

A lucky little fish solves iron deficiency among women in Cambodia - gwern
http://www.thestar.com/news/gta/2011/11/12/canadians_lucky_iron_fish_saves_lives_in_cambodia.html

======
AdmiralAsshat
Before any more "How silly, he had to make the iron look appealing to get
people to do something healthy" comments arise, I invite readers to consider
how many of you have paid $15 or more for a BPA-free glass/stainless
steel/double-walled plastic reusable water bottle. Did you really need that
over a simple plastic water bottle? Or a cup? My guess would be no. But you
did it because you're trying to get yourself to drink more water, and perhaps
that requires getting a vessel that looks or feels aesthetically pleasing to
use habitually.

Disclaimer: I bought an Ello glass bottle from Target less than 48 hours ago
for this very purpose--to make myself drink more water. I don't consider
shaping iron into the shape of a fish all that different.

~~~
johansch
Or put a completely different way: Why would the people of Cambodia trust
their government if they came out and said you should put some iron stuff in
your pots?

This would be from one of the few governments on earth that are less
trustworthy than the average american one. Perception-wise or in reality, does
it matter? Anyway, this is an angle americans should be able to identify with.
:)

~~~
electromagnetic
We've got lots of hard proven facts on a lot of topics, like vaccinations.
People still don't get their kids vaccinated, and then we get outbreaks where
kids die from the measles.

Perception can easily outweigh facts for a lot of people. If we could find a
way to trick people into vaccinating their kids we would use it.

The attitude of "they're just stupid people who don't know better" is kind of
disgusting when we've got college and university educated people exhibiting
the exact same behaviour. Who's dumber? The person that doesn't know better or
the person who _should_ know better, because I think it's the latter.

So to all the people who think these are just stupid people. If the US
government had exterminated 70 million Americans three decades ago, would you
be giving your kids a single vaccine? Or would you expect it to be part of
another genocide campaign?

~~~
cperciva
_The attitude of "they're just stupid people who don't know better" is kind of
disgusting when we've got college and university educated people exhibiting
the exact same behaviour._

I have no trouble saying that college and university educated people who
choose to not vaccinate their kids are stupid people.

~~~
m_eiman
Intelligent and stupid, it's a very dangerous combination.

------
destructopuffin
You can support the project at their website.
[http://www.luckyironfish.com/](http://www.luckyironfish.com/)

~~~
nickff
Thanks for the link, I put in $45. Shipping the fish to supporters was a great
idea, because we can show them to friends, and promote the project.

This is the kind of project that I wish more researchers and activists would
do, as it has the potential to improve the lives of a large number of
individuals in a meaningful way, as well as giving other people who are far
away the means to help.

------
pdm55
I'm confused. (It easily happens). How does adding an iron (Fe) object to a
cooking pot increase intake of iron ions (Fe 2+). Note that I am saying Fe(2+)
intake. As I understand it, haemoglobin has an Fe(2+) ion trapped in it's
structure. This is required for the uptake of oxygen molecules (O2) from the
lungs, carrying it in the blood stream and releasing it at sites where there
is an oxygen deficit. This is a long way of saying that Fe (2+) is utilised by
the body, not Fe. If this is unclear, think in terms of sodium. We use sodium
ions (Na+) not sodium atoms (Na). We put NaCl on our food, not Na. Na is very
reactive and would react violently with our moist skin. We know that once it
loses its electron to chlorine, a similarly highly reactive element, and
becomes Na+ (in combination with Cl-) it is in an unreactive form and is used
by the body for propagation of impulses along nerves. Back to Fe (2+). I guess
that talking about Fe is just an imprecise way of talking about our need for
Fe2+. The question then in my mind is "How does the Fe added to the cooking
pot become Fe(2+)?" Does it just become oxidised to iron oxide (FeO,Fe2O3,
Fe3O4?). I am trying to think what would a soluble form of Fe2+. Wikipedia
lists these as insoluble. Perhaps salt is required in the cooking pot and iron
chloride Fe2+ Cl2- is formed. But I cannot see Fe winning in a charity tustle
with sodium for the donation of it's electrons to chlorine. Maybe, the
formation of iron oxides are an interim step. Who knows?

~~~
sjg007
Acids from what you cook in the iron pot leech out the Fe2+ needed. E.g. throw
in a tomato, lemon, ...

~~~
pdm55
Thanks. More power to balsamic vinegar!

------
pcrh
What are the local cooking pots made of? Steel and cast iron would be the
cheapest, and I assume leach iron into the food. I also imagine that the
surface area of the pot is much larger than that of this "lucky fish".

A quick search found this, which appears to be cast iron:

[http://www.pbase.com/bmcmorrow/image/28438185](http://www.pbase.com/bmcmorrow/image/28438185)

~~~
pcrh
OK, I searched a bit and found an article from 2011, which appears to be the
original source (free access [1]). It appears that aluminum is the most common
material from which local pots were made.

[1]
[http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011....](http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02878.x/pdf)

~~~
thizzbuzz
Correct, it is hard to find anything other than aluminum pots here.

