Starvation Diet, 1915

Type 1 and LADA
#1

Starvation Diet, 1915

This article was published six years prior to the discovery of insulin. The link below describes a doctor's method of starving diabetic patients until they were sugar free. Then a carefully structured diet was used to keep the patients relatively free of sugar. The diet was low in carbs, and high in fat. Several case histories are presented so we can see exactly how effective the diet was. Very impressive!!

Apparently a LCHF diet was the only way of staying alive and healthy before insulin was discovered.

http://www.gutenberg.org/files/26058/26058-h/26058-h.htm

#2

The older members of my family referred to diabetes as "galloping consumption." Rural Tennessee. Illinois, few doctors--people faded, literally from DKA weight loss, away.

My family had no idea in 1915 what D was or how to treat it.

Life is better today.

#3

Fascinating, thank you Richard.

A couple of the things I found most interesting: this protocol (starvation followed by carefully increasing carb and protein until sugar in urine, at which point go back to starvation and then increase carb and protein to a lower level) worked for every case of adult-onset diabetes (this is long before anyone referred to T1 and T2).

This treatment was not nearly so successful with juvenile-onset - what we now refer to as T1. As he wrote: "Diabetes in children is likely to be a good deal more severe than it is in adults. ... Most diabetic children, however, are thin and frail, and they have no extra weight to lose, so it does not seem so desirable to bring about any very great loss of weight, which is quite an essential part of the treatment for most adults."

In fact two of the three juvenile-onset diabetics he treated with his diet died as part of the treatment. The third survived, though there was no follow-up to indicate how long she lived. And as the author stated: "The question is, can she grow and develop on a diet which will keep her sugar-free?"

This case was particularly sad:
"Case 9. M. D., female, age 3-1/2 years, entered April 7, 1915, with a history of having progressively lost weight for a month past, and of having had a tremendous thirst and polyuria. Had been on a general diet at home. At entrance the child was in semi-coma, with very strong sugar, diacetic acid and acetone reactions in the urine. For the first 12 hours she was put on a milk diet, with soda bicarbonate gr. xxx every two hours, and the next day was starved, with whiskey 1 drachm every 2 hours, and soda bicarbonate, both by mouth and rectum. She died after one day of starvation."

#4

The diet discussed in this book is generally called the "Allen Diet" after Frederick Madison Allen who developed the diet. Allen, who was at the Harvard Medical School eventually started an association with Elliot Joslin and by 1914, Joslin starting using those dietary principles to lower the mortality of his patients. This diet gave young patients up to 4 years of life. While a big advance over the few short months faced before the diet, patients still suffered terribly. Joslin kept extensive detailed records of his patients. This diet was employed to prolong the life of a young Elizabeth Hughes Gossett who was eventually saved as one of the first patients to receive the newly discovered insulin in 1922 which was documented in the recent book "Breakthrough." Even after the discovery of insulin, Joslin advocated for the use of a restricted carb diet and tight blood sugar control to minimize complications. Unfortunately, the medical profession rejected many of his ideas and only recently have we started to "relearn" things.

Many of these early books are now available freely having been transcribed or scanned.

"Studies concerning glycosuria and diabetes (1913)," Fred Allen

"The treatment of diabetes mellitus: with observations (1917)," Elliott Joslin

#5

I'm curious, do you know if there are any accounts, other than Elizabeth Hughes, of children surviving for 4 years on the starvation diet? I thought Elizabeth was such a "miracle" because she survived for so much longer than people thought she could. So I'm curious if 4 years was "usual" or "extraordinary" for a young diabetic. According to Breakthrough, the average life expectancy of a child diagnosed with diabetes before insulin was less than a year. I wonder if this was with or without the starvation diet.

I find this historical stuff interesting, but sad in the case of children. There are accounts of children not being able to walk or stand by the end, and diets having to be cut back more and more as their honeymoon ended. Sometimes when I feel like I'm having a bad blood sugar day, I think of what life would be like if I'd been born 75 or 100 years ago, when I wouldn't have even had the chance to try and control things.

1 Like
#6

Aren't you glad that we live in this day and age? We are lucky that so many of the earlier misunderstandings have been debunked!!

Lois

#7

In the Allen paper that Richard cited, 66% of the juvenile-onset (T1) patients died in less than a year even with the starvation diet when they were given no insulin. But 0% of the adult-onset (T2) patients died when given no insulin (and most of them lost weight). The T2's were able to tolerate different (though always small) amounts of carbohydrate without passing sugar in their urine - remember this is before the days of not only insulin but all the other T2 medicines that are used today.

