Dr Edoardo Ughi – Italy -1886

THE CARNIVOROUS DIET IN GENERAL AND PARTIAL OBESITY

COMMUNICATION BY DR. EDOARDO UGHI Prof. of Propaedeutic Medical Clinic at the University of Parma

The method to be followed in the treatment of obesity is now the subject of lively discussion in Germany, where it appears that such an affliction is frequent due to abundant nutrition, and perhaps most of all due to the exaggerated consumption of beer. Three systems are now followed in the cure of corpulence, and each of them has valid supporters.

The first, and oldest, used without contest for many years, is that of Banting. It is based on the fact that one must eat much albumin, without starch and without fat. The exact prescription is as follows: in the morning 150 gr. of lean meat with bitter tea and 30-40 gr. of bread; at midday 150-180 gr. of lean meat with a small quantity of legumes, little wine, no beer, no farinaceous foods; in the evening 60-100 gr. of meat and later another 120 gr. In total about 170 gr. of albumin, 10 of fat and 80 of carbohydrates are administered.

The cure of Ebstein consists in giving fewer fats and carbohydrates than the body consumes, with the prescription of eating slowly and stopping at the first sense of fullness.

Oertel subtracts liquids as much as possible, with the aim of producing a desiccation of the body. He permits all foods, but in small quantity, so that the pre-existing substances must be consumed in part. He also recommends muscular exercises, both because much water is subtracted from the body through sweat, and because more fats are consumed and the respiratory muscles and heart are strengthened.

The cure of Schweninger, with which Prince Bismarck was cured, is identical to that of Oertel. He too permits all foods in small quantity, prohibits drinking during meals and prescribes muscular exercises. It cannot be denied that each of these methods is founded on good physiological arguments, and is not in disagreement with the laws that regulate material exchange. Therefore, it is no wonder that each of them is effective in achieving the goal, and is thus preferred by various authors. But objections have been raised against all of them.

It has been said that Banting’s cure should not be adopted, because it is poorly tolerated, and gives rise to gastro-enteric disturbances due to the large quantity of meat that must be introduced. Oertel’s cure is burdensome due to the thirst that must be suffered, and Ebstein’s is long and uncertain. It suffices, moreover, to read the debate that took place between these two authors and the various opinions expressed within the Medical Society of Leipzig, last year, by Wagner, Hoffmann, Heubner, Taube and others, to recognize how results and assessments vary. I therefore gladly take this occasion to bring to the attention of the medical public my not insignificant experience on the subject, having treated many sufferers of obesity over various years. I will thus be able to demonstrate the advantages of the exclusive carnivorous diet in obesity, and in general the tolerance that the organism presents for such a diet, which should therefore be more easily utilized even in other cases. It should be noted that I consider here, with many German authors, not only the general increase of fat in the organism as obesity, but also more specifically that limited to certain organs (heart), in such a way as to disturb their function and give the same phenomena as general obesity. I therefore distinguish between absolute and relative obesity.

1st Case. -- B.L. 30 yo, weighs 126 kg

1st Case. — B. L. aged 30, whose father died of apoplectic stroke and was very obese, is 1.88 m tall, weighs 126 kg, and suffers heart disturbances, without having any valvular defect: when climbing stairs, and walking at only a moderate pace, he is seized by strong shortness of breath; moreover this gentleman is affected by dyspepsia due to chronic catarrh of the ventricle. He habitually took two meals a day, a soup and a meat dish for breakfast, a soup and two dishes for dinner, plus 300 gr. of bread, and usually drank a liter and a quarter of wine and almost no water. I suspected that the aforementioned disturbances were caused by obesity and fatty infiltration of the myocardium. The weak and sometimes irregular pulse, the cardiac tones also weak and not very clear, and the arrhythmia that was observed, confirmed me more in my suspicion, so I subjected him to the following dietetic cure: For each day: lean meat from 700 to 900 gr., broth 300 gr., a bottle of wine, and when he ate a smaller quantity of meat, I allowed two or three eggs. I also prescribed that the individual maintain his habits strictly, that is, to always do that exercise to which he was accustomed, not to exert himself more than usual and to drink the usual quantity of water, etc. In five months of practicing these dietetic and hygienic prescriptions, his body weight decreased by 22 kg, that is, it went to 104 kg; the shortness of breath and heart disturbances disappeared, the conditions of digestion improved. For two years now he has returned to his habitual regimen, and his weight oscillates between 106 to 108 kg.

