DIABETIC FOODS OFFERED FOR SALE IN THE UNITED STATES
A Preliminary Report
John Phillips Street, M.S.
Chemist, Connecticut Agricultural Experiment Station
NEW HAVEN, CONN.
Recent references in The Journal to gluten flours and certain other foods offered for the use of diabetics suggest that a preliminary report of an investigation just about completed in my laboratory by Prof. L. B. Mendel and myself might be useful to many diabetics and to physicians who are called on to arrange their dietaries.
In 1906 this laboratory, then under the direction of Dr. A. L. Winton, who is now with the Department of Agriculture, made its first examination of commercial diabetic foods. In nearly every year since it has analyzed various other brands as they appeared on the market. The demand for the reports on these foods and the many inquiries directed to us have led us to make a more extensive review of the situation, and to collect as far as possible all information as to the quality of the so-called “diabetic” foods offered to the American public. That the present state of the market is unsatisfactory is well known, and the inferiority (from the diabetic’s point of view) of many of the products at present offered is unfortunately familiar to all careful dietitians. The most dangerous feature of the present situation is that the unsuspecting patient is led to purchase foods, generally at an exorbitant price, which are not only misrepresented but which may be positively harmful to him. In this day of self-medication this condition is all the greater menace to the diabetic.
Without any attempt to suggest methods of treatment for diabetes, which is the province of the physician, I may say that it is well recognized that diabetes is primarily a disturbance of nutrition, in which the normal ability of the body to make use of carbohydrates is more or less completely impaired. All recent authorities agree in placing the chief emphasis on the role of diet in the management of this disease. Janeway, Benedict, Joslin, Futcher, Falta, Strauss, von Noorden and other writers on diabetes could be quoted at length in support of this view. The importance of a restriction of the carbohydrates in certain cases and certain aspects of diabetes is admitted by practically all competent authorities. In order to prescribe a starch-free and sugar-free dietary, which at times is necessary, and to know accurately the actual amount of these carbohydrates contained in the various available foods, the physician must rely on the cooperation of the chemist to furnish this requisite information. This is our excuse, if any be needed, for our present investigation.
There seems to be some uncertainty as to what sort of preparation is entitled to be sold as a “diabetic” food. Granting the desirability of feeding the patient all the carbohydrate he can tolerate, and recognizing the possible value of the oatmeal, potato, rice and other treatments, in which a relative abundance of carbohydrate is fed for a limited period, it would seem that a low percentage of carbohydrates should be a requisite for a “diabetic” food. Certainly no special food containing nearly as much carbohydrate as a normal food of the same class should be entitled to this appellation. Flours, breads, biscuits, chocolates, breakfast-foods, macaroni, etc., containing only a slightly lowered percentage of carbohydrates, are no more entitled to be called “diabetic” foods than the normal foods themselves. It is true that, when a patient’s carbohydrate tolerance is well established, the use of foods containing 20, 25 and even 35 per cent. of carbohydrates might be permissible, when used under the direction of a competent physician; but when a strict diet is necessary, such as is required to determine this tolerance, even these relatively low percentages are objectionable, if not dangerous.
It has been our purpose to include in this investigation, as nearly as possible, all available data on the composition of all diabetic foods sold in America. Our report, therefore, will be in part compiled, but in greater part will consist of our original analyses. It will show 539 analyses of about 400 brands, 200 of which are our own new analyses and 110 those made in this laboratory in previous years.
While the purpose of this preliminary note is to call attention to the better preparations rather than to emphasize those which are obviously objectionable and fraudulent, it may not be out of place to summarize briefly our findings in general. The full details of the investigation are now being prepared for publication and will shortly be issued as a report from the Connecticut Agricultural Experiment Station.
One hundred and eight samples of sixty-eight brands of flours and meals are included in the report. Sixty-seven of these were sold as “gluten” flours, twenty of which did not even satisfy the low government standard of 35 per cent. protein. Twelve samples contained less than 13 per cent. carbohydrates, while the remaining gluten flours ranged from 28 to 76 per cent.
The soy bean flours contained from 23 to 26 per cent. of carbohydrates, the almond meals 17 per cent., and a cotton-seed flour 21 per cent. Other “diabetic” flours, not specifically sold as “gluten” flours, contained from 67 to 80 per cent.
The purchaser of gluten flours at the present time may obtain preparations containing from 87 to 11 per cent. of protein and from 4 to 76 per cent. of carbohydrates, at a cost of from 9 cents to $1.56 per pound.
