Fat

At this point, however, it may be well to mention that the standard amount of proteid matter taken, in the construction of all these tables, was 130 grammes — 4.5 ounces. Moleschott's original diet-table contained only 120 grammes or (4.2 ounces), but as almost all observers agree quite closely as to the amount of proteid material necessary to be used, and also as to the results obtained from its oxidization, the same quantity was used in all instances that a more exact comparison might be established. The chief difference of dispute, however, is in relation to the relative value of the fats and carbohydrates, and particularly in reference to the latter compounds. 

In trying to develop out of a purely vegetable diet, anything like the same amount of working power for the system that is obtainable by the use of Porter's or Moleschott's diet, almost double the amount of proteid had to be taken with the proportionate rise in the fat and starch as is contained in the vegetable chosen. 

To produce the same amount of work by using a vegetable diet necessitates the outlay of a much larger amount of oxygen, and the production and handling by the glandular structures of the body of an excessive amount of the nitrogenous excrementitious elements. These facts illustrate quite conclusively the manner in which the damage to the system is brought about by indulging too freely, or living exclusively upon a cereal or vegetable compound. 

The vegetable proteid in these tables is further given an undue advantage, to which it is not justly entitled, by crediting it with the same atomic formula as that possessed by an animal proteid ; since the nitrogenous element found in plant-life contains a much larger number of nitrogen atoms, and consequently requires more vital force and oxygen to digest and assimilate it. This naturally decreases rather than improves the nutritive value of the proteid compound of vegetable origin. 

An average of a compound fat molecule is taken as the working standard in all these tables. 

Attention is also directed to a probable error in the rating of the heat-producing power of the carbohydrate. It is & commonly stated, that the comparative oxygenating capacity of a carbohydrate and fat is as one to two and one-half, but by their chemical atomicities, it is as one to thirteen, or thirteen and one-half in favor of the fat. 

That such an error exists in the computations in Moleschott's standard is sustained by a comparative study of the atomicities of the food-stuffs used in both Porter's and Moleschott's diet tables, and of the amount of oxygen required for complete oxidization in both instances. In the former, or Porter's proteid and fat diet table, a little more oxygen is needed than is necessary in Moleschott's mixed diet* yet it is claimed that in the latter instance 393,170 kilogramme-metres or 54,358 more foot pounds of work is produced. This, however, is directly opposed by the smaller quantity of oxygen used in the oxidization processes. When this error in work, produced out of the carbohydrates in Moleschott's diet, is corrected in accordance with the difference in atomicity and the amount of oxygen used between the fat molecule and the carbohydrate molecule represented as glucose, and a computation is made in accord with the correction, a slight difference in work produced when living on a Moleschott's or Porter's diet, is found to exist. The increase in work produced, however, is now found to exist in connection with Porter's diet and is in accord with the larger amount of oxygen used, which makes atomicity, oxygen used, and work produced correspond, while the reverse was stated in the calculations formerly made in connection with Moleschott's diet. 

If this error be true, as it appears to be, the profession have been sadly misguided in all their attempts in the construction of diet tables starting with Moleschott as their standard. 

On the other side, if these chemical and physiological laws be true, as based upon the atomicity of the proximate principles, by carefully considering the percentage composition of each food product to be used, exact results can be obtained. Another point to which attention is called by Dr. Porter is this, that the factors 1.812 and 3.841, which are used in computing the kilogramme-metres in Table VIII., are taken from Frankland — Philosophical Magazine XXXII., and are those which are generally quoted in all scientific works upon physiological chemistry and upon diet. 

In studying the proximate principles, however, by the atomicities, and considering the amount of oxygen required to completely transform a fat molecule into its final products of excretion water and carbon dioxide and a proteid molecule into its final products of excretion — urea, uric acid, kreatinine, carbon dioxide, water, etc. — it is found that only eighteen (18) more oxygen elements are used in the complete oxidization of the fat than in that of the proteid molecule. The computed amount of work performed by the oxidization of the fat molecule is found to be 530 foot pounds as compared to 250 foot pounds for the complete oxidization of the proteid molecule. This makes the eighteen (18) more elements of oxygen used in transforming the fat molecule result in the production of 280 more foot pounds of work than is obtained from the eighteen less used in the proteid. 

