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January 1, 1882

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the German physiologist Wilhelm Ebstein cites Cantani as an authority for the use of pure fat in diabetic diets. “up to about 200 grams of fat is well tolerated by the majority of diabetics”





Obesity (Corpulence) and its treatment according to physiological principles


Important Text:

Cantani’s dietary regime involved periods of energy restriction, however the German physiologist Wilhelm Ebstein cites Cantani as an authority for the use of pure fat in diabetic diets. In 1892 Ebstein published his comprehensive review of the literature on diet, lifestyle, and diabetes, Über die Lebensweise der Zuckerkranken, which includes the statement that “up to about 200 grams of fat is well tolerated by the majority of diabetics” [7]. Also in 1892, Ebstein’s book on Corpulence and its Treatment on Physiological Principles, which contained brief summaries of his findings on fat and diabetes, was translated into English [8]. In this book and his subsequent work On the Regimen to be Adopted in Cases of Gout Ebstein discussed experimental evidence on the metabolism of protein and the desirability of limiting both protein and carbohydrate, and increasing fat, in the treatment of metabolic diseases [9].

German Txt (Very hard to read)

English Translation Scanned PDF:

Ebstein describes Rabbit Starvation:

Page 37:

Notwithstanding the vastly important part played by nitrogenous food in human dietetics, those substances that contain no nutritive ingredients except albumen, as for instance flesh destitute of fat, are not proper food for man. As flesh satisfies his demand for carbon only when it is consumed four times in excess of the quantity required to yield the nitrogen needed for his nourishment, such a course would in the first place be far from economical, seeing that meat is one of the dearest articles of food. And then we should very soon find it impossible to consume every day the 90 oz. of pure flesh required for this purpose.

The dietetic systems of treatment now in vogue are based on an almost exclusively albuminous diet. In 1850 Chambers had already pronounced in favour of this regimen, his system excluding all fat substances such as fat, oil, butter, milk, cream, as well as sugar. Of starch-flour in the form of potatoes and even of bread he remarked, that they should be looked on with the greatest suspicion. He also insisted on a diminished consumption of liquids. 

We thus perceive that strictly speaking Chambers' cure differs in no respect from that, by which Banting grew lean in the hands of his physician Harvey, and which has received the name of the Banting cure from the patient, who has written an account of his malady and curative process. From it's specially operative factor Kisch has named it the "Anti-Fat Cure".

Cantani has gone still more vigourously to work. He bars not only all fats - fat meat, fat fish, cheese (owing to its sebacic acid), but all farinaceous preparations, all saccharine foods, sweet and aromatic fruits. Only when the patient is unable to continue this diet long enough, either through excessive repugnance to meat, or nausea of the stomach, or muscular debility, he combines it with the Harvey-Banting system, which also no doubt anathematises the fats, but allows a certain quantity of carbohydrates. 

    Hence these cures have this in common that both alike to the very utmost exclude fats, which they regard as the chief source of the accumulation of fat in the body.

    Now I will by no means deny that a series of cures does result from the Harvey-Banting and Cantani methods, that is to say, by these means corpulent persons become thin. But on the other hand it must be allowed that: 

Page 44:

Ebstein strongly supports fat for satiety.

"I would now specially insist that the suitable quantity of alimentary fat must not forsooth remove hunger in such a way as to produce dyspeptic symptoms or injure the digestion; and this I dwell upon because the question has already been more than once placed before me by competent colleagues. It is of course a tacit assumption that the fat like all other human aliments, be of unexceptionable quality. The experiments made on persons suffering from fistula in the stomach, have already shown that fat substances disturb the digestion only when they are consumed too abundantly, and I have myself often enough administered with surprising succcess alimentary fat to dyspeptics of the worst type, while limitng their allowance of carbohydrates. But my own numerous experiences have also convinced me, that in the treatment of corpulency fat agrees perfectly well even with those, who had previously regarded it with nausea. I have even noticed a total disappearance of the dyspeptic affections, which the corpulent had hitherto brought upon themselves by an improper diet. The patients preserve a good appetite, which they must learn to moderate by yielding only the actual feeling of hunger. 

The reason of this alleviation of the feeling of hunger with a proper allowance of fat in the diet is due to the circumstance, that fat checks the decomposition of albumen, and that consequently the craving to make good the waste makes itself felt more slowly and less urgently. Precisely because fewer albuminates have been decomposed, fewer require to be replaced. As by the addition of fat to the diet in the same proportion as the decomposition of albumen is diminished, the quantity of nitrogenous refuse from the assimilated substances is also limined, a smaller amount of drink is needed for its removal. Hence in this way thirst as well as hunger becomes appeased. That fats reduce the craving for food was already known to Hippocrates, who remarks in the section dealing with those that wish to become fat or lean: "the dishes must be succelent, for in this way we are easiest sated." Very interesting to me was a communication from Loew, bearing on the point that the use of fat is also effective in checking the craving for liquids. After the consumption of fat in hot climates he always noticed a diminished demand for water; thirst became decidely less irksome.

This property of fat to produce satiety more rapidly, to diminish the craving for food and abate the feeling of thirst, facilitates to an extraordinary degree the introduction of the modified diet. For to the sacrifices which after all must in any case be required of the corpulent, nothing further need be superadded at least in this direction. On the contrary, the permission to enjoy certain succulent things, always of course in moderation, as for instance salmon, pate de foie gras and such like delicacies, reconciles the corpulent gourmet to his sacrifices. These consist in the exclusion of the carbohydrates. Sugar, sweets of all kinds, potatoes in every form I forbid unconditionally. The quantity of bread is limited at most to from 3 to 3.5 oz a day, and of vegetables I allow asparagus, spinach, the various kinds of cabbage and especially the leguminous, whose value as conveyors of albumen, as Voit rightly observes, is known to few. Of meats I exclude none, and the fat in the flesh I do not wish to be avoided, but on the contrary sought after. I permit bacon fat, fat roast pork and mutton, kidney fat, and when no other fat is at hand I recommend marrow to be added to soups. I allow the sauces as well as the vegetables to be made juicy, as did Hippocrates, only for his sesam-oil I substitute butter. 

In spite of all this it would be little to the point to say that I treat the corpulent with fat, whereas I simply vindicate the full claims to which fat is entitled as an article of food. I do not suppose that the corpulent, with who we are practically concerned, will have to consume anything like the quantity of fat that Voit concedes to the working man, or that is allowed to the rank and file of the German imperial army in time of war, say from 7 to 9 oz. daily. I reduce this daily allowance of fat to from 2 to 3.5 oz on an average. The quantity of course changes with the individual relations, nor is it the same for every day. Under the influence of this diet it becomes possible to do with a less quantity of meat. This again I reduce to fully one half or three-fifths of the quantity required in the Banting system, which varies from 13 to 16 oz. a day.

Topics: (click image to open)

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