Fitness

Each of the 252,000 known cases of muscular dystrophy and atrophy in the United States should have been prevented.

The Muscular Dystrophy Association believes this figure to be only a fraction of the cases which actually exist. The incidence of this disease has apparently doubled in the last 10 years, running parallel to the numbers of fats which have been hydrogenated. The disease is little known because you rarely see these crippled people; most are too weak to leave their homes or to move wheelchairs. You do see a few but assume they are suffering from arthritis or the aftermath of polio.

The most depressing week end I have ever spent was last year when I was sent as a delegate to a muscular dystrophy conference in Atlantic City. Here were dozens of victims of this horrible living death; some were skeleton-thin; others appeared fat, bulky fibrous material having replaced normal muscle tissue. Many were pulled out of shape by muscles which had stopped growing long before the bones to which they were attached had ceased developing. It is almost unbelievable that weak muscles can pull the shoulder blades so close to the buttocks or can so disfigure the human form. One of their members, an eight-year-old boy, died that week end. Death occurred, as usual, from a slight cold; mucus cannot be coughed from the throat when muscles have given away. As this death was announced at the conference, one could see a look of dread and horror pass over the face of every parent in the room; you understood why each lived in deadly fear of colds.

All week end I talked with these people, admiring their spirit and marveling at their courage. I asked them about their food. Were any of them taking vitamin E in the hope of stopping the progression of the disease? Yes, a few. It has been known for years that muscular dystrophy runs in families. One Chicago family has six boys afflicted with it; a New York family, four boys. Were these people giving vitamin E to the other members of their families in the hope of preventing the onset of this disease? Not that I could find. Was one word said during the conference about preventing this disease? Not that I heard. These people want a cure, and may God answer their prayers!

It was not the contorted shapes, the emaciated forms or the useless limbs of these wonderful people facing the slow death they were all too keenly aware of which depressed me that week end. It was the mental picture of thousands upon thousands of similar children and adults who were yet to develop the disease and to suffer for seemingly endless years. As far as I know, not one step is being taken to prevent the onset of this horrible disease. Do you know of one obstetrician who routinely asks his patients to take vitamin E during pregnancy? I do not. Breast milk averages 40 times more vitamin E than does cow’s milk, but few babies are lucky enough these days to get breast milk. Do you know of one pediatrician who routinely gives vitamin E to the babies who must live on formulas? I do not.

Nothing is being done because there is no proof. In the name of heaven, how much proof is wanted? There is proof that pregnant women get little vitamin E. There is proof that children are undersupplied with this vitamin. There is proof that oils are refined and bread is white. Muscular dystrophy is produced in a dozen species of animals when the diets of both mother and offspring are undersupplied in vitamin E. Is there any proof that the muscles of these animals differ much from those of people? Since that week end I have been far more afraid of muscular dystrophy than of cancer or of polio.

Physicians have used vitamin E in attempting to treat many diseases. The most encouraging reports on its therapeutic use have come from a group of physicians in Canada led by Dr. Evan Shute (pp. 354-408 of ref. 1, p. 160). He and his co-workers have studied the effect of vitamin E on women who have had repeated miscarriages and on hundreds of persons suffering from heart disease, high blood pressure, peripheral atherosclerosis, Buerger’s disease, diabetes, diabetic gangrene, and gangrenous ulcers. Their results have been dramatic. It is proved that vitamin E fortunately decreases the body’s need for oxygen; presumably death from heart disease is caused by lack of oxygen. Gangrene, gangrenous ulcers, Buerger’ sdisease, and peripheral atherosclerosis are also conditions in which too little oxygen reaches the cells.

The work of these physicians has been confirmed in Canada, but in the United States it has met with bitter medical criticism. Several doctors have warned me that if I want physicians to respect my writing, I must not mention Dr. Shute’s name. Dr. Shute answers his critics by pointing out that if, in the early days of insulin, every physician had had all the insulin he wished and had given each patient the same amount, no two batches standardized, experimental studies could not have produced identical results. My feeling is that Dr. Shute’s work should be viewed with an open mind.

Although these Canadian physicians have found that they cannot obtain results with much less than 300 milligrams of natural vitamin E daily and that the need for at least adequate vitamin E is unquestioned, the diet used by physicians for high blood pressure (p. 303 of ref. 1, p. 160) contains only 7.22 milligrams per day. The reducing diet recommended by the American Medical Association (p. 303 of ref. I, P: 160), frequently given to persons suffering from heart disease or women wanting a healthy baby, supplies 4.3 to 6.6 milligrams. The diabetic diet in a textbook (p. 619 of ref. 1, p. 160) used in medical schools and by practicing physicians supplies 8.6 milligrams. A tablespoon of soybean oil, taken as salad dressing at lunch and/or dinner, could at least supply 30 to 60 milligrams of vitamin E for these patients and prevent the destruction of vitamin A in their bodies.

I have a hunch that vitamin E played a major role, together with the B vitamins and other nutrients, in the vital statistics published in Denmark after World War I; when no grains were milled, there were fewer cases of high blood pressure, diabetes, and heart disease, the very diseases Dr. Shute has found to respond to vitamin E. Another of my hunches is that these same diseases could be less common in the United States. If we applied what is already known, proof might soon be forthcoming.

My final hunch is that if people stayed on adequate diets including a generous amount of vitamin E, they, like the hundreds of animals studied at Columbia University, might retain their appearances of youth and their normal sexual functions to a late age; their life span, too, mi.ght be tremendously increased.

In female animals, the estrus cycle-menstrual cycle to us - becomes irregular when vitamin E is undersupplied. The onset of menopause is early, but if vitamin E is increased, normal estrus (menstruation) and fertility are restored. When large amounts of vitamin E are given, menopause is delayed to an advanced age, although eventually all females become sterile. If middle-aged or older males low in vitamin E are given testosterone, they develop enlargement of the prostate, and their testicles atrophy, or shrivel.

At the College of Physicians and Surgeons of Columbia University a four-year study was made of hundreds of animals past their menopause to see whether vitamin E was involved in the aging process. It was found that the less vitamin E given, the higher the percentage of sick animals. The testicles of males receiving less than optimum amounts of vitamin E atrophied, or became smaller, and both males and females lost sex interest and would not mate. Although animals showed no abnormalities when fed “normal” quantities of the vitamin, added vitamin E had a striking effect in prolonging youth and increasing the life span; the conclusion was that aging may be a consequence of multiple deficiency states rather than the result of “natural” processes.

Such research would indicate that vitamin E plays some role in the production of normal sex hormones. Although the relation of this vitamin, if any, to secondary sex characteristics has not been studied, my hunch is that it is important. A number of physicians have pointed out that young people these days seem to be losing their secondary sex characteristics. The hips of boys and men are often too large, whereas girls and women frequently have flat chests and slender hips. “Falsies” for women and corsets for men, semantically known as “surgical belts,” have both become major industries. I am horrified at the frequency with which I find little boys, whose diets appear to be adequate except for vitamin E, with round-cheeked hips or girls with narrow masculine hips. It has been my experience that when the diet is made completely adequate and vitamin E is increased temporarily to perhaps 100 units after each meal, these children develop normal sex characteristics quite rapidly. In my opinion, a boy’s chest should be at least two inches wider than his hips, and a girl’s hips should be as wide or wider than her shoulders. I have seen a few cases where normal breasts have developed after flat-chested women from twenty to thirtyfive years old have conscientiously followed an excellent nutrition program.

Another problem, possibly the result of multiple deficiencies of the nutrients including vitamin E, needed for normal hormone production, is that of children growing excessively large. The rooster becomes a huge capon when the testicles are removed; the slender-hipped bull becomes a steak-producing steer. Any animal supplied with too little sex hormones grows to a larger-than-normal size, Similarly many girls these days grow so large that their mothers, not realizing that poor nutrition may lead to glandular abnormalities which can result in overgrowth, are afraid, for example, to allow them to take vitamin supplements; the mothers fear that their daughters cannot find boys large enough to date with them or eager to marry them. Although there is no proof, I for one am going to follow my hunch. I want my children to achieve normal growth but neither of them to be excessively large; I want my son to have slender hips and my daughter to have something genuine to put inside her brassiere; it is my belief that adequate nutrition in general and vitamin E in particular may help these wishes to come true.

Another hunch started years ago when a professor in biochemistry class stressed that when the ovaries were inactive, the body fat of women became redistributed; they developed middle-age spread and perhaps piano legs and ankles either long before or during middle age. Since I suspected vitamin E was related to ovarian hormone production, I have recommended 100 units of this vitamin after each meal to dozens of women whose weight was correct but whose faces were too thin and hips too large. Although vitamin E may not have done the trick, the weight of most of these women has been redistributed, which was all they or I care about.

I suspect that the middle-age spread of men is often not so much the result of age or too many calories as of an undersupply of hormones caused by cumulative multiple deficiencies of which vitamin E is one. This change from a former physique, I believe, is analogous to the transition from the narrow hips and Hat abdomen of the bull to the broad hips and sagging abdomen of the steer. Although a hereditary tendency may exist, this theory can perhaps be supported by the fact that many men begin to thicken through the waist at ages of thirty-five or forty, whereas the general build of others does not change until the age of sixty-five, if at all.

Many physicians have reported successfully treating irregular menstruation and excessive or scanty flow with vitamin E. The vitamin has been particularly effective in resolving menstrual difficulties at adolescence or at menopause. When generous amounts of this vitamin are given one or two years after the menopause, normal menstruation may recur. I warn such women who consult me to expect the return of menstruation; otherwise they sometimes get panicky, thinking they have uterine cancer. A few women have conceived after dietary improvement, although menstruation had ceased a year or two earlier. Since the irate husband of one shouted at me, “You and your d– vitamins,” I also warn women that unplanned pregnancies may occur.

I have another hunch that when general nutrition is poor and vitamin E is undersupplied, the onset of menopause is early, whereas it may be markedly delayed if the intake is generous. Among my personal friends whose diets have been unusually adequate, I know of no woman whose menopause has set in before the age of fifty-three to fifty-five. Furthermore, I suspect aging occurs rapidly at menopause when vitamin E is undersupplied and, conversely, that women with delayed menopause stay physiologically young. One woman whose nutrition I have checked annually since 1936 is still menstruating at sixty-two years of age; she can pass for forty any day.

In animals, vitamin E is important in aiding the liver to detoxify a variety of harmful substances. The amino acid, methionine, has been considered one of the body’s most important detoxifying agents. Vitamin E, however, has been found to be 400 times more effective than methionine. Far larger amounts of vitamin E are necessary to maintain normal liver function than normal sex function. Jaundice in humans, resulting from the toxic effects of such drugs as atabrine or bromides, has responded so favorably to large amounts of vitamin E as to indicate the wisdom of taking vitamin-E capsules along with any drug which must be used.
Vitamin-E deficiencies in animals take various forms in different species; enzyme systems also vary with different species. The brain is most affected in chickens and turkeys obtaining too little vitamin E; encephalomalacia is produced. This abnormality, known to experienced poultrymen as crazy chick disease, develops spontaneously in farm flocks. Cattle and monkeys, undersupplied with vitamin E, develop severe heart disease long before sexual function becomes abnormal.

If females of most species are given too little vitamin E during pregnancy and their young in turn are undersupplied with the vitamin, the voluntary muscles of the young become abnormal; when the deficiency is severe, these muscles stop growing, and a condition known as muscular dystrophy 3 develops. Dys means to stop; trophy means growth. Normal muscle cells are often replaced by woody, fibrous tissue which has no power to contract. Muscular dystrophy has been produced in such widely varied species as guinea pigs, rabbits, mice, rats, ducks, hamsters, calves, pheasants, pigs, dogs, and even kangaroos. The rabbits and kangaroos can no longer hop, the rats and mice cannot run, and the ducks and pigs stop waddling. Only in the guinea pig and rabbit can this disease be corrected by giving vitamin E; in all other species, permanent nerve damage occurs. The onset of the disease is slow and insidious; it cripples rather than kills. Although this disease is purposefully produced in the laboratory, animals develop it under field conditions. These animals eat food from the same land we get our food from; the disease may develop in animals which we ourselves may eat as food.

Such research indicates that vitamin E plays a role in building normal muscles and perhaps in maintaining muscle tone. I have a hunch that the lack of vitamin E may be one cause of poor posture seen in perhaps 95 per cent of our population, from the wobbly-headed infant born of a malnourished mother to its stooped grandparents. Do you know of a baby clinic where 10 infants of normal weight can be found without potbellies? Do you know of a classroom of 20 youngsters, none with protruding stomachs and angel-wing shoulder blades? Have you seen a high-school room where all the students stand erect and walk with grace? I would gladly cross the continent to see anyone such group. I find many children, especially adolescent boys, whose intake of protein and other nutrients appears to be adequate but whose posture is atrocious; improvement usually follows when this vitamin is given.

