Meatritionist

In the treatment of diabetes the diet plays tho most important part. We cannot attack the real cause of the disease because we do not know it. Our task, then, is to prevent, so far as is possible, sugar-production. This can bo done only in the mild form of diabetes. The diet should be regulated as follows: 

There should be absolute avoidance of carbohydrates, and accordingly a diet composed exclusively of fat and meat. Cantani and other physicians have wished to embody this principle in its entirety in their practice, and Cantani believes that he has seen a cure following a long-continued diet composed exclusively of meat. The reader has never seen so fortunate a result. Absolute meat diet, if it be long continued, has undoubtedly the advantage that it permits a certain tolerance for starch; but this tolerance is a very limited one, and a diabetic who, after a long-continued life of meat diet, allowed himself to live like a healthy person, would pay heavily for it. 

Aside from its great difficulty of accomplishment, a diet composed entirely of meat has this great drawback: cases so treated quickly acquire a catarrhal gastritis and enteritis. Besides this, the less-determined patients generally break through their diet regulations and eat injurious food without stint, because the treatment is so very unpleasant and of such long duration. 

The theory that diabetes can be cured has another great disadvantage connected with it. Patients from whose urine the sugar has all disappeared except a trace, consider themselves cured, and think their diet may be varied. In this way relapses occur. 

The idea which Seegen follows out in treating his diabetes cases is as follows: there should be ordered for the patient such a diet as can be continued throughout a life-time, with the aid of a strong determination. A diet of meat and fat should prevail. Seegen warns you that the patient must not be allowed to eat meat and eggs in too great quantities for the purpose of building himself up. A diabetic patient does not need more meat than any healthy person who lives chiefly on a meat diet. But with this diet the patient should be ordered green vegetables in any quantity desired, and sour (not sweet) fruit in moderate amount. Bread is indispensable for a time, and Seegen orders 40-60 grs. per diem, but speaks most decidedly against fresh bread, because this always contains starch, and if allowed, the control of the diet (over the disease) will be lost. An exclusive meat diet is strenuously to be recommended :

 (1.) If it is necessary to decide whether the disease is of the first or second form. 

(2.) When wounds do not heal and when gangrene sets in, or a surgical operation is necessary. 

Sour (not sweet) red or white wine is allowed in any quantity, and yet it is an error to allow a diabetic patient to drink large quantities of wine with the idea of strengthening him. Beer may be allowed in moderate quantity, (that is, about half a litre). In diabetes of the severe form abstinence from carbohydrates is important only because, as a result of such abstinence, the excretion of sugar is markedly lessened. To restrict cases of this kind to a meat diet is not indicated, for it makes little difference whether 20-30 grs. (sugar), more or less, are excreted ; and the advantage gained is not equivalent to the privation endured.

At this point, however, it may be well to mention that the standard amount of proteid matter taken, in the construction of all these tables, was 130 grammes — 4.5 ounces. Moleschott's original diet-table contained only 120 grammes or (4.2 ounces), but as almost all observers agree quite closely as to the amount of proteid material necessary to be used, and also as to the results obtained from its oxidization, the same quantity was used in all instances that a more exact comparison might be established. The chief difference of dispute, however, is in relation to the relative value of the fats and carbohydrates, and particularly in reference to the latter compounds. 

In trying to develop out of a purely vegetable diet, anything like the same amount of working power for the system that is obtainable by the use of Porter's or Moleschott's diet, almost double the amount of proteid had to be taken with the proportionate rise in the fat and starch as is contained in the vegetable chosen. 

To produce the same amount of work by using a vegetable diet necessitates the outlay of a much larger amount of oxygen, and the production and handling by the glandular structures of the body of an excessive amount of the nitrogenous excrementitious elements. These facts illustrate quite conclusively the manner in which the damage to the system is brought about by indulging too freely, or living exclusively upon a cereal or vegetable compound. 

The vegetable proteid in these tables is further given an undue advantage, to which it is not justly entitled, by crediting it with the same atomic formula as that possessed by an animal proteid ; since the nitrogenous element found in plant-life contains a much larger number of nitrogen atoms, and consequently requires more vital force and oxygen to digest and assimilate it. This naturally decreases rather than improves the nutritive value of the proteid compound of vegetable origin. 

An average of a compound fat molecule is taken as the working standard in all these tables. 

Attention is also directed to a probable error in the rating of the heat-producing power of the carbohydrate. It is & commonly stated, that the comparative oxygenating capacity of a carbohydrate and fat is as one to two and one-half, but by their chemical atomicities, it is as one to thirteen, or thirteen and one-half in favor of the fat. 

