A Short History of Nutrition.

This is not a comprehensive account (and is very western - UK - focussed) but does identify some key concepts and personalities.

It only constitutes notes – almost every statement seems some qualifying, ‘ifs’ or ‘buts’ or ‘maybes’. There are some excellent biographies on many of the people mentioned on web sites.

 

1. Prehistory.

a) An evolutionary perspective.

Are Homo sapiens ‘naturally’ vegetarians or meat eaters or omnivores.

Consensus suggests that Homo sapiens evolved as hunter-gatherers. The structure of the gut too confirms the ability to deal with an omnivorous diet and our nearest relatives, chimpanzees, are omnivorous and occasionally hunt and kill small ‘game’.

 

Whether eating meat enabled the human brain to develop is more debateable.

 

Agriculture was invented about 10,000 years ago probably in more than one location world wide.

Pre-farming therefore there would be no (or very little): wheat (bread / pasta), rice, sugar, milk, cheese butter etc in the human diet.

 

Some foods are very recent additions (in UK): potato sugar, tea, coffee, tomato, cauliflower citrus fruits, all manufactured foods (bottled, canned, frozen ....), and 'additives'. To what extent our bodies can cope with such ‘unfamiliar’ items is debateable.

 

Certainly early diets must have been primarily plant based with meat a rare luxury?

 

 

b) Food in pre-history (largely after Tremoliere)

Food was sacred – hence eating a sacred act.

Food is magical – cooking was a magico-religous activity, every gesture, act and dish perhaps, endowed with ritual significance (watch what happens in restaurants: maybe it still is!). Wrangham claims that it is cooking that made us human (See "Catching Fire").

 

Purity was considered paramount (and still is!).

Eating (and hunter-gatherer lifestyle) developed community (and still does).

Eating only allowed after doing penance (work) – only work gave right to eat. Work, especially in the physical sense, is now divorced from eating.

 

Food was recognised to give strength and to safeguard health and salvation.

Eating should help prevent and eliminate evil; Egyptians thought food source all evil (?illness).

Balance of opposites made a healthy diet (person):

            Wet – dry

            Hot – cold

            And, perhaps, still does:    sweet – savoury,    fat – carbohydrate

 

Anaxagoras (500 – 450BC):

Reasoned that food became the human body and hence must contain ‘generative components’ – termed by him ‘homeomerics’ (deducing the presence of nutrients).

 

 

 

2.         The Ancients

Egyptian Papyri 1500 – 2000BC

Many dietary recommendations for treatment of disease eg cure night blindness – liver of Ox roasted and crushed. Accurate descriptions of diabetes.

Mixture – religion / magic and empirical observation.

 

Old Testament: first clinical trial diet:

Daniel  1 : 1-15, The Bible revised standard version (1952).

 Nebuchadnezzar commanded his chief eunuch (Ashpenaz) to bring some of the people of Israel to serve in his palace. These were to be people of royal and noble birth, 'youths without blemish, handsome and skilful in all wisdom, endowed with knowledge, understanding learning' and competent to teach.

 The king assigned them a portion of his own rich food and wine.

Daniel resolved that he would not eat the kings food but the chief eunuch was afraid in case they grew thinner and in poorer condition than other youths of their age and he would lose his head (as well). 

 Daniel asked for a test for ten days. He and his companions to be given vegetables to eat and water to drink and their appearances to be compared to youths who eat the kings food. This was done and at the end of ten days Daniel's group were '...better in appearance and fatter in flesh than all the youths who ate the kings rich food and wine'. The steward took away the kings food and wine and gave Daniel and co vegetables and water instead.

 

What’s wrong with this as a scientific experiment?  Controls / blind – interest in outcome?

 

Leviticus – dietary laws of Jews. To what extent were these expressions of sound hygiene measures?

 

Greek

Hippocrates Bo 460BC Island Cos

Focussed on the patient and the importance of direct observation (not astrology or authority etc!).

Accepted disease as a natural process (not a punishment etc) hence its progress could be predicted and altered.

Three elements of treatment:            Dr Physic, Dr Surgery & Dr Diet.