As we examine the findings of animal experiments, let us think of similar abnormalities in humans. Since vitamin E is destroyed by rancidity, deficiencies are most readily produced by feeding rancid fat; other animals given vitamin E with the rancid fat remain in excellent health. Animals in which deficiencies are thus produced lack strength and energy; their hair becomes dull and later falls out; the thyroid arid pituitary glands become underactive. The need for oxygen is tremendously increased. Nerves are so injured that some animals, particularly old ones, walk with a waddling g.a:it, lacking co-ordination; sometimes they develop tremors arid unusual sensitiveness to pain; since vitamin A in the body is destroyed without vitamin E, vitamin-A deficiencies, such as severe eye infections, often occur. The animals develop skin lesions, become emaciated, and may suffer from intestinal hemorrhages and diarrhea long before sexual disturbances are evident; they die early. One can easily find all of . these abnormalities in humans. Who can say that an undersupply of vitamin E does not contribute to their cause?

Autopsy shows abnormal changes in the bone marrow, lymph nodes, spleen, nerves, and sometimes brain cells. The heart muscles, studied in detail, have been found to have undergone such degenerative changes that scientists have made the statement: “These alterations justify the use of vitamin E in the treatment of certain cardiac conditions.” The most characteristic finding is chocolate or cocoa-brown bits of pigment deposited throughout the voluntary muscles, heart, testicles, and walls of the uterus; the liver and adrenals are described as “loaded” with pigmentation. These pigments form when oxygen breaks down essential fatty acids, a chemical change similar to that of fats becoming rancid outside the body. The pigment itself is made of these breakdown products from essential fatty acids combined with lecithin, cholesterol, and certain amino acids. Pigmentation occurs long before sexual function becomes abnormal; it is greatly increased by a diet low in protein, by one high in fat but containing few essential fatty acids, by the giving of certain male or female hormones, and by age. The more severe the vitamin-E deficiency, the more severe the pigmentation becomes. Dr. Hickman refers to these pigments as “dirt” left when “organic housekeeping” becomes untidy.

Nutrition-wise, I believe in playing my hunches; I have played hunches about vitamin E for 23 years. One of them is that “liver spots,” which people get first on their hands and sometimes-usually later if at all-on their faces, necks, and backs, are cousins of the brown pigments produced in animals undersupplied with vitamin E. The only studies apparently made of brown pigmentation in humans is a post mortem examination of the testicles of twenty men and another of “brown atrophy” of the organs of elderly persons (ref. 1, P: 160); all the testicles showed pigmentation considered identical with that of experimental animals lacking this vitamin; the “brown atrophy” was also similar to that produced in old animals.

For several years I have looked for “liver spots” on every person who has consulted me; if such spots are present, I usually recommend that 100 units of natural vitamin E be taken after each meal. Months or years later many of these people have returned with all of the disfiguring spots gone. This spring I was consulted by a woman of fifty who had on her left cheek an irregular area of pigmentation % inch across; six weeks later there remained only the faintest suggestion of a shadow. The arms and hands of one woman of fifty-nine were literally covered with “liver spots” a year ago; recently, when lecturing on vitamin E, I asked her to stand before the audience and let them see her hands; the skin is like that of a baby’s; not a spot remains. Such spots seem to appear most quickly foUowing menopause, when the requirement for vitamin E is known to skyrocket; as in animals, the spots sometimes become markedly worse when in[ections of sex hormones are taken without vitamin E being simultaneously increased. In both men and women they become more severe with age. Conversely, I have never seen these spots on any person of either sex who has followed a good nutrition program for several years preceding the “liverspot age.”

More vitamin E is found in the body than any other vitamin. Dr. Henry A. Mattill of the University of Iowa College of Medicine has made the statement: 1 “Perhaps no other of the vitamins mysteriously affects so many and so varied body processes.” Apparently as part of an enzyme which helps to utilize fat, it appears necessary to the function of every cell. It is particularly concentrated in the pituitary, adrenals, and sex glands. Natural vitamin E also prevents vitamin A, linoleic acid, and perhaps other nutrients from being destroyed by oxygen in the body. If obtained in sufficient quantities, it is stored in body fat. Yet when humans are undersupplied with this vitamin, no recognized deficiency disease occurs.

No one doubts that humans need vitamin E. A hundred years ago, before our foods were refined, the daily intake was an estimated 100 to 150 milligrams. Authorities have variously suggested the requirements now to be 30, 60, and even 100 milligrams per day. Vitamin E, like vitamins A and D, can pass into the blood only when taken with fat and when bile is present in the intestine. The American diet supplies slightly less than 6.0 milligrams per 1,000 calories, or about 12 to 15 milligrams per day (p. 303 of ref. 1 below). The National Research Council ” recommends seven basic foods which, if consumed daily, supposedly supply adequate amounts of all nutrients; yet these foods furnish only 5.74 milligrams of vitamin E. The thousands of persons who eat no fat or whose bile flow is inadequate probably absorb little of even these small amounts. Most investigators claim that this vitamin is never toxic; 1,200 milligrams daily has been given to persons without signs of harm. Since vitamin E can be stored efficiently, massive doses would probably never be needed if diets were adequate enough to allow a small excess daily. As conditions are, however, deficiencies can be expected.

Relatively large amounts are required when new cells are forming; Dr. Kenneth C. D. Hickman of the University of Rochester has pointed out that the basic need for vitamin E is during the entire constructive period which reaches its height at adolescence. The need of the growing fetus causes the vitamin-E requirements to be tremendously increased during pregnancy. Even when all growth has stopped, a virile man produces as many as 200,000,000 sperm per ejaculation; the vitamin-E requirement of a man, therefore, may vary with his sexual vigor. It was brought out at the 1949 world conference on vitamin E that the requirement increases tenfold during menopause and that, to maintain health, the aging human may require 50 times the usual intake. I, as one aging human, am going to see that I get generous amounts of this vitamin.

Fruits contain almost no vitamin E. In most medical texts, lettuce is listed as the richest source; 30 heads might supply your minimum daily need. Less than a third of this vitamin found in vegetables is absorbed by humans. Most of the vitamin from grains is discarded when flours are refined, but if the wheat germ is retained, as in the “national loaf’ in England during World War II, little vitamin E is lost. The amount in prepared cereals is practically nil. When oils are highly refined or hydrogenated, much of the vitamin E is sacrificed. Low cooking temperatures harm it little, but 90 per cent is lost in deep-fat frying, as when doughnuts or potato chips are prepared. Even slight rancidity (p. 42) destroys the vitamin both outside and inside the body. The only dependable sources appear to be fresh-ground, wholegrain flour and cereals, wheat germ, and vegetable oils.

The scientific name for vitamin E is alpha tocopherol; other tocopherols with some vitamin value occur in nature. Natural vitamin-E concentrates, prepared by distilling vegatable oils, and synthetic vitamin E, are available in capsule form. The synthetic vitamin cannot prevent the destruction of vitamin A and unsaturated fatty acids (p. 342, of ref. 1, p. 180) in the body, perhaps the most important function of vitamin E. For this reason mixed tocopherols from natural sources are superior to the synthetic product even though 149 milligrams of the synthetic vitamin equal 100 International units of the vitamin from natural sources.

More than three decades ago it was discovered that when animals were deficient in vitamin E, the males became sterile; females lost their young. If the vitamin was supplied, normal pregnancies occurred, but fertility in males could not be restored. Years passed before attention was directed to subtle deficiency symptoms.

A few years ago in a rural area, I visited four old friends, all of whom had dentures which they put in “for company.” At mealtime the dentures were removed, and the food was gummed in comfort. If an adequate diet is adhered to and well absorbed, one set of dentures should fit during the remainder of one’s life.

The calcification 5 of a person’s bones, shown by dental X-rays, is probably a good index of the density of bones throughout the body. You might ask your dentist to compare your X-rays with those of some person whom he considers to have unusually well-calcified bones. Examine the bone structure both below and around your teeth; the denser bone casts a whiter X-ray shadow. If your own X-rays show poorly calcified bone, rigid adherence to an adequate diet may pay rich dividends.

Fragile bones break easily. Although most people expect to have pyorrhea sooner or later, few expect broken bones. Unfortunately, breaks do occur. When bones are so poorly calcified that teeth are lost from pyorrhea, the condition of the bones throughout the body can degenerate but little more before they may crumble or break at any minor twist or fall. Millions of Americans, including thousands of relatively young persons and almost every person sixty years old and older, have porous bones. It makes no difference except perhaps to some physicians whether or not the porosity is of such a degree that the condition can be called osteoporosis. Formerly it was believed that bones naturally became porous with age. When experimental animals are kept on adequate diets, however, the longer they live, the stronger their bones become. Such evidence indicates that poorly calcified bones are the result of nutritional deficiencies; elderly persons have eaten faulty diets more years than has the younger person; hence the condition is more universal among them.

Since bones cannot be seen, few people trunk of whether theirs are well or poorly calcified. The difference in bones, however, is almost unbelievable. I used to lecture at a dental college where there is a large collection of skulls. The bones of some are so dense and heavy that they appear impossible to crack with a sledge hammer. Other skulls in this collection are so thin and porous that light shines through them; in fact they would make excellent lampshades, Any orthopedic physician or X-ray specialist can tell you that poorly calcified bones are extremely common.

If you think bones do well without care, you should go through an orthopedic hospital and talk with patients; you would soon be convinced that anything which helps to build strong bones and prevents such misery as you would find is worthwhile. Let me tell you about a few cases I have known personally.

A woman in her late thirties hobbled in to see me not long ago and, after putting her crutches aside, told me the following story. Several years ago she had somehow twisted her leg while walking across a lawn; the femur, or thigh bone, had broken near the pelvic joint. She lay in the hospital month after month before healing was sufficient for her to walk with crutches; in time they were discarded. Then one day, without warning, she simply fell in a heap. This time the bone had crumbled at the spot where it had been broken before. A plastic head was put on the femur which involved deep, drastic, and expensive surgery; the gold pin which held it in place showed clearly in the X-rays. Again months were passed in hospital beds before she graduated to crutches, but pain in that joint remained acute. She had been told that the pain was probably caused by calcium forming in rough deposits over the plastic head of the femur; .she came to me requesting a calcium-free diet. She left with a nutrition program which included generous amounts of both calcium and vitamin D and was as adequate in all respects as I could make it. Only three days later she phoned to say the pain had completely disappeared. A month later she came to see me, carrying a cane; she walked, however, without using it and without a limp. Do you suppose she believes that any nutrient which helps to maintain normal bones is unimportant?

A plasterer, forty-two years of age, who had fallen from scaffolding, used to come on crutches to hear me lecture. He too had broken his femur; months had passed without healing. The jagged ends of the bone kept breaking apart. Apparently in desperation, his physicians put a steel plate around the bone to hold the ends together, but X-rays cannot be taken through such a plate to see whether healing has occurred. Eventually the plate had been removed, but the bone still had not knitted. Infection, called osteomyelitis, set in, and operation after operation followed. Great deep scars about two inches apart and each a foot long went round his entire thigh. The wound from the last operation was still draining; the bone was badly infected, and amputation had been recommended. During all these tragic years, he had never once been given vitamin D; certainly he had not been in the sunshine. No diet had been recommended rich in calcium, in protein necessary to form bone base, or in the B vitamins needed to insure that adequate hydrochloric acid could be produced to help the absorption of what little calcium he chanced to obtain. No extra vitamin C had been given to help prevent or fight the infection. When his nutrition was made adequate, improvement was rapid. He now walks to work but with a limp he will have throughout life. Do you suppose he thinks that vitamin D is a nutrient only for babies?

I have seen perhaps two dozen similar cases, most not so severe but many equally tragic. The elderly persons whose hip bones crumble after a minor fall, usually in a bathtub, seem to me most pathetic. The easy breaking of bones and/or their slow healing are, in my opinion, completely unnecessary. Yet such fire insurance, which in this case should cost no more than a dollar or two per year, is usually purchased, if at all, only after the house is burned. The adult who is ignorant of the advantages of vitamin D usually pays both figuratively through the nose and literally through the pocketbook.

Perhaps I am making a mountain out of a molehill, and “vigorous adults leading normal lives” do not need vitamin D. A friend jokingly implied as much once when I had mentioned something about saving teeth; he remarked, “Some of the nicest people I know wear dentures.” He is undeniably right. In fact, there are some 32,000,000 nice people in these United States wearing dentures. I myself would gamble that all of these 32,000,000 nice people wish they had 32 nice teeth stuck firmly in their own jaw bones.

Long ago it was learned that excessive amounts of vitamin D can be toxic. A toxic dose for adults appears to be 300,000 to 800,000 units per day provided this quantity is taken daily for several months: Toxicity causes vomiting, diarrhea, and sluggishness; calcium is withdrawn from the bones, the amount in the blood becomes excessively high, and much is lost in the urine. These symptoms are prevented if generous amounts of vitamin C are supplied. Fear of toxicity has caused the National Research Council to recommend only 400 units daily for persons of all ages.

