Weight Control

The simple and reliable advice is the same as it has been for the better part of two hundred years. It dates back at least to Jean Anthelme Brillat-Savarin in 1825 and The Physiology of Taste, which has never been out of print, an accomplishment that very few nonfiction books can claim after nearly two centuries. Brillat-Savarin got it as right as anyone. He had his own conversion experience, just as fad diet book authors typically do, and he wrote about it. He spent thirty years struggling with his weight—he called his paunch his “redoubtable enemy”—and eventually came to what he considered an acceptable standoff. He did so only after digesting the message “of more than five hundred conversations” he had held with “dinner companions who were threatened or afflicted with obesity.” In every case, he wrote, the foods they craved were breads and starches and desserts. 

As a consequence, Brillat-Savarin considered it indisputable that grains and starches were the principal cause of obesity—along with a genetic or biological predisposition to fatten easily, which not everybody has—and that sugar exacerbated the fattening process.† He lived in a time, though, when sugar was still a luxury for the wealthy, and sugary beverages were exceedingly hard to come by, at least compared to their ubiquity a century later. So he focused his advice on starches and flour, assuming that abstinence from flour would imply abstinence from sugar, since sugars back then came predominantly in baked goods, pastries, and desserts. 

Brillat-Savarin acknowledged that those who wished to reduce their weight needed something more than just the usual advice to “eat moderately” and “exercise as much as possible.” The only infallible system, he said, had to be diet, and that diet had to remove the cause of the excess body fat: 

"Of all medical prescriptions, diet is the most important, for it acts without cease day and night, waking and sleeping; it works anew at every meal, so that finally it influences each part of the individual. Now, an anti-fat diet is based on the commonest and most active cause of obesity, since, as it has already been clearly shown, it is only because of grains and starches that fatty congestion can occur, as much in man as in the animals; in regard to these latter, this effect is demonstrated every day under our very eyes, and plays a large part in the commerce of

fattened beasts for our markets, and it can be deduced, as an exact consequence, that a more or less rigid abstinence from everything that is starchy or floury will lead to the lessening of weight." 

Brillat-Savarin even went so far as to imagine his readers complaining that more or less rigid abstinence from everything that is starchy or floury meant no longer eating the foods they craved. In other words, his readers then might be much like readers now. “In a single word he [Brillat-Savarin] forbids us everything we most love,” he wrote, “those little white rolls from Limet, and Achard’s cakes, and those cookies … and a hundred other things made with flour and butter, with flour and sugar, with flour and sugar and eggs! He doesn’t even leave us potatoes, or macaroni! Who would have thought this of a lover of good food who seemed so pleasant?” Brillat-Savarin’s response was simple (although I’m bowdlerizing the translation for the more sensitive times in which we live): Then eat these foods and get fat and stay fat!

For many or most of us, this logic offers little or no escape, and as Brillat-Savarin said, the conclusion can still be deduced as an exact consequence. If carbohydrate-rich foods make us fat, then we have to deprive ourselves of the pleasure of their eating if we want to avoid this fate or possibly reverse it. But then, as Brillat-Savarin also noted, these restrictions left plenty to eat and as much of it as desired, which meant meals could be consumed that were still plenty tempting but not fattening.

Gary Taubes. The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating (Kindle Locations 2519-2522). Knopf. Kindle Edition. 

 “My patient, Mr. Banting having published for the benefit of his fellow sufferers, some account of the diet which I recommended him to adopt with a view to relieve himself of a distressing degree of hypertrophy of the adipose tissue. I have been frequently urged by him to explain the principles upon which I was enable to treat with success the inconvenient and in some instances distressing condition of the system. 

“The simple history of my finding occasion to investigate the subject is as follows: when in Paris in the year 1856, I took the opportunity of attending a discussion on the views of M. Bernard who was at that time propounding his now generally admitted theory of the liver functions. After he had discovered by chemical processes and physiological experiments, which it is unnecessary for me to recapitulate here, that the liver not only secreted bile, but also a peculiar amyloid or starch-like product which he called glucose, and which in its chemical and physical properties appeared to be nearly allied to saccharine matter, he further found that this glucose could be directly produced in the liver by the ingestion of sugar and its ally starch and that in diabetes it existed there in considerable excess. 

