Ketogenic Diet

Madame d'Aries, a resident of Bilbao, in Spain, wife of the French Consul wrote to me on the 12th of May last:—"Following your directions, I have lost weight. Since my last two confinements the abdomen had remained unduly large: it is now much smaller. I feel lighter. I have always been able to walk without experiencing much fatigue. It was a great trouble, however, to move from my seat. A peculiar inward feeling, which was a source of great annoyance, has become almost imperceptible. I can go up stairs without bringing on shortness of breath, and the benefit derived is as evident to myself as it is visible to others."

On the recommendation of this patient, Madame de M., in the month of June, 1852, requested me to call upon her. She was between thirty and thirty-five years of age, and during the last eight years she had become enormously fat. She was ailing, and had been under treatment for almost every variety of disease. Most of the medical men whom she had consulted, owing to the pain she complained of, ascribed her trouble either to organic pulmonary lesion, to bronchial affection, or to disease of the heart. She had tried every means of cure. Had been under the care of many of the principal physicians to the hospitals of Paris, and also of professors of the faculty. Deriving no advantage from these, she had consulted homœopathic practitioners, and had been treated by them unavailingly. In her despair, she had sought the advice of a female clairvoyant; and in order that she might obtain every possible benefit from the treatment, had taken her into her own house—but her sad condition was in no wise ameliorated.

Possessed of a naturally active and energetic temperament, she was nevertheless compelled to remain seated in an arm-chair, yet could not lean back in it, owing to a sense of suffocation which such a position was sure to induce. When weary of this erect position, the only relief she could obtain was by leaning upon her left elbow, resting on the knee of the same side. If she attempted to recline upon the right side, she was subject to fits of coughing and suffocation. Her days were passed in this position: at night she was obliged to sit upright, without any support to her back; and when overcome with weariness, would fall forward upon the left elbow, the only support she could endure. Finally, however, in consequence of the great and continued pressure of the weight of the body, the elbow became inflamed, an extensive sore formed upon it, and a pad for the elbow became necessary. She had scarcely any appetite, and had long since given up the use of meat. She could walk a little about her apartment, and although her sister had lived for the last six years in the house on the opposite side of the street, she had not been able to visit her. Madame de M. although by no means tall, weighed between one hundred and eighty and one hundred and ninety pounds. Under percussion the chest proved resonant throughout, and air entered freely the whole extent of the lungs. By the aid of the stethoscope a râle was heard in both lungs. Beneath both clavicles there existed scars, the result of blisters and cauteries. And the whole surface of the chest and the pit of the stomach were covered with the marks of leech bites. There were no febrile symptoms. Complexion blonde, with a remarkably fair skin and large blue eyes, which seemed never to have known pain. Under such circumstances no organic lesion either of the lungs, the bronchi, or of the heart could be suspected: and I was satisfied that the great disturbance of health in the case of this lady arose from excessive obesity. Having placed herself under my treatment, she experienced relief the first week, and, at the end of a fortnight, Madame de M. had perceptibly grown thinner. One morning, when calling to see her, I was told that she had gone for a ride to the Bois de Boulogne, and that she had been out also the day before, and was able to get in and out of the carriage without assistance. She continued to lose her embonpoint and her health became thoroughly re-established. She was able to lie down in bed, and upon either side. At the end of the month she visited friends whom she had not called upon for the last six or eight years, and six weeks or two months after commencing my treatment, she danced repeatedly at a ball given by her sister upon the occasion of her recovery. Until then she had not worn corsets for the last six years.

It was not until the month of October following, that I again had occasion to see Madame de M. Not feeling well, she sent for me. She had caught cold the day before, when returning late in the evening from the country, and was slightly feverish. She was, however, quite well again in a day or two. The last two years she has enjoyed excellent health, although, like most other ladies, she is occasionally subject to trifling nervous attacks. In the enjoyment of health and riches, she leads the fashionable life of a gay young lady. How forcibly does her present condition contrast with the previous eight long years, passed in weariness and suffering!

On the 7th August, 1852, M. Alcide Desbouillons wrote to me from Brest, to the effect that his corpulence was a source of great inconvenience; that his duties required him to be much on horseback, and consequently in hot weather he suffered greatly from fatigue. He weighed two hundred pounds, and measured forty-nine inches in circumference. On the 2nd September, after twenty days' trial of my system, and, as he says, perhaps not as rigorously carried out as it should have been, he weighed himself again, and obtained the following result: Weight, one hundred and eighty-nine pounds: circumference, forty-five inches. Twenty days after this he weighed one hundred and eighty-seven pounds, and measured forty-three inches in circumference. This was but a slight difference; yet M. Desbouillons, after the first few days of treatment, could walk with less difficulty, was more active, and was no longer bathed in perspiration. In his last letter he says, "I am continuing your plan of treatment, and expect to find a notable amelioration both in size and weight. The effects produced by your medicine have been in perfect accord with what you had led me to expect. The experiment appears so far conclusive, and I trust that my case will prove thoroughly demonstrative."

