The Dutch “Hunger Winter” and two medical discoveries resulting from it

The 1944-1945 winter is etched in the memory of the Dutch as “de hongerwinter” (the hunger winter), in which about 20,000 mostly elderly people died in what was arguably a man-made famine.

map from http://www.hongerwinter.nl . Gray=liberated territory, olive green=German occupied territory, dark olive green=areas hardest hit by the famine. Bars compare all-cause mortality between early 1944 [baseline] to early

Several factors conspired to create it.

  • much of the Dutch population is concentrated in a dense Western area known today as Randstad Holland (“suburbia Holland”) with very limited food production; much of the agriculture was/is concentrated in the eastern region across the inland see called the Ijsselmeer (formerly the Waddenzee), and in the South and Southeast which had already been liberated by the Allies
  • in support of Montgomery’s failed “one bridge too far” attempt to seize the Rhine bridges by airborne troops [and thus cut the war short by an early swing into Germany itself] a railway strike had been called. In retaliation, a German military commander named Christensen forbade all civilian train transport, including of foodstuffs. By the time the blockade was lifted, a lot of damage had been done
  • the winter was quite cold, though not one of the 20th century coldest winters on record, and there was such a dramatic shortage of heating fuel in the cities that people resorted to all manner of expedients, from sawing down trees via demolishing abandoned houses for wood to removing the crossties from streetcar tracks. The country’s main sources of coal, in Dutch Limburg, were across the front line.
    Keep in mind that a large percentage of our daily calorie consumption at rest, our “metabolic base load”, is to maintain body temperature, and you will realize why a famine causes dramatically more fatalities in very cold weather [Leningrad Siege, the hunger winter] than in warm weather [e.g., the siege of Jerusalem during the Israeli war of Independence].
  • years of privations left people with few reserves of body fat to draw on

Eventually the weather improved, flour was allowed in from neutral Sweden, and the Allies were allowed to drop humanitarian food supplies from bombers [Operation Manna and Operation Chowhound]. But only the Nazi capitulation put a real stop to it.

In the wake of the Hongerwinter came two medical discoveries.

(1) A Dutch pediatrician named Willem Dicke was looking after a ward with celiac patients. With wheat being in short supply, other carbohydrate sources were being substituted ranging from potatoes to sugar beets and tulip bulbs. Surprisingly, the health of his patients improved. Then after liberation, the precious bread arrived, was given to his patients, and… they got worse again. This led Dicke to start experimenting with their diet until he arrived at the gluten-free diet that is now the standard for managing celiac patients. [One side effect of the recent “gluten free” fad is that people who actually do have celiac have more options available.]

Dicke was nominated for the Nobel Prize for Medicine and Physiology in 1962, but the nomination became moot when he suddenly died of a stroke. [Nobel Prizes are not awarded posthumously.]

(2) Epigenetics. What the heck is this even, you say? Well, you have the genetic information, but in addition organisms have mechanisms for up- or down-regulating certain genes, either as part of the development cycle or in response to external/environmental factors. One mechanism is the targeted methylation (or demethylation) of certain base pairs.

Under certain circumstances, these changes can be passed on to offspring for at least one generation. One of the earliest studied examples, if not the earliest, was among children of parents born during, or shortly after, the Dutch hongerwinter. That the parents on average are shorter and have “slower” metabolisms (which lead to obesity and diabetes when food is abundant) was not unexpected: that the same held true of their offspring was the surprising discovery. If you will permit a metaphor: It appears the epigenetic “energy saver mode” switches that had been triggered in the parents made it down to their offspring.

A popular science article in the New York Times [archived copy]

A few scholarly articles:

Painter, R.; Osmond, C.; Gluckman, P.; Hanson, M.; Phillips, D.; Roseboom, T. Transgenerational Effects of Prenatal Exposure to the Dutch Famine on Neonatal Adiposity and Health in Later Life. BJOG An Int. J. Obstet. Gynaecol. 2008, 115, 1243–1249. DOI: 10.1111/j.1471-0528.2008.01822.x [paywalled] [PubMed link]

Tobi, E. W.; Goeman, J. J.; Monajemi, R.; Gu, H.; Putter, H.; Zhang, Y.; Slieker, R. C.; Stok, A. P.; Thijssen, P. E.; Müller, F.; van Zwet, E. W.; Bock, C.; Meissner, A.; Lumey, L. H.; Eline Slagboom, P.; Heijmans, B. T. DNA Methylation Signatures Link Prenatal Famine Exposure to Growth and Metabolism. Nat. Commun. 2014, 5, 5592. DOI: 10.1038/ncomms6592 [Open Access]

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