In view of the government’s low standard for gluten flour, and because of the wide variations in composition found in the brands at present on the market, proper protection of the diabetic demands that the manufacturers of these flours should be required to state on the label the guaranteed percentages of both protein and carbohydrates.
Three samples of American soft gluten breads contained from 35 to 37 per cent. of carbohydrates; two other brands contained 49 and 54 per cent., little, if any, lower than found in ordinary wheat bread.
One hundred and forty-eight analyses of 112 brands of hard breads, biscuits, rusks, cakes and other bakery products are included. Eight brands of Luftbrot, or aerated bread, are reported; two of these contained from 9 to 12 per cent. of carbohydrates, one 20 per cent., two from 31 to 33, and the other three from 44 to 54 per cent.
A number of the brands of rolls, biscuits, breads, etc., showed satisfactorily low percentages of carbohydrates, thirty-five samples containing from 1 to 25 per cent., forty-four samples containing from 35 to 55 per cent., and forty-one over 55 per cent., seven of the latter exceeding 72 per cent.
The cost of the Luft breads ranged from 71 cents to $2.33 per pound. Biscuits, containing 11 per cent. or less of carbohydrates, cost from 72 cents to $3 per pound. A number of brands, containing from 43 to 77 per cent., cost from $3 to $3.60 per pound. Even the cheaper preparations, containing from 50 to 77 per cent., no better, and in some cases even worse, for the diabetic’s use than ordinary bread, cost from 30 to 41 cents per pound.
Fourteen samples of breakfast-foods were analyzed, five of which contained from 44 to 54 per cent. of carbohydrates, somewhat lower percentages than normal. Seven of the ten brands of recommended macaroni, noodles, etc., contained over 70 per cent. of carbohydrates, the other three from 42 to 51 per cent.
The analyses are given of fourteen samples of peanut butter, five of almond paste and butter, two of pine-nuts, one of almonds and ten of miscellaneous nut foods. As was to be expected, most of these preparations proved to be suitable diabetic foods. The peanut butters contained from 12 to 20 per cent. of carbohydrates, with an average of 15 per cent. The three almond pastes contained from 30 to 40 per cent., one showing an addition of 11 per cent. cornstarch. The two almond butters contained only 7 and 8 per cent., the pine-nuts from 3 to 8 per cent., and the almonds 16 per cent. The other nut preparations contained from 6 to 44 per cent. carbohydrates.
Seven brands of diabetic chocolates contained from 10 to 50 per cent. carbohydrates, while four cocoas contained from 21 to 51 per cent. The chocolates cost from $1.63 to $2.06 per pound, and the cocoas were similarly expensive.
Two sugar-free milks were examined which were true to name, containing only the merest traces of carbohydrates. One “diabetic” baking-powder examined contained no starch, another brand from 14 to 16 per cent. Various jams, preserves and other fruit products were examined which contained from 1.24 to 7 per cent. of invert sugar, percentages far below the normal. A currant-juice contained only 0.85 per cent. of invert sugar. Four of the fruit preparations were artificially colored with a coal-tar dye—a permitted color to be sure, but seemingly quite out of place in foods intended primarily for the use of invalids.
As already stated, the main purpose of this investigation was not so much to detect fraud as to secure information which would be of benefit to the diabetic and to the physician who seeks foods suitable for a low carbohydrate diet. In the accompanying tabulations a summary is given of the brands, sold as diabetic foods, which showed less than 35 per cent. of carbohydrates, arranged in the order of their carbohydrate[149] content. A date in parentheses following a brand name signifies that the brand named showed variations in different years; in other cases, in which the agreement was close, the results have been averaged.
