In the United States during a certain period, various commercial medicines were available claiming to cure diabetes. These medications often contained substances like opiates, bromides, ergot, and arsenic. With the understanding of the pancreas’s role in diabetes, products with pancreatic extracts also gained popularity.
Treatment for diabetes in the past involved strict diets low in carbohydrates. The “starvation diet” or undernutrition was developed, with some patients being among the first to receive insulin following its discovery in 1922.
The Starvation Treatment of Diabetes by Lewis Webb Bill, M.D. and Rena S. Eckman in 1915 provided detailed insight into the starvation diet.
Severe Fasting and Undernutrition in the Early 20th Century
Prior to the discovery of insulin, doctors such as Frederick Allen and Elliott Joslin recommended extreme fasts and undernutrition for diabetic patients to prolong their lives. Unfortunately, some patients perished from starvation using this method, which was viewed as a desperate measure derived from animal experiments. Nevertheless, the outcomes of severe undernutrition were not much better than those achieved with low carbohydrate diets.
It is important to note that the understanding of diabetes and its treatment has come a long way since the early 20th century. With advancements in medical research and technology, we now have a better understanding of the importance of balanced diets, medication, and proper management of blood sugar levels in the treatment of diabetes.
In the early 20th century, starvation diets were widely promoted as a treatment for various health conditions, including diabetes. However, these severely restricted diets presented significant risks, such as death from starvation and stunted growth, particularly in children. Despite the initial enthusiasm for these diets, concerns about their long-term effectiveness and safety led to skepticism among medical professionals.
One notable case from this time period is that of Elizabeth, a patient who experienced severe health decline while following a starvation diet in 1921/22. Fortunately, her mother sought help from Frederick Banting, a doctor who had recently discovered insulin. Elizabeth participated in a trial of insulin therapy, which proved to be successful. Thanks to the insulin treatment, she regained her health and was able to live a full and active life, ultimately passing away in 1981 at the age of 73.
Overall, the shift towards more evidence-based and balanced approaches to diet and nutrition has since overshadowed the practice of starvation diets in modern medical treatment.
Allen’s Early Work
Frederick Madison Allen (1879-1964) graduated with an M.D. from the University of California at Berkeley in 1907. Despite challenges in publishing his research, Allen’s work on diabetes provided valuable insights into the condition. In 1913, he moved to the Hospital of the Rockefeller Institute in New York to further his studies.
Promoting Starvation
Allen conducted experiments on animals to understand how diet affects diabetes. By restricting calorie intake and implementing fasting, he treated a small group of human patients. His research indicated that controlling diet and weight could influence the progression of diabetes. Despite facing skepticism and controversy, Allen remained convinced of the effectiveness of his approach, even in the face of resistance from patients, families, and other medical professionals.
In a hospital room, a blind boy managed to sneak food from his mother’s and governess’s lunches, as well as ingesting toothpaste and birdseed. Sadly, the boy passed away after four months.
Allen assessed the staff at Rockefeller, categorizing them as either supportive or against him. Dr. Stillman was deemed “inept” and “unhelpful,” while Dr. Fitz was considered “competent and pleasant” but avoided interactions with Allen. Bliss indicated that Allen’s harsh methods led to his removal from the diabetes clinic.
In 1917, Allen was informed that he would head a diabetic service in New Jersey, marking the end of his tenure at Rockefeller. Despite his controversial career and questionable treatments, Allen’s approach eventually gained widespread acceptance.
Further research conducted by Allen paved the way for the development of new dietary guidelines for managing diabetes. His work highlighted the importance of nutrition in controlling blood sugar levels and preventing complications associated with the disease.
Despite initial resistance, Allen’s findings led to a shift in the medical community’s understanding of the role of diet in diabetes management. His contributions continue to impact research and treatment approaches in the field of diabetes care today.
Allen Back in Civilian Life
By the conclusion of the war, Allen had become a notable figure in the diabetes field, attracting both followers and detractors. In 1919, he co-authored a second book with his former colleagues. The Physiatric Institute, founded by Allen in 1920, focused on natural treatments through personalized diet plans. Patients had the option to relax on the grounds or in the nearby town. Following 1922, both Allen and Joslin adopted insulin, but Allen’s practice dwindled, especially after the market crash of 1929.
