MEDICINAL FOODS

A report, of which the following is an abstract, was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined the medicinal foods:

In order to determine the food value of any food product it is necessary to consider the following points: Chemical composition; available potential energy; absorbability and cost. No attempt is made in this article to discuss each of these features separately, but they are utilized as required.

The ingredients on which the food value of any article of food depends are the proteid substances, carbohydrates, fats, certain inorganic bodies and—under certain conditions—alcohol. The amount of each of these present in a preparation must be established by chemical analysis. From the results thus obtained it is possible to calculate the potential energy represented by a given food product. In this report the potential or food value is expressed in the large or kilocalorie, that is, the amount of heat required to raise the temperature of one kilogram of water one degree centigrade.

The factors employed in this report for expressing in calories the actual amount of energy utilized by the system are 4.8 for proteid substances, 4.1 for carbohydrates, and 9.2 for fats.

The accompanying table embodies the results obtained by submitting all the well-known so-called “predigested foods” to chemical examination. The table as published in The Journal included columns on: Price of bottle, number of cubic centimeters in a bottle, cost per 500 cubic centimeters, reaction, specific gravity, percentage of non-volatile residue, ash, percentage of nitrogen, calories as proteids in 500 grams, carbohydrates before inversion, alcohol by volume, average recommended adult dose per diem in cubic centimeters, cost per diem to supply 1,430 calories. These columns were eliminated from this abstract, as they were unessential, so far as the practical value of the article is concerned. In most cases two samples of the same brand were purchased at an interval of about six months. All the analyses were made before Jan. 1, 1907. Some of the preparations contain much glycerin which does not, so far as known at present, possess any recognized food value, although there are a number of experiments on record to indicate that it influences metabolism.

The percentage of nitrogen accredited to each of these products represents the total amount of nitrogen, irrespective of the nature of the nitrogenous substances, although some of this nitrogen has no nutritive value.

By multiplying the percentage of nitrogen found by the factor 6.25 we obtain the percentage of nitrogenous matter (proteids) contained in the various preparations. By multiplying the number of grams of nitrogenous matter present in 500 grams of material by the factor 4.8 it is found that the potential energy available by the nitrogenous matter varies from 10.3 calories to 153.1 calories. Five hundred grams of the material is made the basis of calculation, because it approximates a pint, the amount usually believed to be present in the various trade packages, and because it affords a ready basis of calculation.

The carbohydrates are represented by cane sugar, maltose, dextrin and invert sugar. Lactose is probably also present in some, but it is impossible to establish this. By multiplying the number of grams of carbohydrates present in 500 grams of the foods by the factor 4.1 we obtain the potential energy represented by the carbohydrate, which varies from 11.3 to 319.2 calories. The total calorific value of both proteids and carbohydrates ranges from 54.7 to 397.5 calories. The total food value of an equal quantity of milk, including fat, approximates 360 calories.

The value of alcohol as a food product pure and simple in disease is, however, an open question. There is no doubt whatever but that it acts to a certain degree as a food even here, not as a tissue builder, but as a saver of fat and carbohydrate material, and in order to give the preparations in question full value as food products, the calories represented by the alcohol, are credited to each preparation, as are the proteids and carbohydrates. The factor usually recognized for expressing the calorific value of alcohol is 7. By multiplying the number of grams of alcohol present in 500 grams of material by 7, the number of calories varies from 420 to 658.

On looking over the literature and printed matter distributed by some manufacturers, the physician is frequently left under the impression that these preparations contain all the essential constituents necessary for maintaining normal nutrition of the body, as is clearly shown by the following quotation: “Contains sufficient nutritive material to maintain normal nutrition of the body, a valuable food in typhoid fever, pneumonia, tuberculosis,... and all the conditions of the system associated with enfeebled digestion and malnutrition.”

In order to show the insidiousness of such representations it is only necessary to give the actual food value of the average daily dose (the average amount to be taken for twenty-four hours) recommended by the various manufacturers for their products. The average adult daily dose recommended varies from 50 to 150 c.c. The total available calories per daily dose based on the proteid and carbohydrate bodies varies from 9.8 to 110.5. Adding to these figures the amount of energy represented by the alcohol, in each case, the total available calories varies from 55.0 to 299.5. The number of calories per diem in sickness should not fall much below 1,500 during twenty-four hours.

TABULATED RESULTS OF EXAMINATIONS OF MEDICINAL FOODS

Column Headings:
2 = Glycerin and undetermined matter
3 = Per cent nitrogenous matter (6.26)
4 = Calories as proteids in 500 grams
5 = Carbohydrates after inversion
6 = Calories as carbohydrates in 500 grams
7 = Calories as proteids and carbohydrates in 500 grams
8 = Alcohol, by weight
9 = Calories as alcohol in 500 grams
10 = Calories as proteids and carbohydrates per diem dose
11 = Total calories in per diem dose*
12 = Number c.c. required per diem to supply 1,430 calories