~~~
SiVal
In rural Asia, cast iron tends to be--relative to flimsy aluminum--too
expensive, too heavy (a large percentage of those doing the cooking weigh less
than 100lbs/45kg), and too poor at conducting heat and too good at absorbing
it (thermal inertia), meaning that more cooking fuel is required to cook small
meals in cast iron pots than in aluminum.

------
ars
And now you know why so many people believe in luck or talismans.

Next time you come across such things don't ridicule them, or the people that
believe in them.

~~~
Zikes
It wasn't until it was spun as a lucky charm that they actually deigned to use
it properly. The pre-existing superstition was only a delivery method for the
solution, not a result of it.

~~~
ars
Only for the first year, after that cause and belief will be swapped, and
people will believe the fish is lucky because of the iron fish.

Give it a generation and people might not even remember that the living fish
was ever considered lucky (or why).

------
pzxc
I'm getting a 404 Not Found

Here's the google cache version for anyone else:

[https://webcache.googleusercontent.com/search?q=cache:SfJuFH...](https://webcache.googleusercontent.com/search?q=cache:SfJuFHxKLswJ:www.thestar.com/news/gta/2011/11/12/canadians_lucky_iron_fish_saves_lives_in_cambodia.html+&cd=2&hl=en&ct=clnk&gl=us)

------
Scoundreller
> A disease of poverty, iron deficiency affects 3.5 billion people in the
> world.

> They found a local scrap metal worker who could make them for $1.50 each

Paging Bill Gates... A one-off payment (these would last forever, right?) of a
few billion would solve this problem... everywhere and forever?

~~~
PhantomGremlin
They can't last "forever" because if they did there wouldn't be any increased
iron in people's diet!

~~~
evilduck
At $1.50/ea I feel like humanity can afford to replace them like once every
800 years.

~~~
UntitledNo4
From [http://www.luckyironfish.com](http://www.luckyironfish.com):

"One Lucky Iron Fish can provide an entire family with up to 75% of their
daily iron intake for up to 5 years".

So we'll need to replace them a bit more often than that (not that I'm saying
it's not a good cause).

~~~
evilduck
Back of napkin math says we need approx 8mg/adult/day, say we're cooking for a
family of 4, we'd need 32mg of iron leached from the fish per day. I'll guess
from the picture that the fish weighs about 3/4 of a pound as pure iron, or
453593mg, so it should last about 38 years at that rate. So I was off by a
bit. :) Surface area would obviously reduce as it dissolved and the rate of
leaching iron would underserve the family before it really began to look
unfamiliar, so you'd not want to completely dissolve it. 5 years is definitely
overly cautious, it should easily last 2-4x that long, but gives them a good
excuse to reinforce the reasoning of the fish when a replacement is provided.

------
jedanbik
It solves the problem and looks cute, while costing next to nothing. This is
good design.

------
lovemenot
Better print on it: "Not for human consumption" in Khmer and/or a crossed-out
icon of a person dangling a lucky fish into their mouth.

------
FractalNerve
Is his MSc. or PHd. thesis on the iron fish online?

~~~
kaybe
I found three papers on the topic authored or coauthored by Charles:

Iron content of Cambodian foods when prepared in cooking pots containing an
iron ingot
[http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011....](http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02878.x/full)

Iron-deficiency anaemia in rural Cambodia: community trial of a novel iron
supplementation technique
[http://eurpub.oxfordjournals.org/content/21/1/43](http://eurpub.oxfordjournals.org/content/21/1/43)

Women's nutrient intakes and food-related knowledge in rural Kandal province,
Cambodia.
[http://apjcn.nhri.org.tw/server/APJCN/23/2/263.pdf](http://apjcn.nhri.org.tw/server/APJCN/23/2/263.pdf)

(I'm not logged in, so it should be public, I hope)

~~~
teddyh
That second link leads to a paper containing this:

 _Results: Blood iron levels were higher in women in the iron fish plus
follow-up at 3 months compared with controls, but this was not maintained. At
6 months, haemoglobin and serum iron had fallen in all groups and the
proportion of anaemic women had increased.

Conclusions: This study shows that the iron ingot was effective in the short
but not longer-term against IDA. Though a novel treatment option, further
research is warranted to determine bioavailability of leached iron and whether
or not the surface area is large enough for sufficient iron leaching._

(The third paper does not seem to mention the iron fish.)

Does this mean that the whole thing is another bogus gimmick which only
survives because it’s a cute thing which first-worlders like to throw money
at?

------
coralreef
How is the iron from the fish absorbed exactly? Do trace amounts just fall off
from the fish when rubbed against the cookware?

------
hwgd
interesting. does cooking with cast iron also help increase iron levels? Or is
the increase insignificant?

~~~
randlet
It helps, but it mentions in the article that they didn't want to switch to
cast iron cookware because they are heavy and expensive.

