Ketuvot 60b ~ Everything is Bad For You

 

תלמוד בבלי כתובות דף ס עמוד ב - סא עמוד א

דמשמשא בי ריחיא - הוו לה בני נכפי, דמשמשא על ארעא - הוו לה בני שמוטי, דדרכא על רמא דחמרא - הוו לה בני גירדני, דאכלה חרדלא - הוו לה בני זלזלני, דאכלה תחלי - הוו לה בני דולפני, דאכלה מניני - הוו לה בני מציצי עינא, דאכלה גרגושתא - הוו לה בני מכוערי, דשתיא שיכרא - הוו לה בני אוכמי, דאכלה בישרא ושתיא חמרא - הוו לה בני בריי, דאכלה ביעי - הוו לה בני עינני, דאכלה כוורי - הוו לה בני חינני, דאכלה כרפסא - הוו לה בני זיותני, דאכלה כוסברתא - הוו לה בני בישרני, דאכלה אתרוגא - הוו לה בני ריחני. ברתיה דשבור מלכא אכלה בה אמה אתרוגא, והוו מסקי לה לקמיה אבוה בריש ריח

A woman who copulates in a mill will have epileptic children. [A woman] who copulates on the ground will have children with long necks. [A woman] who treads on the excrement of a donkey will have children who lose their hair.  [A woman] who eats mustard will have children who are gluttons. [A woman] who eats cress will have children with teary eyes.  [A woman] who eats small fish will have children with fluttering eyes.  [A woman] who eats clay will have ugly children.  [A woman] who drinks beer will have dark children.  [A woman] who eats meat and drinks beer will have children who are healthy.   [A woman] who eats eggs will have children with large eyes.  [A woman] who eats fish will have charming children.   [A woman] who eats celery will have radiant children.  [A woman] who eats coriander will have fat children.  [A woman] who eats an esrog will have fragrant children...

Everything is Bad For You. Or Good For You.

In their highly entertaining 2013 paper, Schoenfeld and Ioannidis looked at 50 common ingredients from random recipes found in The Boston Cooking-School Cook Book Then they searched for any recent scientific studies that evaluated the relation of each ingredient to the risk of cancer. And what did they find?

Eighty percent of ingredients from these randomly selected recipes had been studied in relation to malignancy.  (Those ingredients that had not been studied tended to be more obscure, like hickory or terrapin.)

Thirty-nine percent of studies concluded that the studied ingredient conferred an increased risk of malignancy; 33% concluded that there was a decreased risk, 5% concluded that there was a borderline statistically significant effect, and 23% concluded that there was no evidence of a clearly increased or decreased risk. In most (80%) of the studies, the statistical effect was weak.  As you can see in the table, the same ingredient (like tomatoes, tea, carrots and coffee) was found in different studies to both increase and decrease the risk of cancer. 

Effect estimates by ingredient. From Schoenfeld and Ioannides. Is everything we eat associated with cancer? Am J. Clin. Nutrition 2013:97;127-34. 

Effect estimates by ingredient. From Schoenfeld and Ioannides. Is everything we eat associated with cancer? Am J. Clin. Nutrition 2013:97;127-34. 

The authors concluded that:

“Nutritional epidemiology is a valuable field that can identify potentially modifiable risk factors related to diet. However, the credibility of studies in this and other fields is subject to publication and other selective outcome and analysis reporting biases, whenever the pressure to publish fosters a climate in which “negative” results are undervalued and not reported. Ingredients viewed as “unhealthy” may be demonized, leading to subsequent biases in the design, execution and reporting of studies.”

So that's the lesson: Be really careful when ascribing risk or benefit to commonly found ingredients. And with that warning, let’s analyze the passage in today’s daf:

THE RISK OF EPILEPSY

According to the Talmud, copulating in a mill is a risk factor for epilepsy.  Although there has not been a significant attempt to categorize the causes of epilepsy, one recent paper suggested that the etiology of this condition be broken down into four types:

Idiopathic (predominantly genetic or inherited in a complex way)

Symptomatic (acquired or genetic, together with gross anatomical or clinical features)

Provoked (the predominant cause is environmental)

Cryptogenic (cause has not been identified)

The Talmud is describing the mill as one of the environmental causes of epilepsy. While no such link has ever been suggested outside of the Talmud, the claim that epilepsy has an environmental cause is certainly plausible.

