Survival of the Sickest: The Surprising Connections Between Disease and Longevity. Jonathan Prince

about prescientific medicine. Now, new research indicates that – like so much else – the broad discrediting of bloodletting may have been a rush to judgment.

      First of all, it’s now absolutely clear that bloodletting – or phlebotomy, as it’s known today – is the treatment of choice for hemochromatosis patients. Regular bleeding of hemochromatosis patients reduces the iron in their systems to normal levels and prevents the iron buildup in the body’s organs that is so damaging.

      It’s not just for hemochromatosis, either – doctors and researchers are examining phlebotomy as an aid in combating heart disease, high blood pressure, and pulmonary edema. And even our complete dismissal of historic bloodletting practices is getting another look. New evidence suggests that, in moderation, bloodletting may have had a beneficial effect.

      A Canadian physiologist named Norman Kasting discovered that bleeding animals induces the release of the hormone vasopressin; this reduces their fevers and spurs their immune system into higher gear. The connection isn’t unequivocally proven in humans, but there is much correlation between bloodletting and fever reduction in the historic record. Bleeding also may have helped to fight infection by reducing the amount of iron available to feed an invader, providing an assist to the body’s natural tendency to hide iron when it recognizes an infection.

      When you think about it, the notion that humans across the globe continued to practice phlebotomy for thousands of years probably indicates that it produced some positive results. If everyone who was treated with bloodletting died, its practitioners would have been out of business pretty quickly.

      One thing is clear – an ancient medical practice that “modern” medical science dismissed out of hand is the only effective treatment for a disease that would otherwise destroy the lives of thousands of people. The lesson for medical science is a simple one – there is much more that the scientific community doesn’t understand than there is that it does understand.

      Iron is good. Iron is good. Iron is good.

      Well, now you know that, like just about every other good thing under the sun, when it comes to iron, it’s moderation, moderation, moderation. But until recently, current medical thinking didn’t recognize that. Iron was thought to be good, so the more iron the better.

      A doctor named John Murray was working with his wife in a Somali refugee camp when he noticed that many of the nomads, despite pervasive anemia and repeated exposure to a range of virulent pathogens, including malaria, tuberculosis, and brucellosis, were free of visible infection. He responded to this anomaly by deciding to treat only part of the population with iron at first. Sure enough, he treated some of the nomads for anemia by giving them iron supplements, and suddenly the infections gained the upper hand. The rate of infection in nomads receiving the extra iron skyrocketed. The Somali nomads weren’t withstanding these infections despite their anemia: they were withstanding these infections because of their anemia. It was iron locking in high gear.

      Thirty-five years ago, doctors in New Zealand routinely injected Maori babies with iron supplements. They assumed that the Maori (the indigenous people of New Zealand) had a poor diet, lacking iron, and that their babies would be anemic as a result.

      The Maori babies injected with iron were seven times as likely to suffer from potentially deadly infections, including septicemias (blood poisoning) and meningitis. Like all of us, babies have isolated strains of potentially harmful bacteria in their systems, but those strains are normally kept under control by their bodies. When the doctors gave these babies iron boosters, they were giving booster fuel to the bacteria, with tragic results.

      It’s not just iron dosing through injection that can cause this blossoming of infections; iron-supplemented food can be food for bacteria too. Many infants can have botulism spores in their intestines (the spores can be found in honey, and that’s one of the reasons parents are warned not to feed honey to babies, especially before they turn one). If the spores germinate, the results can be fatal. A study of sixty-nine cases of infant botulism in California showed one key difference between fatal and nonfatal cases of botulism in babies. Babies who were fed with iron-supplemented formula instead of breast-fed were much younger when they began to get sick and more vulnerable as a result. Of the ten who died, all had been fed with the iron-enhanced formula.

      By the way, hemochromatosis and anemia aren’t the only hereditary diseases that have gained pride of place in our gene pool by offering protection from another threat, and they’re not all related to iron. The second most common genetic disease in Europeans, after hemochromatosis, is cystic fibrosis. It’s a terrible, debilitating disease that affects different parts of the body. Most people with cystic fibrosis die young, usually from lung-related illness. Cystic fibrosis is caused by a mutation in a gene called CFTR; it takes two copies of the mutated gene to cause the disease. Somebody with only one copy of the mutated gene is known as a carrier but does not have cystic fibrosis. It’s thought that at least 2 percent of people descended from Europeans are carriers, making the mutation very common indeed from a genetic perspective. New research suggests that, sure enough, carrying a copy of the gene that causes cystic fibrosis seems to offer some protection from tuberculosis. Tuberculosis, which has also been called consumption because of the way it seems to consume its victims from the inside out, caused 20 percent of all the deaths in Europe between 1600 and 1900, making it a very deadly disease. And making anything that helped to protect people from it look pretty attractive while lounging in the gene pool.

      Aran Gordon first manifested symptoms of hemochromatosis as he began training for the Marathon des Sables – that grueling 150-mile race across the Sahara Desert. But it would take three years of progressive health problems, frustrating tests, and inaccurate conclusions before he finally learned what was wrong with him. When he did, he was told that untreated he had five years to live.

      Today, we know that Aran suffered the effects of the most common genetic disorder in people of European descent – hemochromatosis, a disorder that may very well have helped his ancestors to survive the plague.

      Today, Aran’s health has been restored through bloodletting, one of the oldest medical practices on earth.

      Today, we understand much more about the complex interrelationship of our bodies, iron, infection, and conditions like hemochromatosis and anemia.

      What doesn’t kill us, makes us stronger.

      Which is probably some version of what Aran Gordon was thinking when he finished the Marathon des Sables for the second time in April 2006 – just a few months after he was supposed to have died.

       Chapter Two A SPOONFUL OF SUGAR HELPS THE TEMPERATURE GO DOWN

      The World Health Organization estimates that 171 million people have diabetes – and that number is expected to double by 2030. You almost certainly know people with diabetes – and you certainly have heard of people with diabetes. Halle Berry, Mikhail Gorbachev, and George Lucas all have diabetes. It’s one of the most common chronic diseases in the world, and it’s getting more common every day.

      Diabetes is all about the body’s relationship to sugar, specifically the blood sugar known as glucose. Glucose is produced when the body breaks down carbohydrates in the food we eat. It’s essential to survival – it provides fuel for the brain; it’s required to manufacture proteins; it’s what we use to make energy when we need it. With the help of insulin, a hormone made by the pancreas, glucose is stored in your liver, muscles, and fat cells (think of them as your own internal OPEC) waiting to be converted to fuel as necessary.

      The full name of the disease is actually diabetes mellitus – which literally means “passing through honey sweet.” One of the first outward manifestations of diabetes is the need to pass large amounts of sugary urine. And for thousands of years, observers have noticed that diabetics’ urine smells (and tastes) particularly sweet. In the past Chinese physicians actually diagnosed and monitored diabetes by looking to see whether ants were attracted to someone’s urine. In diabetics, the process through which insulin helps the body use glucose is broken, and