Vírus zika, placenta e feijoada

Em Uganda, em 1947, o vírus Zika foi isolado pela primeira vez. Zika ocorre em muitas partes distantes do mundo. Há apenas alguns anos, Zika chegou ao Brasil (https://www.usatoday.com/story/news/2016/03/24/study-zika-virus-may-have-arrived-brazil-2013/82210986/), e logo percebeu que Zika estava associada e provavelmente causava microcefalia e outras malformações fetais.(http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30883-2/fulltext, https://www.nytimes.com/2016/01/22/world/americas/zika-virus-may-be-linked-to-surge-in-rare-syndrome-in-brazil.html).

Por que demorou até Zika chegar ao Brasil para que a conexão Zika-microcefalia se tornasse aparente?

Zika chegou aos EUA, com 40 mil casos confirmados em Porto Rico, mas Puerto Rico viu apenas um pequeno número de casos de microcefalia. (http://www.huffingtonpost.com/entry/zika-puerto-rico_us_5903a419e4b05c39767f8317?t59) Isso reflete a experiência dos países centro-americanos, onde Zika se espalhou, mas os casos de microcefalia não aumentaram dramaticamente de maneira paralela ao que eles fizeram no Brasil. Isso levou a teorias de conspiração sobre pesticidas e água no Brasil.(http://fortune.com/2016/02/16/monsanto-zika-virus-conspiracy/, http://www.who.int/emergencies/zika-virus/articles/rumours/en/) Proponho uma explicação mais simples e muito menos controversa:

• Os brasileiros comem algo regularmente que ajuda o vírus Zika a desenvolver fetos, algo de contrário inócuo.

E que algo parece ser sulfato de condroitina solúvel em água da cartilagem contida em seu prato nacional, feijoada à brasileira. Feijoada é um guisado de feijão preto feito com vários cortes de carne, mais notavelmente orelhas, pés e focinhos de porco (https://pt.wikipedia.org/wiki/Feijoada_(Brasil), http://eatrio.net/2013/06/pig-parts-and-feijoada.html), E a feijoada geralmente é cozida a fogo pequeno por horas, uma excelente maneira de extrair substâncias dessas peças de carne. Como as orelhas de porco são principalmente de cartilagem, elas são uma fonte muito boa de sulfato de condroitina, um suplemento feito de cartilagem de animais e usado por muitos para osteoartrite.(http://www.umm.edu/health/medical/altmed/supplement/chondroitin, https://link.springer.com/article/10.1007/s10719-016-9665-3, http://slism.com/calorie/111173/)

Pouco menos de dois meses atrás, investigadores identificaram o sulfato de condroitina como uma molécula à qual Zika se liga firmemente e qual "pode ser o bilhete do vírus Zika na placenta". (https://www.sciencedaily.com/releases/2017/04/170404084445.htm, http://pubs.acs.org/doi/abs/10.1021/acs.biochem.6b01056) Se esta descoberta for correta, então, seria imprudente comer sulfato de condroitina extra durante a gravidez e em risco de doença do vírus Zika, pois o sulfato de condroitina administrado por via oral é absorvido e aumenta a quantidade de sulfato de condroitina no plasma sanguíneo. (https://www.ncbi.nlm.nih.gov/pubmed/27108107)

Eu enviei um e-mail para os dois autores correspondentes dos resultados da pesquisa de sulfato de condroitina e Zika para chamar a sua atenção a possível conexão de feijoada com microcefalia. Espero que meu e-mail não acabe em suas pastas "spam." Talvez a conexão que eu desenhe aqui é muito simples e já foi descartada como irrelevante, mas parece ser uma possibilidade que deve ser examinada. Enquanto isso, se você conhece uma mulher grávida que viaja ou reside em áreas onde o vírus Zika é conhecido por ser, você pode querer considerar avisá-la para evitar alimentos e bebidas feitos com quantidades significativas de cartilagem animal.

(Esta é uma versão em português de uma publicação anterior em inglês.)

Virus Zika, entrada a la placenta y guiso de feijoada

En Uganda en 1947, el virus Zika fue aislado por primera vez. Zika ocurre en muchas partes lejanas del mundo. Hace apenas unos años, Zika llegó a Brasil (https://www.usatoday.com/story/news/2016/03/24/study-zika-virus-may-have-arrived-brazil-2013/82210986/), y se dio cuenta de que Zika está lanzado con y probablemente causa microcefalia y otras malformaciones fetales. (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30883-2/fulltext, https://www.nytimes.com/2016/01/22/world/americas/zika-virus-may-be-linked-to-surge-in-rare-syndrome-in-brazil.html).

