A Boy Ate Only Potato Chips & French Fries
for 10 Years. This Is What Happened To His Eyes. DA is a 17 year old boy, presenting to the
emergency room with a progressive deterioration in hearing, sight, and vitality. He tells the admitting nurse that his field
of vision had been slowly going dark over the last several months and a ringing in his
ears had been washing out his hearing for some time. You see, DA was an average teenager. He didn’t take any medicines or have any
past history of disease. At his age, he didn’t have any records of
recurring behavior. A few years earlier, a 14 year old DA came
in for his regular checkup. He reported good health, but some chronic
tiredness and told the doctor that he preferred eating only french fries, potato chips, and
white bread because he enjoyed their texture. A blood test at this visit noted that DA had
macrocytic anemia. An meaning without and emia meaning presence
of blood. His blood cells were larger than normal, and,
he didn’t have a lot of them floating around in his body. Less blood cells means less oxygen getting
to the brain, which could explain his chronic tiredness. This was accompanied by a marked vitamin B12
deficiency, unifying all his problems. Low vitamin b12 causes anemia. Potato chips, French fries, and white bread
are completely devoid of vitamin b12. The body doesn’t make b12 on it’s own,
but that’s ok because basic foods like eggs, beef, yogurt, and fortified cereals have it,
so it’s almost impossible to miss. But his levels are low, so DA was given vitamin
injections to boost his levels. The doctor gave him dietary advice to add
more variety in his foods, and 14 year old DA was sent home with no problems. Several months after that first visit, DA
was examined by a different doctor. He complained that there were spots hanging
out in front of his eyes. An MRI of his brain found no abnormalities
and a slit lamp exam returned normal. Nothing seemed to be the problem, and there
were no signs of immediate life threatening injury, so come back if you have more problems,
they told him. Over the next several months, DA noticed something
wrong when his field of vision started going dark. Maybe looking at screens for too long, he
thought. One day, he turned his headphones to the maximum
volume and could barely hear anything. Probably watched too many of those loud meme
videos, he thought. Skin-deep, DA appeared to be healthy. But, a neuro-ophthalmology examination finds
bilateral central visual field defects, confirming blind spots in his field of view. Nerve fiber loss was detected in both eyes. But his motor and cognitive functions were
normal. All of this pointing to some potential neurodegeneration
localized to his optic nerves. There was definitely something happening to
him. As the days go by, DA is acutely aware of
the deteriorating sight in both his eyes. Normal vision is typically 20/20, meaning
that you can see something that’s 20 feet away. But DA’s vision is 20/200, meaning for an
object that’s 200 feet away, he needs to be 20 feet from it to see it. That is the E on the chart, and by definition,
20/200 is legally blind in the United States. A repeat slit lamp examination finds no abnormalities
in optic nerve appearance. No visible damage can be seen. Typically, an injury to the brain may cause
visual field defects, but a second MRI confirmed no lesions present. These need to be ruled out immediately because
they could signal an immediate life threatening emergency. A test was administered for Leber hereditary
optic neuropathy. Neuro referring to the nerves. opathy- meaning a disorder and optic referring
to the eye. A disorder of the nerves of the eyes. This genetic disease is characterized by painless,
vision loss in both eyes, that disproportionately affects young males. It’s not common. It’s almost a perfect fit. But the test returned negative. Analysis of DA’s blood reveals the same
macrocytic anemia found at his original checkup from 3 years ago, but this time, something’s
wrong. Malnutrition is well documented to cause optic
neuropathy, but subsequent testing of his liver, thyroid, and vitamin b12 levels return
normal. DA’s history of B12 injections from 3 years
ago had lapsed meaning he hadn’t received them for quite some time now. If it’s possible that a lack of this vitamin
could be causing DA’s vision loss, but his b12 levels are normal, and he still has that
anemia from his initial visit, then what could be going on? Well, there’s some biochemistry to be known
here. Vitamin B12 is a coenzyme, meaning it’s
a chemical needed by an enzyme to function. An enzyme, is a protein that makes a chemical
reaction happen. If there’s a problem with an enzyme in the
body, no chemicals, or maybe the wrong chemicals are made in the cells, which would cause disease. In humans, vitamin B12 coenzymes for 2 specific