Many aphorisms – some still sound advice:

‘Old people endure fasting most easily, then adults but young persons (esp infants)  not so well’ – reflects energy requirements!.

‘A slender and restricted diet is always dangerous’ = modern notion variety / balanced diet!

‘Persons who are naturally very fat are apt to die earlier than those who are slender’ – Obesity!

 

The influence of ‘Greek’ medicine spread though the middle to far east and is still practised as Unani medicine in India.

 

3. The Middle Ages / Renaissance:

The School of Salerno Regimen Sanitatis Salernitatum (1484) recognised importance diet;

 

‘Good dyet is a perfect way of curing:

And worthy much regard and health assuring.

A king cannot rule him his dyet,

Will hardly rule his realme in peace and quiet.

….

Doctors should thus their patients food revise –

What is it? When the meal? And what its size?

How often? Where? Lest by some sad mistake,

Ill-sorted things should meet and trouble make.

….

A stated diet, as is well known,

Of physic is the strongest cornerstone -’

 

Sanctorius (1561 – 1636) Padua, apparently spent most of his life weighing himself (and all he ate and drank and all excretions)! Noted that he lost weight which could not be accounted for (‘insensible perspiration’): Measurement as the basis of observation.

 

Summary:            a ready understanding of the importance of ‘diet’ both in treating disease and in promoting health and a knowledge of importance of physical signs of a variety of nutritional problems: obesity, weight loss etc

 

 

3.         Post-renaissance C17 – C19

Rise of Science: experimentation, measurement / analysis, alchemy becoming chemistry, physiology forming the scientific basis for medicine

 

Sydenham (1670s) showed that adding iron fillings to wine could improve anaemic (cholrotic) patients – not recognised that iron was ‘essential’.

 

Lavoisier (1743-1794) & wife (lost heads in French revolution);            Life powered by oxidation – which could be measured. Food + Oxygen => Heat + Water. Lavoisier can be considered to have laid the foundation of the modern science of nutrition.

 

Lind – scurvy could kill one third crews on long voyages (beginning to last years). 1747 clinical trial: – 12 patients with scurvy – gave: 2 quart cyder each day, 2 – elixir vitriol, 2 – vinegar, 2- sea water, 2 – 2 oranges &  1 lemon, 2 an ‘electuary’ made by the hospital surgeon. Only those fed citrus fruits recovered – fit for duty in 6 days. Possible the first true ‘clinical trial’.

 

William Stark (1740-1770) experimented with diet (on himself and died) – gradually restricted his diet more and more to find what was minimum range foods could exist on – bread & water (31days – After 16 days gums began to bleed), adding: olive oil, milk, roast goose, boiled beef, fat, figs, veal – died!  What of???

 

Magendie (1816) noted that dogs fed only carbohydrate (CHO) and fat lost body protein and died in a few weeks but dogs fed protein as well survived – showing protein in the diet was essential..

 

Liebig   (1803-1873) – a chemist:    Showed

• sodium to be the major cation in blood and K the major cation of tissues.
• nitrogen ends up in urine as urea and uric acid, and the amount of nitrogen in urine is proportional to the amount of organ tissue destroyed.
• oxidation explains constant temperature of body.
• Calculated energy values of foods (accurate for fat and CHO).
• Associated protein with ability to ‘work’.
• Thought adequate diet was made of Protein, fat, CHO and a few minerals – this view dominated C19

 

However:   Pereira (1847) noted that diets restricted to a small number of foods led to development of diseases such as scurvy and,

Dumas, in siege Paris (1870-71) noticed children fed diets thought to be adequate (protein , fat and CHO) still deteriorated.

 

Malthus (1830) Essay: ‘A summary view of the principle of population’. A warning that population could out-strip food supply. A piece of the evolutionary jigsaw (only the best adapted would survive).

 

John Dalton (1831) Conducted a ‘series of experiments on the quantity of food taken by a person in health’.

 

The Nineteenth Century:

Development of: Social conscience, Philanthropy and Government responsibility for health – 1848 Public Health Act.