From this a decided discrepancy is quite evident between the results obtainable by former calculations and those based upon our modern chemical atomicities. 

However, for an illustrative and comparative study of the working power obtainable from the use of the various food-stuffs, this table is still of great value, as the same figures are used in each and all the calculations. 

As these same factors, 1.812 and 3.841, appear in all the modern scientific works, they were retained in the arrangement of this table, but not without appreciating and calling attention to this discrepancy when the computation is based upon the atomicities of the food elements used, the amount of oxygen required, and the results obtained. 

Again, it must be remembered that the proteids are not directly transformed into their final products, but undergo a series of intermediate changes, all of which require the use of oxygen and must of necessity yield more or less heat and energy, so that all our estimates are approximate. 

When upon Moleschott's diet with the proteid substances raised to the common standard of 130 grammes and the carbohydrates rated in accord with the correction previously noted, it requires 36,115 oxygen elements to produce 678,270 kilogramme-metres or 93,773 foot pounds of work. 

When upon Porter's diet of proteid and fat, it requires 38,415 oxygen elements to produce 734,890 kilogrammemetres or 101,602 foot pounds of work. When upon a purely vegetable diet that will yield anything like the requisite amount of work that can be obtained by using Moleschott's or Porter's diet, it requires 47,191 oxygen elements to produce 742,018 kilogramme-metres or 102,587 foot pounds of work. 

To obtain the 63,748 more kilogramme-metres or 8,814 foot pounds of work out of the vegetable diet as compared with Moleschott's diet, it requires the expenditure of 11,076 more oxygen elements. 

To obtain the 7,128 more kilogramme-metres or 985 foot pounds of work out of the vegetable diet as compared with Porter's diet, it requires the expenditure of 8,776 more oxygen elements. The vegetable diet in both instances yielding an excessive amount of nitrogenous excretory matter, carbon dioxide, and water. 

A careful study of Table II. and VII., and Porter's diet in Table VIII., proves beyond a question of doubt that upon an exclusive diet of our ordinary average meat alone very nearly the required proportions of the proteids or CHNOS compounds and of the fat or CHO element can be established. 

The only defect in the perfection of Table VII. and VIII. is found in the saline column, which contains much more mineral matter than perfect physiological laws indicate are required. This excess in saline or inorganic compounds, however, appears to be true in all kinds of food products — that is, if the proportion of salts in the milk is taken as the guide for a working basis. The reason for looking upon the amount of salts in the milk as the guide to the maximum quantity required is based upon the fact that during the infant period of life, where milk forms the only source of food supply, bone formation is most rapidly progressing, and the amount of mineral matter needed by the system is at its height and much larger than at any other period of life. The bones continue to grow and become fully and perfectly developed with the ordinary quantity of mineral matter contained in the milk. 

Physiology also teaches that a little less than one ounce of mineral salts are required daily by the system, but in all the tables given, except the one containing milk alone, the amount of salts is fully up to or more than an ounce. 

The only great objection that can be raised to an exclusive meat diet is the lack of variety, but that is quite easily adjusted by varying the kinds of meat used. The perfection of the proportionate composition of the proximate principles when using a meat diet, the smaller liability to imbibe an excessive quantity of any one kind and the little danger that there is of taking an excess of the CHO or stimulating and non-nutritious compounds, clearly establishes the fact that in meat we approach the nearest to an ideal food. 

If attention is turned for a single moment to the lower orders of the animal kingdom, it is quite apparent that the most supple and intensely powerful organisms are found among the carnivora only. This tends to substantiate the high utility of the meat diet. Another interesting point is the almost universal absence of tuberculosis among meat-eating animals, while the vegetable-feeding class are specially prone to suffer from this fatal malady. 

Diet. — Our injunctions to-day aro thoso of Sydenham : " Let the patient est food of easy digestion, eiich aa voal, mutton, and the like, and abstain from all sorts of fruit and garden stuff." The carbohydrates in tho food should be reduced to a minimum. Under a strict hydrocarbonaceous and nitrogenous regimen all casc«are benefited and some arc cured. The most minute and specific instructions should be given in each case, and the dietary arranged with scrupulous care^

 It is of the first importance to give the patient variety in the food, otherwise the loathing of certain essential articles becomes intolerable, and too oft«u tho patient gives up in diegiiet or despair. It is wcl), perhaps, not to attempt the absolute exclusion of the carbohydrates, but to allow a small proportion of ordinary bread, or, belter still, as containing less starch, potatoes. It is beat gradually to cnforoe a rigid system, cutting oH one article after another. Tho following is a list of articles which diabetic patients may take :

1.  Liquids; Soups — ox-tail, turtle, bouillon, and other clear soops 

2. Lemonade, coffee, tea, chocolate, and cocoa; these to be taken without sugar, but they may bo sweetened with saccharin. 