Almost nothing is known of the amount of vitamin D which can be taken advantageously by an adult. Dr. Johnston 2 of the Henry Ford Hospital in Detroit studied the needs of adolescent girls, some of whom had ceased growing. He found that even though a generous amount of calcium was supplied by the diet, if no vitamin D was taken, more calcium was excreted than was eaten. When the vitamin was supplied, the amount of calcium absorbed into the blood paralleled the vitamin-D intake. For example, when 650 units of vitamin D were given daily for a time, and later 3,900 units were given, the quantity of calcium absorbed was increased tenfold. In some cases 1,950 units of vitamin D were given with more calcium than could be obtained from an average quart of milk (1,343 milligrams); still no calcium whatsoever was retained in the body; this amount of calcium was well absorbed when vitamin D was increased to 3,900 units daily.

Unfortunately, Dr. Johnston did not study the calcium absorption when still larger quantities of vitamin D were given. His studies indicate, however, that the adult can profit by taking at least 4,000 units of this vitamin daily. It is entirely possible that the ideal intake may be nearer 7,000 units per day; since this amount is certainly not toxic, it appears wise to err on the side of obtaining slightly too much rather than too little. Aside from the need during pregnancy and lactation, I suspect the. highest requirement is during the menopause; the calcium intake is usually lower then than during adolescence. Hot flashes, night sweats, leg cramps, irritability, nervousness, and mental depression, so frequently experienced at this time, can usually be overcome in a single day by giving calcium and vitamin D; when the calcium intake is already adequate, vitamin D alone can relieve these symptoms.

Vitamin D can be stored in the body provided an excess is obtained. For example, in England during World War II mothers were given cod-liver oil for their babies. Uncooperative babies sometimes burp up the oil, which stains clothing and smells bad; the oil is a nuisance for a busy, tired mother to give. Despite the fact that the oil was supplied free, severe bone abnormalities developed. English physicians, desperately trying to solve this problem, studied the effect of giving single massive doses of vitamin D by mouth to tiny infants in the doctors’ offices. Many similar studies were made later on the Continent and in America. It was found that a single dose of 300,000 units of the vitamin promoted good bone growth for a year, indicating efficient storage of the excess; this amount was never found to be toxic.

Since vitamin D is stored, the cheapest source I know of for adults is a capsule of 25,000 units each which can be taken once a week, as after breakfast on Sunday. When the requirements are unusually high, as during adolescence, pregnancy, and menopause, such a capsule might be taken to advantage every Wednesday and Sunday. These capsules, although available,” are so little used that druggists often tell customers they cannot be sold without a prescription. The Food and Drug Administration has asked that the 50,000 unit capsules of vitamin D be sold only on prescription but not the 25,000 unit capsule. Since vitamin D, like vitamin A, cannot be absorbed unless in the presence of fat and bile, this vitamin should be taken after a meal containing some fat.

The positive results gained by taking adequate vitamin D throughout adult life are identical with the advantages of having ample calcium, to be discussed in chapter 21. Since adults can absorb calcium without vitamin D, the taking of this vitamin is similar to buying fire insurance: you hope you will never need it, but if you do, it is wonderful to have.

An advantage is that vitamin D helps to prevent tooth decay. All decay is apparently caused by sugar being broken down by bacteria-produced enzymes into lactic and pyruvic acids; any acid can combine with calcium. If the saliva can reach the area where the acids are being formed, and if it contains ample amounts of dissolved calcium, these acids are neutralized by the salivary calcium, and no decay results. Dental erosion appears to be prevented in the same manner. Although the subject is still controversial, an increasing amount of evidence 4 indicates that both the enamel and dentin of mature teeth can be built up provided the nutrition is adequate; probably the two most important nutrients in such rebuilding are calcium and vitamin D.

Ample vitamin D undoubtedly plays an important role in the prevention of pyorrhea. If the diet is made adequate and all infection is removed, even severe pyorrhea can usually be arrested. Although pyorrhea is a disease involving infection and resulting from multiple nutritional deficiencies, the loss of teeth is caused by decalcification of the bones. When too little calcium is supplied the tissues, minerals are withdrawn from the jaw bones; the bones themselves become smaller and recede from around the teeth. As the bones recede, the gums likewise recede, exposing more of the tooth surface. The teeth appear longer than they should be, and the gums cannot fit tightly around the base of each tooth. Eventually, so little bone structure remains that it cannot hold the teeth firmly in place; the teeth, though they may be free from decay, become loose and must be removed.

Even when the teeth and all infection are removed, the destruction of jaw bones does not cease, nor does this destruction cease to be a problem. Dentures can fit well only when sufficient jaw bone remains on which to anchor them. If the nutrition is poor, so much bone tissue can be lost even six months or less after perfectly fitting dentures are made that the dentures shift, wobble, or refuse to stay in place. One of the delightful memories of my childhood is an occasion when a malnourished Methodist minister, apparently believing that the gospel was more effective when thundered, shouted his upper dentures into the congregation. An innocent dentist was probably blamed even by this good Christian; at least a dentist usually is. It is not a dentist’s fault that a person’s diet cannot maintain normal bone structure.

Often set after set of dentures have to be made as the destruction continues. Furthermore, persons whose bones are undergoing rapid destruction are so deficient in calcium that they are nervous wrecks; often they cannot stand to wear dentures no matter how well they fit. For a time a dentist referred to me many patients who complained that new dentures did not fit. As soon as the patients’ diet was made adequate and their nerves relaxed, there were no more complaints.

It is undisputed that vitamin D aids the absorption of calcium, favors its retention, and improves its utilization.

Certainly it is a fact that calcium is needed by adults; this mineral helps to relax nerves, induce sound sleep, and decrease sensitiveness to pain. The National Research Council concedes that small amounts of vitamin D are desirable for people working at night, for elderly persons, and for nuns and others whose clothing shields them from the sunlight. According to this Council, however, “vigorous persons leading normal lives” appear not to need vitamin D. What about the almost vigorous person leading an almost normal life? It seems to me the scientific scientists are indulging in unscientific double talk here.

Vitamin D is scantily distributed in foods. There is some in egg yolks provided the hens sat in the sunshine and preened their feathers well; .50 to 200 eggs daily might supply your needs quite adequately if modern hens were not forced to live in shaded cages. Caviar contains some vitamin D; there is a little in the milk from cows pastured on high mountain slopes. Artificially produced vitamin-D milk is excellent, but as a sole source it has little value in my opinion. Fish-liver oils are the only natural foods containing sufficient quantities of this vitamin to promote health; that is, if you call them natural foods as my children do.

Vitamin D can be produced in foods or oils by exposure to ultraviolet light; the commercial concentrate, viosterol, is made bv such a method. This vitamin is formed by ultraviolet light from sunshine in the oils on the skin, provided you have oils on your skin and the shortest rays from the sun reach the earth. In winter, these rays do not penetrate our atmospheric blanket; during the summer they reach the top of the Empire State Building but usually not the street below it. Sunshine would be an excellent source of this vitamin if it were not for the facts that people are surrounded by smog, wear clothes, live in houses, have bathtubs and hot-water heaters, and listen to soap operas.

Most medical textbooks say that vitamin D is formed by sunlight on the oils in the skin although it was proved 16 years ago 1 that the oils must first be on the skin, then exposed to ultraviolet light, and later absorbed back into the body. If persons take a bath before going into the sunshine, the oils are washed off, and no vitamin D is formed; if they do not bathe before exposure to sunshine but bathe immediately afterward, the oils are removed before the vitamin can be absorbed into the body. Most of the oils appear to be washed off by cold water, and still larger quantities by warm water; warm soapy water does the job thoroughly. Time was when wood was hard to split, water hard to carry, and soap hard to make (and smelled too bad to use anyway); the Saturday-night bath was then a family institution. During the remainder of the week the oils stayed on the skin and absorbed any ultraviolet rays which reached them. The early settlers described the Indians as being great of stature with teeth “as even as piano keys,” both the advantages of having no hot-water heaters and no soap. Now as a nation we are bath-happy and soap-happy; I, for one, call it progress.

There are to be found in any medical library many books and thousands of articles concerning the need of vitamin D by children. Except for a few articles and short paragraphs on diseases known as osteomalacia, meaning literally bad bones, and osteoporosis, meaning porous bones, the need of adults for vitamin D is rarely mentioned. These diseases are identical except in degree; bad bones are worse than porous bones. In both, so few minerals are available that the bones become porous and honeycombed; the persons so afflicted may become shorter and may suffer from muscle cramps, twitches, and even convulsions, or tetany. Osteoporosis is usually painless, but in osteomalacia pain is experienced, especially in the hips; such pain is customarily spoken of as rheumatism; spontaneous fractures and breaks may occur. This disease is common in China and India, particularly when the need for minerals is increased by pregnancy and «becomes more piteous” (p. 684 of ref. 2, p. 36) with each child, especially when the mother “suckles her infant in the vain hope of thus warding off her tragic fertility.” Skeletal remains indicate that the Norse colony founded by Eric the Red in Greenland gradually became extinct because the pelvic deformities of women suffering from osteomalacia hindered childbirth; it is thought that the colonists did not eat the local diet of fish and fish-liver oils; too little vitamin D could be obtained from the Arctic sun. Osteomalacia results from famines and food shortages during and after wars. It occurs in American and English cities “where solitary old people live in proud self-respecting poverty rather than apply for charity” (p. 684 of ref. 2, p. 36). This disease can be cured by vitamin D alone, but to speed recovery calcium and phosphorus are customarily given with the vitamin.

Sir Robert McCarrison, the great English physician, wrote of osteomalacia in India among the Mohammedan women observing the custom of purdah. These women veil their faces at adolescence and rarely go outside their homes. No milk or other food rich in calcium is eaten. Vitamin D, however, either from sunshine or cod-liver oil, so increases the absorption and utilization of the meager dietary calcium that health is restored. Here, at last, is proof that vitamin D alone, without any increase in calcium or phosphorus, can help adults as well as rapidly growing children.

Americans have no more cause to worry about osteomalacia than about scurvy; 60 per cent or more of our population, however, obtain too little calcium in their diets. Much of this supply fails to reach the blood. Calcium is tricky in that it does not dissolve easily; your teeth and bones, even though washed by saliva or tissue fluid, do not dissolve. Unless calcium from food is dissolved, it remains in the intestine and is lost in the feces. The calcium supply to the tissues can be increased by eating more foods containing calcium or by obtaining ample vitamin D; both should be adequate.

Although I have never been up a night with a sick child, I know of nothing which brings me greater comfort as a mother than the knowledge that vitamin C can help in emergencies. Other mothers feel the same. For example, a friend’s little boy, then the only child, died of meningitis. Three children were born later. The mother’s fear that something would happen to one of these children was ruining her life and theirs. During polio season they were not allowed to go to a pool or mingle in crowds. The mother gathered files of articles concerning diseases from newspapers and magazines; she became overcautious about sanitation and still lived in fear and dread. 1 saw her recently for the first time in years; the children were at a park, swimming. I commented on her change of attitude.

“I never worry about them any more,” she answered. “At the first sniffle I give extra vitamin C. The kids haven’t been sick a day in two years.”

My first personal experience with massive doses of vitamin C came when my Geordie, then five years old, had the mumps. One morning when we awoke, the evidence was unmistakable. Starting at 7 A.M., I gave him 1,000 milligrams of “melted” vitamin C and a little calcium powder in ;4 glass of pineapple, apricot, or orange juice every hour except when he slept, making a total of 10 grams during the day. By that evening, all swelling was gone, and there was no further sign of illness. Within the next two months every member of our family including me-which proves I am younger than you think I am-had the one-day mumps. The children have now weathered most of the childhood “diseases” in the same delightful fashion. There has been no irritability, nausea, or vomiting; no meals have been missed; after vitamin C has been given, there has been no fever.

My only other personal experience occurred a year ago when I returned from an out-of-town trip to find that my daughter Barbara, then three years old, was ill. She had appeared to be well when put to bed, but when she was checked shortly before my return, her breathing was labored, her skin Hushed and burning, and her rectal temperature 1040 F. Fortunately, she was thirsty. I immediately gave her 2,000 milligrams of vitamin C in juice. Her temperature appeared to be normal within 15 minutes; she slept soundly the remainder of the night, awoke full of her usual vivacity, and went to play school that morning. She had no further evidence of illness. The amounts of vitamin C I have found effective with my children may be inadequate for youngsters who have received smaller amounts of this vitamin. I try to keep their tissues saturated at all times; at least I cannot recall having seen a bruise on either child.

