Diabetes

In the effort to control blood sugar in diabetes, dietary management used to be concentrated on restriction of sugar and on secondary restriction of carbohydrates as providers of sugar. This meant either starving the patients on a diet too low in calories or giving them a high fat diet. Many diabetic patients were maintained on high fat diets in the pre-insulin era (before 1923), but some experts even then believed that such diets, high in fat, low in carbohydrate, were bad.

The present view sides with the critics of the old high fat diet for diabetics. Though the old high fat diet provided calories, it seemed to reduce the sugar tolerance of the diabetic patient. Since the discovery of insulin, the blood sugar can be controlled even on a high carbohydrate diet, so the modern trend is to give more carbohydrates to the diabetic patient and to adjust the insulin dosage to his needs. It is now believed that if the diabetic eats carbohydrates his own pancreas is stimulated to produce more insulin. Some specialists now advise a low fat diet for diabetics, but the majority opinion favours moderation, with 30 to 40 per cent of total calories from fats.

Insulin prevents people from dying in diabetic coma, but the death rate of diabetics is still very high; they die of arteriosclerotic complications, particularly coronary heart disease. Diabetes is not only a "sugar disease"; it involves deranged fat metabolism and a marked tendency to high blood cholesterol. Some of the coronary deaths among diabetics today may be the result of high fat diets; or perhaps diabetes always upsets the fat and cholesterol system of the body. It seems to be particularly desirable for diabetics to watch the dietary fat. A rather reduced proportion of around 30 per cent for total fat calories should not be troublesome from the standpoint of insulin control. And, of course, the saturated fats can be reduced to a very low level.

Epilepsy

Severe epileptics were once treated with a high fat, "ketogenic," diet so as to overwhelm them with fat in the diet (80 per cent of calories) to the point where the fat could only be incompletely "burned" in the body and the "smoke" of this incomplete combustion, the "ketone bodies", would accumulate in the blood. This is a heroic measure, only justifiable as a last resort in otherwise uncontrollable epilepsy. Fortunately, this is practically never used today. The basic physiological unsoundness of the "ketogenic" diet is well recognized. New drugs are available that do a great deal more for the epileptic patient.

Skin Diseases

Patients with skin diseases often think a special diet is needed and that, in fact, their trouble is dietary in origin. In both respects the patient is usually mistaken and all that a diet can do will be done by any reasonably well-balanced diet. If the skin disorder is related to a specific food sensitivity, allergy tests may detect offending foods which thereafter should be forbidden. But such allergies relate to specific food items, not to classes of nutrients, so the general character of the diet need not be changed.

Carbohydrate restriction is often suggested for infantile eczema, but some authors suggest that some patients need more fat. Neither for infantile nor for adult eczema is there a specific kind of diet to recommend. The same may be said of most skin disorders, including psoriasis and the wide variety of conditions called "dermatitis".

Low fat diets are suggested for some skin troubles, including adolescent acne. Usually fats are restricted for patients with rosacea, a condition that is associated with abnormal flushing of the face, but there is some doubt that dietary fat has much effect. Even more questionable is the idea that intolerance to carbohydrates is involved in ordinary acne. One recent study reports that a high carbohydrate diet seemed to benefit most acne patients! If there is any agreement at all about acne it is to avoid high fat diets. The net result of considering the skin diseases is to conclude that the kind of diet recommended in this book is generally suitable for these patients.

Athletes

Twenty years ago we worked much with athletes. We tested and measured football players, all kinds of record-breakers and, incidentally, talked with them. Most of them liked to talk about what they should eat to build more speed, endurance, and agility into bodies already perfected far beyond what the rest of us can ever aspire to. This went on for years and carried us into research on diets for military combat, to ration trials with skiers and flyers and tank men.

So what did we learn? We found that in sprint races and most track events except the really long distance (five miles and up to the marathon of 26 miles), the meals just before competition did not matter, so long as they were small, light, and bland. For these events the performer needs and uses practically no energy beyond that in his own body. He is as taut as a bow string, and the main concern about eating is that it should not upset him in this highly nervous condition.

Long-distance swimmers and runners, however, may run out of easily available fuel in the body before the race is over. They may profit from stoking up with sugar just before they start or as they go along; eating sugar or any other food an hour or more before the race has little effect. In very prolonged severe exertion, such as mountain climbing or swimming the Channel, a supply of fuel during the exercise is critical. Sugar, especially glucose, has been the favourite recommendation, because it was thought that glucose is the preferred fuel of muscular work. This idea should be modified because of recent research findings - some fatty acids may be equally acceptable to the working muscle - but the rapid absorption of sugar is a consideration when the need is to get calories, any calories, fast.

Arguments about food on the day of competition have little to do with the regular diet of athletes, the diet they do or should train on. Athletes fall into two classes, the team players (rowing, football, etc.), and the individualists (runners, swimmers, wrestlers, and so on). They differ temperamentally and in regard to the diets they favour. Team players have personal foibles, including dietary ideas, but mostly they swear by whatever the coach tells them, including the choice of foods. Since the coaches are themselves former team players with only slightly more scientific knowledge than their charges, the diets they favour are built on a mixture of superstitions of what they were told in their time, and of hopeful interpretations of "modern nutritional science". The team player's diet is apt to be built on the same philosophy as the old Chinese idea - if you want to be big and strong you eat the muscles of big and strong animals - plus the notions of the nutritionists who believe that whatever grows baby rat meat faster is better. So they are stuffed on the biggest (and most expensive, therefore fattest) steaks to be found, they guzzle gallons of milk, and nowadays they may be plied with vitamin pills as well.

This is an indoctrination into adult dietary foolishness. When the rowing blues leave the university and no longer are forced to keep in training they soon turn into heavy business men; not much later the atheromata are in full bloom in their arteries.

Athletes in individual competition are very different, especially if they are of champion calibre. Each has his own ideas about training, often very peculiar. They, too, may believe in the "strength" of meat, but they may insist on eating it raw or cooked to death or they will eat only beef or never eat beef. Raw eggs are often favoured, or gallons of orange juice, or no sweets of any kind, or yoghourt by the bucket. Some eat only once a day; others eat five times a day. Murray Rose, the 17-year-old Australian who won the 400 and 1,500 metre free-style swimming races at the last Olympic Games, is not untypical. He subsists on sunflower seeds, sesame, millet, unpolished rice, and bread made from pulped carrots and cabbages, and he drinks only goat's milk and fruit juices.

The point is that there is no special diet for athletes. They need enough calories, which is far more than most of us should eat, and about the same amount and kind of proteins, vitamins, and minerals as anybody else. Each has to find for himself the foods that agree with him (who doesn't?). But there is not the slightest reason why the athlete, like other people, should not thrive without a vast amount of saturated fats.

The actual amounts of foods needed and allowable for the athlete are dependent on how big he is and how hard he trains, that is to say on his calorie needs. If this means 5,000 calories a day and we allow 30 per cent of calories from fats, a third being saturated types, he gets 500 calories or over 55 grammes of saturated fats. He can drink two quarts of milk and still have a sizeable remainder of saturated fats for his quota for the day. The amount of fat allowable is proportional to the total calories needed to maintain equilibrium.