 

• Alexis Soyer’s  (1860) ‘Shilling cookery for the people’ – set up mobile kitchens to feed poor, including soldiers in the Crimean war.
• Florence Nightingale, worked at Scutari, to improve conditions and recognised the importnace of good food to recovery.
• Fanny Calder (1875) wealthy Liverpool ‘lady’ – recognised that ‘decent food, properly prepared’ was vital for health – set up cookery classes in poorest parts Liverpool. Was a lack of knowledge or lack of money the main reason why people starved? A debate still going on!
• Isabella Beeton (1859-61) ‘Book of Household Management’ ‘there is no more fruitful source of family discontent than a housewife’s badly-cooked dinners and untidy ways.’ Cook books still make celebrities!

 

Pavlov (1902) mechanical stimulation not essential to trigger digestion; conditioned reflexes.

 

 

Summary:            a developing understanding of the properties of matter and that the human body was a ‘natural’ organism which displayed these same properties.

People can be geniuses but still get it wrong! Knowledge has to be continually reviewed, questioned and refined.

Key concepts: value ‘experiments’, ‘balance’ – what goes in comes out. Critical thinking – challenge authority views. The poor need food skills.

 

 

4.         Late nineteenth and early twentieth centuries:

Vitamins:

• Takai (early 1880s) observed that Japanese sailors, but not British, developed Beri beri – adding milk and meat to Japanese diets prevented BB but NOT due to protein. ie BB a disease caused by a deficiency of something in the diet.  Eiijkman (1890s) noticed that chickens fed polished rice developed symptoms like BB but not chickens fed whole rice.  Showed this protective substance could be extracted with water but could get no further.

•  Gowland Hopkins (1912) Identified ‘Accessory food factors’, ie more to a healthy diet than energy, protein and minerals. Organic materials which the body could not synthesise were essential to health.

• Casimir Funk (1884-1967)  – postulated the presence of vitamins B1, B2, C and D and coined term ‘vitamine’ from vital amines (vitamins were thought to all be amines).

• Osborne & Mendel (1913) observed that fed purified diets to rats and showed growth failed, but by substituting milk fat for lard growth occurred.

• McCollum & Davis: Fat soluble A (1913) and Water soluble B (1915) – ie growth was supported by a fat extract and by a water extract of adequate diets.

• Mellanby (1919) rickets deficiency of a vitamin

• Hungarian: Szebt-Gyorgyi (1935) isolated vitamin C

 

Summary:            Key concept developing of ‘essentiality’. A range of organic chemicals which could be extracted, characterised and synthesised were necessary for normal function (growth).

The notion of ‘deficiency’ in essential dietary components dominated nutritional thought in the C20. Only gradually has the notion of the dangers of excess taken hold to be replaced by ‘optimum’. Notion of a balanced diet has had a chequered history – in & out fashion: In 1940s, out 1983, in ‘Balance of Good Health’ 1990s.

 

4.         C19 – C20     Energy & Protein

Claude Bernard (1813-1878): body fat could be synthesised from CHO and protein, blood glucose could be stored as glycogen.

 

Carl von Voit (1831-1908): first applied physics to nutrition – measured energy expenditure different species & Rubner (1854-1932) in Germany: chemical analysis food & digestion / absorption nutrients.

Atwater – Benedict (1903) invented a respiration chamber to perform direct & indirect calorimetry. Performed incredibly accurate balance studies still use results today: ‘metabolisable energy’.

Benedict (1909) showed doing examinations did not burn off appreciable amounts extra energy.

 Du Bois (1936) calculates BMR in health and disease.

Comprehensive measurements of energy cost different activities and ‘Basal Metabolic rate’ (as early as 1865 Playfair had estimated energy requirements eg: Soldier – light work – 3029 kcals). Noted links between intake and work performance (and school performance).

 

Wilcock & Hopkins (1906) showed a supplement of the amino acid tryptophan was necessary for survival mice fed on a diet low in Tryptophan.

Osborne  & Mendel (1909-1913) showed proteins not equally ‘nutritious’: rats needed supplies of the amino acids lysine and histidine.

Turn C20 fixation importance protein ‘protein optimum’: Liebig 150g Voit 120g.

 

Seebhom Rowntree’s studies of poverty in York: ‘Poverty a Study of Town Life’ (1901, 1941, 1951) revealed monotonous and inadequate diets. Showed that money was key factor in deciding what was eaten.

