Downton Abbey finale has a lesson in nutrition

I’m going to miss Downton Abbey. Escaping into the lives of the Crawleys was a wonderful Sunday night treat – that always left me grateful to be living in our era, especially as a woman.

For those of us nostalgic for old times, and especially those who claim nutrition science is useless, there was a small lesson to be learnt from the drama-packed finale.

(If you haven’t been following the series it really doesn’t matter; read on. Spoiler alert for those who haven't watched the chapter yet, although I'm not giving away much.)

Lord Merton, Isobel’s onetime fiancé discloses that he has a terrible diagnosis. He was feeling weak, and visited the best doctors in London, who ran all the tests and diagnosed anemia. Isobel’s worried face lightens up hearing this, but Lord Merton quickly brings her hopes down. At this point I thought he was going to say he has leukemia, but what he has is pernicious anemia – and Isobel realizes his end is near.

Pernicious means dangerous, destructive, deadly.

So what’s Lord Merton malignant condition? Are Isobel’s gloomy tears justified?

Pernicious anemia was described by English researchers in the mid nineteenth century. Patients had anemia with all its symptoms (fatigue, pallor, rapid heart beat), and also mental slowness, memory loss, numbness and tingling of hands and feet, walking difficulties and mild dementia. In the lab, a blood smear would show megaloblasts: abnormally large immature blood cells. It was an invariably fatal, rapidly progressive disease.

Nowadays, pernicious anemia’s death sentence is overturned within 1-2 days – with one injection.

What causes this mystery fatal illness?

Pernicious anemia is B12 deficiency. This vitamin was finally discovered and isolated in 1948 – many decades after the disease was first described and 23 years after the time described in this Downton Abbey chapter. B12 deficiency is usually a result of inability to absorb the vitamin, but can also develop in cases where intake of the vitamin is very low – such as in vegans who don’t take B12 supplements and their exclusively breast-fed infants. Only animal-origin foods have B12: dairy, eggs fish and meat and shellfish are all good sources.

There might be pieces of the past we wish we could have held on to, but with all the criticism we rightfully have of modern medicine let’s be thankful for all the suffering it has helped us avoid. It’s because we now know so much more about nutrition that the classic nutritional diseases (such as scurvy, beriberi, pellagra and rickets) are rare and easily treated.

People often say nutrition science is confused, that advice changes every other week. Well, nutrition science is a young science, and like all science it is moving towards the discovery of truth – sometimes taking an unfortunate detour on a path that leads nowhere before correcting course. The main problem is the abuse and hype nutrition science suffers by the hands of weight-loss and food marketers. Diet and exercise programs sometimes latch onto flimsy evidence, twisting and exaggerating findings, and creating an enormous amount of hype – to their gain and the general public’s confusion.

Science is complex and slow moving. Nutrition science it especially difficult, because it deals with people eating – at their own will – diverse foods throughout a lifetime. We are moving towards answers and consensus at a much faster rate than we did in Downton’s time, and with some patience and perspective – and less distractions – we will know much more.

I’m going to miss Downton Abbey, and its reminders of how far we’ve come.

Dr. Ayala