Published Science

During recent years there has been increasing interest in the blood lipids in patients with diabetes mellitus, chiefly because of the uncertain relationship between dietary fat, hypercholesteremia and the frequent development of atherosclerosis in diabetic subjects. It has been repeatedly demonstrated that atherosclerosis can be produced in rabbits by feeding large amounts of cholesterol. It is also well known that many diabetic patients have hypercholesteremia, that arteriosclerosis develops at a relatively early age in many diabetic patients and that this complication accounts for most of the incapacitation and fatality from this disease. The cause of a high cholesterol content of the blood and of vascular disease in diabetic patients has naturally been the subject of much investigation.

Before the advent of insulin it was necessary for all patients with diabetes except those with mild involvement to live on a high fat-low carbohydrate diet. Since 1922, with the use of insulin,

The question of minimal and optimal protein requirements has received considerable research attention in recent years. There is now very little disagreement among students of nutrition as to what these requirements are. On the effects of a high protein dietary, however, not only do opinions of authorities differ but the results of carefully controlled experiments show considerable variance. It is a traditional belief that a high protein intake leads to high blood pressure, arteriosclerosis or nephritis. Among physicians it has almost become a dietetic dogma to reduce or eliminate entirely the intake of meat whenever diets are prescribed. Unless proper interpretation is given to certain present-day investigations on protein metabolism, including the results of the experiment reviewed in this paper, there is danger that the dietetic pendulum will swing too far in the opposite direction.

The Eskimos have lived on a high protein dietary as far back as records go.

The question of minimal and optimal protein requirements has received considerable research attention in recent years. There is now very little disagreement among students of nutrition as to what these requirements are. On the effects of a high protein dietary, however, not only do opinions of authorities differ but the results of carefully controlled experiments show considerable variance. It is a traditional belief that a high protein intake leads to high blood pressure, arteriosclerosis or nephritis. Among physicians it has almost become a dietetic dogma to reduce or eliminate entirely the intake of meat whenever diets are prescribed. Unless proper interpretation is given to certain present-day investigations on protein metabolism, including the results of the experiment reviewed in this paper, there is danger that the dietetic pendulum will swing too far in the opposite direction.

The Eskimos have lived on a high protein dietary as far back as records go.

Dental caries may be properly considered as a disease of childhood, susceptibility at this age period being almost universal. In surveys of school children it is unusual to find a mouth free from caries. The average child will have seven or more affected teeth in various stages of destruction. The rate of progress of the carious process and the number of teeth involved varies with the individual. As the child approaches maturity, retardation of destruction becomes evident. In some instances active caries may become arrested spontaneously during childhood. The factors involved in the inactivation have not been understood, nor have many instances been recorded.

The etiology of dental caries is a subject of controversy. It is generally conceded that a break in the continuity of the enamel is a primary requisite. The exposed dentin thus becomes susceptible to attack by external agencies. Any factor leading to enamel defects will thus

The dextrose tolerance test is now being extensively employed as a diagnostic procedure. It is most beneficially used in the differentiation of mild diabetes mellitus and renal diabetes. It is also being used, and is believed to be of diagnostic value, in many pathologic conditions, such as encephalitis, malignant tumor, pituitary and thyroid dysfunctions and nephritis.¹

Although it is definitely established as a diagnostic procedure, there is some diversity of opinion concerning what constitutes a normal response to the oral administration of dextrose. Some writers state that in a healthy person there may be a postprandial rise in blood sugar of from 14 to 16 per cent and a return to the normal within two hours.²There are other writers³who consider a postprandial hyperglycemia of 20 per cent within normal limits. It is generally believed that the persistence of the postprandial hyperglycemia is of more diagnostic significance than the

In view of the present trend of thought away from the former conception of nephritis as a purely renal disease, and bearing in mind particularly the revision of attitude toward the rôle of protein, especially of animal origin, in the production of renal and vascular disease, I considered it worth while to make a cardiovascular and renal survey of a group of people subsisting exclusively on meat. The opportunity presented itself during the MacMillan arctic expedition of 1926, where we were in close contact with the Eskimos of northern Labrador and of Greenland.

Furthermore, since the vitamins have assumed a position of such medical and economic importance, and their sources are as yet not wholly understood, evidences of scurvy and rickets were sought and an examination was made of food sources and of food composition and preparation when these conditions were found.

