href="#ulink_c9f11b72-16cf-54dd-9a26-d78fd3b30a69">1].
If we accept Allen’s claim that undernourishment worked to some degree, it is worth asking if it worked any better than more filling low-carbohydrate diets. As contemporary critics, Newburgh and Marsh [5] put the issue thus:
A diabetic diet, in order to be satisfactory, must be capable of enabling the patient to lead a moderately active life for an indefinite period... [T]he severe diabetic may be kept sugar free by a sufficient reduction of his total caloric intake, but it is frequently necessary to reduce the total calories so much... that such patients suffer from slow starvation, and are quite incapable of earning a livelihood – indeed many of them may be said to merely exist.
We cannot say whether Elizabeth Hughes would have lived until the advent of insulin if Allen had not nearly starved her to death. But it does appear, more generally, that undernourishment therapy was promoted as a treatment for diabetes without clear supporting evidence from either animal or human studies.
Why, then, did the treatment and its promoter achieve such prominence? Joslin’s support was critical for Allen to carry the day. This may have hung partly on the prior relationship between the men. Joslin did have some observational grounds for his enthusiasm. Prolonged fasting seemed to alleviate coma as the proximate cause of death in his pathetic child patients, even if it barely extended their lives.
Possibly the self-discipline required by the Allen Plan appealed to the puritanical outlook of the two physicians. Allen and Joslin were very hard working, self-disciplined men, physically trim and averse to excess or sloth. Both believed that diabetic patients must take charge of their own wellbeing. Allen often saw deteriorations in health as his patients’ own fault for lapsing from their diets. Joslin proselytized that it was the diabetics’ responsibility to rigorously control their lives. Indeed, their moral ideology may have been as important for their advocacy as evidence-based effects.
The entire episode was brief. The primacy of diet diminished once insulin became available, leading to the primacy of medication [24]. Weight loss apart, there is still today no evidence-based consensus on proper diabetic diets.
References
1Mazur A: Why were “starvation diets” promoted for diabetes in the pre-insulin period? Nutr J 2011;10:23.
2Joslin E: The diabetic. Canadian Med Assn J 1943;8:488–497.
3Joslin E: The Treatment of Diabetes Mellitus, ed 2. Philadelphia, Lea and Febiger, 1917.
4Cox C: The Fight to Survive. New York, Kaplan, 2009.
5Newburgh L, Marsh P: The use of a high fat diet in the treatment of diabetes mellitus. Arch Inl Med 1921;27:699–705.
6Woodyatt R: Objects and methods of diet adjustment in diabetes. Trans Assn Amer Phys 1921;36:269–292.
7Henderson A: Frederick M. Allen, M.D., and the Psychiatric Institute at Morristown, New Jersey, 1920–1938. Acad Med New Jersey Bull 1970;16:40–49.
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14Metzer S: Scope of paper by Kleiner and Meltzer. JAMA 1916;65:895.
15Bliss M: The Discovery of Insulin. Chicago, University of Chicago Press, 2007.
16Joslin E: The Treatment of Diabetes Mellitus. Philadelphia, Lea and Febiger, 1917.
17Feudtner C: Bittersweet: Diabetes, Insulin, and the Transformation of Illness. Chapel Hill, University of North Carolina Press, 2003.
18Joslin E: Present-day treatment and prognosis in diabetes. Am J Med Sci 1915;150:485–495.
19ADP: Catalogue of the Alpha Delta Phi, 1832–1909. New York, Executive Council of the Fraternity, 1909.
20Harvey A: The Interurban Clinical Club (1905–1976): A Record of Achievement in Clinical Science. Philadelphia, Saunders, 1978.
21Joslin E: The treatment of diabetes mellitus. Canad Med Assn J 1916;6:673–684.
22Kitabchi A, Murphy M, Umpierrez G, Kriesberg R: Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2006;29:2739–2748.
23Radical new method of treating diabetes. New York Times Magazine, Feb 13, 1916.
24Vecchio I, Tornali C, Bragazzi NL, Martini M: The discovery of insulin. Front Endocrinol 2018;9:613.
Prof. Allan Mazur
The Maxwell School, Syracuse University
102 Maxwell Hall
Syracuse, NY 13244 (USA)
Jörgens V, Porta M (eds): Unveiling Diabetes - Historical Milestones in Diabetology. Front Diabetes. Basel, Karger, 2020, vol 29, pp 58–72 (DOI: 10.1159/000506559)
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