Two Stories about Diet and Diabetes in Europe.

Unhealthy weight gain and diabetes are global challenges that threaten not only the well-beings of hundreds of millions of persons but also the global economy. The authors in this article describe two overlapping stories, one is about a 150-year-old diet, known as the Banting Diet, which is similar to the Atkins or Keto Diet, and the other is about a provider-patient relationship story that helped the patient make lifestyle modifications that were effective in significant weight loss, improved quality of life, and reduced need for exogenous insulin for Type 2 diabetes. Both of the stories are from England but might be useful worldwide.

Apollinaire Bouchardat (1806-1886): founder of modern Diabetology.

Apollinaire Bouchardat is regarded as the founder of the field of Diabetology. His contributions to the field include the first known recommendations for specific diets for the management of Diabetes Mellitus and his emphasis on patient education and self-monitoring. He was moreover a great pharmacist as well as a distinguished physician and biochemist.

Why were "starvation diets" promoted for diabetes in the pre-insulin period?

In the decade before the discovery of insulin, the prominent American physicians Frederick Allen and Elliott Joslin advocated severe fasting and undernutrition to prolong the lives of diabetic patients. Detractors called this "starvation dieting," and some patients did indeed starve to death. Allen and Joslin promoted the therapy as a desperate application of animal experimentation to clinical treatment, and texts still describe it that way. This justification was exaggerated. The public record contains only the briefest account of relevant animal experiments, and clinical experience at the time provided little indication that severe undernutrition had better outcomes than low carbohydrate diets then in use.

[Apollinaire Bouchardat and diabetes]. / Apollinaire Bouchardat et le diabète.

Apollinaire Bouchardat (1806-1886) begins its hospital formation by the pharmacy internship and then starts his medical studies. He becomes chief pharmacist of the Hôtel-Dieu in 1835 and during 20 years, he devotes his life to the study of diabetes. Through observations and experiments, he builds new concepts allowing to establish the bases of clinical diabetology due to a solid competence in fundamental sciences and his intelligence in semiologic observations. He studied urine glucose as a reflect of the clinical state of the patients and, in order to carry out its exact measurement, he recommended the use of the polarimeter. He engaged himself in many studies concerning well as the patients diet as to their way of life. Thus he recommended a large decrease in starchy foods and sugars, he encouraged physical exercise and considered that, since the assumption of responsibility of the diabetic was serious, it could foresee the remission of disease. Due to encouraging results, he developed self-monitoring by the patients by the means of simple chemical reagents, convinced that making patients responsible, despite difficulties of the diet, could modify their attitude. Precursor of the modern diabetology, one can consider that he founded it as a true medical discipline. Its major work: De la Glycosurie ou diabète sucré, son traitement hygénigue is pro-bably the first textbook on diabetes, associating clinical observations, experimental steps and proposals for a treatment based on the patients' way of life: mainly diet and exercise: still preached steps, a hundred and fifty years later.

Dietary treatment of diabetes mellitus in the pre-insulin era (1914-1922).

Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.

A history of insulin: from discovery to modern alternatives.

Following on from the first article in this series (Vol 12(18): 1091-5), which described the history of diabetes, this article, the second of three literature reviews, explores the early production and development of insulin, from its initial production in a university laboratory to becoming a major pharmaceutical product. Also discussed are the various forms of insulin developed over the last 80 years and their means of delivery to the patient. The future is considered and the development of insulin analogues (substances that mimic the effect of human insulin) is described. The article also looks at the introduction of DAFNE (dose adjustment for normal eating) - an intensive programme of education aimed at teaching individuals the necessary skills to adjust their own insulin injection dosage to reflect their individual eating patterns.

A history of diabetes: from antiquity to discovering insulin.

This article, the first of a three-part series, gives a historical account of events for diabetes, dating from antiquity and its first recording in the Ebers Papyrus--an Egyptian document circa 1500 BC. This article describes initial thoughts that diabetes was linked to an alimentary complaint, and concludes with the discovery of it being a chronic systemic disease. It highlights the discoveries and also includes details of the failed attempts to locate the cause and identify a solution to the ancient mysterious disease which became known to all as diabetes mellitus. Early remedies and treatments are included. The article tells how for many centuries individuals suffered from the debilitating complaint with very little offered in terms of treatment or relief. Eventually the pancreas was identified as the causative organ and, some time later, animal experimentation resulted in the abstraction of the substance insulin. The article concludes with Frederick Banting and John Macleod being awarded the Nobel Prize in 1923 for their revolutionary discovery of insulin.

Dietary advice in the management of diabetes mellitus--history and current practice.

Diet has been recognised for over three thousand years as being vital to the overall management of diabetes mellitus (DM). Today dietary advice for the person with diabetes continues to play just as an important role, not just as regards the day to day control but also in respect of the prevention of complications. The history of dietary advice for diabetes is examined as well as current dietary advice.