The quantity of vitamin C to take depends on the type . and severity of the illness and whether it is of short duration or chronic. Large amounts are usually needed at first to saturate the tissues; the quantities can later be reduced. Persons suffering from arthritis, asthma, or other chronic diseases have often taken drugs for months or even years; these drugs must apparently be detoxified before vitamin C is available to the tissues. For example, two years ago I was consulted by a man who had come to California for his health in 1927. He had suffered with severe asthma for several years before and continuously since that time; he told me that during this entire period he had taken mugs daily. Although I planned the most adequate diet for him that I could and recommended what I considered to be massive doses of vitamin C, he showed little improvement from September until December; his symptoms then disappeared and have not returned. It is my belief that results were slow in his case and similar cases because of the drugs remaining in his body.

The quantity of vitamin C most advantageous under all circumstances for all persons can probably never be known. Our requirements vary daily. Almost every person is exposed to chemicals from water purifiers, smog, smoke, or smoking; from arsenic, DDT, and other pesticides, traces of which are found in fruits, vegetables, meats, and milk; many people take drugs occasionally; and most of us are threatened by one or more infections per year. Each individual must find his own dosage, depending upon his own symptoms and the number of toxic substances he is exposed to. If you are going to use massive doses over a prolonged period, however, do it only when your diet is adequate in every respect and with your physician’s permission and under his care. During normal times, use natural sources first: a glass of orange juice daily; salads; and fresh fruits for desserts and midmeals. Watch for bruises; if they occur, know that your intake of vitamin C is not meeting your needs; then supplement your natural sources if you need to.

Although massive doses of vitamin C appear not to be toxic, much research must be done before any long-term harm can be ruled out. If harm is caused by massive doses, however, it appears to be far less than that done by a disease. Large amounts of this vitamin often act as a diuretic, causing excessive urination, corresponding dehydration, and extreme thirst. These symptoms are largely prevented if calcium is taken with the vitamin. If calcium is not taken, extreme nervousness sometimes results; therefore let us be cautious.

The greatest value of massive doses of vitamin C will never be shown by research or found in a laboratory. It is in the hearts and prayers of the parents of the nation. They will render silent tribute to the wonderful scientists and physicians who have brought them peace of mind.

Dr. Klenner, Chief of Staff at the Memorial Hospital in Reidsville, North Carolina, appears to have given the largest quantities of this vitamin to date, usually by injection.” It was my good fortune to visit with Dr. Klenner recently and hear him lecture. He showed slides of hospital records and fever charts and told of case after case of meningitis, encephalitis, polio, virus pneumonia, and serious complications following scarlet fever and other diseases treated with massive amounts of vitamin C. Many patients had not been expected to live; often penicillin, aureomycin, and other antibiotics had been given without success; in most instances, fevers ranged from 103 to 105° F. Within a few minutes after the vitamin was injected, fevers started to drop and temperatures often reached normal within a few hours. Usually the patient enjoyed the next meal and was ready to be discharged from the hospital in two or three days. The amount of vitamin given varied with the severity of the illness. The initial dose was usually 2,000 to 6,000 milligrams .( 2 to 6 grams), Iollowed four and eight hours later by a second and a third injection of 2,000 to 4,000 milligrams if the temperature did not remain normal; injections were continued around the clock when needed.

Dr. Klenner told of an eighteen-month-old girl suffering from polio. The mother reported that the child had become paralyzed following a convulsion, after which she soon lost consciousness. When Dr. Klenner first saw the child, her little body was blue, stiff, and cold to the touch; he could neither hear heart sounds nor feel her pulse; her rectal temperature was 100° F. The only sign of life he could detect was a suggestion of moisture condensed on a minor held to her mouth. The mother was convinced that the child was already dead. Dr. Klenner injected 6,000 milligrams of vitamin C into her blood; four hours later the child was cheerful and alert, holding a bottle with her right hand, though her left side was paralyzed. A second injection was given; soon the child was laughing and holding her bottle with both hands, all signs of paralysis gone. Dr. Klenner quite understandably speaks of vitamin C as “the antibiotic par excellence.” A physician who has obtained striking results in treating polio with vitamin C at the Los Angeles County Hospital matched Dr. Klenner’s enthusiasm with the remark, “If anything should be called a miracle drug, it is vitamin C.”

With his extremely ill patients, Dr. Klenner found that no vitamin C whatsoever could be detected in the blood only a few minutes after massive doses were injected; nor was any vitamin C found in the urine. It is his belief that this vitamin combines immediately with toxins and/or virus, thus causing the fever to drop. In cases where the fever rises again later, he believes that too little vitamin C has been given in the initial dose; that virus not destroyed multiplies and again causes the temperature to increase. For this reason, he emphasizes that if the original dose is sufficiently large, no further massive amounts need be given.

Many other investigators have studied the effect of massive doses of vitamin C. In an attempt to saturate the tissues, physicians have recommended as much as 1,000 milligrams every hour during the day from 1 to 3 days to persons suffering from arthritis, gout and almost any infectious disease, infection, or allergy, the same amount being repeated during subsequent acute attacks. They have also recommended that this quantity be taken immediately at the onset of a cold or any infection and that the vitamin be stopped as soon as the symptoms have disappeared. On the other hand, satisfactory results have been reported when an allergy or lead poisoning has been treated with as little as 300 milligrams daily. These problems, however, are medical ones; our problem is prevention.

Physicians have pointed out that patients with polio, for example, have often been sick several days before a doctor is called in and a diagnosis made. By the time such cases are cleared by a social worker and a March-of-Dimes committee and are actually checked into a hospital, they are in what has been described as “a sorry state.” Vitamin C has proved to be most effective when taken at the onset of an infection, at which time a patient rarely sees his physician. Relatively smaller amounts are needed than those required after an illness becomes serious. If sufficient quantities of the vitamin are obtained, often serious illness may be prevented. It appears desirable, therefore, for persons to learn when large amounts of vitamin C should be taken and how much should be taken. Such information has great comfort value.

I asked 15 physicians if they felt it wise to recommend that families keep high-potency, vitamin-C tablets in the medicine chest and use them at the onset of any illness. The most frequent reply was, “They are certainly safer than aspirin.” Several physicians remarked, “Tell people to take them when they need to, but the rest of the time to stick to orange juice and natural sources.” Others pointed out the importance of advising large initial doses rather than smaller frequent ones, the total of which might be larger than would be needed if the original dose were sufficient.

When persons are too ill to eat or retain food and/or to digest or absorb it easily, as were Dr. Klenner’s patients, injections of vitamin C are obviously advantageous. If the vitamin is taken immediately at the onset of an illness, however, such difficulties rarely arise. Occasionally undissolved tablets can be seen in the stools, particularly if diarrhea occurs. For this reason I usually tell people to bring one cup of water to a boil, add to it 50 tablets of vitamin C of 500 milligrams each or 100 tablets of 250 milligrams each, stir until the tablets are dissolved, pour the solution into a glass jar, and keep it refrigerated. Since tablets do not contain the enzymes found in natural foods, the synthetic vitamin is quite stable to heat. Each teaspoon of this solution would contain 500 milligrams; one or two tablespoons added to any sweet juice are quite palatable. Less vitamin C is needed if the solution is taken in fresh, canned, or frozen orange juice to which are added the juice of a lemon, sugar to taste, and perhaps W teaspoon of a calcium salt 3 (p. 181); the fresh citrus juices supply vitamin P, or rutin, which prevents vitamin C from being destroyed in the body by oxygen; the calcium helps to prevent the toxic substances from entering the cells. An adult can take tablets of both vitamin C and calcium. Since the vitamin is an acid, large amounts can cause severe burning of the throat and stomach. When more vitamin C is taken than is needed, the acid being thrown off in the urine usually causes a burning sensation when voided.

Although it has been known for centuries that a person dying of scurvy could make a startling and dramatic recovery if fresh foods were given him, vitamin C can bring about other startling and dramatic recoveries only recently discovered. Most of the research being done is still unpublished; only a few articles have yet reached the medical journals.  Aside from helping to build collagen, this vitamin appears to be a busybody with its fingers in every pie. When toxic or poison substances gain access to the body, adequate vitamin C, if available, detoxifies them, making them harmless. The toxic substance apparently combines with the vitamin, and the two are excreted together in the urine; this combination is now given the name of ascorbigen.  It has long been known that during infections and diseases, vitamin C disappears from the blood and urine; that the more vitamin C given, the less ill the person usually is, and the more quickly he recovers; and that 20 to 40 times more of the vitamin has to be given during illnesses to keep the tissues saturated than during periods of health. Furthermore, antibodies are unable to render bacteria harmless unless vitamin C is adequately supplied. Antibodies must be helped by a complement; if there is no vitamin C, there is no complement. Vitamin C seems equally helpful whether the disease is caused by virus or bacteria or is non-infectious, as is gout, arthritis, or a stomach or duodenal ulcer. Almost endless infections and diseases have been studied: colds, polio, rheumatic fever, tuberculosis, diphtheria, infections of the prostate, ears, eyes, sinuses and tonsils, the childhood diseases and many others. In every case, vitamin C appears to be the good little Christian ready tc soothe the aching brow.  It has been found that vitamin C can prevent or cure chemical poisoning. This vitamin has been valuable in correcting the toxic effects of lead, bromide, arsenic, benzene, and many other substances which sometimes gain access to the body, especially of persons doing industrial work.  Studies have proved that vitamin C helps to prevent allergies; if enough is given, it can detoxify the harmful effects of allergins which have entered the blood, whether they be pollens, dusts, dandruff, or foods. This vitamin seems to be equally effective in treating all varieties of allergies, whether rhinitis (stuffy nose and/or postnasal drip), hay fever, asthma, eczema, or hives; spectacular relief often results from massive doses of vitamin C. Even the effects of poison oak and poison ivy often disappear when sufficient vitamin C is taken.  Any foreign substance reaching the blood appears to be more or less toxic; the harm is prevented by vitamin C, but the vitamin itself is destroyed in the process. For example, every drug apparently destroys vitamin C in the body. When a drug promises to save your life, the vitamin destruction is unimportant; if it is being taken promiscuously without a physician’s prescription, both the drug and the vitamin loss may be unnecessary. It has been found that a single tablet of anyone of several drugs widely used and considered harmless can continue to destroy vitamin C in the body for three weeks after the drug is taken. The Journal of the American Medical Association carried an editorial entitled “Is Aspirin a Dangerous Drug?” I pointing out that aspirin had proved more dangerous in England and Europe than in America because our diets contained more vitamin C with which to detoxify it.  This vitamin appears to play no major role in producing energy; yet it helps to prevent fatigue. For example, a group of soldiers was given vitamin C until the tissues were saturated. Their performance was compared with that of a similar group not given the vitamin. After maneuvers involving carrying heavy equipment, walking miles, and climbing mountains, the soldiers given vitamin C experienced little fatigue, recovered quickly, and had no leg cramps, whereas the other soldiers suffered severely from cramps and fatigue and did not completely recover for days. The harmful “ashes” left from incompletely burned fats, known as acetone bodies, which accumulate in the tissues when the blood sugar falls below normal, is a major cause of fatigue; these acetone bodies are detoxified by vitamin C.  Vitamin C seems to help everything by being destroyed by everything. For a nutrition consultant, the situation as regards vitamin C becomes progressively more embarrassing. No one seems to be in danger of coming down with scurvy; yet almost every person has abnormalities which vitamin C has been proved to help. In order to do good work, a nutritionist seems to have to accept the fact that people think him a crackpot hipped on liver, yeast, orange juice, and vitamin-C tablets.  The quantity of vitamin C needed to detoxify a foreign substance depends upon the amount of that substance gaining access to the body. Relatively small quantities are required by the healthy person to prevent harm, particularly when adequate calcium is absorbed (p. 132). Many toxic substances, however, might enter the body simultaneously. For example, a person suffering from allergies and doing industrial work where toxic chemicals have reached his blood might suffer from a serious infection which prevents him from eating and for which he is given various drugs; his temporary need for vitamin C would be tremendous indeed. Fortunately, even massive doses of this vitamin are thought to be harmless; any excess not needed in the body is quickly lost in the urine.

Scar tissue formed in healing wounds and injuries is a connective tissue made of collagen which depends on both vitamin C and calcium for strength. During the First World War it was noticed that wounds healed slowly or failed to heal unless fresh foods were eaten. Experiments prove that speed of healing and strength of the scar tissue are directly proportional to the vitamin-C intake. Operative patients deficient in this vitamin not only heal slowly, but their wounds frequently break open. When 4,000 milligrams or more of vitamin C has been given daily to such patients, the speed of healing is often dramatic. Medical journals have urged all physicians to recommend large amounts of this vitamin before and after surgery.

Vitamin C is especially important in the healing of broken bones. When it is lacking, a collagen bone base fails to form; hence the ends of the broken parts are unable to knit. Such abnormal healing occurs frequently in older persons whose diets are notoriously deficient in multiple nutrients. Bones heal readily at any age when an adequate diet is given and steps are taken to assure normal absorption. Protein, calcium, vitamin D and other nutrients, however, are equally as important as are large amounts of vitamin C.