¿Por qué se tardó hasta Zika llegó a Brasil para que se hiciera evidente la conexión de la microcefalia con Zika?

Zika ha llegado a los Estados Unidos con 40.000 casos confirmados en Puerto Rico, sin embargo, Puerto Rico ha visto sólo un pequeño número de casos de microcefalia. (http://www.huffingtonpost.com/entry/zika-puerto-rico_us_5903a419e4b05c39767f8317?t59) Esto refleja la experiencia de los países centroamericanos, donde Zika se ha extendido pero los casos de microcefalia no se han aumentado de forma espectacular en paralelo como lo hicieron en Brasil. Esto ha llevado a teorías conspirativas sobre pesticidas y agua en Brasil. (http://fortune.com/2016/02/16/monsanto-zika-virus-conspiracy/, http://www.who.int/emergencies/zika-virus/articles/rumours/en/) Propongo una explicación más simple, mucho menos controvertible:

• Los brasileños comen algo (normalmente inocuo) regularmente que ayuda a que el virus Zika llegue a los fetos en desarrollo.

Y esto "algo" parece ser soluble en agua sulfato de condroitina que se obtiene del cartílago contenido en feijoada, el plato nacional de Brazil. Feijoada es un guiso de frijoles negros e incluye varios cortes de carne, especialmente orejas, pies y hocicos de cerdo (http://boliviachef.blogspot.com/2011/03/feijoada-el-sabor-de-brasil.html, http://eatrio.net/2013/06/pig-parts-and-feijoada.html), y la feijoada típicamente se coce por horas--una excelente manera de extraer sustancias de esa carne. Debido a que las orejas de cerdo son principalmente de cartílago, son una muy buena fuente de sulfato de condroitina, un suplemento hecho de cartílago de animales y utilizado para la osteoartritis por mucha gente.(http://www.umm.edu/health/medical/altmed/supplement/chondroitin, https://link.springer.com/article/10.1007/s10719-016-9665-3, http://slism.com/calorie/111173/)

Hace apenas dos meses, investigadores identificaron el sulfato de condroitina como una molécula a la que Zika se une firmemente y que "puede ser el boleto de entrada del virus Zika a la placenta."(https://www.sciencedaily.com/releases/2017/04/170404084445.htm, http://pubs.acs.org/doi/abs/10.1021/acs.biochem.6b01056) Si esta identificación es correcta, sería imprudente comer extra sulfato de condroitina durante el embarazo si está en riesgo de Zika virus, debido a que el sulfato de condroitina administrado por vía oral se absorbe y aumenta la cantidad de sulfato de condroitina en el plasma sanguíneo. (https://www.ncbi.nlm.nih.gov/pubmed/27108107)

Envié un mensaje por correo electrónico a los dos autores correspondientes de los hallazgos sobre Zika y sulfato de condroitina de abril para llamar su atención a la posible conexión con feijoada. Espero que mi mensaje no termine en sus "spam" carpetas. Tal vez la conexión que hago aquí es demasiado simple y ya ha sido descartado como irrelevante, pero me parece una conexión posible que debe ser examinado.

Mientras tanto, si conoce a una mujer embarazada que viaja o reside en áreas donde se sabe que el virus Zika está, podría ser beneficioso advertirle que evite los alimentos y bebidas hechas con cantidades considerables de cartílago animal.

(Esta es una versión en español de una publicación anterior en inglés.)

Zika virus, placental entry, and feijoada

In Uganda in 1947, Zika virus was first isolated. Zika occurs in many far-flung parts of the world. Just a few years ago, Zika arrived in Brazil (https://www.usatoday.com/story/news/2016/03/24/study-zika-virus-may-have-arrived-brazil-2013/82210986/), and it was soon realized that Zika was associated with and likely causing microcephaly and other fetal malformations. (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30883-2/fulltext, https://www.nytimes.com/2016/01/22/world/americas/zika-virus-may-be-linked-to-surge-in-rare-syndrome-in-brazil.html).

Why did it take until Zika arrived in Brazil for the Zika-microcephaly connection to become apparent?

