The 1944–1945 Hongerwinter (Hunger Winter) in Holland during World War II was brutal. A German blockade had cut off food and fuel, and the result was widespread starvation among the population. But out of this horror came an inadvertent experiment in epigenetics, as well as a breakthrough in treating an autoimmune disease that also starved people to death: celiac disease.

About The Disappearing Spoon

Hosted by New York Times best-selling author Sam Kean, The Disappearing Spoon tells little-known stories from our scientific past—from the shocking way the smallpox vaccine was transported around the world to why we don’t have a birth control pill for men. These topsy-turvy science tales, some of which have never made it into history books, are surprisingly powerful and insightful.

Credits

Host: Sam Kean
Senior Producer: Mariel Carr
Producer: Rigoberto Hernandez
Associate Producer: Sarah Kaplan
Audio Engineer: Rowhome Productions

Transcript

To the pediatricians, it just didn’t make sense. Their patients were caught in a famine during World War II. And they had a disorder that made them especially prone to starvation. By all rights these children should be dead. So how on earth were they thriving?

The setting was Holland, the winter of 1944–exactly 80 years ago. The doctors specialized in a disease we’ve probably all heard of: celiac disease. Today it’s a serious but manageable disorder for most people. But in the early 1900s, it was one of the most baffling and heartbreaking diseases around.

The pediatricians’ victims were seemingly normal children, with access to all the food they wanted. Yet they would starve down into skeletons. And the doctors couldn’t do anything.

During the winter of 1944, things should have been even worse. The ruling Nazis had disrupted the food supply in Holland and plunged the country into a disaster known as the Hongerwinter. By December, daily rations had dropped below 1000 calories. Millions were starving.

And yet, the already-starving celiac children were gaining weight—during a famine. How? 

For one doctor, however, the situation made sense. In fact, for Willem Dicke, the famine only confirmed his suspicions about celiac disease. 

Dicke’s work would go on to save millions of children’s lives. But this story isn’t just about him. It highlights an uncomfortable fact—that for all the death and destruction, wars often benefit medicine tremendously.

This story suggestion came from listener Robert Anderson. 

In the 1920s, the best cure for celiac disease was bananas, as in, the fruit.

The banana cure for celiac came from a well-meaning American doctor named Sidney Haas. Haas based it on something he’d observed while working in Puerto Rico. 

Cities in Puerto Rico had lots of cases of celiac disease. Children would have abdominal pain, bloated stomachs, bone deformities, stunted growth, and “slimy foul” diarrhea. 

Those last two, stunted growth and foul diarrhea, were linked. For whatever reason, much of the fat and other nutrients in their food wasn’t being absorbed in their intestines. Instead, it was sluicing right through them. Sadly, this malnutrition killed nearly one third of the children who had celiac disease, in Puerto Rican cities and elsewhere.

But then Haas made an observation. While cities in Puerto Rico had many cases, there were virtually zero cases among farming families in the countryside. And at nearly every meal, those families ate bananas. This lit a fire in Haas’s brain. Bananas must cure celiac disease!

It’s hard to imagine nowadays, when you can buy bananas by the pound in any American grocery store, but bananas were once a luxurious fruit in the United States.

When bananas first arrived on American shores in the 1870s, they came individually wrapped in tinfoil—like a present. In New York, guards stood watch over banana trees at shipping yards to prevent mobs from stealing the fruit.

The craze had died down somewhat by the 1920s, but people still thought of bananas as exotic and special. Haas certainly did. He considered them a superfood. He went on and on about their powers—the way some people babble about açai berries or CBD oil today.

In fact, Haas pushed bananas so hard as a panacea that other doctors accused him of taking money from banana corporations. That wasn’t true, but he started prescribing bananas to his celiac patients. Lots of bananas. 

Desperate parents would drag whole banana branches home from the docks. Then they forced their children to eat them—up to 200 bananas a week, nearly 30 bananas per day. Can you imagine stuffing 30 bananas in your mouth every day? Ugh.

But, however quacky it sounded, the diet worked. Celiac patients started putting on weight. However nauseated with bananas, they weren’t starving anymore.

Still, the banana cure wasn’t unique. There were other fad celiac diets, too. One had children eating tomato purée. Another called for gulping oysters. And the weird thing was—those diets worked, too. Children gained weight on them.

Which left doctors scratching their heads. What possible link was there between bananas, tomato purée, and oysters?

