MENUS FOR ABNORMAL CONDITIONS.
Where the body is not in normal condition, because elements are lacking in the blood, these elements must be supplied in larger proportions with the food, and the case is one for a food chemist, or for one who has made food conditions a study. When medical colleges broaden their curriculum, or physicians employ methods other than medicine and the knife, for correction of physical ailments, the relief will be with this profession. If they do not, professional schools for the education of the physical culturist and food specialists, for the correction of deranged conditions of the system, due to poor circulation and abnormal blood conditions, which have so long been controlled entirely through medicine, will spring up and replace much of the correction previously left entirely to the medical fraternity.
In case of an abnormal condition, the food must be regulated according to the case. This also applies to a diet where one carries an abnormal amount of fat.
In the early stage of various diseases, where toxins are hoarded in the system, it is often advisable to abstain from food for from one to three days, according to conditions. As previously stated, where the system is not properly eliminating the waste, it is wise to abstain from food, to take brisk exercise, breathe deeply and drink freely of water, until the waste is eliminated. A laxative is also desirable.
The above suggestions are for abnormal conditions. To keep the body in health, eat at regular periods.
It is the purpose here to give diets for chronic cases, which the average person attempts to regulate without a physician in regular attendance.
The foundation education in regard to foods, belongs in the public schools. How many lives are lost on account of the lack of knowledge of food values will never be known.
The system readily excretes an excess of vegetable products, and, as a rule, no acute difficulties result; however, such chronic difficulties, as Constipation, Torpid Liver and Indigestion, frequently result from an excess of starch, over that consumed in energy. On account of the readiness to putrefaction of protein products, care should be taken not to consume these in too great proportion.
Broadly speaking, a diet largely of protein, which is digested in the stomach, rests the intestines, and a diet largely of carbohydrates, rests the stomach, because the gastric juice is not active in starch digestion. In case sufficient saliva is not swallowed with the food to digest the starches and sugars in the stomach they are passed into the intestines for digestion. In the absence of sufficient saliva, water with the food is desirable to dissolve the starches, that they may more readily pass the pylorus.
A study of the habitual taste for foods, in connection with the physical ailments of eighteen thousand women, shows that by the constituents in the blood, and the condition of the different organs of the digestive system, one can usually determine which food the individual has formed a habit of eating, because the blood will show a lack of the elements which that patient has denied himself on account of his likes and dislikes.
It is necessary to change the mental attitude toward certain foods before the system will assimilate them; thus a taste for the foods which the body requires should be cultivated.
Every mother, with growing children, should be a thorough student of the chemistry of food. If the child’s bones do not grow to sufficient size and strength, care in the selection of foods, rich in proteins, lime, magnesium and phosphates, may correct it. Such a child should have meat, whole wheat bread and eggs.
Where the child stores up too much fat, care in the amount of exercise, and of oxygen consumed, as well as the regulation of diet, are of vital importance. If one is thin and undernourished, chemical analysis of the contents of stomach, intestines and kidneys should be made, the nerves be rested and proper food, exercise and breathing should accompany medical treatment, if medicine is needed.
Anaemia
Regular exercise and deep breathing are fully as important as the regulation of diet for the anaemic. In anaemia the red blood corpuscles are lacking, or there is not sufficient blood. The red corpuscles not being sufficient in number to carry the necessary quantity of oxygen to the tissues to oxidize the waste, the system becomes clogged with waste, which affects the nerves and brain cells. The patient is tired and disinclined to exercise, thus the decreased number of red corpuscles are not kept in forceful circulation and the carbonic acid gas is not freely thrown off by the lungs; this further aggravates the condition.
Pus formation, in abscesses, are frequent in anaemic cases.
There is little desire for food when the system is clogged, and there is little use in forcing food.
The red corpuscles are made in the red marrow of the bones and free action of the joints is desirable.
The initial work, therefore in the correction of anaemia, lies in brisk, every day exercise and deep breathing of fresh air. Such exercise should be intelligently directed to the joints and to the vital organs, particularly to the liver, that it may be kept in normal condition to break down the protein waste. The windows at night should admit of a good circulation of air through the sleeping room. These habits being established, the diet should consist of foods containing iron, such as red meat, eggs and the green leaves of vegetables. Milk sipped slowly and a free use of butter are desirable.
It will usually be found that the anaemic individual has no taste for vegetables containing iron, or for meats rich in albuminoids,—or, that these foods have been denied because of their scarcity; therefore, the elements necessary for red blood corpuscles have been deficient.
The following is a suggestive diet:
BREAKFAST
Fruit, in plenty.
Two eggs, soft boiled, poached or baked.
Cereal coffee or cambric tea.
Toast, graham bread or graham or corn muffins.
MIDDLE OF THE FORENOON
Lemonade with spoonful of beef juice (not beef extract) or with a beaten egg.
LUNCH
Split pea or bean soup with dry toast.
Fruit and nut salad (no vinegar).
Fruit, fresh or stewed.
Cake.
Glass of milk.
MIDDLE OF AFTERNOON
Egg lemonade or eggnog.
DINNER
Bouillon.
Tenderloin steak or lamb chops.
Baked potato.
Spinach, beet or dandelion greens.
Custard, fruit gelatin, or cornstarch pudding, or rice with lemon cream sauce.
Glass milk.
If the patient still has no appetite, more exercise, deep breathing and abstinence from all food for a day or two are desirable. This will give the system a chance to clear itself of waste and when the waste is relieved through exercise and diet the desire for food will assert itself.
