Goiters on the Inner Asian Trails

I once read about the consumption of dried seafood among the Turkic elite in the western reaches of the Qing Empire—a curious inversion of the sailor dying of thirst at sea.

While long-distance trade in such delicacies was likely marginal compared to the flow of tea, rhubarb, and cotton, I have wondered lately if it was somehow linked to the goiters once so prevalent across the expanses of Inner Asia.

The scientific link between iodine deficiency and goiter was a late discovery, though intuitive connections between life in high mountains and the chronic swelling of the thyroid gland appear in Japanese folklore and Chinese medicine. In these traditions, seaweed served as a practical antidote to what were perceived as poisonous mountain mists.

In any event, goiters were apparently a common sight throughout Inner Asia. Early evidence appears in the work of the renowned 11th-century Turkic scholar al-Kashgari, who noted an ailment called "buquq" as being particularly widespread in the Fergana Valley. Documentation of endemic goiter recurs in the travels of Marco Polo, who attributed the condition to drinking foul water—a theme echoed by many of the European adventurers who traversed the region in the 19th century and beyond.

The water in question was not necessarily "foul," but the consumption of glacial meltwater, combined with the fact that the local mountain salt was largely devoid of iodine, meant the regional diet lacked this essential trace element. These conditions turned the goiter into an Inner Asian hallmark for centuries.

On the other side of the Tibetan Plateau, vast swaths of Nepal were known as the "Goiter Belt," with prevalence rates exceeding 50 percent in some areas until quite recently. It is reported that the affliction, which was more common among women, was sometimes even considered a mark of beauty—perhaps a case of making the best of a difficult reality. Goiters were also extremely common further down the road in Yunnan until the very recent past.

The link between iodine deficiency and hormonal disruption was discovered in the early 20th century, roughly around the same time the causes of bubonic plague and malaria were identified. All this serves to remind the modern wanderer—whether on the ground or in an armchair—that alongside any nostalgia, the power of the modern state and its overbearing institutions has enabled a significant improvement in living conditions. The exotic pastoralism of the past does not always go down easy.