Although not yet understood, vitamin C apparently plays a role in maintaining normal vision. In healthy eyes, the vitamin is concentrated in the lens; the vitamin is lacking or reduced in the lens of persons having certain types of cataract. Experimental cataracts have been produced by a restricted vitamin-C intake. Marked improvement in eye infections and inflammation of the eyes often follows when large amounts of vitamin C are taken.

This vitamin cannot be stored in the body. The tissues, however, can be saturated as a sponge might be saturated with water. The state of saturation, in which every cell has all of this vitamin it can use, is considered to be most compatible with health. After saturation occurs, any excess vitamin C obtained is promptly thrown off in the urine. The amount of vitamin C found in foods, blood, or urine can easily be measured. The tissues of seemingly healthy persons whose diets have been inadequate frequently soak up as much as 4,000 milligrams of this vitamin before any is excreted; this amount is equivalent to 40 glasses of fresh citrus juice. After saturation, the amount of vitamin obtained minus that lost in the urine gives the requirement for a particular day. By this method requirements of different people under various circumstances have been studied.

About 50 milligrams of vitamin C appears to be needed daily by the genuinely healthy adult to prevent scurvy, provided his tissues are already saturated; 75 to 100 milligrams is recommended by the National Research Council as the minimum intake. This amount can be supplied by a glass of fresh orange or grapefruit juice. The scurvy-preventing requirements of vitamin C appear to increase with advancing years, probably because absorption is often faulty and much of this vitamin is destroyed in the intestine when the stomach fails to produce normal amounts of hydrochloric acid. Studies show that the aged are appallingly deficient in this vitamin. Dr. Walter H. Eddy of Columbia University pointed out years ago that many signs considered typical of old age are actually symptoms of scurvy: wrinkles, or loss of elasticity of the skin; loss of teeth; brittleness of bones. Certainly the person who wishes to retain his youthfulness should see that his ascorbic-acid intake is ample.

The vitamin C in all plants is produced, by the aid of enzymes, under conditions of warmth and moisture at which the plant grows best. Unfortunately, the action of the enzymes is reversible; they can quickly destroy what they have made. After a food is harvested, the destruction of the vitamin occurs most rapidly under the same conditions as those at which the plant grew best, that is, in a heated market or a warm room. Furthermore, the enzymes destroy the vitamin by combining it with oxygen; hence, if a fruit or vegetable is peeled or chopped, the destruction is unusually rapid. The enzymes are kept inactive by refrigeration or are destroyed by heat at about 1400 F. Since the vitamin dissolves in water, much or all of it is lost when foods are washed slowly, soaked, or boiled. The average housewife, untrained in nutrition, is a genius at destroying vitamin C before the food can be swallowed.

For practical purposes, the best source of this vitamin is citrus fruits and juices. Fresh orange juice averages 130 milligrams for an eight-ounce glass; grapefruit and lemon and canned orange juice, about 100 milligrams. Frozen orange juice may be as rich as fresh or may contain little, depending on the type of oranges from which the juice came, the method of extraction, and the length of time it has been stored. Often culls, containing little vitamin C, are used for juice. In general, the sweeter oranges, to which no sugar need be added, have the highest vitamin-C content. Other juices, such as apple, pineapple, or grape, are not good sources, whether canned, frozen, or fresh. Tomato juice may supply 30 milligrams of vitamin C per glass or may contain none. A ripe pimiento or bell pepper or one California persimmon often contain 300 milligrams of vitamin C, whereas lh cup of guavas may supply 1,000 milligrams.

Tomatoes, both fresh and canned, all salad greens, fresh strawberries, and raw cabbage average 30 to 50 milligrams per serving. Green vegetables, such as spinach, Brussels sprouts, and broccoli, may be good sources, but 50 to 90 per cent is often lost in the water in which these foods are cooked. Apples, bananas, lettuce, potatoes, and peas may supply only 20 to 30 milligrams per serving but are important sources because of the quantities eaten. Foods such as butter, cheese, eggs, all breadstuffs, and dry beans lack ascorbic acid. Milk and cooked meat other than liver contain almost none.

Climate, soil, the degree of ripeness, storage, temperatures and methods of handling, cooking, canning or freezing all affect the vitamin-C content of foods. Little ascorbic acid is destroyed when foods are quickly frozen, but losses of 90 per cent may occur within an hour after the food has thawed. The variations are so great that tables of food analysis are of little value; hence they have been omitted.

Since citrus juices are the most dependable sources of vitamin C, a glass should be drunk daily by every child and adult. It is wise to serve a fresh salad at each lunch and dinner and to have appetizers of fresh fruit on the menu frequently. Studies have shown that people living on the Pacific Coast buy three times more vitamin C on the same budget than do those on the Atlantic Coast. Even today when frozen foods are widely used, fewer vitamin-C deficiencies occur in summer and fall when fresh foods are available than in winter and spring. This deficiency is especially common among the poor of all ages and the aged of all economic groups. If care is given to the purchase and preparation of food and the planning of menus, adequate vitamin C can be obtained even when little money is available.

The changes in collagen breakdown can be swift, harmful, and hidden. For this reason, a bruise should be interpreted as a danger signal, indicating that more vitamin C should be added immediately to your diet.

Although the word vitamin was not coined until this fi century, vitamin C has been known for over 200 years; its deficiency disease, scurvy, has played a major role in history. In 1754 James Lind wrote a treatise on scurvy recommending lemon juice for its prevention or cure. Despite the fact that we live in a land of plenty and our need for this vitamin can scarcely be called news, surveys show that three-fourths of our populations receive less than the minimum daily allowance recommended by the National Research Council.

All fresh, growing foods contain vitamin C, or ascorbic acid. The richest sources are citrus fruits, guavas, ripe bell peppers and pimientos, and the seed pods of wild roses, known as rose hips. During World War II, the English extracted quantities of vitamin C from rose hips, simultaneously using hops from beer for the B vitamins; a wit remarked that England’s magnificent strength was maintained by “her hips and her hops.” Tomato juice, cabbage, and fresh strawberries are fair sources. Scurvy has resulted whenever people have been unable to get fresh foods.

One function of vitamin C is to help form and maintain a strong cement-like material, known as collagen, which holds together every cell in your body. The amount of collagen required uses about a third of all the body protein. The collagen serves much the same purpose as cement does in a brick building except that the “concrete” in a healthy body is in the form of a stiff jelly, like gristle or a tough gelatin, known as connective tissue; thus every cell in your body “reposes” in a protective bed of jelly. This connective tissue is concentrated in the cartilage, the ligaments, the walls of all the blood vessels, the base of the bones and of the developing teeth, and gives all of these structures both great strength and elasticity. Although vitamin C is necessary for the formation of this tough jelly, adequate calcium must be present before the “[el” can set.’ Calcium is not part of the structure; it merely has a stiffening effect much as pectin does. In fact, pectin is to the plant world what connective tissue is to the animal body; neither can be formed without vitamin C or be strong in the absence of adequate calcium.

Strong connective tissue plays a role of far greater importance than has heretofore been appreciated. Cell walls are only a few molecules thick; almost any harmful substance can penetrate them, whether it be virus, poisons, toxins, dangerous drugs, allergins or other foreign materials which often gain access to the body. Strong connective tissue is not easily penetrated; thus the cells are protected. An undersupply of vitamin C, however, allows this tissue to break down; a lack of calcium allows it to weaken; protective doors are flung open, and pirates are invited in.

The walls of blood vessels must be able to expand or contract, depending on the amount of blood needed at a certain place and time; hence elasticity and strength are of paramount importance. Normal blood vessels are amazingly elastic, like rubber bands. Although a partial lack of vitamin C causes changes in all blood-vessel walls, those of the capillaries, made of single cells cemented with minute quantities of connective tissues, are affected most. When a deficiency exists, therefore, the capillary walls readily break down, and blood is freed into the tissues. These tiny hemorrhages occur first in the intestinal walls, the bone marrow and joints, sometimes causing pain spoken of as “rheumatism.” When the walls break near the surface of the skin, the freed blood discolors to produce a bruise. Regardless of the severity of a blow, a bruise shows brittleness and loss of elasticity in the blood-vessel walls; it is usually the first visual evidence of a vitamin-C deficiency, especially in women and children. “Pink toothbrush” may be the first symptom in men, who bruise infrequently because their muscles are generally harder than women’s. Bruises and bleeding gums are both important danger signals. When adequate vitamin C is added to the diet, however, the capillary walls become strong within 24 hours.

A subtle lack of this vitamin causes profound changes in growing teeth. A deficiency in childhood causes slow dental growth or temporary cessation of growth. The dentin formed during a deficiency is porous and soft; if decay later penetrates the enamel, it meets little resistance; the pulp quickly becomes infected; the tooth dies and is probably lost. Experiments with labeled minerals show that when vitamin C is added to the diet of a child lacking it, normal dentin formation is resumed within a few hours.

If vitamin C is inadequate, the foundation of the bones partially breaks down, minerals are lost, the bones become rarefied and brittle and lack elasticity and strength; such bones break easily. Even when generous amounts of calcium and phosphorus are available, they cannot be deposited in the bones because the collagen base is too weak to hold them.

If vitamin C is generously added to a diet otherwise adequate and the vitamin is well absorbed, dramatic changes take place in the bones whether during childhood or advanced age. New bone foundation forms within 24 hours, and minerals, if available, are quickly laid down. Bones thus continually change; a deficiency of vitamin C during the winter, followed by generous amounts from summer fruits and vegetables, produces alternate softening and strengthening of the bones, causing them to break easily at one time and to resist fractures at another.

Gum tissue fits tightly around the base of each tooth in a healthy mouth; it does not bleed even when brushed vigorously with a stiff-bristled brush. If vitamin C is undersupplied, the gums become puffy and spongy and bleed easily. Ever-present bacteria live on the dead cells of the gum tissue, and infections such as pyorrhea pockets often develop. When such patients have the pockets cleaned out and an adequate diet is eaten, soreness and inflammation often show marked improvement in a few days. A lack of vitamin A or niacin, however, also causes susceptibility to gum infections.

In pyorrhea the gums not only bleed easily and become infected, but much bone surrounding the teeth is destroyed, causing them to become loose. When guinea pigs (used experimentally because most animals produce their own vitamin C) are kept only mildly deficient in this nutrient, a condition strikingly similar to pyorrhea develops in nine months, which is equivalent to 40 years of human life, the age when pyorrhea most frequently appears. It seems probable that a subtle undersupply of vitamin C over a period of years plays a causative role in the onset of pyorrhea. Typical pyorrhea, however, is not uncommon among malnourished children and adolescents. If the infection is not too far advanced, an entirely adequate diet unusually high in vitamin C can restore oral health.

Although one could argue endlessly as to the differences between experimental animals and humans, the fact remains that almost everything learned about positive health has first been found in experimental animals and its counterpart later recognized in humans. I know of no exception. In our present state of ignorance concerning the B vitamins, it seems to me we must have caution in believing that the cheap B vitamins supply all the body requirements, that bacterial synthesis in the intestines takes care of the other B-vitamin needs of each individual, and that the B vitamins still little known or unknown are not important.

Let us consider, for example, heart disease. Heart failure is not produced in animals when they are deficient in vitamins A, C, D, and K, in any of the minerals, or in sugar, protein, or fat. Heart damage or collapse or failure is produced when animals are undersupplied with almost anyone of the B vitamins. The thousands of persons who have died from the B-complex-deficiency disease, beriberi, have died of heart failure. In Denmark during World War I and in England during World War II, when wheat germ remained in all breadstuffs and decreased calories reduced the B-vitamin requirements, the incidence of deaths from heart disease dropped markedly. Dr. Morrison’s spectacular results in treating coronary occlusion and coronary thrombosis with B vitamins cannot be ignored. Animals under stress not given the anti-stress B vitamins die of heart collapse, often while still having all the appearances of health. There is absolutely no proof that the human counterpart of these deaths is not widespread.

Six times more men than women die of heart attacks. It is recognized that men, as a rule, need much larger amounts of B vitamins than women do; men are usually larger, have more muscle tissue, do harder physical work, take more vigorous exercise, are submitted to greater and more numerous stresses, and often drink larger amounts of coffee and alcohol, each of which increases the need for the B vitamins. Perhaps men’s greater need for these vitamins has caused more men than women to die of heart disease.

The scientist working with deficient animals for years learns to predict when death will occur. Similarly, those of us in clinical nutrition can sometimes predict death with depressing accuracy. One has only to watch an individual, learn of his dietary habits, and estimate his vitamin-B requirements to guess the severity of his deficiencies. He may appear to be healthy, but usually many telltale signs are obvious.

Not long ago a friend invited me to a lecture on psychology. She was much annoyed afterward because I commented that I could not listen to what the lecturer said for observing his numerous symptoms of multiple B-vitamin deficiencies and especially the way he breathed. I told her that unless he improved his diet, he would die soon of a bad heart.