3. Potash or soda water, and the Apoltinatis, or the Saratoga Vichy, and milk in moderation, may be used. 

4. Of animal food : 

• Fish of all sorts, salt and fresh, 

• butcher's meat (with the exception of liver), 

• poultry, 

• and game. 

• Eggs, 

• butter, 

• buttermilk,

•  curds,

•  and cream cheese. 

• Of bread : gluten and bran bread, and almond and coconut biscuits. 

• Of vegetables: Lettuce, tomatoes, spinach, chiccory, sorrel, radishes, water-cress, mustard and cress, cucumbers, celery, and endives. Pickles of various sorts. 

5. Fruits : Lemons, oranges, and currants. Nuts are, as a rule, allowable 

Among prohibited articles are the following : 

1. Thick soups, liver, crabs, lobsters, and oysters; though, if the livers are cut out, oysters may be used. 

2. Ordinary bread of all sorts (in quantity): rye, wheaten, brown, or white. 

3. All farinaceous preparations, such as hominy, rice, tapioca, semolina, arrowroot, sago, and vermicelli. 

4. Of vegetables : Potatoes, turnips, parsnips, sqimslies, vegetable marrow of all hinds, beets, corn, artichokes, and asparagus. 

5. Of liquids: Beer, sparkling wine of all sorts, and the sweet aerated drinks. 

The chief difficulty in arranging the daily menu of a diabetic patient is the bread, and for it various substitutes have been advised — ^bran bread, gluten bread, and almond biscuits. Most of these are unpalatable, and the patients weary of them rapidly. Too many of them are gross frauds, and contain a very much greater proportion of starch than represented. A friend, a distinguished physician, who has, unfortunately, had to make trial of a great many of them, writes : 'That made from almond flour is usually so heavy and indigestible that it can only be used to a limited extent. Gluten flour obtained in Paris or London contains about 15 per cent of the ordinary amount of starch and can be well used. The gluten flour obtained in this country has from 35 to 45 per cent of starch, and can be used successfully in mild but not in severe forms of diabetes." ' Unless a satisfactory and palatable gluten bread can be obtained, it is better to allow the patient a few ounces of ordinary bread daily. The " Soya " bread is not any better than that made from the best gluten flour. As a substitute for sugar, saccharin is very useful, and is perfectly harm- less. Glycerin may also be used for this purpose. It is well to begin the treatment by cutting off article after article until the sugar disappears from the urine. Within a month or two the patient may gradually be allowed a more liberal regimen. An exclusively milk diet, either skimmed milk, buttermilk, or koumyss, has been recommended by Donkin and others. Certain cases seem to improve on it, but it is not, on the whole, to be recommended.

Some differences of opinion exist as to the relative value of foods of the same class. Albuminates, as has been seen, can be obtained from either the animal or vegetable kingdom ; they have a similar chemical composition, and they serve the same purposes in the body. It has, however, been suggested that they are probably utilised in a somewhat different manner, or with different degrees of rapidity, and that the man who feeds on meat, like carnivorous animals, "will be more active, and more able to exert a sudden violent effort, than the vegetarian or the herbivorous animal, whose food has an equal potential energy, but which is supposed to be less easily evolved." In support of this view it has been urged that the movements of carnivorous animals, especially in the pursuit of their prey, are far more active than those of herbivorous cattle ; that the form in which they take their food enables them to give out sudden spurts of energy of which the vegetable feeder is incapable. But this view has been questioned by others, who refer to the known activity and speed of the horse, the rapid movements of the wild antelope and cow, and even of the wild pig, all animals mostly herbivorous, as inconsistent with the conclusion that vegetable feeders cannot give forth energy as rapidly and continuously, or even more so, than the predaceous carnivora. It is further stated that with the human race also, the East Indian native, if well fed on corn, or even on rice and peas, shows, when in training, no inferiority in capacity for active physical exertion to the animal feeder. It has also been argued that the complicated alimentary canal of the herbivora pointed to a slower digestion and absorption of food; and with certain kinds of vegetable food this would certainly seem to be the case ; but it has again been contended that this is chiefly intended for the digestion of cellulose, and that the digestion and absorption of albuminates may be as rapid as in other animals. 

