The History of Nutrition: A Cautionary Tale

What may be the first controlled clinical trial of all time was conducted in 1747 by James Lind, a Scottish surgeon, for the sake of finding a cure for scurvy. Scurvy, of which symptoms include excessive bleeding of the gums, wounds that fail to heal, and open sores, is a fatal disease caused by vitamin C deficiency. In Lind’s time, it usually afflicted sailors on long voyages who lacked access to fresh fruits and vegetables, but it could also be found wherever poverty or the ravages of war had made vitamin C–containing foods (such as cabbage) unavailable.

At the time of Lind’s study, it had not occurred to doctors and scientists that there might be substances in food essential to life. It was known that food provided energy, but no one imagined that a disease might result from a lack of a nutrient normally provided in the diet, rather than from the presence of something dangerous, such as a virus or bacteria. The purpose of Lind’s experiment was simply to see if there was a food that would suffice to protect a man from the mysterious scurvy–causing agent (whether it was damp sea air, or perhaps clogged pores).

Twelve scurvy–ridden sailors were divided into six groups of two, each group receiving a different remedy. One lucky group got two oranges and a lemon per day. The other groups got such miracle cures of the day as sulfuric acid, vinegar, sea–water, cider (the alcoholic version), and an “electuary” of various roots and herbs. The results of the experiment were stunningly definitive. After six days the men on citrus fruit were symptom–free. The men on cider were a tiny bit better. Everyone else was the same or worse. James Lind concluded that oranges and lemons were the necessary cure for eliminating the scourge of scurvy throughout the world’s navies.

This story is described in a book by the biophysicist Walter Gratzer, entitled Terrors of the Table: The Curious History of Nutrition. In the course of writing this article, I have drawn heavily on the material in Gratzer’s book, which I highly recommend as one both informative and entertaining. In the context of Terrors of the Table, what’s significant about Lind’s trial is not the remarkable discovery that he made. Rather, it’s how long it took for that discovery to be put to use. Lind didn’t publish his results until ten years later, in a magnum opus devoted to muddled theories about probable causes of scurvy. Because Lind didn’t know why the oranges and lemons worked as a cure, he didn’t put much emphasis on them. In fact, he recommended an extract of the fruits instead, as a way to avoid spoilage, but the process of extraction destroyed the vitamin C, so the extract was useless. Lind eventually realized his mistake, but was unable to publicize the error effectively. Scurvy continued to plague the British Navy until the end of the 18th century, after Lind’s death, when another Scottish surgeon, Gilbert Blane, managed to distribute lemon and lime juice to sailors (with positive results) despite stiff resistance from the skeptical Admiralty Board. Finally, Admiral Lord Nelson, who had been able to observe the efficacy of the juice, ordered 30,000 gallons for his men during the war with Napoleon. It eliminated scurvy from the navy and thereby aided Napoleon’s defeat. Medical authorities could no longer ignore the curative powers of fruits and vegetables, even if they didn’t understand why they worked. In the time between Lind’s experiment and Nelson’s order, thousands of men had died every year from this easily preventable disease.

If you read in Terrors of the Table the scientific histories of the other vitamin deficiency diseases (such as beriberi, pellagra, rickets, night blindness, and pernicious anemia), you will see that they follow the same pattern as the history of scurvy. First, something essential is removed from the diet, whether by poverty, war, food processing, or other causes. This leads to a disease of malnutrition. Second, science demonstrates that whole foods can cure the disease, but these conclusions are rejected either by the individual researchers themselves or by the medical establishment. Third, the establishment proposes some form of processed extract or medicine as a cure instead, but the disease persists. Finally, the establishment either concedes its error and upholds the original science pointing to whole foods, or its guardians simply pass away. With reference to this phenomenon, Gratzer quotes the following saying of the physicist Max Planck: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.” This triumph of new truth is what scientist and philosopher Thomas Kuhn called a “paradigm shift.”