~~~
pcrh
What do they use then?

~~~
randlet
Aluminum or steel I would imagine.

------
oopsiforgot
I got this for my wife for our 6th anniversary. Iron!

------
sa1
How is rust dealt with?

------
iopq
Nutritionists HATE it!

------
Zikes
It's pretty incredible that so much effort was even necessary. The solution
was there at the start - put a chunk of iron in the pot - but despite the
known and obvious health benefits and miniscule amount of effort, the
population simply rejected it.

~~~
code_duck
I've spent a great deal of effort trying to convince people around me to do
things that are clearly healthy in the short and long-term… Eat vegetables,
drink enough water, avoid artificial colors, preservatives and sweeteners,
exercise proper precautions in workshops. It's futile.

I agree it's frustrating that people won't simply believe facts about how to
fix their health problems when presented to them, and then are happy to
embrace superstitious symbols instead of logic. But I'm not surprised,
considering how many people I know who complain about the common symptoms of
dehydration daily but refuse to believe that what they need to do is just
drink some water... But are happy to take an Excederin with Coca Cola to mask
their dehydration headache.

~~~
csours
Ok, so what is the issue with:

> artificial colors, preservatives and sweeteners

I understand that they are a signal that what you are about to consume has
been processed, and is likely unhealthy on balance; do you see an inherent
problem with these ingredients?

~~~
code_duck
That one isn't the greatest example of what I was trying to say. While I avoid
additives I don't really often suggest to other people that they do.

My perspective is that additives are nutritionally neutral at best, and many
may be mildly harmful. So, given the choice I don't consume them. If I'm
shopping I would prefer something like butter vs Blue Bonnet margarine. I
don't feel convinced of the safety of chemicals like Yellow #5, and if I need
for my food to be fluorescent yellow for some reason, would prefer turmeric. I
consider whole foods to be better tested over time for human health than a
semi-synthetic concoction.

As you say, generally the presence of synthetic colors and presevatives tells
me the manufacturer has the wrong priorities (cost and surface presentation vs
flavor, freshness or nutrition).

An example of food I shun is the typical grocery store tortilla. Most are
loaded with presevatives so they can last on the shelves for months, which
gives them a bitter taste. When I compare one of those brands, with 10-15
ingredients, most of which aren't technically food, to what I'd call normal
tortilla with 4 ingredients, all of which are something someone would have in
their own kitchen, and it's clear the simple tortilla wins in every way but
shelf life. Since I consume my tortillas within a couple of days and am
willing to keep them in the refrigerator, presevatives enhancing shelf life
benefits the manufacturer and distributors, but fails to benefit me in terms
of flavor and possible negative nutritional effects.

------
pvaldes
mmmh... Aluminium in excess inhibes enzymes, can cause colic, lost of memory,
desorientation, kidney damage and even is claimed to cause dementia at long
term.

So (unless this fish can float?) I understand that you are also scratching the
bottom of the pan with the iron chunk and this should release a lot of more AL
than before because this metal is soft.

I wonder what are the efects of using the fish in the aluminium intake of
these people. They did some research about it?.

Maybe a better solution could be to make pans with some iron embedded (ring?,
bottom?, cover?) but not mobile pieces.

------
Scoundreller
The body is very good at conserving iron and unfortunately not very good at
dealing with iron overload.

It says that the device can provide up to 75% of iron requirements, but under
what conditions could it start to give >100%?

~~~
electromagnetic
That's a very misleading statement, the body is able to significantly reduce
the amount of iron absorption through the intestines.

Non-genetic related iron overload is rarely heard of outside of dietary
supplement overuse, predominantly children eating iron fortified supplements.

For an ordinary person to eat too much iron, you would have to have an
exceptionally bizarre diet, especially if you're overdosing on iron via
elemental iron.

The upper tolerable limit for a daily intake of iron is 45mg. To get this via
sirloin steak, you would have to eat _three and a half pounds a day!_ Or 3700
calories of steak _per day._

Given that heme-iron is the most readily absorbed by the body, and that
guidelines suggest vegetarians consume 1.8 times the RDI, which would suggest
an 80mg upper tolerable limit for non-heme iron.

So lets take Broccoli, everyone knows that's iron rich. 2.1mg per medium stalk
(1/3lb), which would amount to 7 lbs of Broccoli a day.

Please, don't state bullshit like it's a fact.

~~~
Scoundreller
Food examples are great and all, but the article is about an _iron block_ that
you cook food with. Per your numbers, one would only need to consume 80mg+ per
day (of the elemental) to start getting into trouble territory.

My concern is over how cooking conditions (or other factors) may affect how
much iron leaches out into the food, which would cause iron overload if high
enough, just like those iron fortified supplements.

I never stated that the body can't adjust the amount of iron absorbed.

I stated that iron overload, which is when one's body already has too much
iron accumulated, is not well handled by the body. This is true, because the
body is very poor at _excreting_ iron in response to excessive iron levels,
because iron is conserved very well (unlike, say, Vitamin C).

~~~
Turing_Machine
People have cooked in cast iron pots for thousands of years.

It's not a problem.