Name of Preparation and Manufacturer	2		3		4		5		6		7		8		9		10		11		12
Carpanutrine—John Wyeth & Brother	28	.45	4	.28	102	.7	5	.34	109	.5	212	.2	12	.5	437	.5	25	.5	78	.0	1,100	.7
Carpanutrine—John Wyeth & Brother	21	.29	6	.24	149	.8	5	.78	118	.5	268	.3	14	.0	490	.0	32	.2	91	.0	942	.9
Liquid Peptones—Eli Lilly & Company.	3	.63	4	.50	108	.0	6	.05	124	.0	232	.0	18	.0	630	.0	69	.6	258	.6	829	.4
Liquid Peptones, with Creosote—Eli Lilly & Company	4	.34	3	.84	92	.2	13	.47	276	.1	368	.3	18	.0	630	.0	110	.5	299	.5	716	.2
Nutrient Wine of Beef Peptone—Armour & Company	14	.97	0	.64	15	.4	15	.43	316	.3	331	.7	17	.5	612	.5	66	.3	188	.8	757	.4
Nutrient Wine of Beef Peptone—Armour & Company	13	.70	0	.43	10	.3	15	.57	319	.2	329	.5	17	.0	595	.0	65	.9	184	.9	773	.3
Nutritive Liquid Peptone—Parke, Davis & Company	1	.02	1	.86	44	.6	12	.89	264	.2	308	.8	18	.8	658	.0	74	.2	232	.1	739	.5
Nutritive Liquid Peptone—Parke, Davis & Company	1	.95	1	.16	27	.8	13	.19	270	.4	298	.2	17	.7	619	.5	71	.5	220	.2	779	.2
Peptonic Elixir—Wm. Merrell Chemical Company	3	.21	2	.54	61	.0	11	.46	234	.9	295	.9	16	.5	577	.5	53	.3	157	.2	818	.6
Tonic Beef S. & D.—Sharp & Dohme	12	.91	3	.40	81	.6	2	.36	48	.4	130	.0	12	.0	420	.0	13	.0	55	.0	1,300	.0
Tonic Beef S. & D.—Sharp & Dohme	12	.63	3	.28	78	.7	2	.22	45	.5	124	.2	13	.0	455	.0	12	.4	57	.9	1,234	.4
Liquid Peptone—Stevenson & Jester Company	0	.44	1	.81	43	.4	0	.55	11	.3	54	.7	12	.0	420	.0	9	.8	85	.4	1,506	.8
Cow’s Milk (3.8 per cent. fat)	....		3	.50	84	.0	4	.80	98	.4	182	.4	....		....		7	.3	1,429	.6	2,000	.0

*: Total calories per diem dose includes the calories of alcohol in the liquid medicinal foods and the calories of the fat in milk.

In order to get a fair conception of the actual food value of these various preparations, it is desirable to make some comparison which can be readily comprehended by every physician. The amount of good milk necessary each twenty-four hours to sustain the vitality of a patient during a serious illness is not less than 64 ounces, or approximately 2,000 c.c. The food value in calories represented by this amount of good milk may be placed at 1,430. This includes not only the proteid and carbohydrate matter, but the fat as well. By comparing this available potential energy with the total energy available in the predigested foods under consideration, it can be readily seen that if a physician depends on the representations made by some of the manufacturers, and feeds his patient accordingly, he is resorting to a starvation diet. The largest number of available calories, including alcohol, present in any of the recommended daily doses, is less than one-fifth of the number of calories represented by 2,000 c.c. of milk; and the calories represented by the daily dose of the preparation poorest in food products is only one-twenty-fifth of the amount present in 2,000 c.c. of milk. These figures tell their own story.

Making 2,000 c.c. of milk the basis of calculation, and estimating the amount of the various preparations required to yield this number of calories, it is found that the quantity to be administered daily to supply 1,430 calories, including alcohol, varies from 716.2 to 1,506.2 c.c. In many cases the amount of alcohol exhibited by these quantities would keep the patient in an alcoholic stupor continually. The cost necessary to supply this energy varies from $1.48 to $3.39. Compare these prices with the cost of two quarts of milk. Is further comment necessary?

It is urged in justification of the use of preparations of this class that they contain constituents not found in our ordinary foods and in a more perfectly assimilable condition. As pointed out above, these so-called predigested foods contain no fats; the carbohydrates in them are the ordinary sugars present in our common foods, while the proteins belong to the peptone or albumose class. It is for these latter that the greatest claims are made, but even here no value can be pointed out not found in whey, peptonized full milk or peptonized skimmed milk.

There is likewise another point of considerable importance to consider in this connection. The terms peptone and albumose include bodies of very uncertain composition, and their suitableness as food substances depends largely on how they are prepared. Animal experiments have shown that nitrogen equilibrium may be maintained, for a time at least, by use of enzymic hydrolytic products of the proteins, even where the hydrolysis has been carried far beyond the so-called peptone stage, but it appears to be likewise true that the mixtures secured by acid or high temperature steam hydrolysis have no such value. Some of these, indeed, may exhibit a toxic behavior. This is true in particular of some of the commercial varieties of peptone, and until more is known of the source of the bodies of protein character employed in the makeup of these “predigested” mixtures it is unwise to assume anything concerning the food value of the nitrogen compounds found in them by analysis or even to dignify them by the name of foods.—(Abstracted from The Journal A. M. A., May 11, 1907.)