The scientific truth of vitamins triumphed for good in the early 1930s, and we are not just familiar with them; we take them for granted. This despite the fact that nutritionists of the 18th and 19th centuries outright rejected the possibility that food contained essential nutrients. But the acceptance of vitamins has been only a partial victory for human health. On a deeper level, our paradigm for handling health crises has not shifted at all. People are still suffering from poor health due to war, poverty, and food processing. The mainstream medical establishment is still rejecting whole, natural foods as the main prevention and treatment for disease. And that same establishment (both mainstream and alternative) is still pushing drugs and supplements to treat chronic illness. Vitamins are now among those supplements, and are added back in to processed foods, so we no longer have to fear scurvy. But vitamins aren’t everything. There’s still a health crisis in America, which indicates that the old paradigm, described above, is still at work. In order to better understand what’s going on today, let’s take a look at how this paradigm has repeated itself in the past, starting with the most common sources of malnutrition: processed foods.

For most of human history, malnutrition popped up as a result of the destruction or theft of crops. In times of peace, and in the absence of natural disasters, traditional diets and methods of food production were usually sufficient to keep a society fed and healthy. Processing food to make white flour or sugar was difficult and expensive, so only the wealthy could enjoy that blessing—and the diabetes or gout that accompanied it. But as the advancement of technology picked up speed during the Enlightenment, so did the ease of food processing for various purposes, like taste and preservation. And a whole host of foods that were previously available only in “whole,” “natural,” and “organic” form began to suffer improvement by the scientists and processors.

I warn against processed foods with regularity in this newsletter. And yes, they are bad for you. But in truth, they could be much worse. Take white bread, for example. Modern white bread is fortified with the B vitamins that are lost in processing it from whole wheat. But in the 18th and 19th centuries, no one knew about vitamins, so white bread was unfortified and even less nutritious than it is now. A French scientist, Francois Magendie, tested white bread and whole grain bread on dogs during the Napoleonic wars; dogs eating only white bread died within weeks, while the dogs on whole grain bread survived. When technology arrived to mass produce white bread, the poor could finally eat it, but unfortunately, since the poor were able to afford very little besides bread, they stopped getting as many B vitamins and started to suffer from malnutrition accordingly. The millers resisted going back to producing whole grain bread, because they made a greater profit from refining the flour and selling the wheat germ separately as cattle feed, than from keeping the constituents of the bread together. And it’s not just what wasn’t in the bread that caused problems; it’s what the bakers used to adulterate it. Chalk, pipeclay, plaster of Paris, sawdust, bonemeal and lime were all added to flour to make it go farther. Even potassium aluminum sulphate was included—it caused rickets as well as kidney, nerve and brain damage.

Milk was even more dangerous. With the growth of towns and cities, particularly during the Industrial Revolution, hygiene and health of cows raised in or near these areas plummeted, so their milk often contained pus and blood. Suppliers also watered down the milk to sell more product. To eliminate translucency, the popular chalk and plaster of Paris, along with sugar and ground rice, could be added. To reintroduce creaminess, they added snails or calves’ brains. The creamy color was provided by a poisonous yellow pigment, lead chromate. Drinking this milk raw would have been deadly. Pre–refrigeration, milk producers used formaldehyde and boric acid to preserve their product. Only by means of pasteurization and refrigeration were bacteria from pus rendered harmless and preservatives unneeded (modern day cows are just as sickly as these 19th–century cows, due to being raised in factory farms, which is why pasteurization is still with us).

Infants suffered perhaps more than any other group during this period of history. If a family was poor and both parents had to work, the infants would be given the watered cow’s milk described above, which lacked vitamin D among other nutrients, increasing the incidence of rickets. Children of the middle class and wealthy, while not starving, fell victim to a new invention: infant formula. Heavily advertised and doctor–recommended, these formulas (Nestlé’s first among them) sold like crazy, but, despite claims of complete nutrition, usually consisted of nothing but flour, sugar, salt, and dried milk. Again, rickets was the result. Wealthier children could afford cakes and candy, which relied on poisonous chemicals such as mercuric sulfide, lead chromate, copper carbonate, lead carbonate, and others to provide brilliant, enticing colors. To quote Gratzer again, “These and related substances would have caused anemia, bone disease, and rotting teeth.” It’s enough to make one wish for a relatively innocent package of M&Ms.