That certainly sounds to me like a significant difference between T1 and T2 diabetes.

I agree, its very sad. We came so close in time to meeting the same fate; just one generation away.

#8

The survival at 4 years was very rare. However the paper cited by Richard is an an outlier looking at just a few cases compared to the 1300 cases cited by Elliot Joslin. The protein sparing starvation diet was clearly a hardship. It would break my heart to have to have my child eat this diet, and I clearly recognize that most children did not survive four years, but rather succumbed much earlier only after having suffering terribly.

#9

Interesting, thanks for the info. I checked out the papers you linked to but they are all in image formats. Would be interesting to read, though.

#10

I stand corrected: it's available in a variety of formats, including DAISY (digital talking book format). :)

#11

Makes me so glad there's an effective treatment that works for me 99% of the time without starvation. I'm still so sad though that they had to try to do this, starving people, to allow them to live for only a slightly longer bit of time.

#12

Hi Jen,

I think she was a miracle and very rare probably. It's hard to tell from this study which only shows 4 children and since none of those, children or adults, who survived and apparently fare well on the treatment were followed for very long apparently... but I think most children died with one month to a few months. They all died if they went to dka as did the adults who went to dka..

According to what I found adults who were type 1 also died rapidly without insulin, within a few months to two years usually.

http://www.trumanlibrary.org/histday/insulin/diabetes-before-insulin.html

With no effective treatment aside from a semi-starvation diet, a diabetic's outlook appeared grim. Before 1922, diabetic children rarely lived a year after diagnosis, five percent of adults died within two years, and less than 20 percent lived more than ten (Berger 57). Untreated diabetics faced blindness, loss of limbs, kidney failure, stroke, heart attack and death (Yuwiler 12).

Life Without Insulin
Before the discovery of insulin, a diagnosis of diabetes meant eventual coma and certain death, often with a lifespan of only one month to two years. Doctors eventually found that a near-starvation diet of a few hundred calories per day helped to extend some patients' lives by a year or two. Most diabetic patients were severely malnourished and very few weighed much more than 70 pounds towards the end of their illness.

Read more: http://www.ehow.com/facts_5498585_diabetes-before-insulin-discovered.html#ixzz2urr6HL9c

The distinction between the two forms of diabetes was indeed stark in the preinsulin era. Most children and some adults died of diabetes within months, whereas overweight older patients often survived for years. When insulin became available, those in the first category no longer wasted away, whereas those in the second continued to get by on diet alone.[1] [a]

http://www.diapedia.org/type-1-diabetes-mellitus/discovery-of-type-1-diabetes#fn:1

Although this last link says those adults who lived longer got by for years the other source says less than 20% actually lived longer than 10 years. Still a much better outcome for them on the starvation diet.

#13

I don't know if you know about https://openlibrary.org/, but they have an extensive collection in DAISY format that I believe contains all of archive.org but is much easier and familiar to use.

#14

Thanks, meee! This is a very well prepared and informative reply.

#15

Off the point somewhat but an interesting anecdote:

When the preliminary results of the DCCT were announced, indicating that tighter control of blood sugar correlated strongly with reduced complications and mortality, the Joslin staff were going around wearing buttons that said "We told you so".

#16

It's remarkable that anyone could last 4 years without any insulin at all. I would expect large muscle to atrophy away, and the person to be extraordinarily weak. What little glucose gets into those muscle cells must be simple diffusion leakage.

It's almost cruel that cardiac muscle doesn't require insulin for glucose uptake, thereby enabling this slow suffering death.

1 Like
#17

Maybe you missed the fact that unlike the T1's, ALL the T2 (adult-onset) diabetics survived the diet with no insulin and did rather well, losing a relatively small amount of weight "which is quite an essential part of the treatment for most adults". They could remain medication free with weight loss and low carb diet (between 30 to 60g per day depending on the patient).

Sounds like a significant difference between T1 and T2 diabetics, don't you think?

#18

Type 2 suffer loss of beta cells, but usually at a much slower rate than type 1, an average of 4% per year. That does not sound like a lot, but where does that leave you in 10 years? Where does it leave you in 20 years? Type 2 also usually have increased insulin resistance as time goes on. For some, weight loss can help, for others it makes no difference at all.
After 20 years, my c-peptide is 0.2, or about 1/30 normal.

#19

+1

Going on 20 years and c-pep comes in at a whopping 0.3. Without insulin I would be lost. Wish I'd started it 10 years sooner. Or even 20.

#20

Unfortunately, at that time, there were juvenile patients and adult patients. There were no T2s. I'm glad that the adult patients did well losing weight, but there was no T1/T2.