R.D. Lawrence, H.G. Wells, G.B. Shaw: a vignette.

Among the unpublished autobiographical notes of Dr R.D. Lawrence are numerous references to his contacts and friendship with the author H.G. Wells, who was to become the first President of the (British) Diabetic Association. Wells was responsible for Lawrence being called in for consultation by George Bernard Shaw, a meeting which was to have surprising consequences.

[Diet and diabetes mellitus]. / Dieta a diabetes mellitus.

Diet is the basic treatment of every diabetic patient. The first diabetic diet was described in detail by John Rollo in 1797. During the second half of the 19th century and first half of the 20th century great changes as regards the composition of the diabetic diet occurred. The findings on the association of atherosclerosis and fat intake led to a reduction of fat in the diabetic diet. A great deal of research in the seventies and eighties of this century was devoted to exchange of foods in the diabetic diet with regard to the carbohydrate content or the rise of the blood sugar after their intake. The possibility to include sucrose and simple sugars in the diabetic diet was also repeatedly tested. Findings on the blood sugar level after ingestion of different meals, but also lipid levels and epidemiological results led to recommendations of scientific associations worldwide, incl. the Czech Diabetological Society.

Historical changes in diabetes therapy in Japan.

The origins of many aspects of ancient Japanese culture lie in knowledge brought from China, and medicine was no exception. Subsequently, however, in the middle of the 16th century, Portuguese missionaries introduced Western medicine to Japan along with Christianity. They were followed by the Dutch in the 17th century, who introduced Western culture while carrying on commerce at their Dejima outpost in Nagasaki. This was called the Dutch school in Japan, and although there was thus contact with Western culture and the Japanese eagerly studied Western medicine, it was not until after the establishment of the Meiji Reform government in the middle of the 19th century that there was aggressive incorporation and acceptance of modern Western medicine in Japan. The University of Tokyo was the first university in Japan. Preserved in the library of the Third Department of Internal Medicine are old records of hospitalized cases in Japan, and those documents form the basis of this review of the history of the treatment of diabetes mellitus in Japan.

The quest for normoglycaemia: a historical perspective.

One of the longest-running controversies in medicine concerns the aims of diabetes treatment. The question debated for 80 years has been whether the clinician should just relieve symptoms, or try to achieve the much more difficult objective of near-physiological normality as measured by an absence of glycosuria and/or normal blood sugar levels. At the beginning of World War One, most clinicians and physiologists thought the severity of diabetes was inversely proportional to the number of functioning islets of Langerhans. Hyperglycaemia, it was hypothesized, stressed the surviving islets and led to a downward spiral of increasing glandular fatigue and hyperglycaemia. The aim of undernutrition was to rest the damaged tissue in the hope of promoting a return of functional efficiency and possibly regeneration. Most experts stressed that rest of the islets could only be achieved by abolishing glycosuria and restoring normal blood sugar levels. The first clinical use of insulin in 1922 led to astonishing improvements in the health and strength of patients with diabetes and the concept of pancreatic rest seemed to be confirmed when some regained such carbohydrate tolerance that after weeks or months they could reduce the dose of insulin without developing glycosuria. Initially there were expectations that insulin would allow the islets of Langerhans to recover completely, so that diabetes was cured. Most physicians insisted that the best chance of preserving what pancreatic function remained was biochemical normality. It was also contended that patients who had normal blood sugar levels were more healthy than those without and had fewer 'complications'. The complications in question were mainly infective, since specific diabetic tissue damage was not recognized until the late 1930s. The toll of microvascular complications (retinopathy and nephropathy) in those whose lives had been saved by insulin did not become apparent until the late 1930s and early 1940s, when it generated an often acrimonious debate about whether they were due to the metabolic disorder or an associated phenomenon. Liberalization of diet in patients taking insulin began in 1926 and by 1930 it was clear that patients who were prescribed 200 g of carbohydrate per day felt better and more energetic than those on the old regimens of 50 g or less per day. Even these more liberal diets were measured but, in the early 1930s some paediatricians, feeling that a strict measured diet was psychologically damaging, experimented with 'free' or unmeasured diets.(ABSTRACT TRUNCATED AT 400 WORDS)

Nutritional management of diabetes.

The ideal therapeutic diet for diabetes mellitus is currently unknown; however, it continues as a cornerstone of treatment for this complex disease. Dietary guidelines dictate a prudent, healthy diet that is recommended for all healthy people, with or without diabetes. Individuals with diabetes are counseled according to their life-style demands and presence of complications. In fact, there may be as many diets for diabetes as people with diabetes, based on the many manifestations, presentations, and complications of diabetes mellitus. Nutrition research in diabetes is a viable pursuit and will continue to generate interest and further modifications until the cure for diabetes is found.