These are just some of the breakthroughs in food processing that wreaked havoc on the health of millions. In accordance with the second and third stages of our paradigm, doctors and scientists were reluctant to promote a return to natural foods, regardless of the evidence that processed foods were dangerous. Instead, they trusted in their own abilities when it came to curing disease, and produced and marketed a vast quantity of useless, or even harmful, medicines and remedies, in response to the problems caused by the poor quality foods that were flooding the market.

We already know about the extract of lemons and limes that James Lind recommended in place of fresh fruits for treating scurvy. He was legitimately concerned about the problem of preservation on long voyages, and his proposed solution was at least reasonable. Scurvy treatments loudly promoted by his contemporaries, however, were based on a magnitude of nonsense only exceeded by their widespread adoption. “Doctor James’ Fever Powder,” of which the main ingredient was the toxic metal antimony, similar to arsenic, was one recommended by the British Admiralty Board. Heavily marketed, Dr. James’s powder was also tried on the mad King George, and was probably responsible for the death of novelist, poet, and physician Oliver Goldsmith. The powder and another panacea, the “Pill and Drop,” also antimony–based, killed many sailors. Another doctor, William Cockburn, held that scurvy was the result of laziness. Nevertheless, he claimed that his “Electuary” (made of vinegar) could cure it. It didn’t, but at least it wasn’t lethal. Richard Mead, Physician to the King, recommended sulfuric acid. One thing these respected doctors could all agree upon was that citrus fruit was useless for curing scurvy. In fact, they even accused citrus of being “the commonest cause of fevers and obstructions of the vital organs.”

Other deficiency diseases inspired similar treatments, or worse. Early methods for dealing with rickets included cauterizing veins and strapping infants with the disease into leather and iron straitjackets for months. But in the 19th century, as processed foods multiplied, so did medicines. Crying, malnourished infants who had difficulty sleeping could be given cordials with names such as “Mother’s Helper” or “Soothing Syrup.” These contained drugs such as opium and morphine. As Gratzer comments, “It is little wonder that infant mortality throughout the 19th century could reach 80% in some places.” Cure–alls for gullible adults multiplied, such as “Lydia Pinkham’s Blood Purifier” or “Bile Beans for Biliousness.” These supplements, as we could call them today, usually consisted of nothing more than milk, sugar, flour, and occasionally alcohol. Sometimes remedies were promoted by amateurs and quacks, some by doctors and experts, but all were ineffective regardless. The only question was whether they were actually harmful or just made no difference.

Fortunately, there were many doctors, scientists, government workers and concerned citizens who were not a part of this deadly pattern and who did their best to break the cycle—such as Gilbert Blane, Francois Magendie, Frederick Accum (who exposed the food adulterators) and Harriet Chick, (who demonstrated that rickets was a nutritional deficiency disease and saved lives with cod liver oil). Terrors of the Table is full of stories of brilliant and courageous researchers such as these who spent many years of their lives, often despite stiff resistance, uncovering many of the truths about nutrition that we are taught today. There were also a few who demonstrated timeless wisdom, such as Hermann Boerhaave, a 17th–century Dutchman who was the most eminent physician and scientist of his day. His theory of the digestive process was surprisingly accurate for his time, and he was renowned for continuously being able to diagnose his patients’ diseases with great accuracy. He founded the first academic hospital, and he also understood the importance of nutrition, saying that with the right diet, “a long life, untroubled by ill–health, would be the reward.” Gratzer relates the following story about Boerhaave: after his death, a notebook was found among his belongings that claimed to contain inside it “every secret of medical practice.” All the pages were blank except one, which read “Keep the head cool, the feet warm, and the bowels open.” This is still excellent advice today.

