The most eloquent advocate of a diet consisting almost wholly of nitrogenous substances was Louis Banting, who published an account of Harvey's method according to which the diet was as follows : (1) In the morning: 120-150 grams of meat or fish, with the ex ception of pork and salmon, tea without milk and sugar; 30 grams of toasted white bread.
(2) For lunch 150-180 grams meat, vegetables exclusive of pota toes, 30 grams toasted white bread ; two to three glasses of red wine or sherry. No farinaceous dishes, no champagne, port wine, nor beer.
(3) Afternoon : 60-100 grams of fruit; a little toast, tea.
(4) In the evening : 100-120 grams meat or fish; one to two glasses of red wine, claret.
The use of water is permitted without limit.
Albumin.—This diet as laid down by Harvey is characterized by its high percentage of nitrogenous food, so that the masses of fat stored up in the body must be surely attacked in the physiological processes, and a quite considerable reduction of fat can be secured.
However it happened very soon after this publication of Banting that there were a number of individuals who when they followed out this diet for a considerable period decreased in weight, but finally be came so weakened and miserable, nervous, and sleepless that the treat ment had to be interrupted. In others the continued meat diet caused dyspeptic symptoms with consecutive catarrh of the stomach and in testinal tract.
The cause of these manifestations was on the one hand the impos sibility of the human body to maintain its metabolic equilibrium during the process of feeding with exclusively nitrogenous sub stances. No fat and carbohydrates being taken in, the quantity of albumin was soon endangered, being liable to be partly used up in the production of the requisite calorie values necessary to the maintenance of life. Furthermore the food, which was in itself already insufficient in quantity to maintain proper Metabolism of the nitrogenous substances, could not be properly digested, and gave rise to diseases of the stomach and intestines. It follows that we have to dispense with a purely albuminous diet on account of its slight value as a heat-producer. Indeed such a diet, in a quantity which to be sufficient would have to be very large, would usually not be digested and assimilated; but if together with the albumin so much fat and carbohydrates are taken in as to maintain nitrogenous metabolism, and if by greater muscular activity more non-nitrogenous substances are decomposed in proportion than fats and carbohydrates are introduced with the food, the deficiency of these latter substances will be made good by consumption of the fat deposited in the body, i.e., the obesity of the patient will be diminished and he will become
leaner. If this process of fat oxidation due to muscular activity is repeated at short intervals, while at the same time but small quantities of fat and carbohydrates are given with the food, the fat stored up in the body grows less and less until it finally attains a figure below which we do not want to go. The supply of nitrogenous food must, aside from its influence upon fat oxidation, be larger, because in the majority of cases the patients are already anemic ana most of the muscles of locomotion and of the heart have become weak and atrophic. The new formation of muscular fibres and the increase in volume of those already present, which would result from an increase in the metabolism caused by muscular activity, require an aug mented supply of albumin.
Fat awl Carbohydrates.—In the exhibition of fat-forming articles of food we must discriminate between a. Those cases in which the respiratory and circulatory apparatus have not been markedly disturbed, and where the activity of the mus cular apparatus and a considerable amount of bodily exertion is still possible.
b. Those cases in which the blood is of anaemic or hydrmmic quality, and advanced venous stasis reduces the absorption-of oxygen in the lungs to a minimum, and where slight muscular exertion ex hausts the oxygen, interferes with respiration, and causes dyspnceic symptoms.
In the first category, where the energy of cellular activity is as yet unimpaired, a liberal consumption of fat and carbohydrates can be allowed, since through the increased muscular activity and bodily ex ercise the metabolism is likewise increased. In the latter cases the use of fat and carbohydrates must be reduced to smaller proportions, and by simultaneous reduction of the body fluid by decrease in the fluid supply the circulation is rendered freer, and the liability of ex citing dyspnceic conditions is abolished.