Although advocating the employment of vegetable diet in cases of diabetes of the second class, I do not wish it for a moment to be supposed that I agree with Piorry in thinking that the cause of death, even in this form of diabetes, arises from the loss of sugar; for, on the contrary, I think it springs from the inability of the body to assimilate the sugar it possesses. In such cases, therefore, I give vegetable food, not because it contains sugar, but because it possesses many of the other substances necessary for the purposes of nutrition, which neither exist in the same quantity nor in so easily an assimilated form in animal diet. 

It is well known from the reports of travellers among savage nations, that men restricted solely to animal diet must consume an almost fabulous amount in order to obtain sufficient of all the ingredients requisite in the processes of life. "We know, too, that an animal can be most effectually starved by limiting him to one particular element of food, although that element be even albumen. The benefits derivable from Piorry's plan of treatment, therefore, in my opinion, arise from the fact that when he gives sugar he at the same time ceases to restrict the patient to animal diet, and that in the mixed food they find many of the materials essential to life much more abundantly and in a more easily assimilated form than in animal diet. I shall now give a few typical cases illustrative of the two principal forms of diabetes. 

Diabetes from Excessive Formation. 

In the beginning of 1860 a young gentleman, aged 19, suffering from diabetes, was brought to me by his brother, a Medical Practitioner, who had detected the disease two year previously. This patient had already been under various systems of treatment. What appeared to agree with him best was animal diet, coupled with. small doses of chlorodyne. 

To look at the patient one would have thought that he was a perfectly healthy individual. His weight was 135 lbs. ; the appetite was moderate ; and the amount of urine passed was not at that time excessive. The object of bringing the patient to me, it appeared, was in order that I might, if possible, suggest some remedy to replace the chlorodyne, the constipating effects of which were anything but agreeable. On carefully inquiring into the history of the patient, the case appeared to be one of diabetes by excess, and the origin of the mischief could in some measure be traced to some irritation in the liver, which was painful at its lower margin, the pain being much increased on pressure. Having an intelligent Practitioner to deal with, I at once gave my view of the case, and explained how, as scarcely any two cases of diabetes are precisely alike, it would be necessary to try the effects of different forms of treatment in order to discover what would be best for this particular case. The following table is an abstract of the results : 

TABLE 

The average amount of sugar passed by this patient during the next six months being from fifty to sixty grammes (775 to 930 grains) and his -weight 156 pounds, a quantitative analysis of the sugar -was no longer thought necessary. I may add that-when I last saw the gentleman in August, 1864 (on the occasion of his bringing to me a poor lad, -whose case I shall presently relate), he looked in excellent health, being, as he said, -without any feelings of discomfort, although he had still to continue his medicine, for as soon as he neglected it, the sugar again increased.

Banting accounted all of his unsuccessful fasts, diets, spa and exercise regimens in his past. His previously unsuccessful attempts had been on the advice of various medical experts. He then described the dietary change which finally had worked for him, following the advice of another medical expert. "My kind and valued medical adviser is not a doctor for obesity, but stands on the pinnacle of fame in the treatment of another malady, which, as he well knows, is frequently induced by [corpulence]." (p24) His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, saccharine matter, starch, beer, milk and butter. ([Wikipedia]

 I have felt some difficulty in deciding on the proper and best course of action. At one time I thought the Editor of the Lancet would kindly publish a letter from me on the subject, but further reflection led me to doubt whether an insignificant individual would be noticed without some special introduction. In the April number of the Cornhill Magazine I read with much interest an article on the subject-defining tolerably well the effects, but offering no tangible remedy, or even positive solution of the problem-“What is the Cause of Obesity?’’ I was pleased with the article as a whole, but objected to some portions, and had prepared a letter to the Editor of that Magazine offering my experience on the subject, but again it struck me that an unknown individual like myself would have but little prospect of notice; so I finally resolved to publish and circulate this Pamphlet, with no other reason, motive, or expectation than an earnest desire to help those who happen to be afflicted as I was, for that corpulence is remediable I am well convinced, and shall be delighted if I can induce others to think so. The object I have in view impels me to enter into minute particulars as well as general observations, and to revert to bygone years, in order to show that I have spared no pains nor expense to accomplish the great end of stopping and curing obesity. 

