A Meager Or Low Diet

Many persons suffer from constipation because they do not eat enough. They are in constant fear of overloading the stomach and bowels, and the consequence is that these organs lack sufficient work to stimulate them to proper activity. The writer has many times surprised such patients by the prescription of a meal two or three times as large as was being taken. The patient has usually found that he suffers no harm from his large meal, and is able to digest it without difficulty, and has also experienced a notable improvement in bowel action. The peristaltic waves which move the food along in the stomach and small intestine and the feces in the colon, are set up by reflex action excited by the food itself; that is, contact of the food with the mucous membrane of the stomach and intestine, excites pertain nerves by which the muscles are stimulated to activity. This action may be likened to the ringing of a bell in response to the touch of an electric button, or the starting of an electric fan by the moving of a switch. When taken into the stomach, food by its contact with the mucous membrane sets in operation the food motor that operates in the upper part of the digestive canal to carry the food stuffs along from one part of the digestive tube to another and in the lower part to transport rubbish and refuse to the place of exit. The degree of this movement depends upon the amount of stimulation, while the amount of stimulation depends largely upon the bulk of food taken. This stimulating effect is produced not only in the stomach, but in the small intestine.

It is evident, then, that for vigorous stimulation of the intestine, such as is needed to bring about the evacuation of the colon, a full meal must be more effective than a meagre one. This is one important reason why the taking of food at regular and not too frequent intervals is favorable to regular bowel action. A small amount of food taken at frequent intervals may not at any time set up a sufficient degree of stimulus to give the bowel the impulse required.

People who "diet" do themselves great injury often by too great restriction of the bill of fare, both in quantity and variety of food. A food that the patient imagines to be constipating or otherwise harmful is generally found to have the expected result. Thus, item after item the food is discarded, until the bill of fare is reduced to a few articles which are usually taken without relish and with more or less apprehension of injury. Such patients might far better pay no attention to diet whatever; they would run far less risk of injury by taking whatever the appetite craved.

In this connection it should be noted, however, that in increasing the amount of the food intake, the increase should usually be in bulk rather than in food value. The added bulk should consist of such foodstuffs as lettuce, celery, turnips, tomatoes, greens, fresh fruits and other articles which give large bulk with little nourishment.

Constipating Diets

Nurses, and perhaps physicians also, sometimes unwittingly do their patients great harm by restricting the diet to bland or liquid foods, which are often taken without relish, and which on this account, as well as by lack of bulk, tend in the highest degree to promote intestinal inactivity and obstinate constipation. A diet like this naturally necessitates the use of artificial means for moving the bowels. Many a patient owes the beginning of his constipation to such a course of dieting during temporary illness. Milk, which has been so much relied upon as a sick-room diet, is particularly objectionable in a very large number of cases, for reasons which have already been given. Buttermilk is preferable, because of the lactic acid it contains, while its value is greatly increased by the addition of malt sugar or milk sugar, and wheatmeal porridge, or a porridge of corn meal or oatmeal made with an addition of wheat bran. Fruit juices are extremely useful. There are very few cases in which such fresh things as lettuce and scraped apple and other raw fruits may not be taken with great advantage as well as vegetable purees. The danger of the use of solid food in these cases is purely imaginary, if care is taken to exclude meat, fried foods, and indigestible combinations. Thorough chewing of the food is of course essential.

The dietaries generally prescribed in certain forms of chronic disease, and considered to be essential, are often highly constipating. This is particularly true in the meat treatment for diabetes. Constipation is nearly always found present in persons suffering from this malady. It will always be found, indeed, that constipation existed before the appearance of sugar in the urine. The writer has no doubt that chronic constipation is one of the most prolific causes of the rapid increase of diabetes in all civilized communities. The statistics gathered in the United States Census Bureau, show a death rate from this source nearly ten times as great as twenty years ago. As has been pointed out already, meat, which is usually the staple article prescribed for diabetic patients, leaves little residue, while at the same time promoting putrefaction in the colon, thus establishing conditions which of necessity favor constipation. This difficulty may be entirely overcome by the free use of green vegetables, bran, and vegetable protein or pure gluten.

In the dietetic treatment of hyper-acidity, and especially of ulcer of the stomach and the duodenum; the usual prescription is of such a character as to cause constipation, which in turn leads to intestinal toxemia and to a relapse later on. The withholding of bulk-forming food is by no means so essential in these cases as has been supposed; the essential thing is to avoid the stimulation of the gastric secretion by flesh foods and the extractives of meat that are found in bouillon, broths and meat extracts. These sub-stances powerfully stimulate the gastric secretion, and thus aggravate and perpetuate the ulceration. They also produce autointoxication, which encourages hyper-acidity and tends to the formation of ulcer. Carefully prepared vegetable purees may usually be given in these cases at least after the first few days, not only without injury, but even with much benefit, thus preventing the constipation which is certain to result from the bland, liquid diet.