The amount of food given the patients must always be graduated in proportion to his strength. The feebler the system, always the less digestive power possessed. Stuffing the sick on "rich" viands under the supposition that they need so much food each day, or that "plenty of good nourishing food" will build them up is a common, but fallacious, practice.

Patients should not be fed according to any arbitrary standards, such as that they need and must have 3000 calories each day, or that they need and must have so many ounces of protein a day, but according to their abilities to utilize the food consumed.

It is essential that we recognize that the nutritive needs of the sick organism vary from the needs of the healthy organism. Greater caution must be observed in feeding or in eating where one is trying to eradicate illness than if we have only to maintain health. A firm resolve on the part of the sufferer to do all that is essential, is required. He must abandon his old ways and stick to a new and radically different program.

Where lack of salts and vitamins has exhausted the tissues and organs and where surplus acids exist in the body, one or more crises must usually develop before real improvement becomes apparent.

After controverting the opinion that fleshiness and the muscular power of the body are to be considered as criteria of the excellence of any regimen prescribed for the chronic individual, and pointing out that to eat increases the pain, inflammation, discomfort, fever and irritableness of the system, and does so in proportion to the amount of food eaten and in direct ratio to its supposed nutritive qualities, and that to fast or to consume non-irritating non-stimulating foods and drinks in moderation reduces the "violence" of the disease and renders recovery more certain, Graham says, Lectures, p. 441:

"Nevertheless, the chronic invalid himself, and generally his friends, and sometimes also his physician, seem to think that fleshiness and muscular strength are the things mainly to be desired and sought for, and that any prescribed regimen is more or less correct and salutary in proportion as it is conducive to these ends. Whereas if they were properly enlightened, they would know that the more they nourish a body while diseased action is kept up in it, the more they increase the disease. The grand, primary object to be aimed at by the invalid, is to overcome and remove disease action and condition, and restore all parts to health, and then, nourish the body with a view to fleshiness and strength, as fast as the feeblest parts of the system will bear without breaking down again. (Italics mine, Author). And the regimen best adapted to remove the diseased action and condition, more frequently than otherwise, causes a diminution of flesh and muscular strength (Please note, it is only muscular strength that is diminished. Author's note), while the disease remains, in regulating the general function of nutrition to the ability of the diseased part. But when the diseased action ceases, and healthy action takes place, the same regimen perhaps will increase the flesh and strength as rapidly as the highest welfare of the constitution will admit." The latter increase in weight and strength on the same regimen would not be possible if the previous loss of flesh and strength on it represented an actual loss of vital power. Yet every experienced Hygienist knows that what Graham says here is true. The common practice of stuffing the chronic sufferer like a harvest hand is evil. It is even bad for the harvest hand, but much worse for the invalid. Graham disposed of this practice as follows:

"In regulating the diet of chronic patients, however, it should always be remembered that the extensiveness and suddeness of any change should correspond with the physiological and pathological condition and circumstances of the individual; and most especially should it be remembered that the diseased organ or part should be made the standard of the ability of the system. If the boiler of a steam engine is powerful enough in some parts to bear a pressure of fifty pounds to the square inch, while in some other parts it can only bear ten pounds to the square inch, we know that it would not do for the engineer to make the strongest parts of the boiler the standard of its general ability or power, and to attempt to raise a pressure of forty pounds to the square inch, because some parts can bear fifty pounds; for in such an attempt he would surely burst the boiler at its weakest parts. He must therefore make the weakest parts the standard of the general power of the boiler, and only raise such a pressure of steam as those parts can safely bear. So he who has diseased lungs or liver or any other part, while at the same time he has a vigorous stomach, must not regulate the quality of his food by the ability of his stomach, but by the ability of the diseased part. This rule is of the utmost importance to the invalid, and one which cannot be disregarded with impunity, and yet it is continually and almost universally violated. Few things are more common than to find individuals who are laboring under severe chronic disease, indulging in every improper quality and quantity of food, and other dietetic errors, and still strongly contending for the propriety of their habits and practices, on the ground that 'their stomachs never trouble them.' Alas! They know not that the stomach is the principle source of all their troubles; yet by adopting a correct regimen, and strictly adhering to it for a short time, they would experience such a mitigation of their sufferings, if not such a restoration to health, as would fully convince them of the serious impropriety of making a comparatively vigorous stomach the standard of the physiological ability of a system otherwise diseased. (Italics mine, Author). Science of Human Life, p. 440.

There are dieticians and physicians who work on the principle that if we just put enough of the vitamin, mineral and protein containing foods into the stomach, these somehow will be taken into the blood stream and be utilized.

Vitamin A is supposed to be essential to good eyesight. Peaches and cream contain much more vitamin A than the bread puddings so often eaten as desserts. For this reason, peaches and cream are advised as dessert. Yet these foods eaten on top of a regular meal do not guarantee that the eater will get vitamin A from them. They must be digested, and the dietitian who neglects the digestion of foods, is an ignoramus.