Despite the challenges Allen faced in his later years, his contributions to the field of diabetes management were significant. He paved the way for personalized treatment plans and emphasized the importance of natural approaches to controlling the disease. His legacy lives on through the advancements he made in the field of diabetes care.
The Rockefeller Series
Between 1914 and 1917, Allen, Stillman, and Fitz treated around 100 diabetic patients at Rockefeller Hospital. The 1919 book presented cases, including a seven-year-old with a poor outcome and a four-year-old with a positive result. Allen’s explanations for outcomes often seemed circular, attributing poor results to dietary errors. He acknowledged that his current treatment effectively managed diabetes symptoms but did not constitute a cure.
Without claiming a miraculous cure, Allen recognized that by late 1917, 43% of his cases had resulted in death, including deaths from starvation. The extended fasting regimen aimed to reduce the occurrence of comas, particularly in children. Did severe calorie restriction prolong life more than avoiding coma and death events? Addressing this question without a proper control group presented challenges.
Examining the full range of cases, mortality rates by age at Rockefeller followed a familiar trend. Young children faced high mortality rates, while older individuals tended to fare better. Joslin observed success even with older diabetic patients through carbohydrate restriction.
Table 1.
The mortality rates at Rockefeller Hospital by age were as follows:
| Age upon admission (in years) | Number of patients | Percentage of patients deceased by February 1918 |
|---|---|---|
| 0-9 | 8 | 75% |
| 10-19 | 14 | 71% |
| 20-29 | 14 | 64% |
| 30-39 | 16 | 38% |
| 40-49 | 13 | 31% |
| 50+ | 11 | 18% |
Allen’s malnourished patients experienced some improvement in survival rates, however the outlook was bleak, especially for the younger individuals, as demonstrated in recent additions to the series. The Allen Plan for managing diabetes did not offer much hope.
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During the early 20th century, doctors faced challenges in treating diabetes with limited resources, relying primarily on urine sugar tests. Once diagnosed, patients were advised to lose weight and reduce sugar and starch intake in their diet. The understanding of different types of diabetes was limited, although it was observed that children seemed to be affected more severely than adults. The period before the discovery of insulin was marked by experimental treatments, such as Allen’s plan, gaining popularity.
Between 1914-1917, Allen conducted research at Rockefeller Hospital, where diabetic patients were treated with calorie restriction. The success of the treatment was largely attributed to the patients’ adherence to the prescribed diet. The mortality rate, especially among children, did not show significant improvement in life expectancy beyond avoiding certain coma events.
Allen’s approach to managing malnourishment was compared to high-calorie treatments, sparking debates among critics. Balancing restriction with maintaining a functional, active lifestyle without risking starvation in diabetic patients posed a significant challenge during that period.
A study by Newburgh and Marsh, involving 73 cases mostly consisting of adults admitted to the University of Michigan Hospital, was the final option for physicians in the state. Patients were not subjected to fasting but were instead placed on a high-fat, low-carb diet consisting of 900-1,000 calories. Within 1-2 weeks, the non-sugar diet was increased to 1,400-2,500 calories, predominantly from fat. With the exception of 4 patients, all individuals became sugar-free without experiencing severe acidosis. These findings left a strong impression on the researchers.
While the Michigan study did not provide definitive conclusions, it did boost the confidence of physicians who were against starvation methods, opting to limit carbohydrates as a source of glucose and advocating for fat-based diets for diabetic patients. The case of Elizabeth Hughes raised concerns about the effectiveness of undernourishment treatments, lacking sufficient evidence from research studies.
The Allen Plan and Joslin’s approach emphasized discipline in the lives of diabetic patients, highlighting their responsibility for managing their condition. The shift from diet as the primary focus to the availability of insulin led to a medication-centered approach. The consensus on diabetic diets remains unclear even today.
The author declares no conflicts of interest.
All the research for this article was conducted by AM.
AM acknowledges Michael Bliss for providing valuable suggestions. The study was funded by the author.
References:
- Joslin’s work on diabetes
- Cox’s “The Fight to Survive”
- Newburg and Marsh’s high-fat diet in diabetes treatment
- Woodyatt’s diet adjustment in diabetes
- Henderson’s research on Allen and Morristown Psychiatric Institute
- Allen’s scientific studies on diabetes
Articles from Nutrition Journal are provided courtesy of BMC.