Jude Tunyi
Columbus, Ohio, United States

 

John F. Kennedy leaving on gurney from hospital following spinal surgery, as his wife Jacqueline stands over him. Dick DeMarsico, 1954. Library of Congress Prints and Photographs Division.

Most Americans are familiar with the life and death of John F. Kennedy (JFK), but they may not know about his celiac disease and autoimmune polyglandular syndrome (APS) type 2. Neither condition has been proven by autoantibody tests, but from examining available medical records, several authorities now believe he dealt with these conditions from a young age.

JFK was the second of nine children.¹ His family was wealthy, as his father had amassed a fortune through banking, film, and the stock market.¹ Because of his mother’s breast infection, JFK was not breastfed, unlike his siblings.² Recent studies have noted the immune-protective effect of breast milk on a developing baby³ and that short duration breastfeeding is associated with more autoantibodies to insulin and to glutamic acid decarboxylase.⁴ Such autoantibodies are associated with an increased risk of type 1 diabetes mellitus, though others have extrapolated that the protective effect of breastfeeding might also extend to other autoimmune diseases such as APS and celiac disease.³

As a child, JFK experienced weight loss, abnormally low white blood cell count, fevers, and hives.² His mysterious illness was treated with bone marrow medication. His physicians eventually found that he was allergic to grains, milk, and other foods, and once placed on a special diet, his gastrointestinal symptoms mostly resolved.² Thus was celiac disease unofficially diagnosed.

Celiac disease was described in ancient Greece by a physician who noted the impact of dietary malabsorption on children.⁵ In 1924, pediatrician Sidney Haas realized that carbohydrates could be the disease’s cause, and he started children on a special banana diet.⁵ Years later, autoantibodies such as anti-gliadin and anti-tissue transglutaminase were identified, and celiac disease became recognized as an autoimmune disease.

JFK’s conditions impacted his future aspirations. He enrolled in Princeton but had to withdraw due to “a gastrointestinal illness, jaundice, weight loss and fatigue” that left him in the hospital in his freshman year.² He later reenrolled in Harvard, continuing to have intestinal problems and a low white blood cell count, which his doctors believed to be leukemia.² His family grew concerned with his (now regarded to be) APS type 2 symptoms. He tried to enroll in the military but was rejected until he received treatment and his symptoms regressed.²

APS type 2 can be difficult to diagnose. It develops due to genetic and environmental factors, and affects between 1 in 1,000 and 1 in 20,000 people in the general population.⁶ It is polygenic and has been shown to implicate major histocompatibility complex genes on chromosome 6 with certain human leukocyte antigens, predisposing an individual to the condition.⁶ It manifests itself in at least two out of three conditions: type 1 diabetes mellitus, hyperthyroidism (autoimmune Grave’s disease), and primary adrenal insufficiency (Addison’s disease).⁶ JFK had the characteristic changes of Addison’s disease—weight loss, fatigue, abdominal pain, and, most characteristic of all, skin hyperpigmentation.¹ This “tan” was noticed early, and voters ascribed it to an athletic suntan. However, in reality, it was due to excess adrenocortotropic hormone (ACTH). In Addison’s disease, excess ACTH breaks down and produces alpha-melanocyte stimulating hormone,⁷ which acts on the melanocytes to produce excess melanin, resulting in a noticeable tan, especially of buccal mucosa, nail beds, and exposed skin.⁸

According to his medical records, JFK also probably had hypothyroidism.² He had ongoing complaints of fatigue, constipation, and muscle aches.² Hypothyroidism affects about 5% of the general population worldwide⁹ and can be caused by lack of iodine in iodine deficient areas. It is possible that JFK’s hypothyroidism developed because of a lack of iodine,^1,10 though the more likely explanation is antithyroid autoimmune antibodies.

So why did Kennedy keep his medical information so secret? In a July 1959 interview when he was still a US senator, he said that “no one who has the real Addison’s disease should run for the presidency, but I do not have it.”¹¹ He ran for president in 1960 and defeated the incumbent vice president, Richard Nixon.¹ Kennedy had thought that an Addison’s diagnosis might impact his political aspirations.

But this begs the question: was JFK correct? Would knowledge of his medical ailments have harmed his presidential campaign? And how much of a potential president’s private medical history does the voting public have a right to know? These are appropriate questions as we look forward to future presidential and political campaigns.

 

References

1. Manchester W. John F. Kennedy. Encyclopaedia Britannica. Last updated March 3, 2023. https://britannica.com/biography/John-F-Kennedy.
2. Macchia D, Lippi D, Bianucci R, Donell S. President John F Kennedy’s medical history: coeliac disease and autoimmune polyglandular syndrome type 2. Postgrad Med J. Sep 2020;96(1139):543-9. doi:10.1136/postgradmedj-2020-137722.
3. Borba VV, Shoenfeld Y. Breastfeeding in the systemic lupus erythematosus patient. Lupus Dec 2019;28(14):1737-8. doi:10.1177/0961203319887788.
4. Holmberg H, Wahlberg J, Vaarala O, Ludvigsson J, Group AS. Short duration of breast-feeding as a risk-factor for beta-cell autoantibodies in 5-year-old children from the general population. Br J Nutr. Jan 2007;97(1):111-6. doi:10.1017/S0007114507210189.
5. Losowsky MS. A history of coeliac disease. Dig Dis. 2008;26(2):112-20. doi:10.1159/000116768.
6. Singh G, Jialal I. Polyglandular Autoimmune Syndrome Type II. StatPearls. 2022.
7. Betterle C, Presotto F, Furmaniak J. Epidemiology, pathogenesis, and diagnosis of Addison’s disease in adults. J Endocrinol Invest. Dec 2019;42(12):1407-1433. doi:10.1007/s40618-019-01079-6.
8. Sarkar SB, Sarkar S, Ghosh S, Bandyopadhyay S. Addison’s disease. Contemp Clin Dent. Oct 2012;3(4):484-6. doi:10.4103/0976-237X.107450.
9. Chiovato L, Magri F, Carle A. Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Adv Ther. Sep 2019;36(Suppl 2):47-58. doi:10.1007/s12325-019-01080-8.
10. Leung AM, Braverman LE, Pearce EN. History of U.S. iodine fortification and supplementation. Nutrients Nov 13, 2012;4(11):1740-6. doi:10.3390/nu4111740.
11. Markel H. John F. Kennedy kept these medical struggles private. PBS Newshour. 2023. https://pbs.org/newshour/health/john-f-kennedy-kept-these-medical-struggles-private.

 

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JUDE TUNYI is a second-year medical student at The Ohio State University College of Medicine. He obtained a Bachelor of Science degree from the University of Washington and looks forward to practicing medicine and performing research.

 

Submitted for the 2022–23 Medical Student Essay Contest

Spring 2023  |  Sections  |  History Essays