 

Committee on Physical Deterioration (1904) set up due to concern about numbers of volunteers for the armed forces rejected (for Crimean war) often due to nutrition related ill-health. The report was very wide ranging and recommended amongst other things, mother-baby clinics, school meals (can’t teach hungry children). This all sounds rather modern (including concern about selling cigarettes to children)!

 

Summary:            Nutrition becoming an organised science taking its methods from a variety of disciplines – becoming quantitative – moving beyond describing which nutrients needed to address how much of each?

 

 

5.         Post-WW1.

Hindhede: 1920 – shown can live in full vigour for a year on potatoes and fat. Claimed to be able to live on 3d per day (that’s about 1.5p!)

 

Banting & Best (1922) – discovery / extraction insulin. NB role Paulescu, Collip and others – are those who get the credit really the only ones who deserve it (Fleming / Watson- Crick)? A debate on-going in the very latest Nobel prizes (Oct 2003).

 

Davies (1926) – conducted experiments which claimed to show that if infants allowed to select own diet choose a well balanced variety of foods.

 

Clive McCay (1937) shows restricting intake energy of rats (33%) led to greater longevity (25%) especially if CHO restricted (simple CHO). Still perhaps the only dietary means of enhancing lonegvity.

 

John Boyd Orr (1880-1971) (Set up Rowett Research Institute 1930s) – member of Churchill’s Scientific Committee on Food Policy - scientific basis rationing – based on estimates of need (eg pregnant women got more allowance of ‘protective foods’).

            Published: Food, Health and Income (1936) which revealed the appalling diets of the poor.

 

Le Gross Clark & Titmus (1939) ‘Our Food Problem and its relation to our national defences’. Food security seen to be crucial in time war. The aftermath of this continued until the 1980s – food as a security issue 9recently re-emerging - 2010). MAFF dismantled partly because this no longer thought to be the case. Might we pay a terrible price for neglecting this principle - becoming increasingly dependent upon imports of food and hence world markets? How can it be cost-effective to bring carrots from Egypt!

 

Experiments:

• Sheffield experiment on conscientious objectors: to establish requirements: 1942 water, 1942-44 vitamin A, 1944-46 vitamin C. Conducted by Krebs and Mellanby.
• Minnesota experiment: Ancel Keys (1904- ). The biology of Human Starvation (1950). Conscientious objectors endured a diet of 1500kcals per day and the effects documented. His (other) work led to recognition of the importance of the so-called the Mediterranean diet.
• MRC Trial sugar & caries (1949-1951) – fed large amounts of sugar to orphans – luckily, as it was fed at meal times, it had little effect.

 

Quantitative dietary recommendations begin to appear: Cathcart & Murray (1931); League of Nations (1935), some of the earliest.

 

GE Friend (1935) – the school boys study public vs state school children huge differences in height / growth noted attributed to diet.

 

1930s: Social nutrition: - inequalities

            What is the minimum amount food to keep families alive? Still debateable whether this is an adequate / moral basis for advice and policy.

 

            Dietetics as a profession differentiates from nursing.

 

Beginnings of nutritional epidemiology – dietary surveys / nutritional status.

Dietary surveys begin to focus on wide range nutrients and are larger scale eg Widdowson & McCance (1933) Glasgow  - energy from: fat 24%, Protein 12.1% CHO 65.4%. What is it now?

 

Influence psychology noted: Widdowson’s orphanage study (1946-9): Wuppertal – Love is more important than nutrients (man cannot live by bread alone)!.

 

McCance (1906-1993) & Widdowson (1906-2000): (partnership: 1933 – 1993):

Giants in the world of nutrition in the UK – we will not see their like again either in the scope of what they did or in their professional longevity.

