Avraham Z. Cooper, MD Profile picture
Nov 14, 2021 17 tweets 8 min read Read on X
1/🧵
Ever wonder why cutting onions makes you cry?

Something must be released that causes this irritating response, but what?

It turns out that cutting an onion jumpstarts multiple chemical reactions, in the air and right in front of your eyes.

#medtwitter #tweetorial 🧅
2/
💡Onions are actually one of the oldest cultivated crops, first entering the human diet ~5,000-7,000 years ago.

Ancient Egyptians worshipped onions (evoked eternity) and ancient Indians, Greeks, and Romans believed that they had medicinal properties.

onions-usa.org/all-about-onio…
3/
But as anyone who has ever cut or chopped an onion knows, the simple act of chopping them causes almost immediate eye irritation and tearing.

Why?
4/
First we need to confirm what occurs at the cellular level when an onion is cut.

🔑It turns out that with damage to the onion's cell walls, a specific sulfur compound is released into the air:

S-alkenyl cysteine sulfoxide

pubmed.ncbi.nlm.nih.gov/23443367/
5/
Along with S-alkenyl cysteine sulfoxide, an enzyme called allinase also gets released into the air from the onion.

Allinase converts the sulfoxide molecule into sulfenic acids.

💥This reaction occurs IN THE AIR, mind you.

pubmed.ncbi.nlm.nih.gov/23443367/
6/
Sulfenic acids happen to be very unstable and spontaneously rearrange to thiosulfinates.

Thiosulfinates give onions their pungent aroma/flavor and were once assumed be the source of onion-crying.

pubmed.ncbi.nlm.nih.gov/23443367/
7/
But it turns out that thiosulfinates, while the source of an onion's flavor, are not the source of eye irritation and crying.

In 1971, two chemists isolated a tear-inducing substance from onion extract, a so-called "lachrymatory factor".

pubs.acs.org/doi/abs/10.102…
8/
🔑The lachrymatory factor they found is actually propanethial-S-oxide.

It also derives from sulfenic acids, but requires enzymatic conversion by a second enzyme called lachrymatory factor synthase (LFS).

pubmed.ncbi.nlm.nih.gov/12384686/
9/
So we have established that the source of crying with onion cutting is propanethial-S-oxide, the lachrymatory factor.

How lachrymatory factor induces crying isn't well established but it seems to act as a direct corneal irritant.

iovs.arvojournals.org/article.aspx?a…
10/
Can we prevent this irritating effect?

Contact lenses block propanethial-S-oxide's access to the cornea via barrier action.

In this small study, contacts delayed the onset of irritation compared to no lenses after exposure to propanethial-S-oxide.

iovs.arvojournals.org/article.aspx?a…
11/
3 other potential strategies:

🧅 Goggles

🧅 Chilling onions may ⬇️ lachrymatory factor synthase activity and ⬇️ propanethial-S-oxide production.

🧅 Some believe that cutting onions under running water washes away propanethial-S-oxide as it forms.

pubmed.ncbi.nlm.nih.gov/3975593/
12/
Two final questions. First:

Garlic + scallions are closely related to onions, from the genus Allium.

Why don't we cry w/ chopping them?

💡Scallions + garlic can't make propanethial-S-oxide as they lack the lachrymatory factor synthase enzyme.

pubmed.ncbi.nlm.nih.gov/12384686/
13/
Finally, could an onion be modified to not produce propanethial-S-oxide, the lachrymatory factor?

An onion unable to ultimately produce propanethial-S-oxide should be non-pungent and "tearless".
14/
A group in Japan did genetically transform an onion strain to lack lachrymatory factor synthase.

When cut, these onions cannot produce propanethial-S-oxide and do not cause crying.

They also apparently taste fairly bland.

ncbi.nlm.nih.gov/pmc/articles/P…
15/
🧅Cutting onions ➡️ crying b/c of multiple enzymatic reactions in the air
🧅Allinase converts a released sulfoxide to
sulfenic acids, which rearrange to thiosulfinates
🧅Lachrymatory factor synthase converts thiosulfinates to propanethial-S-oxide (=source of onion-crying)
Thank you for reading and happy cooking!

Cc the legendary @Nigella_Lawson, who might find this interesting.
Correcting a small error in the summary tweet:

Propanethial-S-oxide is derived from sulfenic acids by lachrymatory factor synthase, not from thiosulfinates.

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More from @AvrahamCooperMD

Mar 3
1/THREAD

How could eating black licorice cause life-threatening hypokalemia?

Why in the world could specifically eating this food cause serum potassium levels to dangerously drop?

#medtwitter #tweetorial Image
2/
Let's first review what black licorice is actually made from.

Black licorice is a sweetener found in candy, tea, sweet drinks, and even beer.