That such an error exists in the computations in Moleschott's standard is sustained by a comparative study of the atomicities of the food-stuffs used in both Porter's and Moleschott's diet tables, and of the amount of oxygen required for complete oxidization in both instances. In the former, or Porter's proteid and fat diet table, a little more oxygen is needed than is necessary in Moleschott's mixed diet* yet it is claimed that in the latter instance 393,170 kilogramme-metres or 54,358 more foot pounds of work is produced. This, however, is directly opposed by the smaller quantity of oxygen used in the oxidization processes. When this error in work, produced out of the carbohydrates in Moleschott's diet, is corrected in accordance with the difference in atomicity and the amount of oxygen used between the fat molecule and the carbohydrate molecule represented as glucose, and a computation is made in accord with the correction, a slight difference in work produced when living on a Moleschott's or Porter's diet, is found to exist. The increase in work produced, however, is now found to exist in connection with Porter's diet and is in accord with the larger amount of oxygen used, which makes atomicity, oxygen used, and work produced correspond, while the reverse was stated in the calculations formerly made in connection with Moleschott's diet. 

If this error be true, as it appears to be, the profession have been sadly misguided in all their attempts in the construction of diet tables starting with Moleschott as their standard. 

On the other side, if these chemical and physiological laws be true, as based upon the atomicity of the proximate principles, by carefully considering the percentage composition of each food product to be used, exact results can be obtained. Another point to which attention is called by Dr. Porter is this, that the factors 1.812 and 3.841, which are used in computing the kilogramme-metres in Table VIII., are taken from Frankland — Philosophical Magazine XXXII., and are those which are generally quoted in all scientific works upon physiological chemistry and upon diet. 

In studying the proximate principles, however, by the atomicities, and considering the amount of oxygen required to completely transform a fat molecule into its final products of excretion water and carbon dioxide and a proteid molecule into its final products of excretion — urea, uric acid, kreatinine, carbon dioxide, water, etc. — it is found that only eighteen (18) more oxygen elements are used in the complete oxidization of the fat than in that of the proteid molecule. The computed amount of work performed by the oxidization of the fat molecule is found to be 530 foot pounds as compared to 250 foot pounds for the complete oxidization of the proteid molecule. This makes the eighteen (18) more elements of oxygen used in transforming the fat molecule result in the production of 280 more foot pounds of work than is obtained from the eighteen less used in the proteid. 

From this a decided discrepancy is quite evident between the results obtainable by former calculations and those based upon our modern chemical atomicities. 

However, for an illustrative and comparative study of the working power obtainable from the use of the various food-stuffs, this table is still of great value, as the same figures are used in each and all the calculations. 

As these same factors, 1.812 and 3.841, appear in all the modern scientific works, they were retained in the arrangement of this table, but not without appreciating and calling attention to this discrepancy when the computation is based upon the atomicities of the food elements used, the amount of oxygen required, and the results obtained. 

Again, it must be remembered that the proteids are not directly transformed into their final products, but undergo a series of intermediate changes, all of which require the use of oxygen and must of necessity yield more or less heat and energy, so that all our estimates are approximate. 

When upon Moleschott's diet with the proteid substances raised to the common standard of 130 grammes and the carbohydrates rated in accord with the correction previously noted, it requires 36,115 oxygen elements to produce 678,270 kilogramme-metres or 93,773 foot pounds of work. 

When upon Porter's diet of proteid and fat, it requires 38,415 oxygen elements to produce 734,890 kilogrammemetres or 101,602 foot pounds of work. When upon a purely vegetable diet that will yield anything like the requisite amount of work that can be obtained by using Moleschott's or Porter's diet, it requires 47,191 oxygen elements to produce 742,018 kilogramme-metres or 102,587 foot pounds of work. 

To obtain the 63,748 more kilogramme-metres or 8,814 foot pounds of work out of the vegetable diet as compared with Moleschott's diet, it requires the expenditure of 11,076 more oxygen elements. 

To obtain the 7,128 more kilogramme-metres or 985 foot pounds of work out of the vegetable diet as compared with Porter's diet, it requires the expenditure of 8,776 more oxygen elements. The vegetable diet in both instances yielding an excessive amount of nitrogenous excretory matter, carbon dioxide, and water. 

