Eating for victory!
fifth of the cases were occupational and the mortality rate was slightly less than one percent. This leaves, for the USA alone, over 85,000 people who suffered varying sub-fatal doses who could have benefited from the results of this survey. Against this vast back drop of victims, there is a wide variation in the nature of treatments available to them. In many cases bed rest and observation are all that are available, especially in the developing world. There are certainly no real efforts at preventative work, although sometimes farmers may carry post exposure countermeasures. For many of these people, some temporary preventative measures, i.e., those that involve merely a change in diet during the period working with the pesticides, could confer huge benefits and make a marked reduction in the number of fatal poisonings, as well as a huge alleviation of the effects of chronic poisoning without a reliance on anti-convulsant treatments. This is not without some challenges and further testing, but the potential impact of a new treatment in this area that might be simpler, cheaper and globally available cannot be understated. Intriguingly, the anti-convulsant characteristic of this diet effect has been seen to be efficacious in epilepsy as well. In fact, much of the scientific literature that exists (and there isn’t much yet) looks at the use of diet in the control of seizures. This again should start lighting up the excitement nodes of people to see such a multi-applicable treatment. The incidence of epilepsy can vary widely from population to another, but for the sake of simplicity we will draw on figures from the UK, which are well documented by the UK Epilepsy society. They observe that every day 87 people in the UK are diagnosed with epilepsy and many who develop it in their youth can, inexplicably ‘grow out of it’. It affects one in every 100 people in the UK (over 600,000 people). Worldwide, the WHO believes that around 50 million people have epilepsy. The concept that research in this area might bring benefits to so many people, as well as provide a tool in the fight against the terrorist use of nerve agents is breath-taking.
The way forward
The results of the testing by Langston and Myers are some of the most exciting we have ever seen in the quest to find tools to handle nerve agent poisoning, and the field of diet and metabolic effect on toxicity and convulsion suppression is on the threshold of becoming an incredible leap forward in science. It goes without saying that the exact mechanism of effect is uncertain at this stage and further work needs to be done to ascertain exactly why the diets can have these incredible effects. There is also a need to demonstrate these effects in other species. The potential of this effect is so game- changing to both the civil and military domains, as well as the wider research effects of nutrition on disease and poisoning, that it’s hard not to get overawed by it. So far, the scientists looking at this field are few, certainly enough to support the findings of Langston and Myers, but nowhere near enough to be commensurate with the impact this field could have on human health and security.
At the very simplest level, it informs how we should consider diet pre and post exposure. The practice of providing glucose or lactated Ringer’s solution to nerve agent casualties would be expected to exacerbate toxicity. Additionally, the currently fielded military meals (MREs and chow in theatres of operation) may be placing our soldiers at a disadvantage by increasing the nerve agent toxicity in the event of nerve agent exposure. Thus, higher-fat meals provided before or after nerve agent exposure could lessen the resulting toxicity. With additional research, a novel dietary or pharmacological nerve agent countermeasures could be developed to augment or replace existing ones. Of course, the benefits would extend beyond nerve agents to the more common problem of OP poisoning which affects millions of people worldwide. Recent research on OPs suggests that nervous system dysfunction produced by early life exposure can be treated by a high-fat diet. To our knowledge, survivors of
nerve agent poisoning have not been treated with a high-fat diet to lessen nervous system dysfunction and hasten recovery.
The simplicity of this process as a treatment is an incredibly refreshing and, most significantly, a low-cost option to explore alongside many of the more elaborate research paths being pursued. Rather than the complexity and difficulty of developing new
pharmacological treatments, such as the programmes looking at bio-scavengers, it represents a treatment that in its simplest form would not require approval as a drug and could be having an effect while some countermeasures are still going through years of approvals (always assuming they can deliver an efficacious effect). This should not detract from those efforts, which are laudable and very vital, but diet and nutritional effect should be a key part of the armoury in facing these problems. For now Langston and Myers are looking to draw the focus back a step to try to identify the mechanisms at work in the glucose exacerbation and the ketogenic attenuation of nerve agent toxicity. One working hypothesis is that the ketogenic diet shifts metabolic processes to an energy source that is more resistant to disruption. Alternatively, the diets themselves or their constituents may have direct effects on the biochemical targets of nerve agents. Further characterising the exact mechanisms responsible may require reaching out to biochemists, teaching hospitals, nutrition and metabolic specialists to try to explore possibilities.
Those who wish to engage or correspond with the authors to augment their work with other results, papers, or collaboration – or indeed those that wish to support funding in this area – should contact the authors via phone, e-mail, or by written correspondence:
United States Army Medical Research Institute of Chemical Defense (USAMRICD) MCMR-CDT-N
3100 Ricketts Point Road Aberdeen Proving Ground, MD 21010-5400 USA
todd.myers2@
us.army.mil
CBRNe South America 2012, 13-14 March, Rio De Janeiro, Brazil. More information on
www.icbrnevents.com 34 CBRNe WORLD February 2012
www.cbrneworld.com
CBRNeWORLD
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