Court of Last Appeal - The Early History of the High-fat Diet for Diabetes

George Henderson

doi:10.4172/2155-6156.1000696

Abstract

The first low carbohydrate diets for diabetes, which were introduced in the 18th century, were not high fat diets so much as high protein diets. By the late nineteenth century a consensus had begun to appear in European studies that a higher fat and lower protein intake was more tolerable. Frederick Allen confirmed this in animal studies, but the diet he introduced into clinical practice in 1914 restricted fat, protein, and total calories, becoming in extreme cases a starvation diet with the deadly side effect of “inanition”. Interpreting Allen’s research in light of the studies in chemical metabolism of Rollin Woodyatt, Louis “Harry” Newburgh, with Phil Marsh, dared to increase fat in the diets of diabetic patients at the University of Michigan Hospital in 1918, with gratifying results which were published in 1920. A dispute followed between Newburgh and Allen’s disciple Elliott P Joslin; Woodyatt, Russell M Wilder, Karl Petren and others confirmed Newburgh’s results by experimentation and by 1924 Joslin too was reporting the higher fat diet’s ability to extend life in diabetics untreated with insulin. However, a dispute between Joslin and Newburgh about the long-term safety of the high fat diet continued long into the insulin era. Because the debate about the effect of the high-fat diet in the tabula rasa of the pre-insulin era only lasted a few years, and rigorous research into the question was largely limited to the state of Michigan, medical history has paid little attention to the fact that the question of what is the “optimum”, or default, diet for diabetes, based on physiological principles as well as clinical practice and experiment, was at one time almost settled. This historical review paper summarises the early clinical researches of Newburgh et al. into the effects of the high-fat diet in the treatment of diabetes, with a particular focus on events in Michigan between 1918 and 1930.

Highlights

The First Low-carbohydrate Diet for Diabetes In Two Cases of the Diabetes Mellitus, Rollo and Cruickshank described the treatment of two patients suffering from glycosuria, polyuria and polydipsia with a combination of organic and inorganic salts and a diet restricted in vegetable food, and made largely of meat and fat [1]
This was based on the observation that, while both animal foods and vegetable foods are nutritious and will support life, glucose, found in the urine of patients with diabetes and obviously connected to the disease, can be found in large quantities in vegetable foods but only in trace amounts in meat and fat
Only 50% of the energy from this diet is in the form of the nutrient, fat, which has the lowest requirement for insulin; nor is the diet as low in carbohydrate or as permissive with regard to non-starchy vegetables as modern thought would recommend

Summary

Nineteenth Century Developments

Rollo’s approach was improved upon by subsequent European clinicians. In the third of a series of lectures on diabetes by Lauder Brunton, published in the British Medical Journal in 1874, a diet is recommended: “consisting of nitrogenous food, such as butcher-meat, fish, eggs, and soups. Following the publication of Frederick Allen’s researches in 1913, the clinical benefits of which Joslin enthusiastically promoted, came what Joslin called the Allen Era, 1914-1922, with “control of calories, but carbohydrate low and fat still high With this simple but fundamental expedient coma as a cause of death fell to 40 per cent and in well-regulated hospitals seldom developed de novo.” [11] The essential distinction between the Naunyn and Allen methods was the use of fasting in the latter to reverse glycosuria (“desugarization”) and prevent ketoacidosis. Calorie restriction in some cases lasted long enough to produce inanition and death from starvation, as Mazur describes [13] This was not the whole story – Joslin describes seeing a patient of Allen’s in 1931 who “had lived for 15 years on a low carbohydrate diet, C 60, P 90, F 133 [i.e. The exact hormonal and metabolic mechanisms that regulate such an effect in the insulindeficient state remain to be fully elucidated

Woodyatt Tests the High Fat Diet

Newburgh Remembered in the Modern Era

Findings

Conclusion