A careful study of Table II. and VII., and Porter's diet in Table VIII., proves beyond a question of doubt that upon an exclusive diet of our ordinary average meat alone very nearly the required proportions of the proteids or CHNOS compounds and of the fat or CHO element can be established. 

The only defect in the perfection of Table VII. and VIII. is found in the saline column, which contains much more mineral matter than perfect physiological laws indicate are required. This excess in saline or inorganic compounds, however, appears to be true in all kinds of food products — that is, if the proportion of salts in the milk is taken as the guide for a working basis. The reason for looking upon the amount of salts in the milk as the guide to the maximum quantity required is based upon the fact that during the infant period of life, where milk forms the only source of food supply, bone formation is most rapidly progressing, and the amount of mineral matter needed by the system is at its height and much larger than at any other period of life. The bones continue to grow and become fully and perfectly developed with the ordinary quantity of mineral matter contained in the milk. 

Physiology also teaches that a little less than one ounce of mineral salts are required daily by the system, but in all the tables given, except the one containing milk alone, the amount of salts is fully up to or more than an ounce. 

The only great objection that can be raised to an exclusive meat diet is the lack of variety, but that is quite easily adjusted by varying the kinds of meat used. The perfection of the proportionate composition of the proximate principles when using a meat diet, the smaller liability to imbibe an excessive quantity of any one kind and the little danger that there is of taking an excess of the CHO or stimulating and non-nutritious compounds, clearly establishes the fact that in meat we approach the nearest to an ideal food. 

If attention is turned for a single moment to the lower orders of the animal kingdom, it is quite apparent that the most supple and intensely powerful organisms are found among the carnivora only. This tends to substantiate the high utility of the meat diet. Another interesting point is the almost universal absence of tuberculosis among meat-eating animals, while the vegetable-feeding class are specially prone to suffer from this fatal malady. 

Again, the milk which is so generally considered as being fully equal to all the demands of the system, and especially so during the first few months of infant life, might be brought forward as proof positive and clearly illustrating the fact that nature calls for an excess of the CHO elements, because in the composition of the milk it is found that the CHO substances are about twice as abundant as the proteid or CHNOS elements. When these facts are examined a little more closely and scientifically, it is found that the pancreatic gland and its ferment-forming bodies are imperfecty developed at this period of life. Consequently, the fat, if emulsified and rendered capable of being absorbed by the lacteals of the villi, must have this transformation effected almost exclusively by the biliary fluid alone. It is further taught that the biliary secretion acts but little, if at all, upon vegetable fats and that it has the power to effectually emulsify only about one-half of the total quantity of animal fat introduced into the alimentary canal. This being true, fifty per cent, of the fat contained in the milk, together with the bile constantly flowing into the alimentary tract, is unquestionably utilized by the system as a natural laxative principle, and is undoubtedly the chief method by which nature effectually maintains the regular movements of the bowels and produces the daily evacuations so characteristic of a perfectly healthy infant. 

The proportionately larger size of the liver in a child as compared with an adult also points to the fundamental importance of the hepatic gland and its secretion as a necessary agent of prime importance in the infant; the large size of the liver compared with other organs also indicates its great importance during adult life. 

How much of the lactose — which is the form of sugar introduced in the milk — is inverted into glucose and rendered capable of being absorbed and utilized is an open question. In fact, there is no very reliable data upon this important point, but what is to be found upon the subject indicates quite positively that a considerable quantity of the lactose is not changed so as to be utilized by the system, but passes off with the faeces. Therefore, when the scientific truth is clearly appreciated, it is found that the relative proportion between the CHO and the CHNOS elements contained in the milk and that which can gain access to the vascular channels and be of service to the system is not far from equal in amount the major quantity, perhaps a little on the side of the CHO substances or in favor of the fat and sugar. Then, again, the infant requires a little more of the heat-producing compounds during the first few weeks or months than is needed a little later on or in adult life, because the proportionate amount of energy expended is greater in the infant and child than is the case during the adult period of life. Very early in the infant life there is comparatively little muscular action by which heat and energy can be evolved, while a large amount of heat is needed to maintain a perfect physiological condition, and for a time warmth must be artificially supplied. These conditions will admit of a little excess of the CHO elements during this period of life , but when the stage of infant muscular activity commences its never-ceasing motion, then the proportionate amount of the proteid substances must be raised and the CHO, or fat and sugar lowered, if the most perfect type of physiological development is to be effected. 

