The First Principle

An example of the first principle, viz.: avoidance of all articles that disagree with existing conditions, is seen in the dietary prescribed for diabetic patients. We know that the carbohydrate principle in food is by the process of digestion changed into sugar, that a part of this sugar goes at once into the circulation and a part is stored in the liver for future use as glycogen. In cases of diabetes all the carbohydrates taken as food are eliminated by the kidneys, as grape sugar or glucose, oftentimes in the space of twenty-four hours. This elimination is accompanied by distressing symptons. Under these conditions the carbohydrates are gradually eliminated from the dietary, and to make up for this deficiency the quantity of proteid, principally the quantity of fat, needs be increased. In severe cases sugar is made out of proteid, but it is not formed in such quantity as occurs when starch is contained in the dietary. Bread, being largely starch, is prohibited, as are also vegetables grown under ground. As fat, measured by the amount of heat liberated during its oxidation, has a high nutritive value, a smaller quantity, comparatively, is needed to make up the deficiency than would be the case if the deficiency were made up from proteid. But the problem is to present the fat in a pleasing form. A physician and specialist in diabetes, in lecturing on the food of diabetics, alluded to the following ways in which butter could be presented and which in practice had been found acceptable: Four ounces of butter is often thought to be needed each day, to insure the proper amount of nutriment. Thin slices of cheese, spread generously with butter, were used instead of bread. A piece of butter was put into a cup and hot coffee poured over it; the coffee was sipped while quite hot. Butter was used profusely on all cooked vegetables that were allowed, as spinach, string beans, beet tops, celery, and okra. Bacon is a desirable addition to all sorts of dishes.

The number of vegetables without starch in composition being rather limited, it is advisable to present the vegetables in large quantity, one at a meal to avoid the patients tiring of them. Proteid food being highly concentrated vegetables need be used freely to secure waste and successful elimination. Saccharine is put into cranberries at the close of the cooking, to make them less sour. When cream is allowed, ice cream may be prepared with saccharine in the place of sugar.

Eggs are one of the main dependencies of the diabetic, as many as six are required in a day. These may be taken in egg-nogg (sweetened with saccharine), in coffee, or cooked by any recipe in which starch or sugar is not used. The whites of two eggs, beaten and mixed with a glass of cold water and, if allowed, flavored with lemon juice, are good for diabetics and also in most conditions where nourishment in an easily digested form is demanded.

"More is to be done for asthmatic patients on the side of the stomach than in any other direction," for errors in diet are liable to to precipitate an attack. A cup of very hot water is of advantage if taken an hour before each meal and again at night. No water should be taken with the meals, or until at least three hours after. As the attacks of the disease are usually worse at night, the principal meal should be eaten at midday, and the supper be made light. Fats and sweets should be omitted, as also pork, veal, cheese, and rich desserts. If starchy food be eaten, it needs be thoroughly cooked and masticated, to insure complete salivary digestion. Thompson gives the following as a sample for advanced cases: Breakfast: bread and milk, or well-cooked oatmeal porridge or wheaten grits, without sugar. Dinner (not later than 2 p.m.): beef or mutton, bread, one or two green or succulent vegetables, such as spinach, stewed celery, stewed or raw tomatoes. Blanc-mange or custard (not sweetened) or a little rice pudding. Fresh fruit in season, as a peach or baked apple. Supper (6 p. m.) : a soft-cooked egg or a little cold fowl or game, stale bread, toast, zweiback, milk, stewed fruit (without sugar). Moderation and punctuality in eating are first essentials.