Zika has now come to the USA, with 40,000 confirmed cases in Puerto Rico, yet Puerto Rico has seen only a small number of microcephaly cases. (http://www.huffingtonpost.com/entry/zika-puerto-rico_us_5903a419e4b05c39767f8317?t59) This mirrors the experience of Central American countries, where Zika has spread but microcephaly cases have not dramatically jumped in parallel the way they did in Brazil. This has led to conspiracy theories about pesticides and water in Brazil. (http://fortune.com/2016/02/16/monsanto-zika-virus-conspiracy/, http://www.who.int/emergencies/zika-virus/articles/rumours/en/) I propose a simpler, much less controversial explanation:

• Brazilians eat something regularly that helps Zika virus reach developing fetuses, something otherwise innocuous. 

And that something appears to be water-soluble chondroitin sulfate from cartilage contained in their national dish, feijoada. Feijoada is a black bean stew made with various cuts of meat, most notably pig ears, feet, and snouts (http://eatrio.net/2013/06/pig-parts-and-feijoada.html), and the feijoada is typically simmered for hours, an excellent way to extract substances from those meat pieces. Because pig ears are mostly cartilage, they are a very good source of chondroitin sulfate, a supplement made from animal cartilage and used by many for osteoarthritis. (http://www.umm.edu/health/medical/altmed/supplement/chondroitin, https://link.springer.com/article/10.1007/s10719-016-9665-3, http://slism.com/calorie/111173/)

Just under two months ago, researchers identified chondroitin sulfate as a molecule to which Zika binds tightly and which "may be the Zika virus' ticket into the placenta." (https://www.sciencedaily.com/releases/2017/04/170404084445.htm, http://pubs.acs.org/doi/abs/10.1021/acs.biochem.6b01056) If this finding is correct, then eating extra chondroitin sulfate while pregnant and at risk of Zika virus disease is a terrible idea, for orally-administered chondroitin sulfate is absorbed and increases the amount of chondroitin sulfate in blood plasma. (https://www.ncbi.nlm.nih.gov/pubmed/27108107)

I emailed the two corresponding authors of the Zika-chondroitin sulfate April research findings to bring the possible feijoada connection to their attention. I hope my email doesn't end up in their "spam" folders. Maybe the connection I draw here is too simple and has already been dismissed as irrelevant, but it seems like a possibility that should be looked into. In the meantime, if you know a pregnant woman who travels or resides in areas where Zika virus is known to be, you might want to consider warning her to avoid food and drink made with significant amounts of animal cartilage.

* Fun note for my readers: Almost three years ago, I learned of the existence of feijoada because our family studied Brazil for two weeks, and I learned how to cook it. Who knew it might end up relevant to Zika-caused fetal damage?

How to get more glycine betaine (trimethylglyicine) in your diet

As discussed earlier this week, we miss out on many dietary sources of glycine betaine (trimethylglycine or TMG) with our western style of eating. Here are easy ways to increase the amount of easily-usable TMG in our diet:

1. Eat more soups/stews and cooked purees, especially ones that contain spinach, amaranth (greens or seeds), beets (greens or roots), quinoa, rye, and wheat (preferably including the wheat germ).
2. Eat bulgur pilaf. (Remember not to drain the cooking water.)
3. Boil pasta in less water and then use the cooking water in your sauce or other recipes.
4. Put TMG in your beverages. When they refine sugar from sugar beets, one of the things they remove from the sugar is TMG, which can be purchased as a food supplement and easily mixed into juice or milk. If the TMG is used properly in small amounts, no one can taste it.

Because there are other nutrients besides TMG in cooking water, I think the first three are preferable, but not everyone wants to change the way they eat.

Soups and glycine betaine

Boiling is a wonderful way to extract glycine betaine (AKA trimethylglycine or TMG) from foods that contain it. Around 60-80% of the TMG in plant material leaches out into the water when it is boiled. For instance, one study found 1472 mg/g of TMG in organic pasta when uncooked; once cooked, the amount of TMG was only 352 mg/g. Where did three-quarters of the TMG go? Into the cooking water, from which most of the TMG can be recovered, as it is fairly heat-stable. Yet what do we do with that cooking water in the USA? We throw it down the drain! All that boiling-extracted TMG, a nutrient that supports our bodies in converting homocysteine--see this article for a partial summary of the health problems that appear associated with having too much homocysteine--and we give it to our sewers. Why?

