>>>>Jerry
>>>>>>
>>>>>>At 10:13 AM 3/27/2002 ‑0600, you wrote:
>>>>>>>Dear Dr. Dobson,
>>>>>>> I have read your article on the web and was able to get your
>>>>>>> Geographical Review article from the library. Thank you for telling
>>>>>>> me about them. I am using your information as the conclusive part
>>>>>>> of my paper ‑‑ that will leave the question of cretinism in
>>>>>>> Neanderthals last in the reader's mind.
>>>>>>> But, as I was developing my paper more and more questions came
>>>>>>> to mind. I would like to ask if you have looked into the thyroid
>>>>>>> function in other primates. Do you know if chimps and apes have
>>>>>>> similarly functioning thyroids?
>>>>>>
>>>>>>Any animal will develop it's own form of cretinism if it's thyroid is
>>>>>>removed. I've seen photographs of studies with dogs for
>>>>>>example. However, I do not know of any instance in which chimps, for
>>>>>>instance, become cretinous purely due to dietary deficiency. In
>>>>>>other words, they get from their environment enough iodine to be
>>>>>>whatever is typical of their species. I suspect that's because their
>>>>>>bodies don't demand nearly as much iodine as ours and their thyroids
>>>>>>and diets are adequate to the task. What we don't know, of course,
>>>>>>is what might occur if they regularly consumed substantially more
>>>>>>iodine or, even more interesting, were regularly injected with
>>>>>>thyroid hormones. Would their thyroids capture more iodine as ours
>>>>>>do? Would their bodies assimilate the thyroxine and tri‑iodothyronine
>>>>>>as ours do? Would they develop a larger, thinner skull, for example?
>>>>>>
>>>>>>>
>>>>>>> My line of thinking, of course, is how far back could this
>>>>>>> problem have existed? When you look at the skulls of Homo erectus
>>>>>>> the similarities to that of the Neanderthal are striking ‑‑ the
>>>>>>> recessive chin, large jaw, heavy browridge, and a suggestion of an
>>>>>>> occipital bun. By looking at this ancestor, it is easy to see that
>>>>>>> the Neanderthal could have evolved from him. But, was his family
>>>>>>> also affected by cretinism? Or, did that not become a factor until
>>>>>>> they moved into Western Europe and the near East?
>>>>>>
>>>>>>My suspicion is that Neandertal, Homo erectus, and earlier ancestors
>>>>>>possessed a weak thyroid that perpetually kept them in natural state
>>>>>>employing less iodine, producing less thyroid hormone, and resulting
>>>>>>in a more robust skeleton and musculature. As with the chimps, we
>>>>>>can't say how they might have reacted to more iodine, say in a
>>>>>>coastal environment, or more thyroid hormone in a purposeful experiment.
>>>>>>
>>>>>>Then, on a coast somewhere with abundant iodine and DHA, one branch
>>>>>>of hominid evolved a better thyroid and thrived. They became modern
>>>>>>humans and easily won out over all less evolved species including
>>>>>>Homo erectus and Nenadertal.
>>>>>>
>>>>>>>
>>>>>>> Is Africa generally richer in iodine than Europe? It would be
>>>>>>> interesting to be able to see some of the skeletal remains of Homo
>>>>>>> erectus from Central Africa where they had no access to seafood. Do
>>>>>>> you know what kind of cretinism is presently shown on Africa?
>>>>>>
>>>>>>
>>>>>>The best global description of how cretinism varies geographically is:
>>>>>>
>>>>>>
>>>>>>Pharoah, P., F. Delange, R. Fierro‑Benitez, J. B.
>>>>>>Stanbury. 1980. Endemic Cretinism. In Endemic Goiter and Endemic
>>>>>>Cretinism, Iodine Nutrition in Health and Disease, edited by J. B.
>>>>>>Stanbury and B. S. Hetzel, 395‑421. New York, NY: John Wiley & Sons, Inc.
>>>>>>
>>>>>>Geelhoed is the expert on modern cretinism in Africa.
>>>>>>
>>>>>>
>>>>>>GEELHOED, GLENN W. 1999. “Metabolic maladaptation: individual and
>>>>>>social consequences of medical intervention in correcting endemic
>>>>>>hypothyroidsm.” Nutrition 15(11/12):908‑932.
>>>>>>
>>>>>>>
>>>>>>> Knowing how adaptive evolution changes plants so that they can
>>>>>>> survive in adverse environments, I can not help but wonder where
>>>>>>> and why similar adaptive evolution did not take place in humans to
>>>>>>> correct the iodine deficiency problem, especially if it has truly
>>>>>>> been plaguing us for tens of thousands of years!