In an ideal world, we would have a modern–day attitude towards health inherited from Boerhaave, but we have a received a decidedly more mixed inheritance best represented by the most eminent scientist of the 19th century, Justus von Liebig, a German chemist and agriculturalist. Liebig made many important discoveries (including that nitrogen was a plant nutrient), but he also committed himself to many incorrect theories of nutrition and physiology. This is typical for even a great scientist, but once Liebig had risen to the top of his field, he devoted much of his energy to protecting his reputation and slandering any scientist who disagreed with him. Consequently, he was responsible for many instances in which promising research was set back or abandoned entirely by scientists who found themselves at the wrong end of his wrath.

Liebig believed that the only important constituents of food were protein, fats, and carbohydrates. He did believe in the importance of minerals, but these were easy to isolate in the laboratory or find in nature and were not unique to food. He considered foolish the idea that food might contain unique “accessory factors” (vitamins) essential to life. Consequently, to protect his standing in the scientific community, he had to take every opportunity to shoot down evidence of their existence. However, even though Liebig did not believe in vitamins, he was something of an entrepreneur, and could see the commercial potential in medicinal extracts of food. When he was informed by a friend of an overabundance of beef being produced in Uruguay, he hit upon the idea of producing a liquid extract made from crushed and steamed meat, and selling it as a nourishing tonic.

Liebig’s reputation helped this extractum carnis to become widely accepted as a universal panacea, with many leading doctors jumping on the bandwagon to claim it could cure typhus, dyspepsia, tuberculosis, and ulcers. “Beef tea” became a popular nineteenth–century drink, even though it had little nutritive value and had no effect on the above–mentioned diseases. At one point a London hospital was buying 12,000 jars of the extract each year for its patients. Eventually, however, no one could ignore that Liebig’s beef liquid had no effect on health, even if it did have a pleasant flavor. It is still available today, as Liebig’s company’s descendant produces the Oxo beef broth cubes. Liebig is also responsible for other developments in chemistry and food processing that may have harmed more than they have helped, such as instant coffee, artificial fertilizer, and the very first baby formula. Liebig’s “Perfect Infant Food” contained wheat flour, malt flour, cow’s milk, and potassium bicarbonate. Obviously deficient in vitamins, it was not the worst of the many formulas that it later inspired.

Liebig’s worldview, like the paradigm described above, somehow combined the contradictory notions that food did not provide essential nutrition, but that extracts from food, or processed foods, could be medicinal and nourishing. This is a worldview that has come down to us today; we downplay the importance of mundane whole foods and instead flock to vitamins, supplements, and extracts made from exotic or rare foods that, like Liebig’s beef broth, are supposed to cure all our ills. At the same time, we’re inundated with processed foods like white flour, white sugar, corn syrup, and pasteurized dairy, and our factory farmed animals eat a version of these foods as well. This marriage of extremes leaves us vulnerable to a wide range of chronic health problems.

The state of nutrition is at least somewhat better than it was in the past. As we have seen, mass production of processed foods became possible in the 18th and 19th centuries, people were vulnerable to foods lacking vitamins, foods adulterated with toxic and inedible substances, and putrefied animal foods. The poor in particular were in danger of simply not getting enough food. In the time since then, laws and regulations have caught up to the developments in technology and there are many government bodies, such as the FDA, that regulate the quality of our food, ensuring the presence of vitamins, the pasteurization of milk, and the elimination of many of the toxic chemicals from the 19th century. There are also regulations in place to limit the harmfulness of medicines and remedies that purport to cure our ills, resulting in the disclaimers and warnings listed on drugs and supplements.

Consequently, few people in Europe and the U.S. now suffer from vitamin deficiency diseases, and if they do, they are easily cured. There are toxins in our foods, but none of them immediately poisonous, like antimony or lead. And milk may be hard to digest, but at least it doesn’t give us tuberculosis. So there have been many improvements in our health. But there is still a health crisis in America. As journalist Michael Pollan points out inthis recent editorial, health care is a $2.3 trillion dollar industry, and three–quarters of that spending goes towards the “preventable chronic diseases” that we suffer from today. If our food is so much better regulated, and better quality, who so much disease? The answer is that we’re still stuck in the same paradigm, in which we eat processed foods, skip whole foods, and medicate ourselves instead of addressing the cause.