Observing clinical phenomena a little more closely, it is quite apparent, as life advances, that milk is not equal to the demands of the system, and a more strongly proteid diet is urgently called for by nature. Eggs and lean meat must next be added to furnish this much-needed proteid pabulum for the constructive purposes of the animal economy, and out of which alone the most perfect muscles, glands, ferment bodies, and brain tissue can be formed. 

By this process of reasoning, it is clearly and well established that even with the commonly supposed typical food-stuff, milk, it is not sufficiently perfect in its composition to thoroughly sustain the nutritive economy under all circumstances, but must have added to it a more liberal proteid pabulum. It is also clearly demonstrated that a portion of this excessive amount of fat is not taken up by the circulatory or lymphatic system but is used largely by nature as a laxative agent.

Proceeding a step further in the investigation of the clinical facts bearing upon this most interesting subject and there is found quite a common tendency among people at large to add to the nutritive supply of the infant not the most serviceable kind of food-stuffs in the way of an animal proteid of some kind, but on the contrary the more general practice is that of adding a cereal or vegetable compound, — one in which the CHO elements are very greatly in excess of the demands of nature. Another important point to be remembered in this connection is the well established fact that, although the proteid of vegetable origin, while in quite sufficient quantities, is a much higher nitrogenous compound and, as a rule, is far more difficult of digestion than a proteid body derived from the animal kingdom. 

By this method of infant feeding in which an excess of the fat, sugar, and starch or CHO compounds are used, a natural taste and habit of eating food derived largely from ficially supplied. These conditions will admit of a little excess of the CHO elements during this period of life , but when the stage of infant muscular activity commences its never-ceasing motion, then the proportionate amount of the proteid substances must be raised and the CHO, or fat and sugar lowered, if the most perfect type of physiological development is to be effected. Observing clinical phenomena a little more closely, it is quite apparent, as life advances, that milk is not equal to the demands of the system, and a more strongly proteid diet is urgently called for by nature. Eggs and lean meat must next be added to furnish this much-needed proteid pabulum for the constructive purposes of the animal economy, and out of which alone the most perfect muscles, glands, ferment bodies, and brain tissue can be formed. By this process of reasoning, it is clearly and well established that even with the commonly supposed typical food-stuff, milk, it is not sufficiently perfect in its composition to thoroughly sustain the nutritive economy under all circumstances, but must have added to it a more liberal proteid pabulum. It is also clearly demonstrated that a portion of this excessive amount of fat is not taken up by the circulatory or lymphatic system but is used largely by nature as a laxative agent. Proceeding a step further in the investigation of the clinical facts bearing upon this most interesting subject and there is found quite a common tendency among people at large to add to the nutritive supply of the infant not the most serviceable kind of food-stuffs in the way of an animal proteid of some kind, but on the contrary the more general practice is that of adding a cereal or vegetable compound, — one in which the CHO elements are very greatly in excess of the demands of nature. Another important point to be remembered in this connection is the well established fact that, although the proteid of vegetable origin, while in quite sufficient quantities, is a much higher nitrogenous compound and, as a rule, is far more difficult of digestion than a proteid body derived from the animal kingdom. By this method of infant feeding in which an excess of the fat, sugar, and starch or CHO compounds are used, a natural taste and habit of eating food derived largely from the vegetable kingdom is engendered. The natural sequence is, that on through life the individual is apt to continue eating excessively of all kinds of food-stuffs and particularly those of the CHO and vegetable class. This poorly nourishes the body; adipose tissue in abundance is often acquired from the imperfectly transformed foodproducts. The appetite increases because the system is not properly sustained. The individual continues eating more and more until finally the marginal capacity of the system for supplying oxygen is reached and passed, digestion is imperfectly effected, and the oxidization powers of the body exceeded.

Observations among the animal kingdom show that the carnivora rarely have tuberculosis, while the vegetable feeders are particularly prone to this form of disease. Carnivora, while fed upon an animal diet, cannot be successfully innoculated with tubercular matter ; confined and fed upon an opposite class of food products and the experiments rapidly become successful.

Tuberculosis in the human subject is most frequently found in starch and sugar-fed subjects and in those who are compelled to live in close quarters.

The only line of treatment that has yielded any satisfactory results has been the sending of such cases to the wild mountain regions where the diet of necessity is largely of the animal class, such as game and fish. With this out- of-door life, an almost exclusive use of an animal diet, and a moderate amount of alcohol and cod-liver oil to supply what CHO element the system absolutely demands, has resulted in the positive cure of a fair percentage of genuine tubercular subjects.