Something was missing. And the doctor who figured out what was pediatrician Willem Dicke. Dicke was born in Holland in 1905. He had a pointy nose, ruddy hair, and a big bald forehead. He was regarded as exceptionally caring, a man of true compassion—which, sometimes, was all a doctor could offer a celiac patient. 

But Dicke had a good clinical eye as well. And he grew obsessed with the central mystery of celiac: how you could starve while eating all you wanted. 

The first clue came from a stray remark he heard once. Dicke worked at a hospital in The Hague. The mother of a celiac child there mentioned that her boy’s rashes seem to disappear when they didn’t have any bread around.

Now, this was a paternalistic age in medicine. Doctors told patients what was what—not vice-versa. But the compassionate Dicke took her observation seriously. He even tried an informal experiment.

He told the parents of celiac children to swap different foods in and out of their diet. Add eggs one week. The next week, remove buttermilk. Throw in some applesauce. This wasn’t systematic, but one fact did emerge. Withdrawing bread seemed to help.

Unfortunately, World War II disrupted this work. Nazi Germany conquered Holland in 1940, and luxuries like research went by the wayside. Dicke and his wife also poured their time and energy into the underground resistance movement.

His wife spied on minefields and other Nazi defense measures. She then passed the intel to British agents. Dicke concealed Allied pilots who’d been shot down, hiding them in the basement of his hospital. But someone ratted Dicke out. He was arrested and nearly executed. The Nazis didn’t kill him only because of a serious wartime shortage of doctors.

In June 1944, the D-Day invasions occurred. After a few months of slow progress, the Allies began to bludgeon the Nazis. Southern Holland was liberated in September. 

But pushing the Nazis out of southern Holland only allowed them to concentrate their forces in a smaller area. That made it harder to liberate the northern areas, especially big cities like Amsterdam and The Hague. Allied attempts to liberate these areas failed.

The Dutch people tried to break the stalemate by going on strikes and sabotaging railroad lines. But this only enraged their Nazi overlords, who responded by cutting off food supplies into the cities.

This food embargo kicked off the famine. But it wasn’t the only cause. Nazi officials actually relaxed the embargo in November. They refused to let the Dutch people near the railways anymore, but they did let them ship food in via barges.

But relaxing the embargo barely helped. Many local crops failed that year due to bad weather. This caused shortages. And during the initial embargo, many farmers had shifted to selling food on the black market. That proved more lucrative. And, feeling greedy, they didn’t shift back to the regular market when the embargo was relaxed. This made shortages worse. 

Germany also began seizing food for its own people. Worst of all, the 1944 winter was among the coldest ever in Holland. All the ports and canals froze, making it impossible to ship food over water. As a result, food quickly got scarce.

Butter was the first food to disappear, in October 1944. Cheese and meat became scarce next. Then flour. Soon, food rationing went into place, with strict calorie limits.

In December 1944, the ration dropped under a thousand calories per day for adults. By March 1945, it dropped below 600–and it kept sinking. As one survivor said, “I remember getting up in the morning thinking of food: the whole day long, we talked about food; and I went to bed hungry and dreaming of food.”

To stretch the bread supply, flour was blended with sawdust. People mostly ate potatoes; you’d get around 2½ pounds per week. Community kitchens served potato peel and cabbage soup. If someone spilled any soup, people often dropped to the ground and licked it off the dirt.

Some people fled the city. They’d wander a hundred miles on foot into the countryside, to scrounge for moldy potatoes or scraps of cauliflower. Many brought along jewelry or antiques to trade to farmers who’d been hoarding food. Some people performed sexual favors for food, too.

Most notoriously, Dutch people began eating their pride and joy—the bulbs of tulips. They’d peel off the papery outer layer, then carve out the bitter yellow flower bud in the middle. The remainder of the bulb got blended into soups, or shredded like cabbage. Some people baked them and ground them up to form a sort of meatloaf—or tuliploaf, I guess.

The future actress Audrey Hepburn and her family got caught in Holland during the Hongerwinter when she was 16 years old. She had to eat tulips to survive, as did many others. 

Overall, twenty-thousand Dutch people starved to death during that awful winter. But as crazy as it sounds, one group saw their survival rates increase during the famine. The celiac patients of Dr. Willem Dicke.

During the Dutch Hongerwinter, children got priority for food. Their rations were less strict, and many got shipped to the countryside, where food was less scarce. Still, most children did suffer; there simply wasn’t enough food to fill anyone’s bellies.

Oddly, though, Willem Dicke’s celiac patients improved during the famine. Many gained weight on their diet of gruel, potatoes, and tuliploaf. Meanwhile, given the scarcity of wheat flour, they ate virtually no bread. This supported Dicke’s hunch that wheat and bread were triggering celiac disease. 