It had long been well known that a purely animal diet greatly assisted in checking die secretion of diabetic urine; and it seemed to follow, as a matter of course, that the total abstinence from saccharine and farinaceous matter must drain the liver of this excessive amount of glucose, aid thus arrest in a similar proportion the diabetic tendency. Reflecting on this chain of argument and knowing too that a saccharine and farinaceous diet is used to fatten certain animals and that in diabetes, the whole of the fat in the body rapidly disappears, it occurred to me that excessive obesity might be allied to diabetes as to its cause, although widely diverse in its development: and that if a purely animal diet was useful in the latter disease, a combination of animal food with such vegetable matter as contained neither sugar nor starch, might serve to arrest the undue formation of fat. 

I soon afterwards had an opportunity of testing this idea. A dispensary patient who consulted me for deafness, and who was enourmously corpulent, I found to have no distinguishable disease of the ear. I therefore suspected that his deafness arose from the great development of adipose matter in the throat, pressing upon and stopping up the eustachian tubes. I subjected him to a strict non-farinaceous and non-saccharine diet, and treated him with the volatile alkali alluded to in his Pamphlet, and occasional aperients and in about seven months he was reduced to almost normal proportions, his hearing restored and his general health immensely improved. The case seemed to give substance and reality to my conjectures, which further experience has confirmed. 

“When we consider that fat is what is termed hydrocarbon, and deposits itself so insidiously and yet so gradually amongst the tissues of the body it is at once manifest that we require such substances as contain a superfluity of oxygen and nitrogen to arrest its formation and to vitalize the system. That is the principle upon which the diet suggested in his pamphlet works, and explains on the one hand the necessity of abstaining from all vegetable roots which hold a large quantity of saccharine matter, and on the other beneficial effects derivable from those vegetables, the fruits of which are on the exterior of the earth, as they lose, probably by means of the sun’s action a large proportion of their sugar. 

“With regard to the tables of Dr. Hutchinson, referred to in his Pamphlet, it is no doubt difficult, as he says, to determine what is a man’s proper weight, which must be influenced by various cases. Those tables, however, were formed by him on the principle of considering the amount of air which the lungs in their healthy state can receive and apply to the oxidation of the blood. I gave them to Mr. Banting as an indication only of what the approximate weight of persons in proportion to their stature should be, and with the view of proving to them the importance of keeping down the tendency to grow fat; for, as that tendency increases, the capacity of the lungs, and consequently the vitality and power of the whole system must diminish. In conclusion, I would suggest the propriety of advising a dietary such as this in diseases that are in any way influenced by a disordered condition of the hepatic functions as they cannot fail to yield in some degree to this simple method of treatment if fairly and properly carried out; it remains for me to watch its progress in a more limited sphere. 

WILLIAM HARVEY, F.R.C.S. 

Surgeon to the Royal Dispensary for Diseases of the Ear 2, Soho Square 

April, 1864 

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 

"Alternate feeding and fasting are adopted when it is found that the glycosuria persists after a preliminary four days' fast. The method which I have found most successful has been to allow, following the first fasting period, 20 to 40 grams carbohydrate not far from half a gram per kilogram body weight-and about one gram of protein per kilogram for two days.This can be avoided by still further restricting the carbohydrate, either temporarily or permanently. It is always necessary to bear in mind that one food which the diabetic patient cannot do without is protein, and to it everything else must be subservient. While testing the protein tolerance, a small quantity of fat is included in the eggs and meat given."

"We reported briefly the results of an investigation of the effect of a diet whose energy came largely from fat, to which was added sufficient protein to maintain nitrogen balance and the minimal carbohydrate necessitated in making up a diet that a human being can eat over a long period of time. It was shown that with such a diet, glycosuria was avoided in severe diabetics, and that acidosis was not produced. The twenty-eight cases contained in Table 1 show that a high fat diet such as we have used is capable of bringing the blood sugar down to normal and keeping it at that level during the period of observation."

The first paper stated the method employed and, in a general way, the results obtained. Freedom from glycosuria, however, does not necessarily mean normal glycemia. In this communication we shall deal with the effect of this type of diet on the blood sugar. Blood sugar determinations, sufficiently numerous to permit drawing conclusions concerning the effect of the diet on glycemia, are available in forty-five cases. We include in this group every case in which such a series of determinations has been made, and have omitted only those whose blood sugar determinations have been too few to be of significance. A few patients left the hospital on higher diets than those shown in the tables, but as corresponding blood sugar determinations are not available, the tables for such individuals stop with the last blood sugar reading. These cases are presented in four groups. The first three groups (Tables 1, 2 and 3), consisting of forty cases, show a satisfactory response of the blood sugar to the treatment. The fourth group (Table 4) comprises the five cases in which blood sugars did not reach a desirably low percentage. Of the forty satisfactory cases, those complicated by chronic nephritis have been brought together in Table 2, and those in which diets varied at times from our standard are presented in Table 3.

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