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Forty or more nutrients are needed to build health. Valuable unrefined foods such as milk might supply all 40 of these nutrients, whereas a highly refined food such as sugar supplies only one. Single nutritional deficiencies, therefore, apparently never occur in humans. A person whose diet is faulty suffers from multiple and overlapping deficiencies simultaneously. The symptoms of a single deficiency resulting when animals are given diets adequate except in one nutrient are far simpler than the symptoms found in people. The discussions of single deficiencies in this chapter and the following ones are therefore unavoidably oversimplified and unrealistic. A single deficiency can, however, predominate over other deficiencies. For example, an undersupply for only a few hours of the amount of sugar furnished your tissues can wreck your day.

You determine how you will feel throughout each day by the type of breakfast you eat. You can produce inefficiency in yourself by eating too little food or too much of the wrong kind of food. Your breakfast establishes how readily your body can produce energy that day or, more specifically, the amount of sugar in your blood. Your energy production, which corresponds to the quality of sugar available, determines how you think, act, and feel. Energy is produced in your body by the burning (oxidizing) of sugar alone or sugar and fat together. Only when the blood plasma contains adequate amounts of sugar can each cell select the quantity it needs. The amount of sugar in the blood is an index of the quantity available to each cell.

Thousands of blood analyses have shown that a normal person who has not eaten for 12 hours has 80 to 120 milligrams of sugar in about ½ cup (100 cc.) of blood. This figure, known as the fasting blood sugar, depends on the kind and amount of food eaten at the previous meal. The average is 90 to 95 milligrams. At this point energy is rather well produced. As the supply of blood sugar is used, energy is produced less readily, and lassitude sets in. When the sugar falls to about 70 milligrams, hunger is experienced, and lassitude gradually becomes fatigue. If the blood sugar drops to about 65 milligrams, a craving for sweets is often noticed and/or “growling” in the intestines. A continued drop in the sugar supply causes fatigue to become exhaustion. Headaches, weakness, and wobbliness often occur; palpitations of the heart may be noticeable; the legs may suddenly give way; nausea and even vomiting are often experienced.

The cells of the nerves and brain can produce their energy only from sugar, never from fat by itself or protein. Even when the amount of sugar available to the cells decreases only slightly, thinking becomes slowed and confused, and nerves become tense. The person whose blood sugar falls below normal becomes progressively more irritable, grouchy, moody, depressed, and uncooperative. Since the brain derives its energy only from sugar, blackouts or fainting may occur if the supply drops dangerously low.

On the other hand, if your food intake is sufficiently adequate to cause your sugar to increase above the fasting level, energy is easily produced; you feel wonderful and full of drive. Your thinking is quick and clear. You have no desire to eat; sweets seem distasteful. Your disposition is at its best, your attitude gracious, cheerful, and cooperative. At this level, life is good.

Many studies have been made of the factors influencing the level of blood sugar. In one such study, for example, 200 volunteers ate various types of breakfasts; each individual’s blood sugar was determined before the meal and hourly for three hours afterward. After black coffee alone, the blood sugar decreased, and the volunteers experienced lassitude, irritability, nervousness, hunger, fatigue, exhaustion, and headaches; the symptoms became progressively worse as the morning wore on. Two doughnuts and coffee with sugar and cream caused a rapid rise in blood sugar, but the

amount fell within an hour to a low level, again resulting in inefficiency and fatigue. A basic breakfast was selected because it was typical of the morning meal eaten by millions of Americans: a glass of orange juice, two strips of bacon, toast, jam, and coffee with cream and sugar. The blood sugar rose rapidly but fell far below the pre-breakfast level within an hour and remained below normal until lunch time. The next breakfast was the same except for the addition of a packaged cereal; again the blood sugar rose, fell quickly, and remained below normal all morning. A fifth breakfast was the basic one plus oatmeal served with sugar and milk; the blood sugar rose rapidly but fell more quickly and to a lower level than after any other breakfast studied. Then 8 ounces of whole milk fortified with 2½ tablespoons of powdered skim milk was drunk with the basic breakfast of orange juice, bacon, toast, jam, and coffee. After this meal the blood sugar rose above normal and stayed at approximately 120 milligrams throughout the morning; unusual well-being was experienced. Two eggs were then served instead of fortified milk; again a high level of efficiency was maintained. The last breakfast was the basic one with eggs or fortified milk and larger amounts of toast and jam; efficiency stayed high once more.

