The Dangers of Undereating
WOODS HUTCHINSON, M.D.
From The Cosmopolitan
FEW of the Little Tin Gods of our every-day life are more securely enshrined in the popular Pantheon than the widespread belief in both the virtuousness and the wholesomeness of undereating. We frequently hear it expressed, “If one would always leave the table feeling as if he could have eaten a little more, he would never be sick, and would live to a good old age.” The rule sounds well, and it may be true, but there is no evidence to prove it, for it has never been tried in real life. It, like many other moral maxims with a promise attached, is in much the same case as the famous assurance so confidently given us in our nursery days—when we believed things—that after we had had a tooth pulled, if we would only keep our tongue out of the gap, a silver tooth would grow there. Nobody ever saw a silver tooth so growing, but that is no proof that one wouldn’t if—!
Of course, like all popular beliefs, this one has a considerable element of truth in it. My protest is only against its acceptance as a universal law and its indiscriminate application. It has a curiously double origin. Naturally it was recognized at a very early period that a certain amount of real eating, with a reasonably frequent repetition of the ceremony, was necessary to life. Anyone who cherished any radical heresy or delusion of magnitude upon this subject soon died, and his heresy perished with him. Therefore the habit of eating survived and became popular. But it was early
seen to have two serious drawbacks ; it was expensive, and if one ate too much one became uncomfortable. Ergo to eat as little as possible, consistent with survival, was a virtue.
This sounds both reasonable and convincing, but it overlooks two things: that appetite, “the feeling that you have enough,” means something, and that nature is not an economist but a glorious spendthrift. She scatters myriads of seeds to grow hundreds of plants. Her insects of the air and her fish of the sea pour forth their spawn in thousands, nine-tenths of which go to feed other fliers and swimmers. Enough with her is never as good as a feast; in fact what to our cheese-paring, shopkeeper souls looks like enough is to her far too little. If there be any operation of nature which is conducted with less than at least fifty per cent, of waste, it has so far escaped the eye of the scientist. Her regular plan of campaign is to produce many times as much as she needs of everything and let only the fittest few survive. Is it not possible that the same principle may apply in human diet, that we should eat plenty of the best of everything to be had, and let the body pick out what it wants and “scrap” the rest?
Life, fortunately or unfortunately, is not a thing that can be conducted according to hard-and-fast rules. It is less a business than a great game of chance. That is what makes it so interesting. We get tired of business, of work, of philosophy, of science, but seldom of life, until it is our proper
time to quit. It is a game of chance —a gamble it you like, in the sense that there are large unknown factors involved; that, as George Fliot finely put it, “any intelligent calculation of the expected must include a large allowance of the unexpected"; that von never know what emergencies you may meet. This is not a pessimistic view, for few things are more firmly established than that which we term honesty—which is simply following the age-old rules of the game—and flexible intelligence will win eight times out of ten. Hut the point is that all life’s operations must be conducted upon a very wide margin. As with money on a journey, to have enough, you must always have a little too much.
There is no better illustration of this law than the human body itself. The truth, as usual, is within us, if we would only open our eyes to it. Fverv department of the body-republic is ridiculouslv overmanned: two eyes, two ears, two nostrils, two lungs, two kidneys, two brains, two thyroids, two adrenals, two everything in fact except the stomach with its appendages -—which is us and indivisible. In short, we are a physiologic double “Uncle Tom’s Cabin"—except Uncle Tom. Practically every one of these “twins” is there simply as an understudy to take the place of its chief in case the ¡after should be disabled, though, except in the case of the brains, the eyes, and the hands, it is impossible to tell “which is which," and both of the pair are given a reasonable amount of work to do in order to keep them in training.
I his sounds rather obvious, perhaps, but the margin goes vastlv farther than this. Xot only have we two lungs, either of which is perfectlv competent to do all the breathing of the body, even under severe strain, but under ordinary circumstances about one-third of one lung is sufficient to— economically—oxygenate our blood. The only reason whv nature does not build our lungs about one-third of the present size is that we would not have
enough margin to run for our lives, and il we were attacked bv pneumonia or tuberculosis we would be verv likely to go down in the first round. For precisely the same reason it is not sate to eat exactly what the economists and the laboratory men sav we need. Food is expensive, but it is much cheaper than doctors' and undertakers bills and the support of orphan-asylums and hospitals.
