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Total Dietary Regulation in the Treatment of Diabetes

Aretaeus of Cappadocia (30–90 A.D.) is the second to describe diabetes and uses 'to run through' or 'a siphon' to explain how one urinates unceasingly until death.

Aretaeus of Cappadocia (30–90 A.D.), living under the emperor Nero, and writing in Ionian Greek, was the second to describe dia betes, and the first known to have called it by the name (6taffaively, to run through; Śwaffhrms, a siphon). In a passage translated by Schnée", Aretaeus outlines some of the principal symptoms, the progressive course, and the fatal prognosis. He anticipates modern conceptions of a failure of assimilation, conversion of tissue into urinary products, and possible origin of some cases in acute infections. He was retro grade in treatment, for he advised a non-irritating diet of milk and carbohydrates, and hiera, nardum, mastix, and theriak (opium?sugar?) as drugs. He is commonly credited with being the first to regard diabetes as a disease of the stomach; but his vague notion of a dis order akin to ascites hardly entitles him to a claim upon this false idea which was productive of so much truth in the period from Rollo to Cantani.


“Diabetes is a strange disease, which fortunately is not very frequent. It con sists in the flesh and bones running together into urine. It is like dropsy in that the the cause of both is moisture and coldness, but in diabetes the moisture escapes through the kidneys and bladder. The patients urinate unceasingly; the urine keeps running like a rivulet. The illness develops very slowly. Its final outcome is death. The emaciation increases very rapidly, so that the existence of the patients is a sad and painful one. The patients are tortured by an unquenchable thirst; they never cease drinking and urinating, and the quantity of the urine ex ceeds that of the liquid imbibed. Neither is there any use in trying to prevent the patient from urinating and from drinking; for if he abstains only a short time from drinking his mouth becomes parched, and he feels as if a consuming fire were raging in his bowels. The patient is tortured in a terrible manner by thirst. If he re tains the urine, the hips, loins, and testicles begin to swell; the swelling subsides as soon as he passes the urine. When the illness begins, the mouth begins to be parched, and the saliva is white and frothy. A sensation of heat and cold extends down into the bladder as the illness progresses; and as it progresses still more there is a consuming heat in the bowels. The integuments of the abdomen become wrinkled, and the whole body wastes away. The secretion of the urine becomes more copious, and the thirst increases more and more. The disease was called diabetes, as though it were a siphon, because it converts the human body into a pipe for the transflux of liquid humors. Now, since the patient goes on drinking and urinating, while only the smallest portion of what he drinks is assimilated by the body, life naturally cannot be preserved very long, for a portion of the flesh also is excreted through the urine. The cause of the disease may be that some malignity has been left in the system by some acute malady, which afterward is developed into this disease. It is possible also that it is caused by a poison con tained in the kidneys or bladder, or by the bite of the thirst-adder or dipsas.”



"Aretaeus’ writings were unknown in Europe until 1552. His aim in treating what was clearly type 1 diabetes was to overcome the  diabetes: the biography 12 intense thirst, and to this end he began with a purge and followed it with a variety of mixtures to soothe the stomach."

Diabetes: The Biography

Total Dietary Regulation in the Treatment of Diabetes

A Roman named Aulus Cornelius Celsus describes diabetes 2000 years ago.

Hippocrates (460-377 B.C.) made no mention of any condition clearly recognizable as diabetes. A notion concerning the quantity of urine, in a passage translated by Richardson from the third book of the Epidemics,” is like that of Celsus, but the first known recognition of diabetes occurred at about the height of the Roman power. 


Aulus Cornelius Celsus (30 B.C.–50 A.D.) wrote as follows: 


“When urine, even in excess of the drink, and flowing forth without pain, causes emaciation and danger, if it is thin, exercise and massage are indicated, especially in the sun or before a fire; the bath should be infrequent, nor should one linger long in it; the food should be con stipating, the wine sour and unmixed, in summer cold, in winter luke warm; but everything in smallest possible quantity. The bowels also should be moved by enema, or purged with milk. If the urine is thick, both exercise and massage should be more vigorous; one should stay longer in the bath; the food should be light, the wine likewise. In each disease, all things should be avoided that are accustomed to increase urine.” 