Indigestion and Dyspepsia
Indigestion or Dyspepsia is the broad term commonly applied to most chronic stomach and intestinal difficulties—due, not to structural disease, but to their being incapable of normally performing their functions in digesting ordinary foods. The term includes troubles arising from so many different causes that the cause must be determined and remedied before definite results can be attained through diet.
Most chronic cases are due to improper hygiene,—such as irregular meals; over eating; insufficient mastication; wrong choice of foods; or to a general run down condition, with a weakness of muscles of the stomach, due to insufficient blood supply; or to a weakened or over-strenuous condition of nerves controlling the stomach.
Indigestion is usually accompanied by constipation, or by irregular action of the intestines.
Plenty of fresh air, and exercise, directed definitely to muscles and nerves of the stomach, that it may be strengthened by a better blood supply, as well as exercises and deep breathing to build up the general health, should be systematically followed.
Easily digested food, well masticated, and regular meals served daintily, with following of above directions, will gradually regulate digestion.
Without doubt, the intelligent medical treatment of stomach difficulties in the future will be directed by a chemical analysis of the stomach contents. If the stomach is not secreting normal proportions of pepsin or hydrochloric acid, the deficiency can be regulated. The chemical analysis of the gastric secretions will alone determine what elements are lacking. As stated above, the permanent relief must lie in gaining a good circulation of blood through the entire body and through the stomach, that it may be strengthened and thus enabled to secrete these elements in proper proportions.
Many cases of stomach difficulty are due to the condition of the nerves.
Nervous Indigestion is due to the general nerve condition. In such cases the entire nervous system should be regulated through exercise, breathing, relaxation and a change of thought. Physicians usually recommend change of scene to direct change of thought.
The diet should be light and laxative and low in protein. Cream soup, bread and milk, crackers and milk, custards, egg lemonade, and gruels, furnish an easily digested list. No tea, coffee, very little meat and no fried food. Where the walls of the stomach are weak and distended, light food six times a day is preferable to a hearty meal, which distends the stomach walls.
Where a loss of weight occurs, it usually indicates a failure to assimilate a sufficient amount of food, rather than a failure to eat sufficient. A good circulation, particularly through the vital organs, deep full breathing of fresh air, and regular and complete rest periods, should be observed. Usually a dietitian, or a physician, is not called in chronic cases until the condition has prevailed for so long that other complications have set in and the patient has lost much flesh. It takes months to pull the system down and it takes months of following of proper hygiene to build it up.
Gastritis or Catarrh of the Stomach involving an inflammation of the mucous lining of the stomach, is a most common phase of indigestion. In acute cases the physician is called at once. He can treat the case in its initial stages and bring about a much more rapid recovery.
Acute Gastritis is accompanied by nausea and vomiting and the patient should rest from all food and drink for two days. If the mouth is dry, water or ice may be given frequently and held in the mouth, but not swallowed.
After two days rest, begin the nourishment with water and a small portion of liquid food (not over two ounces) every two hours. Toast tea, made by pouring hot water over toast, oatmeal, or barley gruel (thoroughly strained so that no coarse matter may irritate the stomach), limewater and milk, and egg lemonade are easily digested foods to begin to eat. Increase the quantity the fourth day and lengthen the time between feedings to three hours. Gradually increase the diet by semi-liquid food, soft boiled eggs, moistened toast, raw oysters, etc., slowly returning to the regular bill of fare.
Avoid, as you do so, any food difficult of digestion and any vegetable containing coarse fibre. Tea, coffee, pickles, and alcoholic drinks should be avoided.
Chronic Gastritis is accompanied with a thickening of the mucous lining of the stomach. It is usually caused by prolonged use of irritating foods and the regulation of the diet is of utmost importance. Alcohol is a common cause. The difficulty begins gradually and the relief must likewise be gradual.
The stomach needs water. If the drinking of water causes nausea it is well to wash it out with a stomach pump each morning before breakfast.
If not convenient to use the stomach pump the washing may be accomplished by drinking two glasses of water at least an hour before breakfast, followed by stomach exercises, to cause a regurgitation of the water through the stomach. This will be uncomfortable at first, with a very full feeling and one may begin by drinking one glass, followed by stomach exercises, gradually taking another glass within a half hour of the first. This, with the exercises, will wash out the mucus. In many cases as much as a pint of slimy mucus collects in the stomach during the night. Where the stomach cleansing is impossible, in above manner, the stomach tube should be used.
Chronic gastritis, in any of its phases, is frequently accompanied by constipation, and the diet should be so selected as to be as laxative as possible, without irritating the lining of the stomach. The liquid diet assists the intestines, to a certain extent, particularly if the stomach be cleansed by the water in the morning, as indicated under Mucous Gastritis below.
Fruit in the morning and just before retiring aid the intestines. Two prunes chopped up with one fig or a bunch of grapes or an apple just before retiring assist the action of the intestines and the kidneys.
Almost all fruits contain acid, which increases peristalsis, and the resultant flow of gastric juice. Cooked pears, stewed or baked apples, prunes and dates are mild fruits which may be used if they agree with the patient. The juice of an orange upon first arising may be used, except in case of a diminution, or absence, of hydrochloric acid.
Peptonized milk is an excellent food both for chronic and acute cases especially in severe cases. This is prepared by putting “pancreatin,” a pancreatic ferment, (trypsin), into fresh milk. Preparations of “pancreatin” are sold in the drug stores. The peptonized milk does not form curds and readily passes through the stomach for digestion in the intestine. This may be given for a few days, followed by milk and limewater, barley and toast water, kumyss, oatmeal gruel, meat juices, scraped meat (raw, boiled or roasted), broths thickened with thoroughly cooked cereals, ice cream, egg lemonade, gelatins and whipped cream, custards, raw oysters.
