Published by Gideon Koren & Yona Amitai
Maccabi-Kahn Institute of Research and Innovation and Motherisk Israel Program, Tel Aviv University and Bar Ilan University
These findings are described in the article entitled High risk for neural tube defects; the role of arsenic in drinking water and rice in Asia, recently published in the journal Medical Hypotheses (Medical Hypotheses 119 (2018) 88-90). This work was conducted by Yona Amitai from Bar Ilan University and Gideon Koren from the Maccabi-Kahn Institute of Research and Innovation and the Motherisk Israel Program, Tel Aviv University. Competing financial interests: The authors declare they have no actual or potential competing financial interests.
So many bad things that happen to babies are unpreventable; therefore, it is a pity to miss out on an opportunity to improve an adverse outcome whenever possible.
Neural tube defects (NTDs) are serious and debilitating birth defects, affecting an estimated 300,000 cases a year worldwide. The incidence of NTDs in Northern India (7.7/1000), is tenfold higher than in the US (0.7/1000). Similarly, while very high rates were also reported in Northern China, the causes of these trends are unknown. Arsenic induces NTDs in animals. Toxic arsenic regions in China and India overlap with regions where the NTDs rates are the highest. Rice, the staple food in both countries, absorbs 10 times more arsenic than any other crop.
Despite widespread use of folic acid before pregnancy, and despite the fact that it can reduce NTDs by 75%, NTD rates in these regions remain high. We believe that this NTD-arsenic-rice triad may explain why these areas in the northern regions of both countries have the highest incidence of NTDs worldwide. This is also a critical opportunity in prevention.
Dietary arsenic is a large source of arsenic exposure in the general population, and rice is the major source of arsenic exposure. Rice is very efficient in absorbing arsenic from soil, and, importantly, rice flour and syrup are widely used, hence exposure is not limited only to the people eating the grain itself.
In terms of prevention, cooking rice by repeatedly flushing it through with fresh, hot water can remove over 50% of its arsenic content. In parallel, avoiding rice consumption in favor of non-staple foods during early pregnancy may also be effective. A revolutionary new idea — breeding rice which is genetically resistant to the accumulation of arsenic — has also been attempted. A higher dose of folic acid (0.8 mg per day) could further decrease the elevated risk for NTDs induced by arsenic.
The personal and societal costs of spina bifida and other NTDs exceeds 1 million dollars per case, not counting the suffering and poor quality of life associated with these debilitating congenital malformations. These children are developmentally delayed and paralyzed, and their misery is at the extreme. Future work should confirm our hypothesis and embark on practical ways to prevent arsenic exposure to huge populations in Northern India and China. While arsenic may affect the population at large, in our case, the suffering lies with the children.