'There is more to supplying the body with appropriate nourishment than the mere eating of foods, even the best of foods. A whole list of conditions, particularly diseases of the digestive tract, such as acute gastro-enteritis, peptic ulcers, chronic and acute gastritis, diarrhea, loss of teeth, nausea and vomiting from any cause, as in pregnancy, heart disease, etc., lack of appetite from any cause, such as fevers, severe inflammations, visceral pain or severe pain in any part of the body, operations and anesthetics, and states of mental depression such as worry, apprehension, grief and neurasthenia and psychoneurosis, interfere with the intake of food. Migraine not only interferes with eating but often results in vomiting, as does epilepsy. The absorption of food is interfered with by diarrheal diseases, enteritis, intestinal parasites, tuberculosis of the intestine, sprue, liver and gall bladder diseases and ingestion from any cause. Diabetes mellitus, diseases of the liver, chronic alcoholism, Bright's disease, heart disease, nervous troubles of various kinds, and a general toxic state interfere with the utilization of foods. Overacidity coupled with insufficient rest and sleep, hyperthyroidism, pregnancy and lactation, the wasting that occurs in fevers, etc., increase the food requirements of the body without always increasing the body's ability to digest, absorb and assimilate foods. Indeed, in some instances, there is a marked decrease in the total ability to utilize the food eaten. Many of the "therapeutic" measures of the disease-treaters of the various schools interefere with the proper nourishment of the body. Sippy diets and mush diets used in stomach ulcers, certain types of reducing diets, minerals, acids and alkalies given as "medicines," laxatives, cathartics, and drugs given to increase the excretion of urine, interfere with the digestion, absorption and utilization of foods. Any influence that enervates the body will lower digestive ability and reduce the body's assimilative powers. A lack of sunshine, lack of exercise, insufficient sleep, emotional disturbances--these and many other factors interfere with the nutritive processes of the body. Tobacco inhibits digestion and thus prevents the proper utilization of the food eaten. Coffee and tea cause a premature emptying of the stomach, thus interfering with digestion. Bitters have a like effect.

This failure of digestion, absorption, and utilization of food is not confined to any particular food factor. Indigestion means fermentation of carbohydrates and putrefaction of proteins. It means that fats decompose and minerals and vitamins are also lost. Failure of absorption from whatever cause means that fatty acids, amino acids, sugars, minerals and vitamins are lost. In diabetes there is chiefly loss of sugar, in Bright's disease there is chiefly a loss of nitrogen, but both of these losses cause a loss of other and correlated food factors. It is folly to attempt to remedy nutritive failures resulting from any or all of these conditions by feeding concentrated vitamins and minerals. The body's ability to absorb and utilize these substances is not increased by having them forced upon it in concentrated form or in increased amounts. Nor are these substances usable in the absence of the proteins, carbohydrates and fats. The only rational plan of caring for cases of these kinds is to correct the causes that have produced and are maintaining the troubles and permit health to return. With the return of health normal digestion, absorption and assimilation will also return.

Treating patients with doses of vitamins, or with mineral concentrates, or with both of these combined, and ignoring all of the many causes of their troubles is identical with the older drug practice. It is simply another of the medicine man's long efforts to "cure" disease without the necessity of removing its cause. There is no more sanity in trying to cure the effects of alcoholism by dosing the inebriate with vitamins and minerals than there is in trying to accomplish the same thing by dosing him with drugs of the older varieties.

Too many dietitians are that only, and give no attention to other and important factors of life. They often complain that a particular patient does not or cannot utilize certain food elements or food factors and resort to drugs or some form of drugless stimulation, to gland extracts or to vitamin injections, or some other futile means of treatment and totally disregard the natural factors upon which good nutrition depends. They ignore the need for sunshine, exercise, rest and sleep, peace of mind and a host of other factors of living that are important to nutrition. Tobacco inhibits digestion, hence it interferes with the proper utilization of food stuffs, yet a biochemist will talk about the inability of certain "healthy" tobacco users to utilize vitamins.

True vitamins are not drugs and it is foolish to say that they are used as drugs when prescribed for certain deficiencies. It would be as correct to say water is a drug when used to revive a man famishing from thirst. They are food accessories, first, last and all the time. Synthetic vitamins are drugs; they are never anything else.

I hear and read much about how vegetables, eggs, fruit and milk "cure" many diseases. I have patients coming to me from all parts of the country who are eating these foods prescribed by physicians of the old school as well as by "irregulars" and they are still sick. One of their troubles is that they are still feeding "plenty of good nourishing food to keep up strength." In other words, they overfeed their patients.

In practice we cannot dissociate the effects of deficient and ill-balanced foods from the effects of toxins. The deficiencies and toxemias are so inextricably bound up that they cannot be separated. They are, in fact, Siamese twins. In some of earlier experiments with deficient diets, the addition of wood shavings, blotting paper and other forms of foodless roughage to the diets of animals was enough to clear up pathological conditions and restore health. Graham attributed these pathologies to poisoning resulting from gastro-intestinal decomposition. This is present in most, if not all, cases of avitaminosis.

Overemphasizing a particular food factor, such as protein, vitamins or minerals, is a mistake. Ideal nutrition is possible only when adequate quantities and due proportions of all food factors are present in the diet. Please note that I said these must all be present in the diet: this does not mean that they must all be present in each meal, as is the thought of those who serve "balanced meals." What is needed is a balanced diet. There is interdependence between the various elements of the diets. Vitamins and all other food factors work best in cooperation.