After one week gradually assume the regular diet of easily digested foods. All cereals should be thoroughly cooked. The white meat of chicken is readily digested. As the solid food diet is assumed, regularity of food, in small amounts, and thorough mastication are important. If the patient imagines he is chewing it will help him to keep chewing until the food is reduced to a pulp.
Avoid meat with tough fibre, too fat meat (pork), sausage, lobster, salmon, chicken salads, mayonnaise, cucumbers, pickles, cabbage, tea, coffee and alcohol.
Four or five light meals a day are preferable to three heavy meals.
The regulation of the flow of gastric juices is constitutional. The general circulation must be forceful, the habit of deep breathing and of regular periods of complete rest of body and mind established.
Since one with chronic gastritis is liable to have many idiosyncracies, he should not be urged to eat foods for which he has a dislike. The easily digested foods should be prepared in various ways and served in an appetizing, dainty manner.
There are four special phases of chronic gastritis, Mucous Gastritis, Hyperchlorhydria, Hypochlorhydria and Achlorhydria.
In Mucous Gastritis there is a profuse secretion of mucus into the stomach. In this case it is always well to wash out the stomach before introducing food, as suggested above.
The same general diet, suggested above for acute gastritis, should be followed.
Hyperchlorhydria. The condition known as Hyperchlorhydria shows a liberal excess of hydrochloric acid. The condition is common, and is brought on by worry, nervous excitement, eating when overtired, irregularity of food, imperfect mastication and excessive use of alcohol. The diet should be a mixed one, in about normal proportions. If anything, it should incline more to proteins than to starches. The hydrochloric acid is necessary for the digestion of proteins. It reduces the protein to acid albumin, which is less irritating to the stomach. However the proteins are stimulating to the stomach and the protein proportion should not be carried to excess.
The juice of one-fourth of a lemon taken one half hour before the meal will decrease the secretion of hydrochloric acid into the stomach.
Limewater and milk may constitute the diet for two days; alkaline, effervescing mineral water may be used and then the diet should follow the general principles for chronic gastritis. Avoid all irritating foods.
Hypochlorhydria is a diminution in the amount of hydrochloric acid. Physicians often administer hydrochloric acid about one half hour to an hour after the meal.
Many advocate a diet omitting protein, but since protein foods stimulate the flow of gastric juices, they should not be omitted, but used a little less freely.
Achlorhydria. Where there is an entire absence of hydrochloric acid, as in Achlorhydria, the stomach, of course, cannot digest proteins and this digestion must be done entirely by the trypsin of the pancreatic juice. The presence of liquified protein as beef juice in the stomach, however, acts as a stimulus to the gastric juice and is an agency in again starting its flow.
The foods should be liquid, so as to pass through the stomach without irritation. Clear milk must be excluded, because of the action of the rennin in coagulating the casein. This would irritate the stomach.
Peptonized milk, described on page [245] may be used as an article of diet,—also milk with limewater, gelatin, cream, olive oil, gruels, and any foods which would pass through the stomach in a liquid state. Any cereals must exclude the bran and must be masticated to a pulp, so that they may readily pass into the small intestine.
Dilation of the Stomach results from continued overeating, (especially when the nerves are weak), or eating when over tired. The muscular walls become so weak that they fail to contract. Peristalsis is likewise weak and the food, failing to digest promptly, ferments and forms gas. A dilated stomach is larger and its weight and weakness cause it to prolapse.
In the prolapsed condition the pyloric, or lower orifice of the stomach, is often nearly closed, partly by reason of its position and partly by the weakened folds of the stomach walls. Because of this obstruction to the free emptying of the contents into the duodenum, it is imperative that the food be masticated to a pulp and thus mixed with saliva, that the salivary digestion of starches may be complete in the stomach; or, at least, that all foods be reduced to a liquid state in the stomach. A chunk of food could not easily pass through the pylorus. All liquid or semi-liquid food should be held in the mouth until it, also, is mixed with saliva. The stomach should not be overloaded with either food or water and for this reason six meals a day, of light feeding, is best.
A dilated stomach does not necessarily indicate that the digestive juices are not secreted in normal proportions and easily digested proteins need not be avoided. It is desirable to furnish the proteins in concentrated form, as in meats, so as to get the most nutrition with the least bulk. Milk may be used, with limewater, if sipped slowly and held in the mouth until mixed with saliva.
Sugar should be used very sparingly, because it ferments readily and aggravates the distension. If it is evident that fermented products are in the stomach, it should be washed out with a stomach pump.
A tumor near the pylorus, or constriction of the pyloric orifice, will also cause dilation of the stomach.
Beef juice, any of the better grades of meats, well masticated and containing no gristle, limewater and milk, soft cooked eggs, and well cooked cereals should constitute the diet.
Avoid vegetables containing coarse fibre, fried foods, and bread baked on the same day.
Liquid with the meal should be avoided, on account of the tendency to overload the stomach.
Cold water, taken a swallow at a time at intervals during the day, has a tonic effect upon the relaxed muscles. It also incites the flow of gastric juice.
Ulcer of the Stomach. Where this condition is severe, accompanied with severe pains and vomiting of blood, the dietetic treatment is to give the nourishment through the rectum for from five to ten days. Then follows a period of ten days milk diet, with bouillon, barley water, a beaten egg, and once a day, after the third day, strained oatmeal gruel.
Limewater is added to the milk to avoid the formation of leathery curds and to neutralize the acids of the stomach. The patient is given half a cup of milk every hour for three days, from 7 A. M. to 9 P. M. From the third to the tenth day increase the quantity to one cupful, then to a cup and a half and lengthen the periods between feedings to two hours. If the milk is brought to a boil before the limewater is added, it digests more readily.
