The Chemistry of Food and Nutrition by A. W. Duncan (readict TXT) 📕

It is a common experience amongst rheumatic patients, that they cannot take lentils, haricots and some other foods; sometimes, even eggs and milk are inadmissible. This is not for the alleged reason that they contain purins, or as some misname it, uric acid; but because the digestive organs are unequal to the task. It will be seen, that although Dr. Haig's hypothesis of uric acid as a cause of gout and some other diseases is disputed by many eminent physicians, his treatment by excluding flesh and other foods which contain purins, and also pulse, which is difficult of digestion by the weakly, is a wise one. It has proved of the greatest value in very many cases.

Digestion and nutrition is a complex process, and it may be faulty at various stages and in several ways; there may be either deficient or excessive secretions or inaction. Thus there are exceptions, where gouty symptoms, including an excessive quantity of urates in the urine, have only been relieved by the giving up of milk foods or starch foods (see Lancet, 1900, I., p. 1, and 1903, I., p. 1059).

Those particularly interested in the subject of the purins and gout are referred to the lecture on "The meaning of uric acid and the urates," by Dr. Woods-Hutchinson, in the Lancet, 1903, I., p. 288, and the discussion on "The Chemical Pathology of Gout" before the British Medical Association at Oxford (see British Medical Journal, 1904, II., p. 740).

Dr. George S. Keith, in "Fads of an Old Physician," has a chapter on rheumatic fever; he says that the disease is much more common than it was fifty years ago. He has never met with it in the young or old except when the diet had consisted largely of beef and mutton, and this although he has been on the outlook for at least forty years for a case of the disease in a child or youth who had not been fed on red meat. He speaks of it as being exceedingly common in Buenos Ayres and Rosario in the Argentine Republic, amongst the young; and that it leads to most of the heart disease there. The amount of meat, especially of beef, consumed by old and young is enormous. The main evils there, were anæmia in children and neuralgia both in old and young. Dr. Haig relates how he suffered from migraine all his life, until the time of his discontinuing butchers' meat. As meat contains a comparatively large quantity of purins and other bodies called extractives, it is probable that such quantities have an injurious effect, quite apart from the question of uric acid production. That an excessive meat diet lessens the vitality of the body and pre-disposes to disease is undoubted, but opinions differ as to how the injury is brought about.

On thorough Mastication.—We have written at some length on the quantity and constituents of food required per day and have criticised the usually accepted standards. We have since read a valuable contribution to the subject by Mr. Horace Fletcher in his book, "The A.B.-Z. of our own nutrition" (F.A. Stokes & Co., New York). Ten years previous to the writing of the book, when of the age of 4, he was fast becoming a physical wreck, although he was trained as an athlete in his youth and had lived an active and most agreeable life. He had contracted a degree of physical disorder that made him ineligible as an insurance risk. This unexpected disability and warning was so much a shock, that it led to his making a strong personal effort to save himself. He concluded that he took too much food and too much needless worry. His practice and advice is, be sure that you are really hungry and are not pampering false appetite. If true appetite that will relish plain bread alone is not present, wait for it, if you have to wait till noon. Then chew, masticate, munch, bite, taste everything you take in your mouth; until it is not only thoroughly liquefied and made neutral or alkaline by saliva, but until the reduced substance all settles back in the folds at the back of the mouth and excites the swallowing impulse into a strong inclination to swallow. Then swallow what has collected and has excited the impulse, and continue to chew at the remainder, liquid though it be, until the last morsel disappears in response to the swallowing impulse. In a very short time this will become an agreeable and profitable fixed habit. Mr. Fletcher has been under the observation of several eminent scientific men. Professor R.H. Chittenden, of Yale University, in his report refers to the experiments of Kumagawa, Sivén, and other physiologists; who have shown that men may live and thrive, for a time at least, on amounts of proteid per day equal to only one-half and one-quarter the amount called for in the Voit standard (see p. 32), even without unduly increasing the total calories of the food intake. Such investigations, however, have always called forth critical comment from writers reluctant to depart from the current standards, as extending over too short periods of time.