The same rule holds good all through the rest of the body. About one-half of one kidney would do all the blood-purifying needed, on the Chittenden principle. Why not remove one kidney?Jt is simple a drone in the body politic and must be using up a lot of good food-material. And just think of the wastefulness of carrying around in our bodies nearly two pounds of superfluous liver—and so indigestible as it is, too! Of coure we would probable die in our next attack of tonsilitis or severe influenza, but what is that compared with the virtue and piety of living economically? A squad of soldier volunteers, as brave as any that ever faced the cannon's mouth) mav survive for six weeks on a laboratorv diet calculated by the higher mathematics and consisting of proteids, carbohydrates, and hydrocarbons, instead of real food; but what would be the result the next time they happened to be exposed to tvphoid, tuberculosis, summer dvsenterv. or even a bad cold ? \\ hat was the final effect
this starvation diet on such a squad has already been told bv Maior Woodruff, and it does not exactlv encourage imitation. Five out of nine reported that they felt badlv and were always hungry during the test, and were weak and depressed at its close: and all but one had gladly returned to regular diet. One who had continued the diet for three months thought he had been pcrmanetnly injured bv it. and another thought he would have died if he had continued on the diet. Several confessed that they had been compelled to go out and get a "square meal” repeatedly during the test and
that others did the same. Moreover, one of those w ho was later placed on such a diet—a young man in the prime of life and vigor—died of a comparatively trivial disorder, which developed hemorrhagic complications, for no other reason whatever that could be ascertained than his prolonged food-deprivation.
Such tests may have a certain scientific value, but what we should be concerned about is not the minimum amount of food on which body and soul can be held together, and a moderate amount of work ground out, but the maximum amount of efficiency, endurance, and comfort which can be got out of any human machine by the most liberal and generous supply of food which it can be induced to assimilate. As Robert Hutchison aptly put it, “What we want to find is not the minimum diet but the optimum.” It is no principle of progress to hold men down to a starvation diet any more than it is to starvation wages ; and while economy may be an admirable thing in business, it is, in dietetics, usually not only short-sighted but wasteful, for compared with human life and health food is one of the cheapest things there is.
The man who attempts to save money on his butcher’s and grocer’s bills, seven times out of ten, is starving either himself, his family, or his servants. Economy may be the “soul of wealth” in business, but in the kitchen it is much more nearly the soul of starvation, and is usually practised at the expense of the younger or weaker members of the household. Like all business principles, it is excellent in its place, but its place is never in the feeding of young children. For instance, all careful students of the child-problem are convinced that the institutional or wholesale method of rearing orphan children is a failure and must go. A child reared in an institution, hospital, foundling-asylum or what not, is not much more than half a human being, and can usually be recognized at sight by its dull eyes, pasty complexion, sluggish and lifeless
movements and intelligence to match. Part of this is due to the barracks-like life and the absence ot individual love and care, but no small measure of it is due to the fact that these children, fed by wholesale and with an eye to economy, are usually underfed, either by actual deficiency of calorics or an excess of cheap starches in place of the more expensive meats, fats, and sugars, or by the deadly monotony of the fare, (due children’s hospital, for instance, has had corned beef and red cabbage slaw for dinner every Tuesday for seven years.
The same thing, I am ashamed to say, is too often true of the feeding of adults also in institutions or hospitals. When a superintendent wants to make a record for economy the easiest point at which he can cut down expenditures is in the food-bill. It has been an axiom with the medical profession ever since the days of Oliver Wendell Holmes, that people who are fed by wholesale, with some one else holding the purse-strings, instead of being able to follow their own appetites, are usually more or less starved. Although even then they may be better fed than they were at home under modern industrial conditions. Many of our hospitals, however, particularly those for the care of the insane, are beginning to see light on this subject, to provide a more abundant and attractive dietary, to consult the appetites and preferences of their patients, and to allow their physicians, instead of the superintendent or matron, to control the precise diet of each patient, with the result that money is actually being saved by curing the patients faster and enabling them to get up and back to work in a shorter time. Give nature the wide margin that she needs to conduct her operations on, and she will pay you dividends on it in the long run.