After ten days, for the succeeding ten days the nourishment should be given every two hours and the diet varied by semi-liquid foods, such as gruels, toast water, soft boiled egg (once a day) beef juice, two softened crackers (once a day) gelatin, buttermilk and strained soups.
After twenty days the patient, if all is well, may very gradually resume a normal diet, beginning with baked potatoes, softened toast, lamb chops, a small piece of steak or white meat of chicken. It is imperative that all food, liquid or solid, be thoroughly mixed with saliva and that solids be chewed to a pulp.
Liquids must not be swallowed either hot or cold, but about body temperature. Cold water may be taken into the mouth when more palatable than warm and held there until about body temperature before it is swallowed. All liquid should be sipped, not swallowed in gulps.
Cancer of the Stomach. Since the growth most often obstructs the pylorus, the stomach is usually dilated and the general directions for dilation of the stomach should be followed. If the food will not digest in the stomach, one must resort to rectal feeding. Where gastric digestion is near normal, the general principles of diet for ulceration of the stomach should be followed.
Intestinal Disorders
Most cases of intestinal difficulties may traced to a clogged condition, either due to a weakness of the nerves and of the intestinal muscles, and a resultant weak peristalsis, which does not strongly move the mass along its course, or to a failure of the liver to discharge sufficient bile to lubricate the mass. If the waste is not promptly moved through the intestines, irritation may result and the poisons from bacterial fermentations will be absorbed by the system.
Deranged stomach digestion also interferes with the digestion in the intestines.
Constipation. The causes of this difficulty are so varied that it can seldom be regulated by diet alone. It can be helped. A large number of cases of chronic constipation are due to the failure to respond to Nature’s call at a regular time each day, thus establishing a regular habit at a certain hour. Many others are due to the weakness of the muscular walls of the intestines or to the nerves controlling them. In this event the intestinal peristalsis is weak. Still another cause is a failure of the liver to discharge sufficient bile into the intestines to lubricate the foeces. Many chronic cases are due to the pill and drug habit. Where one continues to take pills, the condition brings a result similar to the feeding of “predigested” food,—if the work is done for the organs they become lazy and rely upon artificial aid. Every part of the body requires activity for strength.
If the straight front corset cramps the intestines it may cause constipation by restraining their normal exercise during movements of the body in walking, etc. Every woman who wears the straight front corset should take exercises for the intestines morning and night.
The most natural relief for constipation is exercise,—particularly exercise directed to the muscles of the intestines and to the nerve centers controlling them.
Such foods as are laxative in effect, with the free use of water are helpful. Figs and raisins (due to their seeds), prunes, dates, grapes, apples, and rhubarb are laxative, due to their acids. These have best effect when eaten just before retiring.
Oatmeal, or any cereal containing the bran, is laxative,—such as bran bread or green corn.
As must be inferred from the above statement, the cause of the difficulty must first be reached.
Children should be trained to attend to Nature’s call regularly every day. The best time is shortly after breakfast.
Enteritis. (Inflammation or Catarrh of the Intestines) is similar in its nature to Gastritis or Catarrh of the Stomach and is treated in a similar manner.
Acute Enteritis, as Acute Gastritis, is usually caused by a strong irritant,—either by some food which disagrees, or by a mass of undigested food. A fast of two or three days is the initial dietetic treatment. A free drinking of water not only soothes the irritated intestines but it cleanses the intestinal tract and assists the kidneys in eliminating elements of fermentation; if these are not eliminated, they will absorb into the blood.
Physicians usually give a course of calomel and castor oil to eliminate all intestinal contents.
After the fast, a liquid and semi-liquid diet is followed until inflammation is relieved. Milk, strained gruels, broths, strained soups, buttermilk, eggs (soft cooked or raw), beef juice, barley water, custards, gelatines, soft puddings, etc., are the foods most nourishing and causing least irritation.
All irritating foods as coarse vegetables, pickles, acid fruits and fruits with coarse seeds, candies, beer, wines and salads should be omitted.
Chronic Enteritis has the same general cause as Acute Enteritis, though its onset is slow and it takes a correspondingly longer time to correct.
Dysentery, if acute, demands complete rest in bed. The diet in both Acute and Chronic cases must be confined to easily digested foods, such as peptonized milk (see page [244]), boiled milk, pressed meat juice, and the white of egg, beaten and served with milk. Blackberry brandy, and tea made from wild cherry bark, tend to check the inflammation.
During convalescence, care must be taken not to over-feed. Begin a more liberal diet with a more liberal allowance of beef juice, gradually adding tender beef steak, roast beef, fish, white meat of chicken, eggs, custards, wine jelly, dry toast, blancmange, well boiled rice and other easily digested food. The beef and egg are particularly valuable, because of the anaemia occasioned by the loss of blood.
Rectal Feeding
is sometimes necessary in cases of ulcer, cancer, or tumor, along the digestive tract. Since food is not absorbed in the large as readily as in the small intestine, the strength cannot be fully maintained through rectal feeding. In cases where the stomach is not able to digest the food, it is the best expedient, however, until the functioning of the stomach is re-established.
The rectum should be prepared about an hour before the feeding by a full injection of water, to thoroughly cleanse the intestine. Place the patient on his side with the hips elevated. If for any reason he cannot lie on his side, let him lie on his back and elevate the foot of his bed. After the water cleansing, inject two or three ounces of water in which a small pinch of salt (6%) has been added and let it go high up into the rectum.