Dr. Chittenden writes that he has had in his laboratory, for several months past, a gentleman (H.F.) who for some five years, practised a certain degree of abstinence in the taking of food and attained important economy with, as he believes, great gain, in bodily and mental vigour and with marked improvement in his general health. The gentleman in question fully satisfies his appetite, but no longer desires the amount of food consumed by most individuals. For a period of thirteen days, in January, he was under observation in Professor Chittenden's laboratory. The daily amount of proteid metabolised was 41.25 grammes, the body-weight (165 pounds) remaining practically constant. Analysis of the excretions showed an output of an equivalent quantity of nitrogen. In February a more thorough series of observations was made. The diet was quite simple, and consisted merely of a prepared cereal food, milk and maple sugar. This diet was taken twice a day for seven days, and was selected by the subject as giving sufficient variety for his needs and quite in accord with his taste. No attempt was made to conform to any given standard of quantity, but the subject took each day such amounts of the above foods as his appetite craved. The daily average in grammes was, proteid 44.9 (1.58 ounces), fats 38.0, carbohydrates 253.0, calories 1,606. The total intake of nitrogen per day was 7.19, while the output was 6.90. It may be asked, says Professor Chittenden, was this diet at all adequate for the needs of the body—sufficient for a man weighing 165 pounds? In reply, it may be said that the appetite was satisfied and that the subject had full freedom to take more food if he so desired. The body-weight remained practically constant and the nitrogen of the intake and output were not far apart. An important point is, can a man on such food be fit for physical work? Mr. Fletcher was placed under the guidance of Dr. W.G. Anderson, the director of the gymnasium of Yale University. Dr. Anderson reports that on the four last days of the experiment, in February, 1903, Mr. Fletcher was given the same kind of exercises as are given to the 'Varsity crew. They are drastic and fatiguing and cannot be done by beginners without soreness and pain resulting. They are of a character to tax the heart and lungs as well as to try the muscles of the limbs and trunk. "My conclusion, given in condensed form, is this: Mr. Fletcher performs this work with greater ease and with fewer noticeable bad results than any man of his age and condition I have ever worked with." "To appreciate the full significance of this report, it must be remembered," writes Professor Chittenden, "that Mr. Fletcher had for several months past taken practically no exercise other than that involved in daily walks about town." Sir Michael Forster had Mr. Fletcher and others under observation in his Cambridge laboratories, and in his report he remarks on the waste products of the bowel being not only greatly reduced in amount, as might be expected; but that they are also markedly changed in character, becoming odourless and inoffensive, and assuming a condition which suggests that the intestine is in a healthier and more aseptic condition than is the case under ordinary circumstances. If we can obtain sufficient nourishment, as Mr. Fletcher does, on half the usual quantity of food, we diminish by half the expenditure of energy required for digestion. By thorough mastication the succeeding digestive processes are more easily and completely performed. What is also of great importance is that there is not the danger of the blocking up of the lower intestines with a mass of incompletely digested and decomposing residue, to poison the whole body. Even where there is daily defæcation, there is often still this slowly shifting mass; the end portion only, being expelled at a time, one or more days after its proper period. All this improved condition of the digestive tract, leaves more vitality for use in other directions, a greater capacity for work and clearness of brain.

Professor R.H. Chittenden, in "Physiological Economy in Nutrition," writes:—"Our results, obtained with a great variety of subjects, justify the conviction that the minimum proteid requirements of the healthy man, under ordinary conditions of life, are far below the generally accepted dietary standards, and far below the amounts called for by the acquired taste of the generality of mankind. Body weight, health, strength, mental and physical vigour and endurance can be maintained with at least one-half of the proteid food ordinarily consumed."

From these and other considerations, we see that it is not only unnecessary, but inadvisable to diet ourselves according to any of the old standards, such as that of Voit, or even to any other standard, until they have been very thoroughly revised. We shall probably find that as the body becomes accustomed to simpler food, a smaller quantity of the food is necessary. The proportion of proteids to other constituents in all the ordinary, not over manfactured vegetable foods, such as are generally eaten, may be taken as sufficient. Several cookery books have been compiled in conformity with certain proteid standards and also with some more or less fanciful requirements; these give the quantities and kinds of food which it is imagined should be eaten each day. Theoretically, this should be calculated to accord with the weight, temperament, age and sex of the eater and the work he or she has to perform. The dietaries that we have seen have their proteid ratio placed unnecessarily high. This high proteid ratio can be got by the use of the pulses, but except in small quantities they are not generally admissible, and in some of the dietaries they are ruled out. The difficulty is got over by the liberal use of eggs, cheese and milk. To admit a necessity for these animal products is to show a weakness and want of confidence in the sufficiency of vegetable foods. Some of these cookery books are of use in sickness, especially as replacing those of the beef-tea, chicken-broth, jelly and arrowroot order. They provide a half-way stage between flesh and vegetable food, such as is palatable to those who have not quite overcome a yearning for flesh and stimulating foods. The liberal use of animal products is less likely to excite the prejudice of the ordinary medical practitioner or nurse. Possibly, also, a higher quantity of proteid may be required on first giving up flesh foods.

The Use of Salt.—One of the most remarkable habits of these times is