“Oh, you” she exclaimed in disgust. “All you can think of is nutrition I” the following week, when this man actually dropped dead, her disgust changed to amazement. I recently watched another seemingly healthy man who sneered at the idea of adequate nutrition but whose requirements for the B vitamins were extremely high; some 10 days after I had predicted that he could not live long, he died of heart disease. Anyone working in clinical nutrition could cite similar examples. Try it yourself. You will find it so easy as to be frightening. A man who has had warning in the form of a heart attack is lucky indeed because he usually takes more rest and thus decreases his vitamin requirements and/or improves his nutrition so that his body needs are met.

The statistics, “885,190 men died of heart failure last year,” are cold and meaningless. But after you have known dozens of these men and seen the sadness of their children and the loneliness of their widows, these statistics become cruelly and tragically alive. You find you care not one iota that the findings proved by animal research are not yet accepted as proved with humans. If the work with animals indicates that lives can be saved, we should apply this knowledge and let the proof come later. A doctor friend, as intolerant as I with the purely scientific attitude, asks persons who defend it, “Have you yet time?”

What kind of men are they who are being taken off by heart failure? They are not the lumberjacks, the ditch diggers, or others who can eat large amounts of food and in so doing obtain at least a certain amount of nutrients. Rather, they are our leaders, our executives, our outstanding men, whose lives are largely sedentary. A friend of mine especially interested in this phase of nutrition has kept hundreds of clippings from newspapers: “Stettinius Collapses of Heart Failure,” “General Arnold Dies from Heart Attack,” and on and on.

At the height of Wendell Willkie’s career he died of pneumonia, although physicians have prevented such deaths since the sulfonamides came into use; the real cause was the coronary attack which preceded the infection. Within recent years other important figures have died of heart disease: Maurice J. Tobin. former Secretary of Labor; John H. Paxton, American Consul; Stephen Early and Joseph H. Short, White House press secretaries; Francis A. Truslow, appointed Minister to Brazil; and Beauford H. Jester, Governor of Texas. Outstanding men in all fields have recently died of heart attacks when still young: fhe Reverend Joseph P. Connor, priest and composer; Dr. Donald A. Stauffer, educator, poet, critic, and novelist; Horace Underwood, educator; Michel Licht, poet and translator; William J. Conners, Jr., publisher of the Buffalo Courier; Roger Riis, Readers Digest roving editor; Fulton Oursler, author of best sellers; Dr. Louis Wirth, sociologist; Edwin Leland James, managing editor of the New York Times; Joseph K. Howard, editor, author, and historian; Albert L. Baker, wartime leader of the Manhattan Project; Arthur Szuk, miniature painter and caricaturist; Leo Pasvolsky, economics expert; David L. Behncke, president of Air Line Pilots’ Association; Walter Geist, president of Allis-Chahners Manufacturing Company; and Lewis Brown, president of the Johns-Manville Corporation. The Army and Navy have been saddened by untimely deaths from heart disease: Captain W. R. Edsall, skipper of the battleship Missouri; Admiral Forrest Sherman, U. S. Chief of Naval Operations; Major General Bryant Moore, Commander of the U. S. Ninth Corps; Major General Robert A. Soule, former division commander in Korea; Dr. Walter Van Dyke Bingham, the Army’s chief psychologist; and Major Samuel Woodfill, Medal of Honor winner. Sports fans grieved on hearing that heart attacks had taken Joseph Jackson, baseball’s great hitter; Norman Ross, former Olympic swimming champion; “Big Bill” Tilden, the tennis champion; Joe H. Palmer, sports writer; and Jacob J. Galomb, of the nation’s largest sports equipment enterprise. Entertainers felt little like entertaining after the news that their colleagues were gone: Al Jolson, singer and comedian; John Garfield, actor of stage and screen; J. Edward Bromberg, character actor; Val Lewton, movie producer, Lamar Trotti, oscar-winning screen writer and producer; and young Hank Williams, singer and composer, who died when only twenty-nine. Not one man among these was old when a heart attack stopped his career. The average age of this group was only fifty-five years when death came. More than one-fourth of these outstanding people did not live to celebrate their fiftieth birthday. My friend adds another clipping from almost every newspaper he picks up.

Brilliant men are often taken at their very prime of life, perhaps in their early forties, after they have gained the education and experience which qualify them for splendid leadership. The years they should have lived would have been the years when their contribution would have been greatest. No country can afford the loss of such a tremendous asset.

Recently I had the opportunity to study such a person, a man of fifty-five years, 190 pounds, with a magnificent physique so rare in middle-aged men. This man is brilliant; moral strength, character, and integrity show in every line of his face. As an international leader, he is making no small contribution toward world peace, but the pressure he is under is unrelenting. Like so many leaders, his work keeps him traveling constantly. He must eat in restaurants where it is literally impossible to obtain adequate B vitamins; he is being entertained by hostesses from coast to coast, and guest meals, as a rule, are even nutritionally inferior to restaurant meals. Women who ordinarily serve whole-wheat breads, milk, perhaps fruit for dessert at family meals substitute white rolls, wine, coffee, and some oversweet pastry when entertaining. A psychologist friend says that when one offers food to one’s guests, one is really offering love; if this be love, I say that it lacks depth. Since graciousness demands that such food be eaten, this man has gained 20 hated pounds during the last year. He tries to maintain his health and normal weight by vigorous exercise. In this case it is tennis, not ordinary tennis but hard games played with professionals.

Although one might consider this man to be in perfect health, close scrutiny and conversation revealed many signs of deficiencies: attacks of gout, showing rapid tissue destruction brought on by stress; concern over elimination; fatigue from exertion which should have caused no fatigue; nervous twitches when extremely exhausted; such exhaustion being fought off with coffee, and tension relaxed by whisky and soda. Although this man expressed the desire for 25 more years of useful, active life, my reaction was, thinking of his large frame, his added pounds, the tremendous pressure of his work, the intensity of his athletics, and the dire inadequacy of his food, that he would be lucky indeed to live another five years. Never in my life have I wanted so much to help another human being; yet this brilliant person knows so little about the needs of his body and I so little about psychology that I failed to do anything more than to antagonize him. One can only pray to God that this man and the thousands of wonderful men like him can learn the rudiments of nutrition before it is too late.

The circumstances in the lives of our leaders who have died at their prime in recent years are frighteningly similar to this man’s. Yet few persons, if any, can study nutrition without obtaining the conviction that everyone of these men could have enjoyed 20 or 5O more productive years.

It will be long before our state of ignorance can be changed to one of enlightenment. In the meantime, let us be open-minded, remembering that the experimental work with animals does eventually find its human counterpart and that the counterpart of the scientist’s report, “The animals died apparently of heart congestion although they still had the appearance of good health,” may be found in the widow’s anguished cry, “He was never sick a day in his life.”

Let us be cautious in feeling secure that a mere capsule of mixed B vitamins will supply the body’s requirements. Let us realize that, in respect to the B vitamins at least, our needs must be met largely by wholesome foods chosen with utmost care. Let us keep on the alert for new findings, being aware that the nutrients which may have the greatest effect upon our health are still to be discovered. Let us stay open-minded to the fact that although nutrition is known to be important in maintaining health, the extent of that importance is still to be learned.

Since these vitamins are concerned with the production of energy, the more exercise you take and/or the harder you work, the more of these vitamins you need. Obviously, your requirement will be higher on the days you work hard than when you are vacationing. Also the less sleep you get, the more of these vitamins you need.
The requirement of all vitamins appears to be greatly increased by stress. Your need, therefore, will depend upon the number and severity of stresses you are under. A person might be upset over a pending divorce (stress 1), working long hours under pressure (stress 2), getting too little sleep (stress 3), taking thyroid tablets and benzedrine to keep going (stresses 4 and 5) and sleeping tablets to relax (stress (3), worrying over a sick child (stress 7), and suffering from a sinus infection (stress 8); his requirements for these vitamins are tremendous indeed. I frequently find persons harassed by as many as 15 or 20 different stressor agents at one time. If you are such a person, it seems to me you have three possibilities: live on yeast, liver, yogurt, wheat germ, and even B-vitamin tablets; or remove the stresses; or look forward to ill health.

Your need for these vitamins also appears to be in proportion to the amount of liquid you drink. Years ago, Dr. George R. Cowgill of Yale University produced B-vitamin deficiencies in animals by force-feeding them water. Alcoholic drinks of all varieties increase the need for the B vitamins; these vitamins are needed in utilizing the alcohol in the body and are washed through the body by the liquid. Recently-I am sincerely sorry to write this-scientists at the University of Wisconsin have produced multiple B-vitamin deficiencies merely by feeding animals coffee. Animals thrived when given caffeine without water. It would appear that caffeine, by stimulating the heart beat, increases the flow of blood plasma through the kidneys and thus causes more of the B vitamins to be lost in the urine. So far no one seems to have investigated tea, but it is a fairly safe bet that the effect will be the same as that of coffee.

Heavy coffee drinkers almost invariably show symptoms of B-vitamin deficiencies even when their diets are excellent. I strongly suspect drinking large amounts of coffee is one factor contributing to the graying of hair and perhaps to baldness. Even drinking too much water may be unwise. This problem of liquid intake is probably more important than is appreciated.

Through the years I have been consulted by many persons who make a fetish of building health. For example, a woman recently told me that her breakfast was whole-grain cereal, hand ground immediately before it was cooked, on which she put powdered whey, bone meal, sunflower seeds, powdered milk, yeast, rice polish, cream, and “raw” sugar. Her husband commented that it was like compiling a compost heat>; he was (understandably) intolerant of her ideas (an understatement). Even with such carefully selected foods, this woman and others not unlike her showed symptoms of severe B-vitamin deficiencies. Invariably I find these people not only believe that one should drink eight glasses of water daily but actually do it. Large amounts of water, coffee, beer, soft drinks, or any liquid wash these vitamins out of your body. On very hot days when B vitamins are lost in perspiration and you drink large amounts of liquids, your need for these vitamins is tremendously increased.

It seems to me there is only one way to determine the quantity of these vitamins which will make you feel your best: find your own dosage. Learn how to vary the amounts from day to day depending upon your own body structure, the quantity and type of food you eat, the strain of your work and exercise, the stresses you are under, and the amount of liquid you drink. For example, during the summer when I vacation in the mountains, I eat yogurt occasionally and take only a tablespoon of yeast daily, usually in juice. When working moderately hard, I drink 1 or 2 glasses of tiger’s milk made with 112 cup of yeast and have some yogurt daily. If under stress, I eat 1 cup of yogurt and % pound of fresh liver or take 2 tablespoons of desiccated liver in addition to the tiger’s milk; on the days when the going is really tough, I have liver and yogurt and drink a quart of tiger’s milk containing 1 cup of yeast.

The one day when I experienced the most exuberant feeling of well-being and felt that my mind was clearest was a time when I was under considerable strain. I was asked to give an intensive post-graduate course in nutrition to physicians and dentists. The procedure was to lecture from 9 A.M. until 5 P.M. with a five-minute break every hour. I was told that the last lecturer to give such a course had blacked out from exhaustion at the end of the day. I realized that if I were to sell nutrition, I had to stay rested and my mind alert. Frankly, I was frightened. I therefore had fruit with yogurt, liver and tiger’s milk at breakfast; milk and a huge serving of lobster for lunch, chosen because lobster is rich in glycogen which would be changed slowly to sugar as the protein digested and would thus give a sustained pickup; and tiger’s milk at 10 A.M. and 2 and 4 P.M. Although I stood except during lunch and spoke without a microphone, I did not experience one second of fatigue throughout the day or evening or even the next day when I kept expecting a letdown. This experience convinced me that, for the relatively healthy person, fatigue can be completely prevented.

The real test, I believe, is this: if you are never tired, the chances are that your intake of B vitamins is adequate or that your intestinal bacteria are pretty efficient. If you experience fatigue, your intake is probably too low. A man said to me recently, “You never realize how terribly tired you were until you’ve found out you don’t need to be tired at all.”

Perhaps a hundred times each year I am asked, “Is it all right to take tablets of B vitamins?” I simply do not know the answer. I wish I did.

There are times when such tablets are of value; I have recommended their use for short periods and have taken them myself. No one knows the harm they may do, however, when used as the only source of B vitamins, especially if continued over a long period. When they are taken together with liver, yeast, wheat germ, yogurt, and the most carefully selected diet possible, they probably do little or no harm. In this case they may not be needed unless your requirements are unusually high.

Such tablets generally contain a day’s requirement of the cheap vitamins B1, B2, and niacin; a small amount of pantothenic acid and just enough vitamin B6 to permit a statement of its content on the label. A vitamin catalogue reveals the reason: vitamin u., $3.50 per kilogram; vitamin B6, $55.00 per kilogram. A few other B vitamins may be included but usually are not. Misleading labels often state that such tablets contain 200 to 500 milligrams of liver or yeast; one serving of liver, or less than % pound, is 100,000 milligrams; a heaping tablespoon of yeast is approximately 45,000 milligrams. What earthly value could 500 milligrams, or 1/50 ounce, of either is?