I am now nearly 66 years of age, about 5 feet 5 inches in stature, and, in August last (1862), weighed 202 Ibs., which I think it right to name, because the article in the Cornhill Magazine presumes that a certain stature and age should bear ordinarily a certain weight, and I am quite of that opinion. I now weigh 167 lbs., showing a diminution of something like 1 Ib. per week since August, and having now very nearly attained the happy medium, I have perfect confidence that a few more weeks will fully accomplish the object for which I have laboured for the last thirty years, in vain, until it pleased Almighty Providence to direct me into the right and proper channel-the “tramway,” so to speak-of happy, comfortable existence. 

Few men have led a more active life-bodily or mentally-from a constitutional anxiety for regularity, precision, and order, during fifty years’ business career, from which I have now retired, so that my corpulence and subsequent obesity was not through neglect of necessary bodily activity, nor from excessive eating, drinking, or self-indulgence of any kind, except that I partook of the simple aliments of bread, milk, butter, beer, sugar, and potatoes more freely than my aged nature required, and hence, as I believe, the generation of the parasite, detrimental to comfort if not really to health. I will not presume to descant on the bodily structural tissues, so fully Canvassed in the Cornhill Magazine, nor how they are supported and renovated, having no mind or power to enter into those questions, which properly belong to the wise heads of the faculty. None of my family on the side of either parent had any tendency to corpulence, and from my earliest years I had an inexpressible dread of such a calamity, so, when I was between thirty and forty years of age, finding a tendency to it creeping upon me, I consulted an eminent surgeon, now long deceased,-a kind personal friend,-who recommended increased bodily exertion before my ordinary daily labours began, and thought rowing an excellent plan. I had the command of a good, heavy, safe boat, lived near the river, and adopted it for a couple of hours in the early morning. It is true I gained muscular vigour, but with it a prodigious appetite, which I was compelled to indulge, aid consequently increased in weight, until my kind old friend advised me to forsake the exercise. 

He soon afterwards died, and, as the tendency to corpulence remained, I consulted other high orthodox authorities (never any inferior adviser). but all in vain. I have tried sea air and bathing in various localities, with much walking exercise; taken gallons of physic and liquor potasse, advisedly and abundantly; riding on horseback; the waters and climate of Leamington many times, as well as those of Cheltenham and Harrogate frequently; have lived upon sixpence a-day, so to speak, and earned it, if bodily labour may be so construed; and have spared no trouble nor expense in consultations with the best authorities in the land, giving each and all a fair time for experiment, without any permanent remedy, as the evil still gradually increased. 

I am under obligations to most of those advisors for the pains and interest they took in my case; but only to one for an effectual remedy. When a corpulent man eats, drinks, and sleeps well, has no pain to complain of, and no particular organic disease, the judgment of able men seems paralyzed,-for I have been generally informed that corpulence is one of the natural results of increasing years; indeed, one of the ablest authorities as a physician in the land told me he had gained 1 Ib. in weight every year since he attained manhood, and was not surprised at my condition, but advised more bodily exercise-vapour-baths and shampooing, in addition to the medicine given. Yet the evil still increased, aid, like the parasite of barnacles on a ship, if it did not destroy the structure, it obstructed its fair, comfortable progress in the path of life. I have been in dock, perhaps twenty times in as many years, for the reduction of this disease, and with little good effect-none lasting. Any one so afflicted is often subject to public remark, and though in conscience he may care little about it, I am confident no man labouring under obesity can be quite insensible to the sneers and remarks of the cruel and injudicious in public assemblies, public vehicles, or the ordinary street traffic; nor to the annoyance of finding no adequate space in a public assembly if he should seek amusement or need refreshment, and therefore he naturally keeps away as much as possible from places where he is likely to be made the object of the taunts and remarks of others. I am as regardless of public remark as most men, but I have felt these difficulties and therefore avoided such circumscribed accommodation and notice, and by that means have been deprived of many advantages to health and comfort. 

Although no very great size or weight, still I could not stoop to tie my shoe, so to speak, nor attend to the little offices humanity requires without considerable pain and difficulty, which only the corpulent can understand; I have been compelled to go down stairs slowly backwards, to save the jarr of increased weight upon the ankle and knee joints, and been obliged to puff and blow with every slight exertion, particularly that of going up stairs. I have spared no pains to remedy this by low living (moderation and light food was generally prescribed, but I had no direct bill of fare to know what was really intended), and that, consequently, brought the system into a low impoverished state, without decreasing corpulence, caused many obnoxious boils to appear, and two rather formidable carbuncles, for which I was ably operated upon and fed into increased obesity. 