These scientists then studied the effect of the different breakfasts on the well-being of the volunteers throughout the afternoon. Persons who had eaten the different breakfasts were given lunch: a cream cheese sandwich on whole wheat bread and a glass of whole milk. Blood samples were taken at hourly intervals. In all cases the blood sugar increased soon after lunch. Persons who had eaten eggs or fortified milk for breakfast showed a high blood sugar all afternoon. When the breakfast allowed blood sugar to be low during the morning, the increase after lunch rose to the level of cheerfulness and efficiency for only a few minutes; then it fell to a low level which lasted throughout the afternoon. Your selection of food at breakfast, therefore, can prevent or produce fatigue throughout the day.

A similar study was made at Harvard University by Doctor Thorn and co-workers who determined blood sugar levels for six hours after meals high in carbohydrate (sugar and starch) fat, or protein. A high-carbohydrate breakfast consisted of orange juice, bacon, toast, jelly, a packaged cereal and coffee, both with sugar and milk. The blood sugar rose rapidly but fell to an extremely low level, causing fatigue and inefficiency. A packaged cereal eaten only with whipping cream formed the high-fat breakfast, after which the blood sugar increased slightly, then remained at the fasting level throughout the morning. The high-protein meal consisted of skim milk, lean ground beef, and cottage cheese; the blood sugar rose slowly to the high level of 120 milligrams and remained there throughout the entire following six hours. To determine the effect of different types of food on energy production, metabolism tests were taken at frequent intervals. The metabolism, or energy production, increased only slightly after the meals high in fat or carbohydrate. After the high-protein meal, however, the metabolism rose more quickly than did the blood sugar and stayed high throughout the entire six-hour study period.

Studies similar to these have been conducted in many universities. The results have been consistently the same: well-being and the level of efficiency experienced during the hours after meals depend upon the amount of protein eaten; the meals which produced a real zest for living also contained some fat and a certain amount of carbohydrate. It is only when there is a combination of sugar, which is the source of energy, and protein and fat, which slow digestion, that sugar is gradually absorbed into the blood, and energy is maintained at a high level for many hours.

The sources of sugar and starch in our American diet are cheap and overabundant; proteins are expensive and scarce. Typical American breakfasts, therefore, consist of fruit or juice supplying natural sugar, cereals, hotcakes, waffles, coffee cake, toast, or other starch quickly changed into sugar during digestion; usually refined sugar is added to cereal and coffee; jam or jelly may be eaten; quantities of sugar pour rapidly into the blood. In a matter of minutes the blood sugar may increase from 80 to 155 milligrams. Any rapid increase stimulates the healthy pancreas into pouring forth insulin; the insulin, in turn, causes the liver and muscles to withdraw sugar and store it as a form of starch, or glycogen, or change it into fat, thus preventing it from being lost in the urine. As the digestion of a high-carbohydrate meal continues, however, sugar keeps pouring into the blood. In effect, it calls to the pancreas, “Send more insulin! More! More!” The pancreas obeys; it is overstimulated; because of its inefficiency, it sends too much. The tremendous amounts of sugar defeat the purpose for which sugar is needed: to produce energy more efficiently. Too much sugar is withdrawn due to the oversupply of insulin; the result, ironically, is fatigue. The more carbohydrate eaten, the greater the insulin oversupply. For example, in the studies mentioned, the largest amount of sugar was freed during the digestion of the breakfast containing oatmeal.

When three high-carbohydrate meals are eaten daily, the pancreas becomes overefficient, or trigger-happy; too much insulin is produced too quickly. Persons eating such meals often produce actual insulin shock in themselves. This fact is emphasized by a diabetic specialist who observed insulin-shock symptoms among his non-diabetic patients. Since American meals are largely carbohydrate, self-produced insulin shock is probably much more common than is realized. The same symptoms, however, can occur whenever the blood sugar drops far below normal because no food has been eaten and/or because exercise has used up the available sugar.