In this compressed passage, Celsus gives the first description of diabetes, introduces an error (fluid output greater than intake) destined to endure eighteen centuries, and touches some modern treat ment. It is not known to what extent this knowledge was original with Celsus or handed down by predecessors. At any rate, the recog nition of the disease was so new that it had not yet received a name. 

https://play.google.com/books/reader?id=NExNAQAAMAAJ&hl=en&pg=GBS.PA3


Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) was a Roman encyclopaedist, known for his extant medical work, De Medicina, which is believed to be the only surviving section of a much larger encyclopedia. The De Medicina is a primary source on diet, pharmacy, surgery and related fields, and it is one of the best sources concerning medical knowledge in the Roman world. The lost portions of his encyclopedia likely included volumes on agriculture, law, rhetoric, and military arts. He made contributions to the classification of human skin disorders in dermatology, such as Myrmecia, and his name is often occurring in medical terms about the skin, e.g., kerion celsi and area celsi.

https://en.wikipedia.org/wiki/Aulus_Cornelius_Celsus

Total Dietary Regulation

Claudius Galenus makes errors in explaining diabetes which retards progress in knowledge for 1500 years.

Claudius Galenus (born 131 A.D.) saw two patients and introduced two ideas: first, that diabetes is a weakness of the kidneys, which can not hold back water and also are thirsty for fluid; second, that the urine consists of the unchanged drink. Galen's great authority maintained these errors for about 1500 years, and retarded progress in the knowl edge of diabetes.

A Comparison of Ancient Greek and Roman Sports Diets with Modern Day Practices

Greeks and Romans depended on a grain-based diet but would suffer from eye disorders, stinking disease, and distended bellies indicating vitamin deficiency.

Greeks and Romans consumed a diet which was mainly based on cereal (carbohydrate), olive oil (lipid/fat) and wine [22]. Milk, which could not be kept in a warm climate, was made into cheese, forming a major source of their protein intake [23]. Such a diet would have provided for the fibre and carbohydrate needs, but seems to be somewhat lacking in protein and perhaps also in vitamins. Indeed, reports of medical ailments from the time often refer to eye disorders, “stinking disease” and distended bellies, suggesting that vitamin deficiency, symptomatic of modern day problems in areas of the world that depend heavily on grain as a staple part of their diet, may have been prevalent [24].

Total Dietary Regulation in the Treatment of Diabetes

Tchang Tchong-king, the greatest of Chinese physicians, describes diabetes in the year 200.

Chronological order here shifts the narrative to the Far East. According to Iwai, the first oriental description of diabetes was given in the year 200 by Tchang Tchong-king, perhaps the greatest of Chinese physicians. “There is a disease called ‘the disease of thirst,’ in which polyuria is the characteristic symptom. One may drink as much as ten liters per day, which is recovered in the urine.”

A Comparison of Ancient Greek and Roman Sports Diets with Modern Day Practices

Galen says on usage of broad beans as food: "Our gladiators eat a great deal of this food every day, making the condition of their body fleshy – not compact, dense flesh like pork, but flesh that is somehow more flabby."

In terms of diets, we also know that specific types of athletes were fed in ways that matched their needs and improved their performance. One such form of sport was the ancient gladiator, and here we learn from Galen, that beans were highly recommended in order to build bulk into such athletes. Galen even goes so far as to state that the bean should be boiled long enough in order to avoid flatulence [28].

On broad beans: “There is also much use made of these, since soups are prepared from them, the fluid one in pots and the thick one in pans. Our gladiators eat a great deal of this food every day, making the condition of their body fleshy – not compact, dense flesh like pork, but flesh that is somehow more flabby. The food is flatulent, even if it has been cooked for a very long time, and however it has been prepared, while ptisane gets rid of all flatulent effect during the period of cooking.”

Galen is unimpressed with vegetables calling them "all unwholesome" and of "little nutriment to the body."

Whilst Celsus [19] provides us with a clear rank order for their nutritive value, Galen [22] seems unimpressed with vegetables as a whole, stating that they give “little nutriment to the body” and that they are “all unwholesome ”.