The proportions of each vitamin found in animal and human tissues and the amounts of each excreted daily in the urine of a healthy person on an adequate diet have been carefully studied. These proportions should apparently be maintained if health is to result. In case you take a tablet of mixed B vitamins, examine the label for the following: if your tablet supplies 2 milligrams of vitamin B1, it should also contain equal amounts, or 2 milligrams, of vitamins B2, B6, and folic acid; 10 times more pantothenic acid and niacin than B1 or 20 milligrams of each; approximately 20 times more PABA, or 40 milligrams; 500 times more inositol and cholin, or 1,000 milligrams of each of these two. I know of no studies of the amount of biotin required. Only 1 to 3 micrograms of vitamin B12 appear to be needed daily and possibly even less of the anti-stress vitamins. Does your tablet contain these proportions? I have never seen one which did.

I believe that these preparations are dangerous unless they are taken only temporarily and with foods naturally rich in these vitamins; even then they should be recommended for you by a person who is thoroughly trained in nutrition. If you take one or more B vitamins, you increase your need for all the other vitamins in the B group. The increased need for the ones you do not take may cause you to develop deficiencies of them; these deficiencies may cause far more harm than the vitamins which you take can do good. For example. during World War II when defense plants were selling tablets of cheap B vitamins and urging workers to take them, dozens of persons with eczema consulted me. Invariably these persons were interested in their health and figured that if one tablet daily was good, three or four would be better. I told them to discontinue the tablets immediately. Usually it took a few days before they purchased the foods I recommended, and in this interval the eczema often cleared up. I became convinced that the B vitamins they were taking had increased their need for pantothenic acid, vitamin Be, PABA,and/or biotin, a lack of anyone of which could have caused the eczema. These people not only suffered from eczema but also from fatigue, constipation, and multiple symptoms which these very tablets are supposed to prevent.

The problem of obtaining adequate amounts of all the B vitamins largely from natural sources when living in a hotel or traveling is a challenging one. I travel a fair amount and often must live in hotels. At such times my requirements for these vitamins are unusually high because I am lecturing or rushing from one engagement to the next or interviewing patients for physicians, often talking 10 hours without a break. For me, fatigue prevention at such times is paramount. I carry tablets of mixed B vitamins; wooden spoons, yeast and/or desiccated liver or yeast mix 2 which I take stirred into water before leaving the hotel room in the morning and perhaps again at noon and/or in the evening. At most hotels, liver and yogurt are available; if not, I ask the maitre d’h6tel to order them for me. Wonderful people from coast to coast simplify my travel problem by inviting me to their homes. I doubt that there is another person in this entire United States who is served such marvelous meals of nutritious and delicious foods, although one hostess told me recently that the thought of my coming made her as nervous as if she were entertaining Socrates. Had she known that I washed my face in a granite wash pan until I was nearly old enough to vote, she might have relaxed.
The question of the quantity of B vitamins which should be taken daily is impossible to answer. The foods themselves vary widely. No two people have the same requirement, and every individual’s requirement changes from day to day. For these reasons, the daily allowances suggested by the National Research Council have been purposely omitted from this book.

Since all the B vitamins appear to be needed by every cell in your body, the amount required depends on how many cells you have. If you are small boned and short, you have relatively few cells, and your B-vitamin needs are probably moderate. Stored fat, of course, has no nutritional requirements. Your need for these vitamins, therefore, is in proportion to your ideal weight rather than to your actual weight. The larger your body structure and especially the more pounds of actual muscle you have, the larger the quantity of these vitamins you need.

Vitamin B1 is used in changing sugar into energy or fat; hence the more starches and sugar you eat, the more of this vitamin you need. Similarly, if your diet is high in fat, you need more inositol and cholin. In one way or another, all B vitamins appear to be concerned with the utilization of foods. The person who eats large amounts of food, therefore, needs far greater quantities of these vitamins than do persons with small food intakes.

One reason for taking yeast in small amounts at first is that, in case your digestion is faulty, yeast may blow you up like a zeppelin. Since faulty digestion is usually the result of inadequate B vitamins, the more gas you get from yeast, the more deficient you can know that you are in B vitamins, and the more you need the yeast. You might eat sugar by the cup and get no gas because it cannot support the growth of bacteria. Yeast is an excellent food, however; hence bacteria thrive on it. If you lack hydrochloric acid in your stomach or produce too few digestive enzymes, much of the yeast remains undigested, and your intestinal bacteria have a feast; they form the gas. The healthy person digests the yeast completely and has no gas or feeling of fullness from taking it.

A method of taking yeast which will give you many times the pickup of yeast mixed in juice is taking it in a drink I call tiger’s milk. Years ago a small boy named this drink, imagining it to be milk from a tiger which had given Tarzan his strength. If you once acquire a taste for yeast and make your tiger’s milk properly, it can be delicious. The ingredients of tiger’s drink are:

• 1 quart milk, preferably certified whole
• 1 teaspoon to ½ cup brewers’ yeast, depending on whether you are a beginner or a veteran
• ¼ to ½ cup powdered skim milk or soy flour
• ½ can frozen orange juice or ½ cup apricot nectar or grape juice or ½ banana or 3 or 4 tablespoons chunk pineapple or frozen berries or any strong flavored fruit or 1 tablespoon blackstrap molasses

The trick in mixing it is this: pour approximately 2 cups milk into a liquefier or blender, start the motor, then add the dry ingredients and the juice or fruit; drink 1 glass diluted with ½ glass of milk, and pour the rest into the quart bottle containing the remaining milk. Keep in the refrigerator. It can be made with an egg beater or electric mixer, but either way is splattery, and the resulting tiger’s milk is usually lumpy and unpalatable. In my opinion, a liquefier is worth buying just for use in making tiger’s milk.

There are endless recipes for tiger’s milk; the point is to find one you actually enjoy. I have been served this drink made with cocoanut milk, boysenberry juice, maraschino cherries, cranberry sauce, Hawaiian punch, yogurt, or buttermilk; or made into a milkshake by freezing milk into cubes and then liquefying them with the other ingredients. It is, however, important that tiger’s milk be made with fruit or molasses to supply natural sugar, the potential energy which gives the pickup.

A number of health-building ingredients can be added to tiger’s milk; 1 or 2 tablespoons of salad oil (it cannot be tasted if the oil is fresh); 1 teaspoon or more of calcium gluconate or powdered bone 1 tablespoon or more of soybean lecithin; several tablespoons of wheat germ; or, in case digestion is faulty, lemon juice or dilute hydrochloric acid (10 per cent solution). If either lemon juice or the acid is used, however, the amount should be too little to cause curdling; that, in turn, will depend upon the amount of yeast, : powdered milk, or soy flour used. The acid, neutralized by the protein, will not change the flavor or harm the teeth as long as no curdling occurs. On the other hand, the more acid you can add without curdling, the more complete digestion will be.

In case you have difficulty in getting started, perhaps you would find comfort in knowing that others have had rough going too. Last year a young man consulted me because of extreme fatigue; he was finishing his doctorate at the University of California, but his fatigue was such that he feared he could neither face nor pass his comprehensive examinations. I suggested that temporarily he eat a half-pound of liver daily for breakfast. Apparently the ink did not take; he believed that I intended him to eat two pounds of liver each morning. He did his best but sent me the following complaint:

My dear Adelle it is plain hell to follow your directions;
But I do try hard, avoid all lard and all the fine confections.
There is much to encourage and much to intrigue, So much to be grateful for this lack of fatigue.
With devotion to you and in spite of my pride…
One thing that I can hardly abide

Is rising each morning at the clang of clocks
and facing the white vastness of the icebox
I withdraw with fright and begin to shiver
on seeing that mountain of slippery liver.
But once it is down, my eyes open wider,
And I can drink deep of the milk from the tiger.

I serve kidneys frequently; kidney creole is hard to beat. Brains I bake in bacon rings, steam and then cream with ham or tuna, or serve liquefied in milk and added to scrambled eggs and soups; I have finally discovered they can be delicious. When liquefied, they have a texture similar to that of whipping cream and are amazingly palatable in ice cream and eggnogs. Unhydrogenated peanut butter and other nut butters are good old stand-bys; the untoasted varieties obtained from health-food stores are nutritionally superior to others. I keep peanuts, almonds, cashew nuts, and walnuts in the house at all times for children’s lunches and afternoon snacks; they are excellent if the budget can take it. The cumulative amounts of B vitamins obtained from all of these foods is worthwhile indeed. Many of them are too high in calories, however, for those of us who are forced to lead sedentary lives.

If I am working under pressure, which seems to be most of the time, I eat liver daily for breakfast. Fortunately it is my favorite meat and has become the children’s favorite, too. I saute it, using the least fat possible to keep it from sticking, sear it on both sides, then turn off the heat, and let it cook slowly, uncovered, from the heat in the pan. If the liver is not the best, I roll it in flour or wheat germ before cooking it or eat it covered with catsup so that I cannot taste it. Raw liver is nutritionally superior to well done because enzymes, which can help you digest it, are not destroyed; I prefer mine medium well and rationalize that I can produce my own enzymes. Every type of liver, be it rabbit, lamb, pork, beef, or giraffe, supplies B vitamins.

If you are one of those people who hate liver yet truly desire the best health you can obtain, desiccated liver, dried under vacuum at below body temperature, is available; not by the farthest stretch of the imagination, however, could one call it palatable; 2 heaping tablespoons are equivalent to one serving, or 1/4 pound, of fresh liver. I often tell people about it, saying they might try it if they want to. I have been surprised at the number of people who not only take it daily but claim it makes them feel so much better that nothing could make them give it up. I use it, stirred into water or tomato juice, when I cannot get fresh liver. Tablets of dried liver are expensive; 30 tablets are usually equivalent to a serving, or 1;4 pound, of fresh liver. Concentrates of liver or yeast are available but have not been tested for the anti-stress vitamins; certainly none contains the marvelous protein of powdered yeast or fresh or desiccated liver.

For all practical purposes, brewers’ yeast is the cheapest and best source of the B vitamins for a person not under stress. In fact, more nutrients are more concentrated in yeast than in any other known food. The use of yeast alone could correct the majority of the world’s nutritional problems: the proteinless meals of China and India; the B-vitamin needs in the Orient and the tropics; the iron starvation of women the world over; and the trace-mineral deficiencies of both sexes of all ages of every nationality. Yeast can be grown in a few hours without acres of land or sweat of a laborer’s brow, its nutritive value increased by the touch of a chemist’s hand. It is said that three hundred years have been required to introduce most new foods, for example, potatoes and tomatoes. Perhaps by the year 2250, yeast will save our overpopulated planet from famine.

Yeast contains almost no fat, starch, or sugar; its excellent protein sticks to your ribs, satisfies the appetite, increases your basal metabolism, and gives you pep to work off unwanted pounds. If any food could be said to be “reducing,” yeast is that food. Powdered yeast is preferable to flaked yeast which usually has a lower vitamin content, weight for weight. Moreover, 1 tablespoon of powdered yeast is the equivalent of 5 to 9 tablespoons of the light flaked. Yeast tablets are quite all right; 90 tablets are equivalent in mineral, protein, and vitamin content to 1 heaping tablespoon of powdered yeast. Uncooked bakers’ yeast grows in the intestine, grabs the B vitamins supplied by other foods, and refuses to give them up; it is dangerous to take.

Just as you may not have enjoyed your first taste of coffee, you may not enjoy your introduction to yeast. The best way for a beginner to take it is to add no more than 1 teaspoon to a large glass of fruit juice; increase the amount very gradually as you become accustomed to it. I must warn you, however, that there are yeasts and yeasts. Some taste so bad that no human being should be expected to swallow them. If you dislike the yeast you have, feed it to the cat and/or dog, and buy a different brand. Some varieties, to one who is used to yeast at least, are quite palatable. The flavor is, of course, a matter of personal preference.

At first it may seem complicated to get your B vitamins from natural foods. Perhaps I can help you most by telling you how I have solved the problem in my family. I have had no white flour in the house for perhaps 20 years. All my flour is stone-ground whole wheat; 1 usually it is “organically grown,” that is, grown on soil rich in humus, without commercial fertilizers. Such flour has a flavor infinitely more delicious than that of ordinary varieties. The machinery which grinds ordinary flour creates such heat of friction that the flour is precooked; its flavor is comparable to last night’s chops reheated. So-called “enriched” flour is my idea of outright dishonesty; at least 25 nutrients are largely removed during refining, and one-third the original amount of iron, vitamin Bi, and niacin may be replaced. Such flour is “enriched” just as you would be enriched by someone stealing 25 dollars from you and returning 99 cents.