At this juncture (about three years back) Turkish baths became the fashion, and I was advised to adopt them as a remedy. With the first few I found immense benefit in power and elasticity for walking exercise; so, believing I had found the “philosopher’s stone,” pursued them three times a-week till I had taken fifty, then less frequently (as I began to fancy, with some reason, that so many weakened my constitution) till I had taken ninety, but never succeeded in losing more than 6 Ibs. weight during the whole course, and I gave up the plan as worthless; though I have full belief in their cleansing properties, and their value in colds, rheumatism, and many other ailments. 

I then fancied increasing obesity materially affected a slight umbilical rupture, if it did not cause it, and that another bodily ailment to which I had been subject was also augmented. This led me to other medical advisers, to whom I am also indebted for much kind consideration, though, unfortunately, they failed in relieving me. At last finding my sight failing and my hearing greatly impaired, I consulted in August last an eminent aural surgeon, who made light of the case, looked into my ears, sponged them internally, and blistered the outside, without the slightest benefit, neither inquiring into any of my bodily ailments, which he probably thought unnecessary, nor affording me even time to name them. I was not at all satisfied, but on the contrary was in a worse plight than when I went to him; however he soon after left town for his annual holiday, which proved the greatest possible blessing to me, because it compelled me to seek other assistance, and, happily, I found the right man, who unhesitatingly said he believed my ailments were caused principally by corpulence, and prescribed a certain diet,-no medicine, beyond a morning cordial as a corrective,-with immense effect and advantage both to my hearing and the decrease of my corpulency. 

For the sake of argument and illustration I will presume that certain articles of ordinary diet, however beneficial in youth, are prejudicial in advanced life, like beans to a horse, whose common ordinary food is hay and corn. It may be useful food occasionally, under peculiar circumstances, but detrimental as a constancy. I will, therefore, adopt the analogy, and call such food human beans. The items from which I was advised to abstain as much as possible were:

-Bread, butter, milk, sugar, beer, and potatoes, which had been the main (and, I thought, innocent) elements of my existence, or at all events they had for many years been adopted freely. 

These, said my excellent adviser, contain starch and saccharine matter, tending to create fat, and should be avoided altogether. At the first blush it seemed to me that I had little left to live upon, but my kind friend soon showed me there was ample, and I was only too happy to give the plan a fair trial, and, within a very few days, found immense benefit from it. It may better elucidate the dietary plan if I describe generally what I have sanction to take, and that man must be an extraordinary person who would desire a better table:

- For breakfast, I take four or five ounces of beef, mutton, kidneys, broiled fish, bacon, or cold meat of any kind except pork; a large cup of tea (without milk or sugar), a little biscuit, or one ounce of dry toast. 

For dinner, Five or six ounces of any fish except salmon, any meat except pork, any vegetable except potato, one ounce of dry toast, fruit out of a pudding, ‘any kind of poultry or game, and two or three glasses of good claret, sherry, or Madeira-Champagne, Port and Beer forbidden. 

For tea, Two or three ounces of fruit, a rusk or two, and a cup of tea willlout milk or sugar. 

For supper, Three or four ounces of meat or fish, similar to dinner, with a glass or two of claret. 

For nightcap, if required, A tumbler of grog -(gin, whisky, or brandy, without sugar) -or a glass or two of claret or sherry.

 This plan leads to an excellent night’s rest, with from six to eight hours’ sound sleep. The dry toast or rusk may have a table spoonful of spirit to soften it, which will prove acceptable. Perhaps I did not wholly escape starchy or saccharine matter, but scrupulously avoided those beans, such as milk, sugar, beer, butter, & c., which were known to contain them. 

On rising in the morning I take a table spoonful of a special corrective cordial, which may be called the Balm of life, in a wine-glass of water, a most grateful draught, as it seems to carry away all the dregs left in the stomach after digestion, but is not aperient; then I take about 5 or 6 ounces solid and 8 of liquid for breakfast; 8 ounces of solid and 8 of liquid for dinner; 3 ounces of solid and 8 of liquid for tea; 4 ounces of solid and 6 of liquid for supper, and the grog afterwards, if I please. I am not, however, strictly limited to any quantity at either meal, so that the nature of the food is rigidly adhered to. 