BRANDS SHOWING UNDER 5 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Casoid Baking Powder | .0 |
Dr. Bouma Sugar-Free Fat-Milk | .0 |
Whiting’s Sugar-Free Milk | .0 |
Rademann’s Currant Juice “ohne Zucker” | 0.9 |
Kalaria Batons (1909) | 0.9 |
Glidine | 1.0 |
Casoid Sugarless Marmalade | 1.2 |
Casoid Sugarless Jam | 1.5 |
Kalari Biscuit | 1.7 |
Casoid Dinner Rolls | 2.1 |
Casoid Flour | 2.2 |
Jireh Diatetic Pine Nuts | 3.4 |
Rademann’s Preserved Fruits, “entzuckert” | 3.5 |
Kellogg’s Protose | 3.6 |
Barker’s Gluten Food “A” | 4.1 |
Kellogg’s Pine Nuts | 4.2 |
Kellogg’s 80 Per Cent. Gluten Biscuit | 4.4 |
Bischof’s Gluten Flour | 5.0 |
BRANDS SHOWING FROM 5 TO 10 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Casoid Biscuits No. 2 | 5.6 |
Rademann’s Preserved Fruits “in eigenen Saft” | 5.7 |
Barker’s Gluten Food “B” | 5.9 |
Kellogg’s Nuttolene | 6.3 |
Nashville Sanitarium Nutcysa | 6.3 |
Huntley and Palmer’s Akoll Biscuit | 6.5 |
Nashville Sanitarium Nutfoda | 6.8 |
Rademann’s Preserved Fruits “ohne Zucker” | 7.0 |
Muller’s Tomatoes für Diabetiker | 7.3 |
Barker’s Gluten Food “C” | 7.7 |
Kalari Batons (1913) | 7.7 |
Casoid Biscuits No. 3 | 7.8 |
Kellogg’s 80 Per Cent. Gluten (1912) | 7.9 |
Casoid Biscuits No. 1 | 8.0 |
Kellogg’s Almond Butter | 8.2 |
Fromm’s Uni Bread | 9.0 |
Metcalf’s Vegetable Gluten (1913) | 9.8 |
BRANDS SHOWING FROM 10 TO 15 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Kellogg’s Pure Gluten Biscuit (1906) | 10.2 |
Health Food Pure Washed Gluten Flour (1913) | 11.1 |
Health Food Alpha Diabetic Wafers | 11.3 |
Loeb’s Imported Gluten Flour | 11.8 |
Health Food No. 1 Proto Puffs | 11.9 |
Kellogg’s Potato Gluten Biscuit (1906, 1909) | 11.9 |
Kellogg’s Nut Meal | 12.1 |
Kellogg’s 80 Per Cent. Gluten (1909) | 12.5 |
Nashville Sanitarium Nut Butter | 13.0 |
Kellogg’s Nut Butter | 13.9 |
Bischof’s Diabetic Gluten Bread | 14.3 |
Jireh Diabetic Baking Powder | 15.0 |
Peanut Butter (range from 12 to 20) | 15.0 |
BRANDS SHOWING FROM 15 TO 20 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Casoid Chocolate Almonds | 16.1 |
California Paper Shell Almonds | 16.3 |
Callard’s Cocoanut Biscuit | 16.4 |
Rademann’s Diabetiker-Chokolade | 16.9 |
Health Food Almond Meal | 16.9 |
Callard’s Ginger Biscuit | 18.1 |
Callard’s Prolactic Biscuit | 19.3 |
BRANDS SHOWING FROM 20 TO 25 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Callard’s Almond Shortbreads | 20.7 |
Callard’s Casoid Rusks | 20.8 |
Rademann’s Diabetiker-Makronen | 20.8 |
Health Food Protosoy Diabetic Wafers | 21.2 |
Jireh Patent Cotton-Seed Flour | 21.3 |
Casoid Lunch Biscuit | 21.6 |
Rademann’s Diabetiker-Chokolade Biscuit | 21.9 |
Cereo Soy Bean Gruel Flour | 23.7 |
Health Food Salvia Sticks | 24.0 |
Health Food Protosoy Soy Flour | 24.5 |
Metcalf’s Soja Bean Meal | 25.0 |
BRANDS SHOWING FROM 25 TO 35 PER CENT. OF CARBOHYDRATES
| Per Cent. | |
Jireh Soja Bean Meal | 25.8 |
Brusson Chocolat with Added Gluten | 26.4 |
Rademann’s Diabetiker-Stangen | 27.0 |
Rademann’s Diabetiker-Dessert-Gebäck | 27.5 |
Nashville Sanitarium Malted Nut Food | 27.5 |
Metcalf’s Vegetable Gluten (1906) | 28.1 |
Health Food Pure Washed Gluten Flour (1906) | 29.5 |
Fromm’s Luft Bread | 30.7 |
Spencer’s Almond Paste | 31.6 |
Fromm’s Conglutin-Diabetiker-Schokolade | 32.7 |
Health Food No. 2 Proto Puffs | 33.3 |
Ferbuson Gluten Bread | 33.6 |
Gum Gluten Breakfast Food | 34.2 |
—(From The Journal A. M. A., June 28, 1913.)