enzymes. In the mitochondria, powerhouse of the cell,
B12 works on Methylmalonyl Coenzyme A mutase to feed into the cycle that produces ATP,
which is what the cell uses for energy. — In the cell nucleus, Vitamin B12 works on
the enzyme methionine synthase, which drives the process of synthesizing DNA, allowing
cells to generate the necessary genetic material to function. — Both these processes either generate or consume
a unique chemical. If normally, homocysteine is consumed in the
nucleus to help make DNA, then high levels of it would mean it’s not being consumed
by the process involving vitamin B12, meaning B12 is likely absent. If methylmalonic acid is produced in high
amounts instead of the correct chemical to produce energy for the cell, then it means
vitamin B12 is absent. — As the medical team orders homocysteine and
serum methylmalonic acid levels in DA, the results come in at 3 times higher then the
upper limit of normal for both, meaning even if DA’s B12 levels in blood are “normal,”
he is functionally deficient. But, how? In America, Europe, and Australia, a common
cause of B12 deficiency is malabsorption. Mal meaning bad and absorption denoting the
process whereby one mass is incorporated into another, meaning that it’s not that people
aren’t consuming it, but that their body doesn’t allow them to have it. B12 is almost everywhere and clinical starvation
is not usual in the overwhelming majority of people in these countries. This problem of absorption, is important because
the vitamin doesn’t just float around in your body, it has to be carefully escorted
in the GI tract. You see, the stomach isn’t just a bag that
holds chewed food. It produces a protein known as intrinsic factor,
which binds to B12 and this intrinsic factor-vitamin b12 complex gets absorbed in the far end of
the small intestines. The problem is, the body can sometimes send
the immune system to wrongly attack the stomach, preventing intrinsic factor production, so
that B12 never gets absorbed. This autoimmune disease can become worse in
a person and attack other parts of the body, like the pancreas and cause type 1 diabetes. But DA has no evidence of autoimmune disease,
or genetic disease, or underlying brain injury, meaning that the small detail of his diet
actually consisting of only French fries, and potato chips is the cause of this malnutrition. This is not to say he was lying and wasn’t
believable about his dietary intake, but without writing down and recording meticulously everyday
what you eat, it’s easy to miscalculate details about one’s own food. This concentrated lack of variety in his diet
and absence of a vital nutrient, is the cause of his problems, bringing us back to the idea
of a coenzyme. DA presented at age 14 with macrocytic anemia. To be oversized, means something was wrong
in the cellular DNA. And DNA, is in the cell nucleus, where Vitamin
B12 cofactors for the enzyme methionine synthase to help drive the cycle to produce genetic
material. Without B12, those materials aren’t properly
made. This impairs the maturation of the nucleus,
limiting the rate of DNA repair, and limiting the blood cell’s ability to hold oxygen. But the cell’s overall maturation isn’t
impaired, and this dysynchrony means less cells are created, and each one is larger
than normal bringing us directly to the definition macrocytic anemia. Without a presence of blood, where each cell
is larger. But this isn’t the end of DA’s problems. In the cellular mitochondria, absence of B12
prevents the production of ATP, which is energy. But as the mitochondria tries to make more
energy, it starts to use the wrong chemicals. This might be ok in tissues that don’t really
need constant fresh sources of energy. The muscles can recycle some of the correct
molecules and still function. Other parts of the body that don’t move
don’t need so much mechanical energy, so they can do for some time without it too. But how about the nerves? The nerves are covered in a fatty myelin sheath
to help conduct signals. Fat is energy dense. It absolutely needs the right molecules to
be properly formed. If the wrong chemicals are being used, because
the right chemicals just aren’t present, then the myelin sheath doesn’t develop properly. Small vacuoles begin to creep their way in
forming gaps. Over time, swelling and separation of the
sheaths develop into lesions that begin to scatter. The myelin becomes spongy and no longer the
formed sheath it should be, coalescing into a combined degeneration, impairing nerve conduction. If the nerves can’t properly conduct a signal,
minimal communication happens. Without a signal, the brain can’t interpret
sensory information. And if parts of his optic nerve become damaged