OTHER PRE-CONCEPTION ENVIRONMENTAL ASSOCIATIONS WITH CHILDHOOD OUTCOMES

It is increasingly clear that some major diseases in later life – like diabetes, high blood pressure and heart disease- have a basis in the impaired growth of the fetus. For example, a long-term British study showed that those infants who had low birth weights had relatively high death rates from coronary heart disease in adult life. Low birth rate has also been associated with the later development of diabetes, high cholesterol, and high blood pressure. In today’s daf, the Talmud claims an association between some foods ingested by a woman and certain characteristics or health traits in the later development of children she may carry. Again, there is no evidence that the details here are correct, but there is no reason to exclude such an association ab initio.

PICA – clay makes you ugly

Pica is the medical term for the craving and ingestion of foods or substances that have no nutritious value. Pregnant women engage in pica behavior all over the world. One study found that three-quarters of pregnant women in Kenya ate soil on a regular basis, and that this practice had a strong relationship to fertility and reproduction. In a study of 128 pregnant women conducted in a rural America, about a third practiced pica and clay was sometimes eaten together with other substances –a practice called polypica. Although women reporting daily pica practice were significantly more likely to have lower prenatal hematocrits than women who did not practice pica, no specific pregnancy complication was associated with the practice of pica. Although the authors did not report on whether the children were more likely to be ugly, the evidence suggests this is not related to pica, and so this claim of Talmud is unlikely to be true.

Pic Frequency. From Corbett et al. Pica in Pregnancy. Does it affect pregnancy outcomes? American Journal of Maternal Child Nursing. 2003: 28 (3); 183-189.

Pic Frequency. From Corbett et al. Pica in Pregnancy. Does it affect pregnancy outcomes? American Journal of Maternal Child Nursing. 2003: 28 (3); 183-189.

Fetal Alcohol Syndrome

The relationship between the ingestion of a pregnant woman’s ingestion of alcohol and the growth of the fetus is clear. It is a terrible idea to drink when you are pregnant. If you drink enough while pregnant, the fetus will be born with Fetal Alcohol Syndrome, which includes facial abnormalities, growth delays, abnormal development of organs, and reduced immunity.  The Talmud suggests that drinking beer before (or during?) pregnancy leads to “dark children” while drinking beer and eating meat will lead to healthy children. Do not follow this advice.  Drinking beer while pregnant is a  really bad idea, at pretty much any dose.

Despite the many gains in knowledge, we still do not know if there is a “safe” dose of alcohol that can be consumed by pregnant women without risking damage to their unborn children. Until such a safe dose, if it exists, can be determined, the only responsible advice to women who wish to become pregnant and to those who are pregnant is to avoid alcohol use entirely.
— Enorch Gordis MD, Then Director of The National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert #50, 2000

 

Eggs and Etrogs

The final intriguing association that is made is between eggs and large eyed children, and etrogs and fragrant children. Here the assumed mechanism is clear. You are what you eat – literally. Eggs have big yellow yolks, so if a woman eats them, her children’s eyes will mimic the egg – and appear to have large pupils surrounded by the white of the conjunctiva. Similarly, by eating a fragrant etrog, the body literally becomes fragrant. It’s a lovely theory really, but totally without of any basis in fact. “Like causes like” is as unlikely as “that which causes the same symptoms leads to a cure.” The latter is called homeopathy, and there is no scientific basis to it whatsoever. (Before you send me that angry email, read the sentence again. I did not say that it is not effective. It is indeed effective; as effective as placebo – and no more. But there is no scientific evidence that homeopathy is any better than sham treatment, that is, a placebo). The latest evidence to show that there is no benefit of homeopathy comes from a lengthy report (actually a series of reports) from the Australian National Health and Medical Research Council. We’ve wasted enough money on chasing the scientific study of homeopathy; let’s not waste still more seeing if eggs make your kids eyes larger because “like causes like”…

The Talmud's list of possible environmental causes is a joy to read, but is it true? With out a doubt yes. And certainly no.

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