It also undermined those earlier supposed “cures”—the bizarre diets of bananas and oysters and tomato purée. 

Again, the health of celiac patients had improved on those diets. And now Dicke realized why. During the Hongerwinter, there were zero fruits available, and no oysters. So it wasn’t the excess of supposed superfoods that was helping patients. It was more that eating thirty bananas a day or whatever left no room to eat bread. Those quack diets did save lives—but for bogus reasons. It’s a complicated legacy.

The end of the war finally confirmed Dicke’s conviction that wheat and wheat flour lay at the heart of celiac disease. In late April, American and British planes began dropping packages of emergency supplies to the Dutch. The British poetically called the effort Operation Manna. The Americans used a grubbier name: Operation Chowhound.

The dropped packages included tin cans, chocolate, and flour. People could eat their fill for the first time in months. Bread! Pasta! Carbs! The places that hadn’t eaten all their tulip bulbs planted them so as to spell out messages like MANY THANKS in giant letters, to thank the pilots in planes.

At Dicke’s clinic, the celiac children tore into fresh bread, too, gobbling down their fill. And within a few hours—all the old symptoms started again. Stomach pain, diarrhea. And over the next few weeks, they began shedding weight again. 

At this point, Dicke could not delay any longer. His work until now had been informal and anecdotal. He now needed to run a proper clinical trial to nail down his suspicions about celiac disease and wheat.

So he selected five children who were hospitalized long term and systematically experimented with their diets. As expected, all five responded poorly to wheat in any form. 

To narrow things down further, he also began feeding them different components of wheat: wheat starch, wheat protein, et cetera. It took years to nail everything down. But by the late 1940s, Dicke had finally isolated the culprit for celiac disease: a protein called gluten.

Gluten is what makes flour elastic and easy to knead. Unfortunately, for some reason, it can also send the immune system into panic. Some people’s bodies mistakenly think gluten is dangerous and attack it. 

This attack damages cells in the intestine that absorb gluten, which causes abdominal pain. In addition, these damaged intestinal cells can no longer absorb nutrients. So food sluices right through the body undigested. And because people can’t absorb enough calories, rapid weight loss follows. It all fit together.

Sadly, Dicke died pretty young, at age 57, in 1962, after a series of strokes. So it fell to later scientists to nail down exactly how gluten triggers celiac symptoms. But his legacy is clear. The disease once killed thousands of children each year across the world, in ghastly ways. But nowadays, thanks to his careful observations, and one brutal winter of hunger, the death rate from the disease is essentially zero.

Surprisingly, the insights into celiac disease were not the only scientific advance to arise from the terrible Dutch Hongerwinter. Another field that benefitted was an offshoot of genetics called epigenetics. 

Epigenetics involves what you might call biological memories—how cells record trauma. I’ve put together a bonus episode about the Hongerwinter and epigenetics at patreon.com/disappearingspoon. Surprisingly, through epigenetics, some of this trauma proved to be multigenerational. That is, the grandchildren of men and women who suffered through the Hongerwinter were still suffering its effect a half-century later. It’s incredible stuff. That’s patreon.com/disappearingspoon.

War and medicine have been uncomfortable handmaidens for a long time. Indeed, war often benefits medicine.

Frankly, only during combat do doctors and surgeons see enough traumatic cases—in a high enough volume—to figure out how to save people. They’re forced to experiment and take risks. 

The U.S. Civil War introduced new types of bullets that shattered limbs. As a result, doctors got much better at amputating limbs and stopping hemorrhages. The Civil War also prompted great improvements in patient transport, anesthetics, and hospital hygiene.

Similarly, modern nursing began with Florence Nightingale in the Crimean War in the 1850s. And the Franco-Prussian War of the 1870s proved once and for all the importance of vaccines. 

Later, the Russo-Japanese War in the early 1900s sparked important vision research, and World War I vastly improved the treatment of facial injuries. More recently, the Korean War, Vietnam War, and other conflicts have taught surgeons how to reconstruct mangled nerves and veins, and reattach severed limbs instead of amputating them.

Now all of this can be unsettling—the realization that life saving cures can spring from senseless death. But there’s another way to look at things, too. Whether it’s Dicke’s work on celiac disease, or new treatments for shattered limbs, good can emerge from evil.

Obviously, no one dedicated to saving lives would prefer war. And in combat, the number of lives lost always exceeds the number saved. But only in the short term. Thanks to people like Dicke, in the long term, life wins.