Today, when it comes to diet, there are three main contributors to poor health. The first is simple carbohydrates. White flour, white sugar, white rice and high fructose corn syrup are high in calories but low in nutrients, even with added vitamins. We can eat more than we need without getting full. Eating these foods leads to obesity, diabetes, heart disease, and gout, diseases of excess that were once the province of the rich, but now afflict all the classes, especially the poor. The second contributor is hard–to–digest foods such as pasteurized milk and commercial deep–fried foods. These contain complex proteins and trans fats, respectively, both of which build up in the digestive system until they form such a significant presence that the body’s immune system starts to attack not just them but the body itself in confusion. Crohn’s disease, Type 1 diabetes, multiple sclerosis, rheumatoid arthritis, allergies, eczema, chronic fatigue syndrome, fibromyalgia, migraines, and depression are just some of the possible consequences. Finally, despite improvements from a century ago, our diet is still filled with substances that are not really foods—artificial sweeteners, artificial pesticides and fertilizers, artificial flavorings and colorings, preservatives, sweeteners, fat substitutes, thickeners, leaveners, firmers, stabilizers, and emulsifiers, all designed to preserve food or make it look or taste better, thereby masking its low quality, and harming your body in the process. Such artificial ingredients will hasten and contribute to cancer, strokes, and Alzheimer’s.

Most people instinctively seek medical help, such as drugs or surgery, for these health problems. A growing minority seek out gentler alternative treatments—supplements, acupuncture, herbs, homeopathy, and more. As helpful as these remedies are, they are never able to eliminate the health problem completely, only the symptoms, and only temporarily.

There are two sides to the problem of getting more people to adopt a truly healthy diet and lifestyle. On the one hand, most doctors, scientists and pharmacists are looking for something distinct to discover, patent or prescribe. They would like to come forward with a name–brand product that everyone thinks they need to be healthy. In the coming years, they will be promoting patented, genetically engineered foods as improvements over the boring old whole foods we have today. The other part of the problem is that the public feeds this desire. We want a miracle cure, a quick fix that will guarantee our health without making any demands on us. We want to add something to our lives that will enable us to keep doing things the way we’ve always done them, without any change or sacrifice, even if that sacrifice actually leaves us stronger and happier. This is why we need self–awareness, and historical awareness.

Fortunately, more people today are aware of the influence of diet and lifestyle on health, and of the fact that food can be healing and detoxifying. And just as in the past, there are a few experts and investigators, like Mr. Pollan, who keep drawing attention to the need for a healthy lifestyle. The number of voices, professional and otherwise, in favor of whole organic foods as a preventative measure for health, and simply as a more pleasurable eating experience, is increasing, and there are signs that we may break out of our destructive paradigm at last. In a time like this, awareness of the past is crucial.

The value of knowing the history of nutrition is the perspective it gives us on the present. We might be inclined to trust the experts over our own experience, unless we know how often (and to what degree) they have been wrong. We might disdain the healing powers of food unless we see that throughout history, food has always been able to heal. We might get excited about the latest miracle cure unless we have in our mind the awareness that miracle cures are never what they claim to be. We might run the risk of thinking that we’ve finally figured out everything there is to know about nutrition, unless we see that the people who’ve thought that have always been wrong in the past. We might commit the fallacy of thinking we’ve discovered all the essential nutrients, and that we don’t need to eat whole foods any more—unless we know that more nutrients are discovered all the time.

Knowing the science of nutrition is valuable and helpful. But knowing the history of nutrition should teach us to trust whole foods, even when we don’t know everything about them, and to trust our bodies’ cravings for them. Do you think the sailors with scurvy who got to experience the benefits of citrus fruit would have thereafter rejected it because they didn’t know why it helped them? Ultimately, what matters is that it did. If we’re fortunate enough to have access to whole grains, beans, fruits, vegetables, herbs, spices, and naturally farmed meat and dairy, let’s build a diet around them and prevent disease, instead of just treating it, while at the same time enjoying the blessing of these delicious foods and the nourishing meals we can make from them.