"A fat person, at whatever period of life, has not a sound tissue in his body: not only is the entire muscular system degenerated with the fatty particles, but the vital organs--heart, lungs, brain, kidneys, liver, etc.,--are likewise mottled throughout, like rust spots in a steel watch spring, liable to fail at any moment. The gifted Gambetta, whom M. Rochefort styled the fatted satrap died--far under his prime--because of his depraved condition; a slight gunshot wound from which a clean man would have speedily recovered ended this obese diabetic's life. Events sufficiently convincing are constantly occuring on both sides of the Atlantic; every hour men are rolling into ditches of death because they do not learn how to live. These ditches have fictitious names--grief, fright, apoplexy, kidney troubles, heart disease, etc.,--but the true name is chronic self abuse."

 

Fortunately there is a considerably greater apprehension in the public mind now than a few years ago as to the evils of growing fat. The writings of Mr. Banting, an enthusiastic layman who was greatly helped by a reduction of obesity, and whose interest in his fellow men prompted him to make as widely known as possible some thirty years ago his method of cure, has done much to dispel dense ignorance concerning this topic; and in more recent years the illness of Bismarck, and his restoration through the reduction of his obesity, was also a great help to spread knowledge on this most important subject. 

The exciting cause of obesity is the ingestion of more food that the system requires, together with the weakening of the excretory organs, which results in the failure of the system to adequately throw off its waste matter. But the profound and primal cause of obesity will one day be recognized to be the use of cereal and starch foods. An obese person weighing two, four or six stone, twenty-five, fifty, or eighty pounds, or even a still larger amount, more than is natural, may be given a diet of flesh with water with or without the addition of starchless vegetables, as lettuce, watercress, tomatoes, spinach, and the like, excluding bread, pulses and potatoes, and the patient will be gradually but surely reduced to his normal weight. As soon, however, as the patient returns to his usual diet of bread and potatoes he straightway begins to increase in weight; and while an obese patient can easily be reduced eight pounds per month when placed upon a flesh diet, he will gain fully this much or more upon returning to a free use of bread and starch vegetables. If this patient who has been reduced, and who has again developed obesity, is persuaded to again adopt the exclusive flesh diet, again the reduction is sure to take place; and in the course of our practice this process has been repeated among many patients, and in a few a reduction and return to flesh has been repeated three times. It is plain from such demonstrations that without starch foods corpulency would not exist. Chemically starch foods are chiefly carbon; adipose tissue is also carbon, and it would naturally be expected that a diet of oil and the fat of animal flesh would contribute quite as much to obesity as bread and starch foods. But experience proves that such is not the case. The reason for this is not, in the present state of science, understood; it will likely be found in the fact that starch foods undergo a complicated process of digestion, whereas oils require only emulsion to render them assimilable by the system. 

The courage and strength of conviction possessed by the average family doctor is curious to behold. It will be found to be inversely to the ratio of his knowledge. The less conversant he is with this malady the greater confidence he seems to have in his opinions. During the years that we were in practice some hundreds of patients came to us for assistance in this trouble, a large number of whom were under the control of their family physician. Many of these patients came in defiance of the express orders of their physicians; and while they had assumed courage enough to disobey their orders and come to us, they needed much encouragement to enable them to proceed with any confidence. They were usually told by their medical advisers that in them it was natural to be stout, that they had "better leave well enough alone," and the direst results were prophesied in the event that they had the temerity to proceed. In point of fact these patients quite invariably experienced nothing but the happiest results. many of them came out of an interest in their personal appearance; finding their figures destroyed and their beauty going, they desired restoration to their youthful form and feature. Others, again, were annoyed at clumsiness in getting about, shortness of breath in climbing stairs, and the general awkwardness and inconvenience that result from this "too, too solid flesh." Only a small proportion of these patients came from a knowledge that obesity is a disease, that it encourages other states of inflammation and other diseases, and that its reduction is a great aid in the return of health. But while thees patients as a rule did not come to us with this expectation, it was common for them to testify to geat benefits that had resulted from their treatment. These benefits were quite frequently greater than the patient would readily admit or remember. It was our custom, with all patients beginning treatment, to take the name, age, height, weight, and a list of the infirmities, if any, from which they were suffering. These details were elicited by a series of questions, and the answers duly recorded. Out of sight out of mind is the old adage; and human beings are fortunately so conditioned that when their aches and pains have taken flight they forget not infrequently that they were ever present. many of these patients would have stoutly denied the benefit rendered but for the diagnosis taken at the beginning of treatment, and a reference to wich only would convince them of the coniditon they had been in.