“Of vegetables the turnip and navew and all bulbs, among which I include the onion also and garlic, are stronger than the parsnip, or that which is specially called a root. Also cabbage and beet and leek are stronger than lettuce or gourd or asparagus” [19].

“Not only do we eat the seeds and fruits of plants, but also the plants themselves, often whole, but often only the roots, branches or young shoots, according as there is a pressing need for each. It is clear that, as well as giving little nutriment to the body, these are all unwholesome except, as I said, the spiny plants that have just emerged from the ground”[28].

A Comparison of Ancient Greek and Roman Sports Diets with Modern Day Practices

Celsus preferred beef while Galen preferred pork in terms of providing the best nutrition.

 In the early days, athletes relied on their trainer to make sure that their dietary needs were met. However, it was not long before medical doctors took over, and the first sports physicians were created. In a report from Philostratos we learn [23].

“...The Sicilian style of fancy food gained popularity; the guts went out of athletics and, more important, trainers became too easy on their pupils. Doctors took the lead in introducing permissiveness, setting it up as an adjunct to their treatment...from these Doctors athletes learned to be lazy and to exercise after sitting around stuffed with enough food to fill an Egyptian or African meal sack; they gave us chefs and cooks to please our palates. They turned athletes into gluttons with bottomless stomachs.”


However, whilst it was popular or fashionable to have a physician designing your diet, it seems that these medical doctors did not always share the same opinion about what the athletes should eat. Celsus, who was not trained as a medical practitioner, although he wrote a great deal about medical practices, and Galen, who was medically trained, did not agree on the type of meat that was the “strongest”, that is to say the most nutritious, for an athlete. Celsus preferred beef whilst Galen, who was particularly enthusiastic about the advice given, considering him to be an expert on diet and exercise [25], gave the Olympic gold, so to speak, to pork, which he felt was the most nutritious form of meat. Maybe this was based on his own positive experience with pork when he was a medical practitioner in Pergamon where he took part in the training of gladiators.


Ancient athletes would most likely not have been able to afford very much protein in the form of meat, and would as a consequence not have eaten meat on a daily basis. However, we know from Celsus [19] and Galen [22] that meat in the form of terrestrial and aquatic livestock was considered nutritious, and was classified among the “strong” foodstuffs. Celsus and Galen [19,22] could not, however, agree as to which meat was the “strongest”, Celsus [19] favoured beef, whilst Galen [22] never misses a chance to sing the praises of pork, which alongside fresh milk was his favourite food.

“Among food from domesticated quadrupeds pork is the weakest, beef the strongest. And so also of game, the larger the animal the stronger the food yields” [19]

“Flesh, when well concocted, produces the best blood, especially in the case of animals such as the pig family, which produce healthy humour. Pork is the most nutritious of all foods, and athletes provide a very visible test of this. For when, after identical exercises, they take the same amount of a different food on one day, straightway on the following day they appear not only weaker but also obviously less well fed.”

“Beef itself gives a nutriment that is neither small in quantity nor easily dispersed; yet it produces blood that is inappropriately thick” [28].

“Lambs also have flesh that is very moist and productive of mucus. But that of adult sheep is more productive of residues and more unwholesome. The flesh of goats is unwholesome too, with bitterness” [28].

Poultry was also considered a nutritious foodstuff, although here size mattered. Celsus [19] ascribed poultry to the “medium” class of foodstuffs, whilst Galen was not so generous in his appraisal, preferring once again to extol the virtues of pigs and terming poultry meat as “poorly nutritious”.

“Likewise of those birds, which belong to the middle class, those which rely more on their feet are stronger food than those which rely more on their wings; and of those birds which depend on flight, the larger birds yield stronger food than the smaller, such as fig-eater and thrush. And those also which pass their time in the water yield a weaker food than those which have no knowledge of swimming” [19].

“The family of all winged animals is poorly nutritious when compared with that of terrestrial animals, especially pigs: you would find no flesh more nutritious than theirs” [28].