It must, we think, be admitted that all practical observations tend to prove that animal food is digested more rapidly than vegetable food, and it therefore seems highly probable that meat can replace the waste of the nitrogenous tissues more rapidly than meal of any kind, and it is probably true that there is a more active change of tissue in meat eaters than in vegetable feeders, and that the former require more frequent supplies of food. Apparent differences in nutritive value in different meals, as in wheatmeal and barley meal, probably depend on difference of digestibility. 

The difference in the nutritive value of different fats would seem to depend on the relative facility with which they are digested and absorbed. Animal fats appear to be more easily absorbed than vegetable. And even different animal fats differ much in digestibility, and, therefore, in nutritive value. This depends partly on chemical composition, and partly on mechanical aggregation or subdivision. Mutton-fat is generally found difficult of digestion, while pork-fat is easily digested. Butter can be readily digested by many persons who cannot digest other forms of fat and the ready digestibility of ccxl-liver oil is one of its chief advantages. 

The different carbohydrates are generally supposed to be of equal value in nutrition. Sugar, from its ready solubility, should be more easily absorbed and more quickly utilised than starch, but it is found that when both are procurable a mixture of the two is usually preferred.

In connection with this interesting and important discussion, the following observations by Tsclierwinsky arc referred to in Landois' "Textbook of Human Physiology." He fed two similar pigs from the same litter. 

No. 1 weighed 7,300 grammes ; 

No. 2 7,290 grammes. No. 1 was killed, and its fat and proteids estimated. No. 2 was fed for four months on grain, and then killed. The grain and excreta and the undigested fat and proteins were analysed, so that the amount of fat and proteins absorbed in four months was estimated. The pig then weighed 24 kilos. ; 11 was killed, and its fat and proteins were estimated : — 

No. II. contained 2.50 kilos. of albumen and 9.25 kilos. of fat 

No. I.                        0.94 „                                        „ 0.69 „ 

Assimilated            1.56 „                                        „ 8.56 „ 

Taken in in Food   7-49 „                                      „ 0.66 „

Difference            — 5.93                                      " +7.90"     

There were therefore 7.90 kilos, of fat in the body which could not be accounted for in the fat of the food. The 5.93 kilos. of albumen of the food which were not assimilated as albumen could yield only a small part of the 7.90 kilos, of fat, so that at least 5 kilos. of fat must have been formed from carbohydrates. Lawes and Gilbert calculated that 40 per cent of the fat in pigs was derived from carbohydrates. How the carbohydrates changed into fat in the body is entirely unknown." 

As has already been stated, the weight of evidence appears to be distinctly in favour of the conclusion that, in some way or other, the carbohydrates are capable of being converted into fat in the system ; but, in any case, the same result occurs, and they promote, either directly or indirectly, the deposition of fat within the body. 

The probability that lactic and other acids of the same class are formed in the body, chiefly or solely from carbohydrates, is drawn attention to by Parkes. "The formation of these acids is certainly most important in nutrition, for the various reactions of the fluids, which offer so striking a contrast (the alkalinity of the blood, the acidity of most mucous secretions, of the sweat, urine, etc.), must be chiefly owing to the action, of lactic acid on the phosphates or the chlorides, and to the ease with which it is oxidised and removed." We may conclude, then, that the carbohydrates by their capacity for rapid metabolism contribute largely to the production of heat and mechanical work, find also that their use greatly favours an increase in the constituents of the body, and especially of the albumen and fat. If we desire to increase the albumen without adding greatly to the store of fat, we should (according to Bauer) give a liberal allowance of albuminates with relatively small quantities of carbohydrates. But if we desire a substantial addition to the fat, the food should contain less albumen and more carbohydrates, with a fair proportion of fats.

Butter consumption was between 13 and 20 pounds per person annually in the nineteenth century, compared to less than 4 pounds per person in 2000. Lard consumption was 12 to 13 pounds per person in the nineteenth century, compared to less than 2 pounds today.