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Back away from the bok choy, ma'am

JoNel Aleccia writes:

Eating extra veggies is a good goal, but an 88-year-old Chinese woman took the quest too far, consuming enough raw bok choy to send herself into a life-threatening, thyroid-induced coma, doctors say.

The woman showed up at a New York emergency room last summer, complaining she couldn't walk or swallow. But the real trouble, according to a report in Wednesday's New England Journal of Medicine, was that she'd been chowing down on 2 to 3 pounds of bok choy every day for several months in hopes of controlling her diabetes.

For those unfamiliar with the vegetable also known as Chinese white cabbage, that's the equivalent of eating two or three large heads a day of the stiff, leafy stalks. And the woman apparently munched them plain, without a dab of dressing or a sprinkle of salt, according to Dr. Michael Chu, a resident at the New York University School of Medicine who helped care for her.

"I am not sure if she had trouble consuming so much bok choy," Chu said. "It never came up that it was difficult to do so."

What was difficult was keeping the woman's thyroid working after the bok choy spree basically shut it down. It turns out that raw vegetables in the Brassica rapa family, which includes bok choy, release an enzyme called myrosinase, which triggers a process that puts the brakes on thyroid function.

Cooking deactivates the enzyme, but by eating so much bok choy raw, the woman sent her system into a severe form of hypothyroidism. She went into respiratory failure and then into a myxedema coma, a rare and usually deadly complication of too little thyroid hormone. 

It took massive intravenous doses of a synthetic thyroid hormone and a powerful anti-inflammatory medication to save her life, according to Chu's report. 

The case could serve as a warning to others, but Chu said he's not sure how many people would consume enough raw bok choy to put themselves in that position.

As for the woman, she recovered and was sent to live in a skilled nursing home for further care. There's no word on whether bok choy ever shows up on the menu.