Two to three ounces four to five hours apart is the desirable quantity of rectal nutrition for an adult. The white of egg, beef juice, and milk, all peptonized, are the best foods. The pancreatic trypsin, sold in preparations of “pancreatin” is best. Unless milk is peptonized the casein will be difficult to absorb. The food should always be salted, as salt aids the absorption.
The white of egg should be diluted with four or five times its volume of water; to beef juice add an equal volume of water. The yolk of egg contains too much oil to absorb readily. Fats are not absorbed through the rectum. If egg and beef juice are used without milk, a little sugar may be added. Milk contains sugar in proportion.
It is not advisable to inject wine as it interferes with absorption of other foods.
The nutriment should be forced eight to ten inches up into the rectum to insure absorption. This can be done by using a small injection point on a rubber tube and gently and patiently turning it as it is inserted. The tube may be oiled to prevent irritation.
Derangements of the Liver
The liver is not, in a strict sense. a digestive organ, but it is very dependent upon them, as all products of digestion must pass through it and the starches, sugars and proteins, after they enter the blood, undergo chemical changes here.
For a fuller understanding of the reasons for the following suggestions regarding diet for the liver, the writer would request a re-reading, at this point, of the chapter upon the “Work of the Liver” upon pages 81 to 92.
It will be recalled that the liver acts, not only upon proteins, sugars, and starches,—the nourishing foods, but it also stands guard over poisonous ferments, due to putrefactions absorbed from the intestines, rendering them harmless; to a limited extent it also oxidizes the poisons of alcohol. The fats also pass through the liver.
Since all products of digestion must pass through this organ, it is easy to see how it may be overworked, for it is an undisputed fact that most people eat more food than is required to maintain the body in nitrogenous equilibrium and to supply the necessary heat and energy.
After the gorging of a heavy meal, the overloaded blood and liver express themselves in a sluggish brain and one feels mentally, as well as physically, logy, or overloaded.
Since both sugar, carbohydrates and protein undergo chemical changes in the liver, it is evident that a diet consisting of an excess of either, must overwork the liver, not only through the nutritive food elements absorbed, but through the toxic substances which must be absorbed,—due to the excessive amount of food not being digested as readily as a smaller amount. If the food remains in the intestines too long, it is attacked by the bacteria always present there, fermentation results and poisons are absorbed and carried to the liver, where they must be broken down and rendered harmless, so as not to affect other parts of the system. If for any reason the liver is diseased, overloaded, or its action is sluggish, it will not promptly oxidize these toxins.
One of the most important corrective agencies for an inactive liver is exercise directed to this organ, to bring a free supply of blood, and deep breathing of fresh air. It is apparent that the blood must carry its full quota of oxygen to assist in oxidizing both the nitrogenous waste and the poisons; and it must be remembered that the liver must oxidize the waste from its own tissues, as well as from other parts of the system.
It is apparent, from the above, that the regulation of diet for an abnormal liver must be more in the quantity than in the quality of food and in the perfect digestion. It depends also upon the activity of the intestines, since the poisonous products of imperfectly digested and fermenting food, not being regularly eliminated, must be absorbed and carried to the liver. It is to free the intestines of the waste containing the toxins that physicians give calomel and other strong cathartics, to work off the toxins. These cathartics also work off foodstuffs from the intestines before they are absorbed, so that the liver has more rest.
Torpid Liver or Billiousness. This condition is due to the sluggish action of this organ and a consequent failure to eliminate the bile through the bile ducts into the duodenum. It may be caused by inactivity and a resultant sluggish circulation of blood, to overwork of the liver, due to overeating, to breathing of impure air, or to insufficient breathing of pure air. It may also result from constipation and a resultant absorption of toxic matter as described above.
Many cases of billiousness are occasioned by obstruction of the opening of the bile ducts into the intestines, which is often occasioned by an excess of mucus in the duodenum. In such cases exercise for the intestines is clearly indicated.
In the bending, twisting and squirming movements which the infant in the cradle makes, the liver is regularly squeezed and relaxed. The same is true in the free movements of an active child at play. If during adult life these same free movements of bending and twisting the trunk were continued daily and correct habits of free breathing of pure air were established, there would be little call for “liver tonics.”
The elaboration of carbohydrates in the liver is an important part of its work and in case of inactive liver the sugars and starches should be limited, allowing that function to rest. Yet it is a mistake to allow a diet too rich in protein. The best method is to cut down the quantity of a mixed diet.
Two glasses of water an hour before breakfast followed by brisk exercise for the vital organs and deep breathing are important. The daily action of the bowels is imperative. In extreme cases a fast of two or three days, with a copious use of water, is recommended. Following this fast the diet should consist of easily digested foods, eliminating those containing starch and sugars in too great proportions, and it should be as limited as possible, consistent with the actual necessity for rebuilding and for energy.
Some authorities restrict fats in a diet for billiousness but the presence of fat in the duodenum stimulates the flow of pancreatic juice, which in turn stimulates the secretion of bile.
Lemon stimulates the action of the hepatic glands and thus tends to increase the liver activity.
There is a prevalent thought that eggs and milk cause sluggish liver action. There is no physiological reason for this if too much food is not eaten. One often loses sight of the fact that milk is a food as well as a beverage, and that when milk constitutes an appreciable part of the diet other foods should be limited accordingly.
The DIET may be selected from the following:[10]
Soups.—Light broths and vegetable soup with a little bread toasted in the oven.
Fish.—Raw oysters, fresh white fish.
Meats.—Mutton, lamb, chicken or game.
Farinaceous.—Whole wheat or graham bread and butter, toast buttered or dry, toasted crackers, cereals in small portions.
Vegetables.—Fresh vegetables, plain salads of watercress, lettuce, and celery.