Information was obtained from two sources: by personal

The dietetic observations and experiences of Vilhjalmur Stefansson during his career as an arctic explorer are worthy of careful scrutiny by students of nutrition. Because of his contributions, he is entitled to prominence in many departments of science, among them anthropology, geography, geology, oceanography, languages and comparative religions. Whether reading Stefansson's books, attending his lectures, or in private conversation with him, one is impressed not only by his broad knowledge of biology but also by the keenness of his observations and deductions in the domain of metabolism, particularly as applied to the science of practical dietetics. An anthropologist by training, an arctic explorer by choice, he became a student of nutrition by necessity. Perhaps there is no other man living today whose experimental studies have been so well controlled and done on so large a scale. His laboratory was the arctic circle, his experimental subjects human beings, and his experimental

The dietetic observations and experiences of Vilhjalmur Stefansson during his career as an arctic explorer are worthy of careful scrutiny by students of nutrition. Because of his contributions, he is entitled to prominence in many departments of science, among them anthropology, geography, geology, oceanography, languages and comparative religions. Whether reading Stefansson's books, attending his lectures, or in private conversation with him, one is impressed not only by his broad knowledge of biology but also by the keenness of his observations and deductions in the domain of metabolism, particularly as applied to the science of practical dietetics. An anthropologist by training, an arctic explorer by choice, he became a student of nutrition by necessity. Perhaps there is no other man living today whose experimental studies have been so well controlled and done on so large a scale. His laboratory was the arctic circle, his experimental subjects human beings, and his experimental

During the last hundred years, continuous efforts have been made, in laboratory and in clinic, to find the cause or causes of chronic nephritis. The problem is still far from satisfactory solution. It is true that a number of substances experimentally employed, notably several heavy metals, have been shown to produce chronic sclerosing disease of the kidney. But chronic heavy metal poisoning occurs too infrequently to be etiologically important in human chronic nephritis.

It is obvious that causes must be sought, exposure to which are exceedingly common in those parts of the world in which chronic nephritis is prevalent. From time to time clinicians have suspected overeating as a factor in the etiology of chronic nephritis, and, since protein is the only one of the three foodstuffs whose end-products are excreted by the kidney, suspicion rests specifically on the nitrogenous foods. No systematic

study of the relation of diet to

It is a truism that persons with diabetes mellitus are prone to develop infection and that the feet are frequently involved. It is also well known that gangrene of the extremities is a common complication of this

disease. These two factors, infection and arterial occlusion, produce in the extremity, and particularly in the lower extremity, a variety of lesions that it is important to recognize from the standpoints of prognosis and treatment. A series of fifty-two cases of diabetes mellitus with associated lesions of the extremities has been observed in the University Hospital during the last four years. The cases were unselected and represent 8 per cent, of all cases of diabetes mellitus seen during this time. This incidence is probably higher than would be found in ordinary practice. It is our purpose in this communication to analyze and classify the cases in this series and to discuss the diagnosis,

My object in this communication is to call the attention of physicians to a method of treatment that has great promise for the control of intestinal disturbances due to the presence of protozoa. Considerable evidence has been obtained from a study of lower animals that a carnivorous diet is unfavorable for the existence within the intestine of flagellates belonging to the generaGiardia (Lamblia)andTrichomonas.¹The effects of such a diet on these and other intestinal protozoa in man can best be determined by physicians who have control of patients suffering from flagellate diarrhea or amebic dysentery. In the following paragraphs are presented briefly (1) the results of observations and experiments on animals, and (2) the results of treating human patients with a carnivorous diet.

Three rats that had been fed on a well balanced carnivorous diet throughout their lives (174 days) were found to be free from

One of us (R. B. G.), in November last, reviewed the chemical findings in a case from our diabetic clinic before the Iowa Clinical Medical Society. Interest in the case centered in the fact that a final diagnosis of what was otherwise a case of pronounced renal diabetes could not be made because the sugar curve indicated a deficient glycogenesis of the mildly diabetic type. A study of the effects of a repeated ingestion of glucose on the sugar curve by Hamman and Hirschman¹was recalled, and we predicted in our report that a decisive differentiation might be obtained if we employed the double sugar curve test in this case. The patient was requested to return for further observation, and promised to come to the clinic in January of this year.

We have in the clinic, at the present time, a second patient with a fasting hypoglycemia and a

INTRODUCTION

During the early part of this century it was customary to use a very liberal protein fat diet in the treatment of diabetes mellitus. This type of diet was characterized by its high protein content, its relative poverty of carbohydrate and its high caloric value. Mild diabetics did quite well on such a regimen, but the more severely ill patients did not tolerate it without glycosuria and the persistence of diabetic symptoms, and, as pointed out by Joslin, coma was so common that the percentage of deaths in hospitals was greater than in homes. It was necessary to conceive of a mysterious "spontaneous downward progress" to explain the constant loss of tolerance in these cases, and the majority of physicians felt that treatment of the severe cases was a waste of time and energy. This type of diet is not by any means without its supporters today, and it

Since patients with diabetes mellitus are more dependent on fat as a source of energy than are normal subjects, it is tempting to try to explain the hyperlipoidemia that is so common in this disease on the basis of some theory that assumes a relationship between the amount of fat in the food and the percentage of lipoids in the blood. In the literature that has accumulated on this subject a tendency to assume this relationship is evident. In the Rockefeller monograph,¹for example, the authors state that lipemia "is largely associated with the fat intake and with other diabetic symptoms." Ervin²states that "the lipemia of a diabetic will disappear with the elimination of fat from the diet." Bang³believed that the lipemia was, in part, alimentary. Joslin⁴suggests a relation between the high protein, fat diets of former days and the high degrees of lipemia reported, and states