because vitamin b12 wasn’t present for methylmalonyl-CoA mutase to convert propionyl CoA to succinyl
CoA so that the Krebs cycle in the cell can properly produce the ATP and fatty acids needed
for synthesis of its myelin sheath, then this could explain why DA has become legally blind
from his strict diet of French fries, and potato chips, because these are foods that
are devoid of vitamin b12. This didn’t have to happen. Optic neuropathy has a long list of causes. Nutrition is not typically the first thing
anyone medically trained in America, Europe, and Australia think of because, malnutrition
especially in the context of Vitamin B12 is simply not common. DA’s bodyweight was well within average
for his height. He didn’t look malnourished from the outside. If doctors just thought of nutritional optic
neuropathy right from the start, and just simply stopped and didn’t look into the
other causes of his blindness, in this case, they would have been correct. But what if it wasn’t nutritional in origin? What if they missed a more common and life
threatening cause of his blindness and let that disease progress? You can’t just stop at a nutritional cause
in this case without ruling out the possible etiolgies. There’s a lot of CYA in medicine, this is
a very clear example of it. Do you remember the name of the stomach protein
intrinsic factor? Well, humans didn’t know what was the extrinsic
factor that binds to it to alleviate the pernicious anemia that these patients were getting. In the late 1800s, humans starting feed patients
with this deficiency raw animal liver, with some success. This was the dietary extrinsic factor at play
as liver has a lot of B12. A Nobel Prize was won in 1934 for those experiments. Decades later, humans used X-ray crystallography
to see what extrinsic factor or what we know as vitamin b12 is today, looks like. And Professor Dorothy Hodgkin was the winner
of the Nobel Prize, for doing exactly that, paving the way for it to be synthesized in
the lab. To be added to foods. To make supplements out of it and injection
formulations of it if their stomach won’t allow them to absorb it. To have it so most people can’t miss it,
because we know without it, the deficiency will cause anemia and neurodegeneration ranging
from mood impairment to blindness and dementia. . But some will always slip through the cracks. The people most susceptible to b12 deficiency
today are those who follow an abnormally strict vegetarian or vegan diet. Who wrongly refuse supplementation. Who don’t eat cereals, which in the US are
almost all fortified with vitamin B12. For DA, vitamin B12 injections were restarted. He was counseled for his eating habits. Problems coming from vitamin B12 deficiency
can be reversible if caught early. And while his rate of vision loss stabilized,
DA’s optic neuropathy and associated hearing loss was not reversed. Thank you so much for watching. Take care of yourself. And make sure you get your vitamins, although,
not 150 gummy vitamins for breakfast. And Be Well.
I went to school with a guy like this. He brought his lunch everyday and it was saltines, pringles and a Coke. As he got older, he switched to almost exclusively french fries but still had pringles occasionally. He also has really bad eyes.
This is similar to case that I saw myself- a young alcoholic patient who complained of loss of peripheral vision. I immediately blamed nutrition and the alcohol but when things continued to further deteriorate I had her see a neuro-opthalmologist who diagnosed tobacco amblyopia. Turns out that of all her unhealthy lifestyle choices it was her smoking that was turning her blind.
Also I found it interesting in this youtube case that the kid would only eat certain foods because of their 'texture' which could point to some sensory type traits seen in the autism spectrum. It could also be an eating disorder. In any case there's likely more to it than just habit/preference.
Lastly I'd disagree that doctors tend to overlook malnutrition as a cause of B12 deficiency. We see it very commonly in the UK in one particular population group- the elderly. There are lots of elderly people who subsist on jam sandwiches and tea, and most of them are deficient in B12.
Oof sad story. Kid must have some pretty terrible parents to have been able to keep that diet.
Title made me expect chubbyemu, was not disappointed.
he ate only french fires, white bread, and chips since he was 4 years old? sounds like its his parents' fault
My great grand dad who won the nobel prize was cited at the end of this video!
TL:DW?
Couple things:
What shitbird parents would actually allow this?
So basically the way it attacks the myelin sheath, this is almost like MS, just in this caae, due to malnutrition?
That brown doctor’s table looked sketchy as fuck.
Just add some cheese to those potatoes.