Why Some Shepherds In Nativity Scenes Have Misshapen Throats

It's the most wonderful time of year — the time when all the piddling troubles of day to day life are washed away in a merry deluge of green and red light. More than any other time of the year, Christmas is when we just want everything to be made right.

Christian Nativity scenes, one of the most sacred parts of the religion's Christmas tradition, are especially not something to muck up. Yet many older Nativity scenes depict shepherds with grotesque throat bulges, as if they were anacondas who'd just swallowed a baby deer whole. You'd think this was some sort of accident, or the result of weathering over hundreds of years, but nay — these bulges were actually an accurate representation of goiter, "an enlargement of the thyroid gland caused by iodine deficiency," according to NPR. The medical condition was historically common in northern Italy, where soil and water lacked iodine.

"In all the Sacri Monti that I and my son visited, we have been able to observe representations of goiters very, very often," says retired surgeon Renzo Dionigi of the University of Insubria in Varese, Italy.

Goiters are generally seen among impoverished people who lack access to proper nutrition, but anyone eating a poor diet is liable to sprout a goiter. The article notes that the US used to have a "goiter belt" throughout the Great Lakes and Northwest regions, before iodized salt became widely available in the 1920s. If you were wondering why most of the table salt you buy is iodized — that's why.

In art, goiters can also be used to represent certain attributes of a character. "Massive goiters sometimes show up on artists' portrayals of tormentors and executioners, apparently as a symbol of evil. But often, goiter just indicates that a person is poor or needy," per NPR.

Today, goiters are still a prevalent issue.

"'About a third of the world's population currently lacks adequate iodine,' says Angela Leung, an endocrinologist at UCLA and the VA Greater Los Angeles Healthcare System."

Other symptoms of iodine deficiency include "fatigue, weight gain, sluggishness and dry skin."

The World Health Organization even goes so far to say that iodine deficiency is "the world's most prevalent, yet easily preventable, cause of brain damage," especially during fetal development.

Those on vegan diets, or anyone who avoids salt should take extra precautions to ensure they are getting enough iodine. Otherwise, they might end up playing a shepherd next Christmas.

Eating too much salt is also a concern, and one far more likely to cause issues in the fast food-crazed US. "Getting the right balance is what we are striving for," says Leung, "but we're certainly not there yet on a global scale."