When one thinks of food in the USA, one thinks of one word in particular: "convenience." Yesterday, I looked over the breakfast and lunch menus for our local school district and found that there will be no oatmeal mush, stew, soup, or chili offered during the entire month of May. All those high-liquid foods are messy! They require separate bowls and don't come prepackaged like fruit cups. Also, who really wants to clean up soup spills in a school full of young children? I rarely serve my own children soup because 1) they don't initially appreciate it, and 2) they spill it.

US breakfasts have been mostly toast, cold cereal, eggs, Pop-Tarts, etc., and in recent years, we've been moving towards even more portable breakfast choices such as yogurt and breakfast bars. (http://www.bbc.com/news/magazine-28761333) Americans like to eat "on the go." Long ago, when I was a typical multitasking US college student, I was surprised at the reaction I got in Poland when Poles saw me eating my sandwich while strolling down the street at lunchtime; what was normal in the USA definitely wasn't normal in Warsaw.

Polish people have traditionally eaten a large main meal, called "obiad," in the early afternoon, and it customarily includes a soup course. Even though traditional eating habits have had to partially give way before workday requirements, Poles still love their soups. In 2015, Poles ate more soup per capita than every other country in the world, according to a 2016 marketing survey (http://www.euromonitor.com/soup-in-poland/report):

TRENDS

Soup was traditionally always an important part of Polish cuisine, as the consumption of 100 litres per capita recorded in 2015 was the largest in the world. Soup was a part of almost every family dinner, often even being a small meal in and of itself. However due to saturation and shifting preferences towards healthier, home-made soup, the growth of packaged soup in Poland was severely hindered. Polish customers still enjoyed occasional help from dehydrated soup or shelf stable soup, which was often considered to be a relatively good base for soup preparations.

That's over a cup of soup each day. How often do Americans, in contrast, eat soup? Or even stew, chili, or curry? From what I've seen, we in the USA tend not to eat high-liquid cooked foods (eat, not drink--we love our blended beverages) and are far below the Poles when it comes to soup consumption. Canned soup has declined in popularity to the point that the Campbell Soup company had to close two of its soup plants a few years ago. (http://www.cbsnews.com/news/campbell-soup-closing-two-us-plants/) Soup is viewed as "old-fashioned" by younger people and is a struggling market, per a 2017 US market study (http://www.euromonitor.com/soup-in-the-us/report):

Experiencing struggles in recent years, soup experienced a volume decline of 2% over the review period, even as value shot up by a 2% CAGR. The latter was because prices rose from sales of more premium offerings and companies’ struggles to make sales were largely passed on to consumers in the form of higher prices. Shelf stable soup, occupying a 95% volume share of the category, has reflected and fuelled many of these stagnating trends, as much of its products have traditionally been disproportionately popular among older consumers (aged 55-74). For this reason, soup has often been perceived as a largely “old-fashioned” or “conservative” product, making it less popular among influential younger consumer groups, particularly millennials who are increasingly health-conscious and have avoided the high sodium and artificial ingredients contained in many soup products. 

Not only do Poles eat a lot of soup, but their main soups tend to be 1) based on beets, 2) based on rye flour, or 3) thickened with thin wheat noodles, flour, and croutons (Poles are taught from childhood not to waste bread, and croutons are a tasty use for stale bread). If you've been reading my blog, you know that beets, rye, and wheat contain substantial amounts of TMG.*

Since I hypothesize that TMG helps protect against autism spectrum disorders--remember, Poland diagnoses autism at a rate of around 1/2900 while the US rate is 1/68--I think it would be very beneficial if the US population were to increase its intake of TMG-containing soups. Perhaps we could all eat minestrone containing spinach and whole wheat pasta and sold in little disposable cups that can be microwaved; that would be convenient, tasty to the pizza-trained palate of Americans, and a good source of TMG and other important nutrients. (Wouldn't it be nice if someone from Campbell's happened across my blog and used this idea?)