One of the corner-stones upon which our diet-economists base their claims is that .by diminishing the amount of food, and more thoroughly masticating and digesting it, they can thereby extract the last remnant of nu-
trition from it, and thus save the enormous waste which goes on upon ordinary diets. Many of them, in fact, have boldly claimed that they can save thirty, fifty, and even sixty per cent, of the food-fuel ordinarily consumed and subsist on from onethird to one-half the standard, popular diets.
Unfortunately for these claims, however, the reformers neglected to ascertain the exact amount of the food in our average or standard dietaries which actually goes to waste in the body. This, of course, can be determined with as absolute accuracy as the amount of ash made by a particular kind of coal. It was one of the first things ascertained in the scientific study of nutrition, and the results, laid down as tables, have been corroborated a hundred times since. These show that upon ordinary diets, under average conditions, only from five to fifteen per cent, of the food taken into the mouth is discharged from the body as waste. Of beef, for instance, all but about two per cent, of its available nutriment passes into the blood, of milk all but about three per cent. ; of bread only six per cent, is wasted. How, out of a wastage of less than ten per cent., our diet-reformers are going to save forty per cent, is, of course, a puzzle to everyone but themselves. If their claims were true we would be justified in leaping to the logical conclusion of the Irishman who, when assured by an enthusiastic hardware dealer that a certain make of stove would save one-half of his fuel-bill, promptlv replied, “Shurc, thin, Oi'll take two an’ save the whole av ut.”
This brings us to the question, \\ hat are the diseases of underteeding, and what the diseases of overfeeding? ho hear the extraordinarv claims trumpeted forth on everv occasion by the apostles ol a slender regimen that “Man digs his grave with his teeth," that gluttony is the deadliest vice of our age, that two-thirds of our diseases are due to over-eating, and that the race is fast gorging it-
self into degeneracy and final extinction, one would surely conclude that the most imposing array of diseases in our text-books of medicine and the hugest totals in our deathlists would be found directly and unmistakably enrolled under the head of diseases due to overeating. On the other hand, from the incessant praises of plain living and high thinking we would confidently expect that all those who, either from necessity or from choice, practised this gospel of starvation would have a high longevity, a low mortality, and an obvious freedom from disease, and that under the head of diseases due to underfeeding would be found a vast and eloquent blank.
But what are the facts? Of the forty-two principal causes of death in the United States census of 1900 only three are to be found which are in any way due or possibly related to overfeeding—diseases of the stomach, diseases of the liver, and diabetes. Two-thirds of the deaths due to these three causes have nothing whatever to do with overfeeding, but even if we were to grant them in their entirety to the anti-food agitators, they would amount to only three per cent, of the total deaths. Those diseases most often and confidently ascribed to overfeeding, such as gout, dyspepsia, apoplexy, obesity, neurasthenia, and arteriosclerosis, are such insignificant factors in the death-rate that they do not appear in this list of principal causes at all. On the other hand, those diseases which are either directly due to underfeeding or in which the mortality is highest among those who are poorly fed and lowest among those who are abundantly fed—consumption, pneumonia, diarrheal diseases, tvphoid and inanition (a polite official term for starvation")—account for a deathroll of 250.000 victims, or nearly 50 per cent, of all the deaths. Diseases even possibly due to or aggravated by overfeeding, three per cent.: diseases certainly due to or aggravated by underfeeding, thirty per cent. Other factors enter in. but surelv. if low
diet were such a wonderful promoter of longevity and warder-off of disease, it ought to have prevented at least half of these 250,000 practitioners of it from falling victims of diseases due to lowered vitality. Such diets as are advocated by our reformers—viz., from sixteen to eighteen hundred calories-—are, in effect, starvation diets for men exposed to the wear and tear of workaday life, for women, and for children. They represent a bare subsistence diet, capable of sustaining life and moderate degrees of activity, but giving no reserve for protection against disease or for recovery from its attack.