Desserts.—Gelatins, fruits, cornstarch, ice cream, junket, simple puddings,—all with very little sugar.
Liquids.—Hot water, lemonade, orangeade, toast water, buttermilk, loppard milk and unfermented grape juice,—not too sweet.
AVOID.—All rich, highly seasoned foods, candies, cheese, pies, pastry, pan cakes, or any fried foods, salmon, herring, mackeral, bluefish, eels, dried fruits, nuts and liquors of all kinds.
Gall Stones
The diet for gall stones need have no reduction in protein nor carbohydrates, since the oxidation, or the chemical action upon sugars is not interfered with. The presence of fat in the duodenum increases the flow of pancreatic juice which, in turn stimulates the flow of bile, so olive oil is often recommended in case of gall stones.
Diabetes
is a serious disturbance of nutrition. It is known and tested by the appearance of sugar in the urine. However, the conclusion should not be drawn that one has diabetes if the urine test for a day shows sugar. This may be due to an excess of carbohydrates, particularly of sugar in the diet a day or two previous and all trace of it may disappear in a day. If continued tests for some period show an excess, nutritional disturbances are indicated.
The most usual form of diabetes is diabetes mellitus. It is supposed to be due to a disturbance in the secretions from the pancreas. Experiments have shown that the general process of putting the carbohydrates in condition to be absorbed into the blood is controlled by a secretion from the pancreas.
The difficulty which confronts the dietitian is to prescribe a diet without carbohydrates which will keep up the body weight and not disturb the nutritive equilibrium. The diet must consist of protein and fat and one danger is in the tendency to acetic and other acids in the blood, which involves the nervous system. The patient has a craving for sugars and starches, but the system cannot make use of them, and the heat and energy must be supplied by fats. While, as a rule, the craving for certain foods is an indication that the system needs the elements contained in it,—this is true in the craving of the diabetes patient for carbohydrates,—yet the desire must not be gratified, because of the inability to digest them.
There is often a distaste for fat, but its use is imperative and in large quantities, because the weight and general vitality must be maintained. The effort of the physician is to get the system in condition to use carbohydrates.
Fats may be supplied in the yolk of egg, cream, butter, cheese, bacon, nuts, particularly pecans, butternuts, walnuts and Brazil nuts.
In beginning a diet, the change must not be too sudden. At least a week’s time should be allowed for the elimination of all sugar and starch. Begin by eliminating sugars and next bread and potatoes.
Van Noorden gives the following diet, free from carbohydrates, which has been in general use in Europe and America.
BREAKFAST.
Tea or coffee, 6 ounces.
Lean meat (beefsteak, mutton chop, or ham), 4 ounces.
Eggs one or two.
LUNCH.
Cold roast beef, 6 ounces.
Celery, or cucumbers, or tomatoes with salad dressing.
Coffee, without milk or sugar, 2 ounces.
Whisky, drams, diluted with 13 ounces of water.
DINNER.
Bouillon, 6 ounces.
Roast beef, 7½ ounces.
Green salad, 2 ounces.
Vinegar, 2½ drams.
Butter, 2½ drams.
Olive oil, 5 drams, or spinach with mayonnaise, large portion.
Whisky, 5 drams, diluted with 13 ounces water.
SUPPER, 9 P. M.
Two eggs, raw or cooked.
Van Noorden includes alcohol, in whisky, in his diet and most physicians follow the theory that whisky or brandy aids in the digestion and absorption of fats; the need is recognized since fats must be supplied in so large quantities, yet the sweet wines and beers contain sugar while the sour wines contain acids, which disturb digestion.
There is a grave question in regard to the advisability of including alcohol in the diet of a young person afflicted with diabetes and the greater activity of the young patient will insure more perfect digestion, so that the physician may not consider alcohol necessary.
Dr. Hall gives the following as a reasonable diet for a diabetic case, after the first week or two, allowing potatoes.
BREAKFAST.
Tea or coffee, 6 ounces.
Cream, 2 ounces.
Meat, (beefsteak, mutton chops, or ham), 4 ounces.
Bread and butter, 2 slices.
Baked potato, with butter.
LUNCH.
Cold roast beef or cold boiled ham, 6 ounces.
Bread and butter, two slices.
Salad with mayonnaise dressing, egg garniture.
Tea or coffee with cream.
4 P. M.
Egg lemonade or egg orangeade.
DINNER.
Clear soup of any kind.
Roast beef or mutton, or pork.
Potatoes, baked or boiled.
Olives, celery, or radishes.
Side dish of green vegetables.
Bread and butter.
Dessert, milk-egg custard, sweetened with saccharin.
After a week on either of the above diets, in mild cases, sugar will disappear from the urine. In extreme cases, it may be necessary to follow this strict regime for two weeks. When the patient begins to eat a little starch, potatoes and bread are re-instated first. Sugar is kept out of the diet, except the little in fruit and vegetables, until the urine shows no trace of it.
The following is a list of foods allowable:
Fresh meat, fish, oysters, clams, lobster, turtle, meat extracts, fats of all kinds, eggs, such fresh vegetables as peas, beans, lentils, lettuce, celery, asparagus, cabbage, pickles, clear soups (all kinds), cheese (all kinds), coffee, tea (without sugar), cream, butter, fruit, acid drinks and carbonated waters.