* Based on all the TMG they get in their soup, Poles should be quite healthy, right? Unfortunately, they really like another liquid in that part of the world: vodka. The name means "little water," and too many people (mostly male) in eastern Europe and Poland (now considered "central Europe" by some, but it still shares many diet commonalities with its neighbors to the east) seem to drink it like it is water. Per wikipedia, Polish women have basically the same life expectancy as US women, but Polish men's life expectancy trails Polish women by nearly 8 years. A study of life expectancy in Russia points to alcohol abuse as a major causative factor behind earlier death for Russian men. (http://www.rand.org/pubs/conf_proceedings/CF124/cf124.chap4.html; see also https://www.theguardian.com/world/2014/jan/31/russian-men-losing-years-to-vodka)

Amaranth greens contain glycine betaine (trimethylglycine)

Several botanical families of plants accumulate betaine (i.e., glycine betaine, trimethyglycine, or TMG). One of the major ones in use for human food purposes is the amaranthaceae family. (https://hungary.pure.elsevier.com/hu/publications/betaine-distribution-in-the-amaranthaceae) Here's the Encyclopaedia Brittanica summary of the primary food species in the amaranthaceae family:

Food crops in the family include the various forms of beet (Beta vulgaris, including garden beets, chard, sugar beets, and mangel-wurzel), lamb’s quarters (Chenopodium album), and spinach (Spinacia oleracea). Some species—namely, Inca wheat, or love-lies-bleeding (Amaranthus caudatus), red amaranth (A. cruentus), and quinoa (Chenopodium quinoa)—are high-protein pseudo-grain crops of interest to agricultural researchers. Quinoa in particular, touted as a health food, grew in popularity worldwide during the early 21st century.

https://www.britannica.com/plant/Amaranthaceae

In the past few posts, I've discussed the TMG contribution to various regional diets from inclusion of beet, spinach, amaranth seed, and quinoa seed. But I only recently learned of the use of amaranth greens for human consumption. They deserve a post, for they are eaten commonly in several places outside Europe and North America.* The leaves of amaranth are reported to accumulate glycine betaine. (http://www.sciencedirect.com/science/article/pii/S0003986196997313)

Amaranth, despite being once a major foodstuff in southern Mexico, fell into disuse after the arrival of the Spaniards:

Grain amaranth was as important as corn and beans to the Aztecs, who believed that it gave them supernatural powers and used it in ceremonies involving human sacrifice. Some 20,000 tons of the seeds were delivered by Aztec farmers in annual tribute to their emperor, Montezuma.
In Aztec rituals, amaranth was mixed with human blood, formed into cakelike replicas of Aztec gods and fed to the faithful, a practice the Spanish regarded as barbaric and a mockery of Christian communion. Hernan Cortes put a stop to it by condemning to death anyone found growing or possessing amaranth.

http://www.nytimes.com/1984/10/16/science/ancient-forgotten-plant-now-grain-of-the-future.html (The article is from 1984, so we haven't reached the future yet.)

And it wasn't just human blood they were mixing into the little amaranth figurines, it was purportedly blood from human sacrifices--at least according to a video program called Ancient Grains Series: Amaranth (https://www.amazon.com/Amaranth/dp/B00VZ4A8D4) that I just watched--which would explain the Spaniards' revulsion. But humans no longer eat amaranth seeds in conjunction with murder victim blood, so it seems like amaranth should be poised to become a major foodstuff again.

Amaranth greens are popular in many parts of Asia, Africa, and the Caribbean, where they are usually eaten stewed, which is a great way to coax TMG out of its leaves. For some reasons, people in the USA just want to use amaranth greens in salads, though. (http://www.appalachianfeet.com/2010/05/10/how-to-grow-and-use-amaranth-greens-wrecipes-sources/, http://www.today.com/food/sick-kale-amaranth-next-super-green-try-6C10658383) (Why don't Americans like to consume liquid from boiled food? That subject calls for its own post.)

In Jamaica, they call amaranth greens "callaloo," which can get confusing because callaloo is also used as an appellation for other greens as well as for the dish made with amaranth and/or other greens. (https://realjamaica.org/what-on-earth-is-callaloo, http://www.africanbites.com/callaloo-jamaican-style/) Despite multiple research papers on autism epidemiology out of Jamaica in the past few years, I can't find any estimates of autism prevalence there, so I can't say whether high Jamaican consumption of amaranth greens is protecting them to any extent from autism spectrum disorders (per my hypothesis).

* According to various wikipedia articles, kañiwa, sessile joyweed, chenopodium album (i.e., lamb's quarters or bathua; popular in north India), celosia argentea var. argentea (Lagos spinach, soko yokoto, or cresta de gallo; popular in India), and epazote are also food/herb crops within the amaranthaceae family and so are likely to be good dietary sources of TMG. I have no experience with eating any of them, and all seem to be relatively unknown in most of the more economically developed countries. I list them in hopes that some researchers will read this and investigate how much glycine betaine these foods might be contributing to the diets of the people who eat them, but I won't do individual posts on them.