Thousands, yes, millions, of the human race have been compelled and are yet compelled to live on just such diets as our reformers recommend, and instead of being healthier, freer from disease, and longer-lived on that account, it is a rule as unbroken as any axiom of Euclid that the death-rate in any given community varies in constant ratio with the social position of the individual, being highest in the lowest and most sparely fed classes, intermediate in the middle and betterfed classes, and lowest of all in the wealthiest and best fed classes. The much-vaunted blessings of poverty exist only in the imagination of the poets, if indeed they have not been invented by both poet and priest for the purpose of making the less-fortunate classes better “content with that station in which it has pleased Providence to put them,”
It is a real surprise to some of our smug pseudo-philanthropists to learn from the stern and unimpeachable evidence of the mortality and morbidity records that the blameless and frugal poor have the highest death-rate, the highest disease-rate, and the lowest longevity-rate of any class in the community. The same statement is equally true of nations. The most abundantly fed races of the world today are those which are in the van of the world’s progress. The measure of the spareness and the slenderness of the diet of a race is the measure
of its backwardness and stagnation. We have heard so much baseless fairytale and poetic cant about the healthfulness and the endurance of the blameless Hindu and the industrious Mongolian that it really comes almost as a shock to us to discover, when we are brought face to face with these interesting peoples, that their working efficiency is from one-fourth to two-fifths less than that of the meatfed white man ; that their death-rate is from double to treble that of the civilized races ; and that the average longevity of the Hindus, for instance, is barely twenty-three years, as compared with some forty-seven years in our American whites. Ten days of practical observation abundantly demonstrate that the only reason on earth why a Hindu or a Chinaman or any other Oriental lives upon a diet of rice, or pulses, or vegetables is that he cannot afford anything better! The sole cause of a vegetarian or low-protein diet in any race is plain poverty. The moment that a Chinese or a Hindu in America begins to earn something like a white man's wages he abandons his former diet and begins, as he expresses it, to “eat American.” As soon as he does so he increases his working power from twenty to forty per cent, and diminishes his liability to disease in the same proportion
The firsr step in the magnificent modernization and civilization of Japan, for instance, was to put, first her army, then her navy, and then as nearlv as possible her population, upon an European diet rich in proteins— wheat, pork and beef. The so-called vegetarian or low-protein victories of Japan were won by an army and navy which had been for fifteen years upon a ration rich in protein, modeled as closely as possible after that of the German army and originally adopted for the purpose of stamping out beriberi.
Finally, apropos of the diseases of underfeeding versus those of overfeeding, I would call attention to the significant fact that practically every prolonged famine is followed bv the
outbreaK of some epidemic. In fact, from one-half to two-thirds of the deaths in a famine are due to some form of fever, which the lowered nutrition of the victims has allowed to gain a foothold. There are a dozen diseases, from typhus and typhoid to cholera and plague, which are known by the significant name of “famine fevers.'’ If any epidemic or widespread disease has ever resulted from overfeeding or followed on the heels of a too abundant crop it has entirely escaped the eye of medical science.
IT) sum up: X’ature is no fool, nor
has she been wasting her time these millions of years past in sifting out the best, both of appetites and individuals, tor survival. A certain definite amount of fuel-value in food is essential to lite, health, and working power, and a surplus is never onetenth as dangerous as a deficit. Particularly is this the case in growing children and in women during the reproductive period. It is doubtful, in fact, whether these two classes can be induced to absorb more real sound.
wholesome food than is good for them. The vast majority of our diseases of dietetic or alimentary origin are now recognized as due to poisons absorbed with the food, or resulting from its putrefaction. What we really need is pure food and more of it. instead of less. The diseases of overfeeding are chiefly the pathologic amusements of the rich, and exercise a comparatively trifling influence upon the death-rate. The diseases of underfeeding are the pestilences of the poor, that sweep them away by the thousand and by the million. Twothirds of the patients who come to us. as physicians, from whatever walk of life, are underfed, instead of overfed. Even gout has little to do with overeating, and nothing at all with red meats. “Poor man’s gout” is just as common as “rich man's,” now that we have learned to recognize it. To paraphrase Goethe. “Eood. more food.” is our cry. Every increase in the abundance, the cheapness, and the purity of our food-supplies lowers the deathrate of the community an appreciable notch.