It's extracted from the root of the legume Glycyrrhiza glabra plant.

licorice.com/blogs/news/wha…
Image
3/
Thousands of years ago, ancient Egyptians drank licorice as a sweet drink, and archaeologists found licorice in King Tut's tomb.

Alexander the Great and Napoleon both chewed on black licorice root during battle for its soothing properties.

klepperandklepper.com/knowledge-base…
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Read 16 tweets
Sep 24, 2023
1/
Why can multiple sclerosis symptoms worsen with heat exposure, something known as the Uhthoff phenomenon?

This question is especially relevant in the era of record-breaking heat waves and climate change.

#tweetorial #medtwitter Image
2/
In 1890, Wilhelm Uhthoff noted multiple sclerosis (MS) patients having a “marked deterioration of visual acuity during exercise" or after a hot bath, which ⬆️ body temperature.

1 patient lost vision just by walking vigorously in Uhthoff's clinic.

pubmed.ncbi.nlm.nih.gov/20375511/

Image
Image
3/
The Uhthoff phenomenon is now recognized as exceedingly common in MS.

Up to 80% of patients experience ⬆️ neurological symptoms w/ even small body temp increases. These can include diminished physical (eg gait) and cognitive (eg mental fog) function.

journals.sagepub.com/doi/abs/10.117…
Image
Read 15 tweets
Jun 25, 2023
1/THREAD
Has it ever occurred to you that Graves' disease presents a conundrum?

Graves' involves an autoimmune antibody that ACTIVATES a receptor, which is relatively unique in the landscape of human disease.

Let's unpack this fascinating mechanism.
#medtwitter #tweetorial
2/
Graves’ disease was first described by English physician Caleb Parry in 1786, when he noted an association between thyroid enlargement, tachyarrythmias, and exopthalmos in 8 patients.

Parry’s son posthumously published his description in 1825.

https://t.co/sklIBMwyzDlitfl.com/graves-disease/


3/
In 1835, 10 years after publication of Parry's description, Irish surgeon Robert Graves described a patient w/ thyromegaly + exophthalmos.

Although clearly not the first description, Trousseau proposed the name Graves' disease in 1862 and it stuck.

https://t.co/D3DY4WwF7dlitfl.com/graves-disease/


Read 18 tweets
Apr 23, 2023
1/THREAD
Ever wonder why amphotericin B can cause severe infusion reactions, including chills/rigors + hypotension?

These infusion reactions are so awful that it carries the nickname "amphoterrible".

Why does this happen? The answer is mind-blowing.

#medtwitter #tweetorial Image
2/
First let's review amphotericin B's history.

In 1953, analysis of a fermentation broth from Venezuelan soil found 2 antifungal compounds: amphotericin A and B.

B had a broader antifungal activity spectrum and so underwent further drug development.

pubmed.ncbi.nlm.nih.gov/33261213/ Image
3/
Amphotericin B (AmB) contains a hydrophobic polyene "tail" and a hydrophilic amine "head".

This amphipathic profile allows AmB to bind ergosterol in fungal membranes, which is thought to cause ion-leaking pores to form, killing the fungus.

pubmed.ncbi.nlm.nih.gov/33261213/ Image
Read 19 tweets
Mar 5, 2023
1/THREAD
Ever wonder why fluoroquinolones increase the risk of tendon rupture?

It seems so random that a whole class of antibiotics could cause tendon injuries, but the risk is real.

#medtwitter #tweetorial
2/
Fluoroquinolones inhibit bacterial function by blocking topoisomerase activity.

They first emerged as an antibiotic class in the 1960s, as byproducts of antimalarial quinine development.

Nalidixic acid = the first quinolone discovered.

pubmed.ncbi.nlm.nih.gov/14056431/
3/
The first report of fluoroquinolone-associated tendinopathy occurred in 1983.

2 renal transplant patients received norfloxacin and subsequently developed achilles tenosynovisitis.

Their symptoms spontaneously resolved w/ cessation of the norfloxacin.

pubmed.ncbi.nlm.nih.gov/6223241/
Read 16 tweets
Jan 22, 2023
A short 🧵 on my 3️⃣-prong approach to rounding with resident teams in the MICU…

I emphasize 3️⃣ themes to the residents and fellows:

1️⃣ Clinical care
2️⃣ Education
3️⃣ Development

#MedTwitter #MedEd
1️⃣ Clinical care

I ask teams to focus on efficiency, ⬆️ time for teaching/ discussion

⏳⬇️ transitions b/w patients by alerting next RN
⏳Enter orders on rounds, w/ clearly defined roles as to who will do that
⏳Present from memory (if possible), focusing on critical issues
2️⃣ Education

🧠I ❤️ to teach but avoid overwhelming residents by teaching high yield points on 2-3 patients max. I supplement w/ PM chalk talks after lunch and notes are done

🧠 I also ask each learner to share one learning point from rounds, and do so myself as well
Read 5 tweets

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