2nd Case. – G.L. 96.5 kg to 88 kg and maintained two years

2nd Case. — G. L. complains of dyspepsia, shortness of breath and inability to resist in the work of grocer; he is 1.73 m tall, weighs 96.500 kg; apart from obesity, I found no sick organ, except for a slight gastric catarrh due to excessive use of wine. The individual is accustomed to taking two meals a day, and in total took a soup, two dishes (sometimes meat, sometimes vegetables), 300 gr. of bread, and drank 2 or 2½ liters of wine, very little water and often made no use of it. I subjected him to the identical cure of the previous case, because in this case too I believed that obesity was the principal cause of the shortness of breath and inability to resist at work. The individual maintained his habits in work, walking, etc. After three months of said cure the weight descended to 87 kg, the shortness of breath and dyspepsia disappeared, and the individual could frankly resist, without need of tiring himself, his occupations. Two years have already passed since the cure, and the weight has oscillated between 87 to 88½ kg.

3rd Case. – Mr. U. O. 87.5 kg to 73 kg over 5 months

3rd Case. — Mr. U. O., 1.69 m tall, weighs 87½ kg, suffers no ailment, except for slight dyspnea when climbing stairs. The individual takes three meals a day: in total he eats a soup, 450 gr. of bread, 300 gr. of meat, and drinks a liter of wine, a black coffee and little or no water. For 5 months he takes 200 gr. of broth, 700 gr. of meat, two or three eggs, and drinks a liter of wine, as usual, nothing or almost no water, does not modify his occupations and habits at all. At the beginning of this cure he felt weakened, afterwards he noticed no ailment. In these five months the weight descended to 73 kg; a year has passed since the end of the cure, and now he weighs 78 kg. Currently he has no longer the slightest trace of shortness of breath.

4th Case. – C. D. 45 yo, 102 kg to 89 kg over 4 months

4th Case. — C. D. aged 45, 1.66 m tall, weighs 102 kg, and suffers from shortness of breath, frequently also from dizziness. The cardiac impulse is weak, as are the cardiac tones; after prolonged efforts the individual remains very exhausted, and then a slight degree of cyanotic color is seen on the lips, face and also hands: it is in these moments that he complains of strong dizziness, to free himself from which the individual resorts to bloodletting. I believed that following fatty infiltration of the myocardium, systolic insufficiency had arisen, hence the cyanosis, shortness of breath, dizziness due to venous stasis. This man eats moderately: a soup, 300 gr. of meat, 350 gr. of bread, drinks two liters of wine. For 4 months he abandoned the soup and bread, and reduced the wine by one liter. In this time, he took a broth of 300 gr., meat 750 to 800 gr., some eggs and one liter of wine. During the cure he did not modify his habits in working, walking, etc. at all. When the cure was finished, the weight went to 89 kg, the shortness of breath diminished, the cyanosis only occurs at some moments and in slight degree, the dizziness is much less frequent and lighter.

5th Case. – B. Appio, 35 yo, 98 kg to 88 kg

5th Case. — B. Appio aged 35, 1.60 m tall, weighs 98 kg, suffers very much from shortness of breath, somnolence, cyanosis, dizziness, sleeps a very agitated and interrupted sleep, has an irritating cough with frothy serous expectoration, and has strong edema in the lower limbs: this man finds himself almost unable to discharge his duties as a tobacco seller. In this man are found in the maximum degree all the phenomena of the previous case, and certainly they arose through the same modality, except that in B. there is severe edema in the lung, legs and perhaps also in the brain, given the disturbances already mentioned and the cries he emits at night. The examination of the heart does not permit admitting any valvular defect, only the 2nd tone of the pulmonary is found anomalous, which is much reinforced relative to the first; a fact that is explained taking into account that there is strong congestion and edema in the lung. B. eats much soup (two or three portions), 300 gr. of bread, little meat, drinks a very large quantity of water and only half a liter of wine per day. I had the individual continue for three months to take from 700 to 800 gr. of meat, some eggs, a broth of 200 gr. and his usual quantity of wine (½ liter) and water. Weighed after this time, he is no more than 88¼ kg. Now he is well; the edema in the legs and lung has disappeared, moreover all the other facts have almost dissipated, except for a slight degree of shortness of breath. The cure ended at the end of November last, and until today the patient has remained in the conditions just described. I note that this man led a sedentary life before the cure, and during the same.