>>>>>>
>>>>>>Geelhoed asked the same question and proposed a fascinating
>>>>>>hypothesis that cretinism is actually a coping mechanism to help
>>>>>>preserve the gene pool during times of resource scarcity. It's as if
>>>>>>a portion of the population is put on ice. Birthrates drop and
>>>>>>individual consumption drops. When iodine and food are increased,
>>>>>>those same individuals resume former levels of reproduction and
>>>>>>resource consumption.
>>>>>>
>>>>>>> If you have time, I would enjoy hearing you thoughts on these
>>>>>>> ponderings of mine.
>>>>>>> Thanks, not only for the information for my paper, but also for
>>>>>>> the work you are doing. I believe it will be of great benifit to
>>>>>>> people the world over.
>>>>>>>
>>>>>>>Sincerely, Dottie Slemmer
>>>>>>
>>>>>>
>>>>>>Jerome E. Dobson, Research Professor, University of Kansas
>>>>>>
>>>>>>President, American Geographical Society (http://www.amergeog.org),
>>>>>>
>>>>>>Kansas Applied Remote Sensing Program Department of Geography
>>>>>>Kansas Biological Survey University of Kansas
>>>>>>University of Kansas 1475 Jayhawk Boulevard
>>>>>>Irving Hill Road 214 Lindley Hall
>>>>>>251 Nichols Hall Lawrence, KS 66045‑7613
>>>>>>Lawrence, KS 66045
>>>>>>
>>>>>>Telephone: (785) 864‑7700 (785) 864‑5536 [same
>>>>>>Voicemail]
>>>>>>Fax: (785) 864‑0392 (785) 864‑5378
>>>>>>
>>>>>>America's oldest geographical association needs you. Go to
>>>>>>http://www.amergeog.org/membership.htm and click "Become an AGS Fellow."
>>>>>
>>>>>Jerome E. Dobson, Research Professor, University of Kansas
>>>>>
>>>>>President, American Geographical Society (http://www.amergeog.org),
>>>>>
>>>>>Kansas Applied Remote Sensing Program Department of Geography
>>>>>Kansas Biological Survey University of Kansas
>>>>>University of Kansas 1475 Jayhawk Boulevard
>>>>>Irving Hill Road 214 Lindley Hall
>>>>>251 Nichols Hall Lawrence, KS 66045‑7613
>>>>>Lawrence, KS 66045
>>>>>
>>>>>Telephone: (785) 864‑7700 (785) 864‑5536 [same
>>>>>Voicemail]
>>>>>Fax: (785) 864‑0392 (785) 864‑5378
>>>>>
>>>>>America's oldest geographical association needs you. Go to
>>>>>http://www.amergeog.org/membership.htm and click "Become an AGS Fellow."
>>>>
>>>>Jerome E. Dobson, Research Professor, University of Kansas
>>>>
>>>>President, American Geographical Society (http://www.amergeog.org),
>>>>
>>>>Kansas Applied Remote Sensing Program Department of Geography
>>>>Kansas Biological Survey University of Kansas
>>>>University of Kansas 1475 Jayhawk Boulevard
>>>>Irving Hill Road 214 Lindley Hall
>>>>251 Nichols Hall Lawrence, KS 66045‑7613
>>>>Lawrence, KS 66045
>>>>
>>>>Telephone: (785) 864‑7700 (785) 864‑5536 [same
>>>>Voicemail]
>>>>Fax: (785) 864‑0392 (785) 864‑5378
>>>>
>>>>America's oldest geographical association needs you. Go to
>>>>http://www.amergeog.org/membership.htm and click "Become an AGS Fellow."
>>>
>>>Jerome E. Dobson, Research Professor, University of Kansas
>>>
>>>President, American Geographical Society (http://www.amergeog.org),
>>>
>>>Kansas Applied Remote Sensing Program Department of Geography
>>>Kansas Biological Survey University of Kansas
>>>University of Kansas 1475 Jayhawk Boulevard
>>>Irving Hill Road 214 Lindley Hall
>>>251 Nichols Hall Lawrence, KS 66045‑7613
>>>Lawrence, KS 66045
>>>
>>>Telephone: (785) 864‑7700 (785) 864‑5536 [same
>>>Voicemail]
>>>Fax: (785) 864‑0392 (785) 864‑5378
>>>
>>>America's oldest geographical association needs you. Go to
>>>http://www.amergeog.org/membership.htm and click "Become an AGS Fellow."
CC: "dslemmer@apex.net".IA4GW.Harper; Jerome Dobson