Fish too were classified as a “middle” foodstuff by Celsus [19], although here preference was given to the oily fish such as mackerel in comparison with bass and mullet. This is in accordance to general recommendations today concerning intake of oily fish like salmon and tuna, although the reason given here is to prevent heart diseases. Galen goes one step further in his assessment of fish, telling us that they are not appropriate for athletes but should rather be reserved for those who are weak and ill.

“The fish most in use belong to the middle class; the strongest are, however, those from which salted preparations can be made, such as the mackerel; next come those which, although more tender, are nevertheless firm, such as the gilthead, gurnard, sea bream, eye fish, then the flat fish, and after these still softer, the bass and mullets, and after these all rock fish” [19].

“But from all the above fish the nutriment is best for those who are not in training, and the idle, frail and convalescent. People in training need more nutritious food, about which there has been previous comment” [28].

“...the best milk is just about the most wholesome of any of the foods we consume”[28].

“For cows´ milk is very thick and fatty, while milk from the camel is very liquid and much less fatty; and next to the latter animal is that from mares, and following this, ass´s milk. Goat´s milk is well proportioned in its composition, but ewe´s milk is thicker” [28].

“Its continued use also harms the teeth, together with the flesh surrounding them, which they call “gums”. For it makes these flabby, and makes the teeth liable to decay and easily eaten away. Accordingly one should rinse the mouth with diluted wine after consuming milk, and it is better if you put honey with it” [28].

“Moreover it is neither unwholesome nor very markedly productive of thick humour, a common charge against all cheeses. A very fine cheese is the one highly regarded by the wealthy in Rome (its name is bathysikos), as well as some others in other regions” [28].

“Among pulses, beans and lentils are stronger food than peas” [19].

“However, they [Figs] do not produce firm, strong flesh like bread and pork do, but a spongy flesh, as the broad bean does” [28].

Claudius AElianus His Various History

Ancient Spartans would only eat flesh, and their black broth was made of animal blood.

Claudius Aelianus, a Roman author and teacher of rhetoric who lived between c. 175 – c. 235 AD, wrote in his "Various History":


"The cooks at Lacedemon might not dress anything but flesh. He who was skilled in any other kind of cookery was cast out of Sparta. Son of Polybiades, for being grown too fat and heavy through luxury and idleness, they took out of the public Assembly, and threatened to punish him by banishment, unless he altered that blamable and rather Ionic than Laconic course of life: For his shape and habit of body was a shame to Lacedemon and our Laws". - Source


"The dish that was in the highest esteem among the Spartans was called melas zomos, or "black broth" a name which has long excited the curiosity of the learned. What were the precise ingredients of this mess has never been determined with certainty. We remember an old traveler, who, on observing the use of coffee for the first time in the East, conjectured that it was the black broth of the Lacedaemonians! Julius Pollux the preceptor of the Emperor Commodus in his "Onomasticon" says that this famous mess consisted of blood thickened in some particular way. Dr. Lister in his "Notes to Apicius" supposes it was hog's blood; and if so the dish must have had no remote resemblance to the black puddings of our own times. Whatever it was, it could have formed no very alluring dish. We are informed that a citizen of Sybaris having tasted their fare, declared that it was no longer astonishing to him that the Spartans should be so fearless of death in battle, since any one in his senses would much sooner die a thousand deaths than continue to exist on such miserable food. Plutarch relates that a king of Pontus having heard of this celebrated broth purchased a Lacedaemonian cook to make some of it for him. But when he came to taste it he expressed his detestation of the mess in very strong terms on which the cook observed, "Sir, to acquire a relish for this broth it is necessary first to bathe in the Eurotas;" meaning that the hardy habits of the Spartans gave a zest to this fare which it could not otherwise possess. The same writer informs us that the old men were so fond of it that they ranged themselves on one side to eat it leaving the meat to the young people". - Source


Nowadays, it is believed that melas zomos was made of boiled pigs' legs, blood, salt and vinegar. It is thought that the vinegar was used as an emulsifier to keep the blood from clotting during the cooking process.

A Chinese medical work of about the year 600 classifies four supposed groups of cases of diabetes.

A Chinese medical work of about the year 600 classifies four supposed groups of cases, and notes the symptoms of polyphagia, polydipsia, and polyuria. Still a later work mentions furunculosis.

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