6th Case. – B. G. 42 yo, 110 kg to 99 kg

6th Case. — B. G. aged 42, 1.85 m tall, weighs 110 kg, suffers from dyspepsia and has impeded movements; has dilatation of the ventricle. This subject eats a kg. of bread per day, in addition to a very abundant soup and a dish; drinks 2 or 2½ liters and little water. For three months I arranged so that the individual did not change habits, did not walk more than usual, did no work more than usual, and always drank the same quantity of water, which he was accustomed to in the past. In these three months he ate a kg. of meat and two eggs per day, and drank a liter and ¼ of wine, 300 gr. of broth per day; after this term he weighed 99 kg. During the cure he improved in digestion, and movements became easier. Having returned to the habitual diet for a year, he now weighs 102.500 kg. The phenomena of altered digestion have renewed.

7th Case. – B. Lawyer, enormously obese loses at least 15 kg

7th Case. — B. Lawyer, 1.68 m tall, is enormously obese, orthopneic, edematous (in the lower limbs); had several attacks of asystole, and due to these serious facts had to abandon his profession and go to the city. Due to the gravity of the aforementioned symptoms, it was not possible for me to establish a physical examination of the circulatory center and therefore a certain diagnosis. This gentleman was always a good eater and a discrete drinker, but I could not say the quantity of food and drink he introduced daily. I saw this gentleman only once, not being his doctor, and I advised him to the identical cure of the first two cases. After about three months of such cure, I learned that all the imposing symptoms had disappeared, but that some shortness of breath remained. A short time ago I met the aforementioned gentleman and saw that he must have decreased in weight by at least 14 or 15 kg. I hope to be able to know where he currently resides and thus specify many of the aforementioned facts.

8th Case. – B. M., 65 yo, 90 kg to 83 kg

8th Case. — B. M. aged 65, 1.55 m tall, weighs 90 kg, and is almost unable to walk due to strong dyspnea. This lady leads a sedentary life; takes daily a coffee and milk with bread, a soup, two dishes (more often meat), 200 gr. of bread and drinks a bottle of wine and very little water. I did not want her to change her habits, except in food; during the cure she therefore led an extremely sedentary life. For two months she continued to take daily 700 to 800 gr. of meat, some eggs, two broths (400 gr. in total), and her habitual bottle of wine. After this time the lady weighed only 83 kg, and walked, moderately, without shortness of breath.

9th Case. – Mrs. Z. G., 32 yo, 92 kg to 84 kg

9th Case. — Mrs. Z. G. aged 32, daughter of an extremely fat mother, weighs 92 kg, has no serious disturbance, only feels heavy, and cannot therefore attend to her affairs with that agility to which she was accustomed in past years. At night she is almost always seized by tingling in the limbs on which she lies. She uses mixed food, but prefers vegetables, and drinks a bottle of wine per day and little water. For two months I had her completely abandon vegetable foods, and allowed her a broth of about 200 gr., 700 to 800 gr. of meat, two eggs and her usual wine. This lady was always very active, and during the cure did not modify her habits at all. Weighed after the cure was finished, she was only 84 kg; she acquired complete freedom of movement, and the tingling completely disappeared.

10th Case. – G. Adele, 39 yo, 95 kg from much use of vegetable food, down to 86 kg

10th Case. — G. Adele aged 39; her father is very obese, and she weighs 95 kg, and for a long time has had shortness of breath, cough, edema in the lower limbs. This lady makes much use of vegetable food, and hardly eats meat except in winter, drinks almost a bottle of wine every day. Having made a delicate examination of the heart, I could find nothing morbid, only the tones were weak, and the radial pulse also weak and small. To explain the phenomenological syndrome, in addition to taking into account the general adiposity, I also had to resort to fatty infiltration of the myocardium and the diminished strength of the same due to this fact. For 70 days continuously she took 700 to 800 gr. of lean meat (for the previous cases too I always gave lean meat), a pair of eggs, a broth of 200 gr., and the usual quantity of wine. During this cure she did not change her habits in any way. Weighed after the cure, she was no more than 86 kg, and her sufferings had almost totally disappeared.

I add to my cases the following treated by my esteemed friend Dr. Guido Musiari.