Derangements of the Kidneys
In the dietetic treatment of any diseased organ, the object must be to give that organ as much rest as consistent with keeping up the general nutrition of the system. The stomach and intestines are so closely allied that, where one is affected, the other is liable to affection also, and the dietetic treatment is regulated accordingly. Yet generally speaking, in stomach disorders the quantity of protein is limited; in intestinal disorders the starches, sugar and fats are limited. Since the office of the kidneys is to pass from the system the soluble salts and the nitrogenous waste, which dissolve in water, the work of the kidneys in most conditions is aided by a copious drinking of water. Since uric acid is stimulated by the kidneys, the proteins should be restricted in the diet, particularly those formed from the glands of animals,—as liver, sweetbreads, kidneys, also brains. Potatoes, green vegetables, stone fruits and cranberries aggravate an acute condition.
Acute Nephritis. In case of inflammation of the kidneys the excretions are interrupted. In this event the quantity of water should be limited to three to four glasses a day. In the event that the kidneys will not excrete the water, the pores of the skin must be kept freely open by sweat baths to assist in the elimination of waste.
Dr. Hall recommends a milk and cream diet of from three to seven pints a day, for a few days, according to the case,—two parts of milk to one of cream. If the urine is scanty, he reduces it to one and one half pints a day, taken in four or five installments. After the three to seven days of milk diet he gradually introduces starches and fats.
Brights Disease. This term covers forms of diseases of the kidneys, associated with albumin in the urine.
Where for any reason the kidneys have difficulty in discharging the nitrogenous waste of the system, the work of the dietitian must be to eliminate protein from the diet as closely as may be consistent with the body necessities. Besides restricting the amount of nitrogenous foods, the kidneys must be assisted in eliminating the nitrogenous waste, and the products of the inflammation, by a copious drinking of water. Hot water and hot diluent drinks are best, such as toast water, barley water, cream of tartar, lemon and acid drinks. In acute cases the patient is put on a milk diet of from two to three pints of milk a day, given one-half pint every three or four hours, diluted with one-third as much hot water. If the case be a prolonged one, broths may be included.
Even in cases which are chronic and not acute, it is well to follow a milk diet for a number of weeks. The quantity of milk, for an exclusive milk diet, must depend upon the age and size of the patient as well as upon his ability to exercise. If he is confined to his room, from five to seven pints of milk a day are sufficient. If he is taking a great deal of exercise, he may take from eighteen to twenty glasses of milk a day. If he loses weight on the milk diet, bread and rice may be added.
It is unwise to begin a milk diet at once, by feeding from eighteen to twenty glasses of milk a day, but this amount may be approximated within a week’s time and the change in diet should be begun by cutting down all meats and legumes and gradually eliminating starches. In changing from a milk diet to a diet including more hearty foods, the transition should be gradual.
A. F. Pattee gives the following diet for Brights Disease.
DIET: Soup.—Vegetable or fish soup, broths with rice or barley.
Fish.—Raw oysters or clams, fresh fish broiled or boiled.
Meats.—Eat sparingly, chicken, game, fat bacon, fat ham.
Farinaceous.—Stale bread, whole wheat bread, toast, milk toast, biscuits, macaroni, rice, cereals of all kinds.
Vegetables.—Onion, cauliflower, mashed potatoes, mushrooms, lettuce, watercress, spinach, celery, cabbage.
Desserts.—Ripe raw fruits, stewed fruits, rice tapioca, bread and milk puddings, junkets, cocoa.
Liquids.—Toast water, weak tea, pure water, peptonized milk, malted milk, fresh buttermilk, milk with hot water, equal parts, whey, unfermented grape juice.
AVOID.—Fried fish, corned beef, hashes, stews, pork, veal, heavy bread, batter cakes, lamb, mutton, beef, gravies, beans, peas, malt or spirituous liquors, tobacco, coffee, ice cream, cake, pastry.
Nervous Disorders
The condition of the nerves depends upon the general condition of the system and upon general nutrition. There is no one food or set of foods which directly affect any nervous trouble, unless this trouble be localized by disturbance in some particular organ. Then the effort must be to correct the difficulty in that organ.
There is no disturbance in any part of the body requiring less medicine than a disturbance in the nerves. The correction must come through general hygienic treatment. Regular exercise, alternated with regular rest periods, the formation of the habit of complete nerve relaxation, the general regulation of an easily digested, nutritious diet, with deep breathing exercises, are the best remedies.
In many cases of nerve debility the nerves seem to be stronger in the latter part of the day. Where this is the case the hearty meal should be eaten at this time.
Neurasthenia. In cases of Neurasthenia, or “Tired Nerves,” all vital organs are more or less affected, because the nerves do not properly direct digestion, absorption, assimilation or elimination and, for this reason, the diet should be light and of easily digested foods. A free, correct breathing of fresh air, day and night, is imperative. It is important also to thoroughly masticate all food and drink freely of water. A change of thought, induced by a change of scene or companions, is helpful.
Gout
This difficulty is usually the result of high living. It most often attacks people past middle age, who have indulged in rich pastries, puddings, meat three times a day, or who have frequently indulged in alcohol.
Being supposedly caused by an excess of uric acid and other waste deposited in the joints, resulting from too much protein and an insufficient elimination of the waste of the system, the dietetic treatment must be a low protein diet. Alcohol is absolutely prohibited and the quantity of carbohydrates and fats must be cut down as well as the protein.
In acute cases a diet of bread and milk, or toast and milk, with light vegetable broths should be followed for one to three days.
In chronic cases the diet may consist of the following:[11]
Soups.—Vegetable broths.
Fish.—Fresh fish, shell fish, raw oysters.
Meats.—It is better to omit all meats. If meat is eaten at all, it should be confined to game, chicken and fat bacon.
Farinaceous.—Cereals, crackers, dry toast, milk toast, macaroni, graham or whole wheat bread, rye bread, oatmeal and any of the breakfast foods.
Nuts.—With salt.