The cells can store only a little glycogen; any remaining sugar is changed into fat. After digestion is completed, however, the only normal source of sugar is stored glycogen, which is broken down into sugar again; this sugar is soon used up, especially if vigorous exercise is taken. Most of the cells then burn fat alone to supply energy, but fat is not burned efficiently without sugar; it leaves “clinkers” or “ashes” in the form of acetone and two acids, all somewhat harmful to the body. Energy ebbs, and damage is done by the acids. The brain and nerves, however, must have sugar to sustain life; the adrenals send out cortisone, and cells are destroyed so that their protein can be converted in part to sugar. Bad eating habits thus force the nervous system to become a parasite, living off other body tissues. If you allow this destruction to happen often, you will not like the sags and bags you see in your mirror.

On the other hand, if breakfast has supplied a small amount of sugar and fat and moderate protein, digestion takes place slowly; sugar trickles into the blood, giving a sustained pickup hour after hour. Insulin production is not overstimulated. Glycogen storage proceeds normally; no hated fat is formed. Energy urges the body into activity; warmth is produced as needed, or the cooling system functions with equal efficiency when the weather is hot.

Proteins are measured in grams. For example, an egg supplies 6 grams of protein; a quart of whole milk, 32 grams. In the studies mentioned, efficiency for three hours after a meal was produced only when 22 grams or more of protein were obtained. The meal furnishing 55 grams of protein sustained a high level of energy and a high metabolism for six hours afterward. It now appears that the more protein eaten at any meal, the greater is the efficiency and the longer it is maintained. Lunches and dinners must also supply high protein with some fat and carbohydrate if well-being is to be sustained for hours after the meals. Further studies show that blood sugar levels are lower during hot weather, when little protein is eaten, than in winter, when sharp winds whet the appetite.

Another means of maintaining a high blood sugar level, now studied extensively, is to eat between meals. The objections to this procedure are that nutritious foods are frequently unavailable and non-nutritious ones too readily available. Also people often gain too much. The mid-meals found most effective contain protein, fat, and carbohydrate; of mid-meals studied so far, a glass of whole milk with 100 calories of fresh fruit has produced the greatest efficiency.

If we now consider typical American meals with a critical eye, we see innocent stupidity elevated to an art. Breakfast may supply too little sugar to maintain the blood sugar level or so much sugar that insulin is oversupplied. Lunches are usually sketchy; mid-meals, if taken, are usually coffee, soft drinks, or sweets; thus is inefficiency produced until dinner time. Protein is eaten at dinner but, alas, efficiency does not always follow. The accumulation of the day’s fatigue may be too great unless masked by alcohol and/or coffee; so much food may be eaten that drowsiness is induced. The husband may snore in his chair while his wife reflects bitterly that their marriage has gone to pot. If it is a social evening, the time is often passed in desultory, boring conversation. By bedtime, the acetone bodies have been excreted, and the food is largely digested; efficiency is then produced and slept off much as a drunkard sleeps off a binge.

There is nothing new about high-protein breakfasts. For morning meals on our Indiana farm when I was a youngster, we had hot cereal, steaks, ham and/or eggs, huge patties of sausage or fried chicken with country gravy; a large pitcher of milk was regularly on the table. Remember the English novels where buffet breakfasts of fish, meats, eggs, hot cereals, and creamed dishes were described? A friend returning from the Scandinavian countries recently told of having a smörgasbord with thirty kinds of fish, cheese, and meats served at breakfast. Actually, breakfasts need not be large.

You may say your are not hungry in the morning: this remark means, “I overate last night.” Hunger sets in only when the blood sugar drops to about 70 milligrams; 12 hours after a typical American dinner the blood sugar is usually 95 milligrams or even higher. To launch a campaign of efficiency, the best technique is to have a mid-meal in the late afternoon. Dinner should be simple and graciously served: a soup or salad so delicious that everyone wants a second helping, meat or meat substitute, perhaps a low-starch vegetable, milk, buttermilk, or yogurt, and fruit. Appetites can be satisfied and the meal enjoyed without potatoes, gravy, and dessert, provided the afternoon snack is sufficient. Such a meal is easy to prepare, creates less havoc in the kitchen, and allows you eagerness for breakfast the next morning. The objection to small dinners is that husbands have no time to eat a large meal in the morning or at noon. Why eat a large meal at any time? All meals should be simple, filling, and enjoyable. When hungry, one always finds time to eat. I have yet to meet a red-blooded man who did not enjoy a high-protein breakfast.