Experience has taught me to believe that these human beans are the most insidious enemies man, with a tendency to corpulence in advanced life, can possess, though eminently friendly to youth. He may very prudently mount guard against such an enemy if he is not a fool to himself, and I fervently hope this truthful unvarnished tale may lead him to make a trial of my plan, which I sincerely recommend to public notice,-not with any ambitious motive, but in sincere good faith to help my fellow-creatures to obtain the marvellous blessings I have found within the short period of a few months. 

I do not recommend every corpulent man to rush headlong into such a change of diet, (certainly not), but to act advisedly and after full consideration with a physician. 

My former dietary table was bread and milk for breakfast, or a pint of tea with plenty of milk and sugar, and buttered toast; meat, beer, much bread (of which I was always very fond) and pastry for dinner, the meal of tea similar to that of breakfast, and generally a fruit tart or bread and milk for supper. I had little comfort and far less sound sleep. 

It certainly appears to me that my present dietary table is far superior to the former-more luxurious and liberal, independent of its blessed effect-but when it is proved to be more healthful, comparisons are simply ridiculous, and I can hardly imagine any man, even in sound health, would choose the former, even if it were not an enemy; but, when it is shown to be, as in my case, inimical both to health and comfort, I can hardly conceive there is any man who would not willingly avoid it. I can conscientiously assert I never lived so well as under the new plan of dietary, which I should have formerly thought a dangerous extravagant trespass upon health; I am very much better, bodily and mentally, and pleased to believe that I hold the reins of health and comfort in my own hands, and, though at sixty-five years of age, I cannot expect to remain free from some coming natural infirmity that all flesh is heir to, I cannot at the present time complain of one. It is simply mhculous, and I am thankful to Almighty Providence for directing me, through an extraordinary chance, to the care of a man who could Work such a change in so short a time. 

Oh! that the faculty would look deeper into and make themselves better acquainted with the crying evil of obesity-that dreadful tormenting parasite on health and comfort. Their fellow men might not descend into early premature graves, as I believe many do, from what is termed apoplexy, and certainly would not, during their sojourn on earth, endure so much bodily and consequently mental infirmity. 

Corpulence, though giving no actual pain, as it appears to me, must naturally press with undue violence upon the bodily viscera, driving one part upon another, and stopping the free action of all. I am sure it did in my particular case, and the result of my experience is briefly as follows:

- I have not felt so well as now for the last twenty years. 

Have suffered no inconvenience whatever in the probational remedy. 

Am reduced many inches in bulk, and 35 Ibs. in weight in thirty-eight weeks. 

Come down stairs forward naturally, with perfect ease.

 Go up stairs and take ordinary exercise freely, without the slightest inconvenience. 

Can perform every necessary office for myself. 

The umbilical rupture is greatly ameliorated, and my sight is restored-my hearing improved. 

My other bodily ailments are ameliorated; indeed, almost past into matter of history. 

I have placed a thank-offering of $50 in the hands of my kind medical adviser for distribution amongst his favourite hospitals, after gladly paying his usual fees, and still remain under overwhelming obligations for his care and attention, which I can never hope to repay. Most thankful to Almighty Providence for mercies received, and determined to press the case into public notice as a token of gratitude. 

I have the pleasure to afford, in conclusion, a satisfactory confinnation of my report, in stating that a corpulent friend of mine, who, like myself, is possessed of a generally sound constitution, was labouring under frequent palpitations of the heart and sensations of fainting, was, at my instigation, induced to place himself in the hands of my medical adviser, with the same gradual beneficial results. He is at present under the same ordeal, auld in eight weeks has profited even more largely than I did ill that short period; he has lost the palpitations, and is becoming, so to speak, a new made man-thankful to me for advising, and grateful to the eminent counsellor to whom I referred him-and he looks forward with good hope to a perfect cure. 

I am fully persuaded that hundreds. if not thousands, of our fellow men might profit equally by a similar course; but, constitutions not being all alike, a different course of treatment may be advisable for the removal of so tormenting an affliction. 

My kind and valued medical adviser is not a doctor for obesity, but stands on the pinnacle of fame in the treatment of another malady, which, as he well knows, is frequently induced by the disease of which I am speaking, and I most sincerely trust most of my corpulent friends (and there are thousands of corpulent people whom I dare not so rank) may be led into my tramroad. To any such I am prepared to offer the further key of knowledge by naming the man. It might seem invidious to do so now, but I shall only be too happy, if applied to by letter in good faith, or if any doubt should exist as to the correctness of this statement. 

WILLIAM BANTING, 

Sen., Late of No. 27, 

St. James’s Street, Piccadilly, Now of No. 4, The Terrace, Kensington 

May, 1863