Vegetables.—Celery, lettuce, watercress, all greens, with vinegar, string beans, green peas, potatoes, carrots and beets.
Fruits.—All fruits, stewed or fresh. Unpeeled apples are especially recommended. (Greens, with vinegar and unpeeled apples increase the action of the kidneys.)
Desserts.—Plain puddings, junket, rice, stewed or fresh fruits.
Liquids.—Pure water, toast water, barley water, butter milk, malted milk, milk.
Eat eggs sparingly and in severe cases, not at all.
AVOID.—Alcohol, coffee, tobacco, dried fruits, nuts, cheese, candies, pastries, pies, spices, rich puddings, fried foods, vinegar, pickles, lemons, rhubarb, mushrooms, asparagus, sweet potatoes, tomatoes, gravies, patties, rich soups, lobster, salmon, crabs, mackeral, eel, veal, pork, goose, duck, turkey, salted, dried, potted or preserved fish or meat, (except bacon).
Rheumatism.
Since the medical profession is unable to determine just what rheumatism is, it is difficult to prescribe a diet. The theory so long believed that it is an excess of uric acid in the system is no longer held by most of the advanced physicians. Some authorities hold that it is a nerve difficulty; others that it is an excess of lactic acid. Some authorities put one on an entire meat diet, in case of rheumatism, and others entirely exclude meat. Uric acid may accompany the disease.
Assuming that it is due to the failure of the system to promptly eliminate its waste, whether this failure to eliminate be through a weakened condition of the nerves, and the consequent failure to properly direct the body activities, the correction of the difficulty must lie in building up the general vitality and in aiding the system in its elimination. Hot sweat baths, a free use of water and a free use of fruits, particularly the citrous fruits, such as lemons, oranges, limes, etc., are desirable, because they increase the alkalinity of the blood. The acid unites with other acids of the body acting as a re-agent. Often when the acids of the stomach are strong, sodium carbonate (baking soda) produces an alkaline reaction.
The diet should be cut down in quantity. Meat may be eliminated if an excess of uric acid exists and the above suggestions under the diet for Gout be followed.
Fruit juices should be used freely because of their alkaline reaction and because of their diuretic effect. Lemonade, orangeade and all fresh fruits and vegetables are diuretic.
Regular exercises, until the body is thoroughly heated, deep breathing of pure air day and night and a copious drinking of water are necessary.
Uremia or Uremic Poisoning
Interference in the action of the kidneys is apt to result in a retention within the system of the elements, which the kidneys, in normal condition, eliminate from the system, such as urea, uric acid, urates, sulphuric acid, sulphates, sodium phosphate, xanthin bodies and conjugated sulphates. These substances are not thrown off by the skin, or by the lungs, and must all be eliminated through the kidneys. They are the result of the oxidation and the breaking down of the proteins of the body. If the kidneys do not throw these off, the result is Uremic Poisoning, and the dietetic treatment must be to cause a free action of the kidneys by the use of diuretics. Of these the citrous fruits, (lemons, oranges, limes, etc.,) are the best; they neutralize acids and produce an alkalinity of the blood. They should be used freely.
Meats, eggs and legumes should be eliminated from the diet. A free drinking of water, milk with limewater, cereals, buttermilk, kumyss, barley water, toast water, lemonade, orangeade, vegetables and fruit should constitute the diet. Exercise and free breathing of fresh air are imperative. All food should be thoroughly masticated.
Excess of Uric Acid
An excess of uric acid may not always cause uremic poisoning, but it indicates an excess of protein in the system above the amount eliminated by the kidneys and the skin. This excess is often the cause of chronic ailments, such as bronchitis, asthma, hay-fever, severe nerve depression, gout, rheumatism, neuralgia, tonsilitis, grippe, influenza, colds, etc.
The natural relief is to control the diet, supplying less protein and to increase the elimination through a free action of the kidneys, of the pores of the skin, and of the lungs. Systematic exercise, deep breathing, a copious drinking of water and fresh air day and night, are the best reliefs.
One may either eliminate the proteins from the diet, or may cut down the entire quantity of food, and, by exercise, breathing, a freedom of the pores of the skin and a free drinking of water, so as to create an activity of the kidneys, may continuously eliminate more uric acid than is consumed in the food.
The regulation of the quantity of the food, rather than the cutting down of the proteins and the feeding of a larger proportion of starches, is the course pursued where one is inclined to an excess of uric acid and still has an excess of fat.
In case of an excess of uric acid in thin persons, such proteins food as meat and eggs may be eliminated and the diet consist almost wholly of carbohydrates and fats.
The diet is the same as that given above for Gout.
Obesity
All diets for obesity must be prescribed for the individual condition. A large number of the obese are afflicted with rheumatism, sluggish livers, sluggish action of the intestines and weak nerves, and the diet must be governed accordingly.[12]
The regulation of food for reduction of flesh must, also, be governed by age, sex, by the manner of breathing and by the amount of daily exercise.
Exercise, breathing and diet are the scientific means of reduction, the food must be regulated in accordance with the quantity of carbohydrates and fats daily consumed in heat and energy.
Leanness
No definite diet can be given for flesh building, because a lack of sufficient fat to round out the figure is due to faulty digestion or assimilation and the cause must first be eliminated.
It may be that the strength of the muscles and nerves of stomach, liver and intestines must first be built up by exercises and deep breathing, and it may be that the habit of nerve relaxation must be established. Where one’s nerves are tense much nourishment is consumed in nervous energy and the nerves to digestive organs and muscles being tense, interfere with digestion and assimilation.
It is apparent that the cause must first be corrected, because to overload the digestive organs with sugars, starches and fats, further weakens them.