11th Case. – Mr. Cotti Giuseppe of Noceto, 40 yo, 137 kg to 97 kg

11th Case. — Mr. Cotti Giuseppe of Noceto, aged 40, 1.88 m tall, weighs 137 kg; is not dyspneic, and it is surprising to see much agility preserved in his movements. This gentleman eats and drinks much, following which a strong dilatation of the ventricle was established. Three years ago, Mr. Cotti ingested a very strong quantity of ice-cold water, and immediately afterwards was seized by an epileptiform attack. The doctor thinking that the attack had arisen from a reflex fact (dependent on the ventricle), advised this man to follow a predominantly carnivorous diet, allowing only a very small quantity of bread, a small soup, meat at will, some eggs and a moderate quantity of wine; the patient has continued for almost three years to put into execution the prescribed diet, and in this time his body weight has diminished by 40 kg, that is, he weighs 97 kg. I note that this man used potassium bromide for a long time, the epileptiform attack still repeating from time to time, but Cottis mental faculties are not altered at all.

SUMMARY TABLE [Table showing 11 cases with columns for: Case number, Initial body weight, Diet used, Duration of cure, Final body weight, and Observations. The table details the results of the carnivorous diet treatment for each patient, showing significant weight loss and improvement in symptoms across all cases.]

From this exposition results:

1) 1st That the exclusive, or almost exclusive, carnivorous diet was well tolerated in all cases, and never gave rise to disturbances; indeed, the dyspeptics improved greatly in their sufferings, and the individuals, after becoming accustomed to it, suffered from flatulence when they returned to the ordinary diet.

2) 2nd That the carnivorous diet always produced a notable diminution of body weight, with improvement of the general state.It especially served to dissipate shortness of breath and all phenomena related to obesity of the heart and weakness of the respiratory muscles, for which Oertel so much vaunts his own method. Finally, I must add the singular observation, that in many of my patients the skin acquired through the use of meat a more intense color than it had before. Some of the men confessed to me that before the cure they also had impotence or almost impotence in coitus; after they became thin, they regained their virile potency.

Physiology gives us reason for these results, and supports them with its laws.

It is true that man can make use of all aliments, but it must be recognized however that the gastro-enteric tube is more conveniently conformed for animal foods, as in carnivores. Therefore, the carnivorous diet must be suitable for him. This moreover satisfies very well the norms to which any system of cure for corpulence must correspond, that is:

1st That the individual does not consume fats, or bodies capable of forming them, in quantity greater than that necessary for the maintenance of the body.

2nd That the individual consumes a part of the fat accumulated in the organism.

In the cases we have reported, the individuals consumed 700 gr. of lean meat per day, with slight addition of wine and other substances.

If we calculate with Voit that an adult man must, on average, introduce with food 18.3 gr. of nitrogen, in the form of albumin, and in total 328 gr. of carbon, the 700 gr. of meat are truly more than sufficient to cover the loss of nitrogen; indeed they give 23.81 gr. of nitrogen, instead of 18.3, but are totally insufficient to supply the 328 gr. of carbon. In fact, according to Voits calculations (Hermanns Handbuch der Physiologie, Bd. VI, pag. 407), it would be necessary for this purpose to eat 2620 gr. of lean meat. Let us also put in the calculation about 70-150 gr. of alcohol, contained in the wine consumed by these individuals, which, as was demonstrated by Albertoni and Lussana (On alcohol, on aldehyde and on wine ethers. Lo Sperimentale 1874), and recently repeated ad litteram by Bohland, copying the work of our compatriots without remembering it, burns almost entirely in the organism, and gives CO₂ and H₂O; nevertheless there always remains a notable deficit in the combustible carbon introduced, that is about half of the necessary, which must be covered by the fat previously accumulated in the organism, which is consumed, thus producing a notable diminution of body weight. Some of my patients did not truly show an increase beyond the ordinary in body weight and a large general deposit of fat, but instead showed well manifest the phenomena dependent on abnormal deposit of fat within the heart and respiratory muscles, whence shortness of breath and other related symptoms. Oertel justly calls attention to such a condition, and insists on the fact that his cure serves to dissipate it. I am pleased to note here that also in the cases reported by me a happy outcome was always obtained with the carnivorous diet. Regarding etiological conditions, heredity often plays a role in my patients. Few of them made use of truly superabundant food, although they belonged to the well-to-do class and had a certain alimentary budget of luxury. But in face of daily observation, that many persons with a luxury budget much greater than that of my patients, and not all of them, do not become obese, one is forced to admit for the development of such an affliction a particular disposition to the formation of fat from albuminoids and carbohydrates. It results finally that meat alone, when there is fat to burn, suffices very well to maintain life for months.