7-7.30 a.m. . . . One orange, apple or pear. Half a pint of water.
8-8.30 a.m. . . . Tea, 5-6 oz.; milk, 1/2 oz.; sweetened with saccharin.
One or two boiled or poached eggs. Dry toast or bread, 1-1 1/2 oz.; butter, 1/4 oz.
11-11.30 a.m. . . Clear soup or butter-milk, 8-10 oz.
1-1.30 p.m. . . . Cold fowl, game, lean meats, ham or tongue, or hot lamb cutlet or sweetbread, 3-4 oz.; salad, 1 oz.; Dutch cheese, 1/4 oz.; celery, radishes, etc.; rye, brown, bran or gluten bread, 1/2 to 1 oz.; butter, 1/2 oz.; fresh fruit or water, 4-6 oz.
4.40 p.m. ... A large cup of plain tea, with a dessertspoonful of milk; one piece of dry toast or bread and jam, or eaten with lettuce, mustard and cress, or tomato.
7.30 p.m. . . . Clear soup, 4 oz.; fish, cooked without butter, or any kind of meat, game or poultry, except pork, 4-6 oz.; green vegetables, of a calorie value not exceeding 5 per oz., ad lib., or smaller amounts of those with a higher calorific value, say 1-2 oz.; farinaceous pudding, 3-4 oz.; water melon or the cooked unsweetened fruit out of a tart; dry toast or various breads, 1 oz.; butter, 1/4 oz.; water, 4-6 oz.; a glass of hot water at bed-time.
If white bread is used in the above diet, the calorie value will vary from a minimum of about 1,100 to a maximum of about 1,500. The chief protein-containing foods are rather high, varying between 8 1/2 and 10 1/2 oz. (240-300 grammes). Ranke gives as a normal diet, meat 240, fat 100, bread 400, water 300-400 grammes. This is a very simple diet, supplying between 2,000 and 2,500 calories. It is easy to regulate, for the quantities can be reduced at will, but its sameness renders it unpalatable after a short time.
On the whole it is advisable to make use of the diet above recommended, as a start. Grilled fish can take the place of eggs. If N-excretion is defective, if the patient is not fond of meat or can do with less, or if satisfied with a more vegetarian diet, the meat can be reduced in quantity at the evening meal and altogether omitted with advantage at the midday meal, and a liberal helping of cooked string beans, celery, onions, cabbage and such like, be given instead. It is important to remember that the nutritive value of vegetables depends greatly on the system of cooking. It is lowest when they are boiled and the fluid in which they are cooked is drained away. This applies especially to the tubers, many of which are rich in carbo-hydrates, which are dissolved out by hot water or weak saline fluids. Fats and carbo-hydrates can be allowed more liberally to the plethoric than in anaemic and hydraemic patients.
General directions must be given to each patient. No sugar should be used; even an ordinary lump has a calorie value of 15-20. Food should be masticated very slowly. This ensures thorough insalivation and is especially necessary to render cellulose foods digestible. It has the further and important effect of considerably reducing the appetite and encouraging a taste for the simpler foods. In choosing the particular articles of food, those should be avoided which contain much fat, e.g. eels, salmon, lobster, crab, sardines, herrings and mackerel among fish and Crustacea; pork and goose, and fat meats among flesh foods; nuts and fats, such as butter, cream, olive oil. Potatoes should be omitted, or taken in very small quantities. Milk must not be used as a drink. Most fresh fruits, except bananas, can be taken in moderation, and many of the green vegetables in large quantities. The ligamentum nuchae of the ox is recommended by Sternberg as an additional food which is appetising, filling and innutritious. It should be boiled in saline solution until quite soft, minced very finely and dried into a fine grey powder, which can be made up into tablets or small loaves. Many antidiabetic foods are also of value. Meals should be small and numerous.
For a few days it is advisable to weigh the different articles of food, but after that an intelligent individual can estimate sufficiently accurately what are the quantities ordered of meat, bread, etc. Rigid accuracy is not essential, for the conditions of life vary from hour to hour and day by day. It is best to keep to a simple diet, with comparatively little variety, for variety is a stimulant to appetite.
Clear soups are unnecessary and innutritious, but may be taken fairly often; so, too, plain tea and coffee. Their stimulating effects are often useful, provided there is no contra-indication to the taking of purins. In a few instances, though expensive, it may be possible to estimate and establish nitrogenous equilibrium and then regulate the amount of fat and carbo-hydrate foods. The calorie value of the diet can be reduced to one half without causing any material increase in N- excretion. The reduction in the diet must be combined with exercise to maintain the nutrition of protein tissues.
The minimum amount of nitrogen required in food should be three to four times the amount excreted during hunger. But a minimum amount in not desirable, as it leaves no store for emergencies, and protein tissues are only built up slowly. In addition, the protein foods contain phosphorus and sulphur salts which are essential. Fat, carbo-hydrates and gelatin are protein sparers. Hence a diet liberal in these constituents need only contain a minimum, or slightly greater amount of protein.
The methods of computation of food requirements are based on the percentage composition of the various foods or on their calorie value per ounce. Irving Fisher has recently devised a new system in which he takes a unit of food value, called a standard portion, of each kind of food. This standard portion is the amount of the particular food which will yield 100 calories. Thus, on a basis of 3.3 per cent of protein in milk a standard portion of milk is 4.9 fluid oz. and of the 100 calories in it 19 are from protein, 52 fat, and 28 carbo-hydrate. By comparison, nuts contain 11 per cent of protein, but 1/2 oz. of nuts forms a standard portion and the calorie-protein in it is only six. Fisher has drawn up tables of the calorie values of the protein, fat and carbohydrate of standard portions of different foods and has devised a diagrammatic map of these foods and their values.