Many of our national problems can be traced directly to our faulty eating habits. For example, a third of our population is obese; missing breakfast aggravates this problem. Ninety-eight per cent of Americans have tooth decay caused by eating too much sugar; the craving for sweets disappears when the blood sugar is kept high. Lassitude, fatigue, nervousness, irritability, even exhaustion and foggy thinking are widespread indeed. Prevention or remedy are easy; for the essentially healthy person, fatigue can be changed to amazing vitality in a single day. Schoolchildren are difficult to handle and often learn slowly; thus much school-tax money is wasted. Confused thinking in political, public, and private life is all too common. The greater number of automobile accidents occur when the blood sugar is lowest, when thinking is confused and reactions are slow. Our excessive use of coffee, cigarettes, and alcohol is related to our level of blood sugar; they stimulate the production of adrenal hormones which cause the blood sugar to be increased, thereby producing the needed “lift”, but insulin is quickly secreted, causing the sugar level to fall again. Irritability resulting from low blood sugar can be a factor in divorces. It now appears that virus infections are usually contracted when the blood sugar is particularly low. Summer heat decreases the appetite for proteins and increases the craving for sugar-filled iced drinks and ice cream; exercise, such as swimming, uses up the sugar available; hot-weather fatigue and crankiness follow.

Blackouts or near-blackouts resulting from low blood sugar are not unusual. For example, I was consulted by a woman who blacked out almost every time she went shopping; on each “dollar day” she came in to the nurse’s office of some department store. Her meals customarily were largely carbohydrate. She hated breakfast; when she became hungry, she bought a pound or more of candy and ate it on the spot; approximately an hour later she blacked out. Another example was a student too psychologically upset to eat; for a short period she blacked out many times daily and had to drop college. She had had so many accidents and near-accidents that only her friends were driving her new Buick convertible. Still another was a motorman on a streamliner who had blacked out on the job and had become so frightened that he had taken sick leave; he had been eating huge meals almost entirely of carbohydrate. Persons who have blacked out usually know when to expect a recurrence by the pounding of their hearts; several tell me that at such times they have parked their cars only in the nick of time. My advice is that if you value your car and/or your life, you should not drive when your blood sugar is low. Low-blood-sugar driving is almost as dangerous as drunken driving.

Weakness or faintness, legs giving away and/or a blackout, together with a pounding heart, cause many people to believe they are having heart attacks. Within the last few months, four men have consulted me because of “heart conditions”; three had “heart attacks” in the evening. One had been hunting all day, a packed lunch forgetfully left behind. A second owned a garage, had gone to work without breakfast, and had been too busy to stop for lunch. A third was vacationing in the mountains; he had taken a walk before breakfast, decided to climb a mountain, and had exercised all day without eating. The fourth was following a strict reducing diet; his “heart attacks” usually occurred between 3 and 7 A.M. Physicians could find nothing wrong with these men’s hearts, but each man was still severely frightened when I first saw him; each was taking as good care of himself as if he were a premature baby; and the life of each family revolved around “Father’s heart condition.” Certainly a person experiencing such symptoms should see his physician immediately; if the physician can find nothing wrong with the heart, however, a blood sugar analysis should be requested.

As long as the adrenal glands are healthy, low blood sugar can be immediately corrected merely by avoiding coffee and by eating small but frequent high-protein meals free from refined foods. If the B vitamin pantothenic acid is undersupplied or if the adrenals are exhausted from prolonged stress, these glands cannot produce the hormones necessary to convert body starch (glycogen) into sugar; hence the blood sugar remains low until adequate nutrition restores adrenal function. Furthermore, too little potassium in the cells prevents glycogen from being formed, thus causing the blood sugar to remain chronically low.

When the blood sugar is extremely low, the resulting irritability, nervous tension and mental depression are such that a person can easily go berserk. If hatred, bitterness, and resentments are harbored, and perhaps a temporary psychological upset causes a person to go on a candy binge or makes it impossible for him to eat or digest food, the stage is set; violence or quarreling can occur for which there may be no forgiving. Add a few guns, gas jets, or razor blades, and you have the stuff murders and suicides are made of. The American diet has become dangerous in many more ways than one.

Maximum well-being and efficiency can and should be produced for every hour we are awake. Your meals can be planned to give efficiency when you need it most. For example, if you are on a swing shift, your meal highest in protein should be eaten before you go to work. The general rule, however, is to eat breakfast like a king, lunch like a prince, and dinner like a pauper.