            Composition Foods

            Dietary intake: adults & children

            Energy expenditure of cadets

            Composition Human body (and differences between species)

            Growth

            Experimental under-nutrition in rats and pigs

            Treatment of malnourished children – catch-up growth, effect caring vs rationing

            An experimental study of rationing

            Absorption Calcium and the extraction rate flour

            Post-war loaf

            Experimental sodium deficiency

            Absorption & excretion iron & trace elements: copper and zinc in babies

            Infant feeding – comparison fatty acids in breast vs formula milks

            Diet (fatty acid composition) during pregnancy – pigs

            Effect of colostrums on gut development

 

Advice for a young scientist from Elsie Widdowson:
"If your results don't make physiological sense, think and think again! You may have made a mistake (in which case own up to it) or you may have made a discovery. Above all, treasure your exceptions. You will learn more from them than all the rest of your data."

 

1940s:            rationing, minimum requirements – for work, pregnancy, growth etc

            vitamins, delivery of advice – health education

            Post-war chaos – threat mass starvation – throughout Europe.

 

1944:            First volume of the Proceedings of the Nutrition Society published.

 

1950s:            University departments of nutrition beginning to appear – previously Domestic Science or Physiology or Chemistry.

 

1960s:  Ancel Keys – 7 countries study: relating fat (especially saturated) & CHD.

            Increasing focus on biochemistry of nutrition:

                        Perutz (1914-2002)  – structure Hb – Nobel Prize 1962.

                        Sanger (1959) structure insulin.

 

Fabry (1969) Feeding pattern and nutritional adaptations – much neglected now but raises very relevant questions: how often should we eat (5+ per day)? Fabry talked about ‘slow calories’ which appears to pre-empt glycaemic index by some 20 years!

 

‘Dieting’ follows trends in fashion .            John Yudkin (1959) This Slimming Business – looks rather like the Atkins diet!

 

The age of protest (CND, Vietnam war) – student riots.

Global issues begin to influence – population, pollution, famine – so-called ‘Green Revolution’ –  science & technology will save the world.

 

• Rachel Carson (1907-1964) Silent Spring (1962) – draws attention to the damage being done to the environment, by pollution and farming practices.
• Pirie (1969) Food Resources Conventional and Novel.
• Paul Ehrlich (1968) The Population Bomb. (with Friends of the Earth).
• Arthur Hopcroft (1968) Born to Hunger (sponsored by Freedom from Hunger Campaign).

Slimming & starvation, affluence and poverty, privilege and discrimination all co-exist just as they do today

 

1970s: so-called diseases of affluence becoming more and more the centre of attention. Nutritionists shift focus from deficiencies.

            Pauling (1970): is preventing deficiency enough – ‘optimal’ intake?

            Burkitt & Cleave – the ‘fibre’ hypothesis – emphasises switching to preventive nutrition.

 

1980s:            quantifying the need for change in the Nation’s diet.

            Glycaemic Index   (??? = Fabry’s ‘slow calories’ from diets high in vegetables!).

            The brown fat / diet induced thermogenesis debate – is obesity the result of eating highly palatable ‘cafeteria’ diets? Can some people dispose of excess calories eaten as heat?

            Genetically engineered human insulin available.

 

1990s: growth public health nutrition / re-birth community nutrition

            resurgence of semi-quantitative food-based recommendations – the plate

            nutritional genomics

            phytochemicals – tomatoes in tablet form.

 

            Rapid growth nutritional Biochemistry

 

2000:  Human genome sequenced - Nutritional Genomics. Can ‘blanket’ (‘one-size-fits –all’) dietary advice continue?  Can those who need to avoid salt (perhaps only 20% population) be identified and given personal advice? Designer diets – but, who pays and, who will care for those with the genes of a ‘metabolic loser’?

 

 

Summary:            bid to understand individual variation in susceptibility to disease, requirements for nutrients.

Commercialisation of dietary advice – functional foods, nutraceuticals, Atkins diet, diet for longevity! Healthy (and healthy diet) as a commodity which can be bought, marketed and sold.

 

 

????Future:            secure food supply, understand behaviour.

If I could answer 4 questions what would they be:

1          How are body fat stores controlled?

2          How can ‘healthier’ foods  (diets) be made more attractive?

3          How can physical activity be promoted?

 4        Why do people value destructive habits (pleasureabel in the short term) over long term health (and happiness)?

NB These last three questions will probably never have definitive answers – the answers will keep changing as society and its food habits change.

Minor revisions made 14-07-10

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