I frequently make my own bread, always with wheat germ added. Bread-making, I believe, is a creative art which will give satisfaction to the soul of any woman who masters it. To my way of thinking, the smell of bread baking is one of the jays of home life. The only argument against making it is that such bread is so delicious that one can easily eat too much. I get the flour from a health-food store or have the miller send it to me the day it is ground; then I make many loaves of bread the next day. Any bread not needed immediately and any flour left over I keep in the freezer; if either is left at room temperature, vitamin E and flavor may be destroyed. Flour, I believe, should be treated as a perishable commodity; I see no more reason for buying a quantity of flour now to be used next month than to buy milk today to be drunk 30 days hence.

The only other bread we have in the house is a wheat-germ bread made by a baker.” I buy many loaves of this bread at a time and keep it in the freezer. Children, given genuinely good bread, eat tremendous quantities of it.

I use stone-ground, whole-wheat-pastry flour for thickening gravies and making wheat-germ waffles, hotcakes, muffins, cookies, etc. I hold that no one has ever tasted delicious waffles until he eats them made with wheat germ and bakers’ yeast. I serve them frequently for suppers with creamed tuna, ham, or chicken.

All wheat germ should be refrigerated. If a fresh, sweet smelling wheat germ cannot be obtained, the toasted kind is preferable. You can toast your own by spreading it on cookie sheets and putting it in the oven at 2500 F. until slightly brown.

Wheat germ I use in dozens of ways. Brownies made entirely of wheat germ are delicious. My favorite dessert for guest dinners is walnut tort made by using wheat germ and no flour. Recently a friend’s husband wired me, “Loved your party loved your guests especially loved your dessert.” I suspect that persons who think delicious foods cannot be prepared with whole-grain flours have never tasted genuinely good food. A friend who serves only health-building foods told me of entertaining guests intolerant of nutrition. One guest remarked on leaving, “Such delicious food could be prepared only by loving hands.”

I rarely serve cereals because they contain so much starch.

If used, they should be the whole-grain cereals. When I do use them, I cook them in milk and add generous amounts of powdered milk and wheat germ. I buy prepared cereals at health-food stores. My youngsters also enjoy toasted wheat germ mixed with powdered milk and fresh cream.

Rice polish (the bran removed when rice is polished) is about half as potent in most B vitamins as is wheat germ. Except in making cookies, I find it difficult to use. Brown rice is preferable to white. “Converted” rice is now available, so treated that the vitamins are carried into the center of the rice before milling; I use it almost entirely. I purchase whole wheat macaroni, spaghetti, and noodles, from health-food stores and keep them under refrigeration; or I buy these same foods prepared for diabetics from the wheat protein (gluten) after the starch has been removed. The flavor in both cases I find superior to that of the usual varieties. Soy flour, which supplies protein, cholin, inositol, and some anti-stress vitamins, I use in tiger’s milk (p. 114) and the best hotcakes I have ever tasted. It is good in breads, if you do not object to a heavy texture, and in cookies. Every effort should be made to see that your supplies are fresh. Nothing is so revolting as rancid wheat germ, weevily flour, or lumpy powdered milk.

Any of these supplies can be purchased from a health-food store. One cannot recommend such stores without qualification. A few of these stores are run by persons who have gained an amazing knowledge of sound nutrition; their stores are excellent, and their prices are fair. The percentage of food faddists, however, runs high among the store owners. I know of one who recommends vegetable-juice diets, spiritualism, and high colonies in the same breath. On the other hand, such a store is often the only outlet for stone-ground whole-grain breads and cereals, unprocessed oils, unheated nuts, raw nut butters, perhaps fertile eggs, and “organically” grown fruits and vegetables; they usually sell desiccated liver, tablets of vitamin D, enzymes, and hydrochloric acid at lower prices than do most drugstores. Go into some health food stores, however, with your brain alert, your sales resistance high, and your tongue in your cheek.

I make my own yogurt which I enjoy more than any commercial variety I have tasted. My favorite recipe is to blend 2 cups water, 1% cups powdered skim milk, and yogurt culture 3 or 3 tablespoons of either commercial yogurt or of the last batch of yogurt made. Then I add 1 quart water and 1 large can evaporated milk; after mixing well, I fill 8 glasses holding 8 ounces each. I set the glasses in a yogurt maker S or a pan of warm water coming to the brim of the glasses, cover the utensil, and keep the temperature at 105 to 1200 F. for three hours, or until it becomes the texture of a pudding. If it takes more than three to five hours to become solid, you probably have sour milk, thickened by lactic-acid bacteria which cannot live at body temperature; hence it cannot make B vitamins for you.

Yogurt will keep well in the refrigerator for a week or more, its bactericidal qualities improving up to eight days after it is made. We eat it plain or served with berries, pineapple, or other fruit, blended into applesauce, apricot puree, or salad dressings, made into sherbet or-my favorite-into a maple-syrup sundae. Yogurt is a food which people usually either hate or love. Learn to enjoy it by the small-bite method, and do not expect fast results. Many persons I know eat an entire quart daily.

Despite the fact that these abnormalities are numerous and varied, vitamin B1 appears to have only one function. As part of an enzyme, it helps to change glucose into energy or fat. During the breakdown of sugar to produce energy, pyruvic and lactic acids are formed. By the help of enzymes containing vitamin Bi, pyruvic acid is quickly broken down still further into carbon dioxide and water; lactic acid is rebuilt into glycogen. If the vitamin is undersupplied, these changes cannot take place, and the acids remain in the tissues; they accumulate, especially in the brain, nerves, heart, and blood; eventually they are thrown off in the urine. The production of energy from sugar slows down, coming only from half-burned sugar or from fat; the acids irritate the tissues. Since energy cannot be produced efficiently from fat alone, the result is fatigue, lassitude, and a general laziness throughout the body,

When people deficient in vitamin B1 are supplied with it, the relief of fatigue is often dramatic. Frequently they exclaim in amazement, “I can work twice as hard without getting tired!” In an experiment, subjects were given a minimum amount of vitamin Bi daily; then that amount was doubled and tripled, and their work capacity was tested by weight lifting; it was found they could work twice and then three times as long without tiring. The first thing I do when I employ help to work in the garden or house is to feed them B vitamins; they not only work three times as hard for the same amount of money but work three times as cheerfully.

The reason for personality changes and such symptoms as mental depression, confused thinking, and forgetfulness which occur when vitamin B1 is undersupplied is twofold: first, brain cells derive their energy only from sugar, and glucose cannot be converted into energy without this vitamin; second, the! accumulation of pyruvic and lactic acids in the brain cells is somewhat toxic. At a Philadelphia hospital persons who had eaten foods inadequate in the B vitamins were given a battery of psychological tests before dietary improvement, after vitamin Bi was given, and again after all the B vitamins were supplied. When vitamin Bi was injected, clarity and quickness of thinking, ability to remember, foresight and judgment somewhat improved. The improvement was far more marked when all the B vitamins were supplied by natural foods. Unfortunately, intelligence as such remained the same under all three conditions.

A deficiency of vitamin B1 causes digestive disturbances in a number of ways. Energy production is so faulty that muscular contractions of the stomach and intestinal walls slow down; food can no longer be well mixed with digestive juices and enzymes; and the already digested food cannot be brought into frequent contact with the absorbing surface where it can pass into the blood. A partial or complete lack of hydrochloric acid allows several vitamins to be destroyed, proteins to be incompletely digested, and many minerals to stay insoluble. Gas pain and flatulence are inevitable. If the nutrition is not improved, more serious deviations from health can be expected.

Interference with energy production so limits the contractions of the walls of the large intestine that waste material remains in the large bowel longer than it should. The purpose {If the large intestine is to conserve water by absorbing it back into the blood; the longer the wastes remain, therefore, the harder and drier the stools become. This condition is constipation. Poor elimination can be corrected by a diet adequate in the B vitamins. Except in cases of diarrhea or severe psychological disturbances, your elimination is a fair index of your energy production. Whenever energy is not produced as it should be, constipation occurs; when energy is readily produced, elimination is usually normal.

Heart abnormalities are also caused by the body’s inability to burn sugar efficiently without vitamin B1. Since the heart must work from birth until death, it must be continuously supplied with energy. In a mild deficiency a resting pulse may drop to 50 or even 40 beats per minute instead of the normal 72. As the vitamin deficiency becomes progressively more severe, the pulse alternates between slow during relaxation and rapid during exertion. Eventually it remains rapid, sometimes reaching 180 beats per minute or more. Irritation of the heart muscles by the accumulated lactic and pyruvic acids is believed to cause both the rapid beat and the enlarged waterlogged heart. I recall a sixteen-year-old girl, suffering from exophthalmic goiter, whose resting pulse dropped from 180 to 80 beats per minute during the first week after she added yeast to her diet. If adequate B vitamins are not given, the condition can increase in severity; the almost complete lack of vitamin B1 can quickly result in death.

Neuritis frequently develops when vitamin B, is inadequately supplied. Like the brain cells, the nerves are particularly affected by this deficiency because they are exclusive sugar burners. Neuritis, which may take the form of trifacial neuralgia, shingles, sciatica, or lumbago, is characterized by a sliding scale varying from a dull ache to excruciating pain following the nerve channels. Such pain is thought to result first from the accumulation of acids and later from actual damage to the nerve cells. Headaches and nerve irritation which bring about nausea and vomiting may likewise be caused by these acids.

Neither persons nor experimental animals undersupplied with vitamin Br show all the symptoms of the deficiency. Symptoms of any deficiency vary in endless degrees among individuals and even in the same person from day to day. These same symptoms, however, occur again and again in both people and animals.

Any woman who reads about the experiments conducted at the Mayo Foundation must surely come to the conclusion that it is selfish wisdom to see that her family is given daily foods rich in the B vitamins; if she does not, she herself must be too deficient in these vitamins to think clearly.

The synthetic form of this cheap vitamin is tossed promiscuously into many of our foods to “enrich” them. Thousands of people take tablets of vitamin B1 or of a few mixed B vitamins, believing that they receive far more than they do. The action of all the B vitamins is synergistic. One alone or several together increase the need for the B vitamins not supplied. Deficiencies of the unsupplied vitamins may produce abnormalities which can do more harm than the vitamins obtained can do good.

It is impossible to write about vitamin Br without saying that an adequate intake aids in producing energy. What is to prevent a tired reader from taking tablets of this vitamin because “Adelle says it will help”? My readers have done that before. Yet the most exhausted woman I have ever seen still walking around had been taking massive doses of vitamin B1 daily for two years.

She was a seamstress, thirty-eight years old, although she appeared to be fifty-five or sixty. Her eyes were bloodshot; she believed they were strained by her work. Her upper lip had completely disappeared; small open cracks cut downward from the corners of her mouth. Such fatigue showed in every line of her face that I wanted to tuck her into bed saying, “There. Don’t move a muscle for six months.” Most of her hair had fallen out during the past year, she told me; the thin, scraggly remainder was white. She had other abnormal ties: her nerves were taut and jumpy; she suffered from insomnia; she worried excessively and felt depressed; the back of her lap was so covered with eczema that she could scarcely sit down; yet she was too exhausted to stand up.

It was only after much questioning that I found the cause of her trouble. She used to be so tired, she said. She had heard that vitamin Br prevented fatigue and had found on taking it that at first she did feel better. When the effect “wore off,” she asked the druggist for the highest-potency B1 tablet he had, and when this tablet had not helped, she had gradually increased the amount to four tablets daily. I had difficulty in convincing her that the vitamin B1 was at fault. She was afraid to give it up. I have seen dozens of cases in which the multiple deficiencies of other B vitamins had been caused by taking vitamin Br. Fortunately no other cases have been as severe as this one. A little knowledge can indeed be a dangerous thing. If a vitamin has been insufficiently supplied, a pickup is experienced when it is added to the diet; increasing the amount over that needed by the cells cannot produce a further pickup. It can only produce deficiencies of other B vitamins still undersupplied, as it did in this case.

The richest sources of vitamin Bi (thiamin) are wheat germ and rice polish; liver is not particularly rich. This vitamin is necessary before seeds can sprout; therefore it is found in all cereal grains, nuts, dry beans, peas, soybeans, and lentils, and in unrefined foods prepared from seeds, such as peanut butter, breads, and cereals. Among animal sources, kidneys, heart, and pork rank highest.

A “bird’s-eye view” of the difficulties you may avoid by keeping your diet adequate in this vitamin is shown by experiments in which vitamin-B. deficiency has been produced in volunteers. Dr. Norman Jolliffe, of the New York University School of Medicine, studied men living on a diet adequate except for vitamin BI. After only four days they noticed pain around their hearts, palpitation and shortness of breath on exertion. They became constipated, unusually fatigued and mentally depressed, the symptoms becoming progressively more severe as they continued the diet. Dr. Jolliffe, studying the hearts by fluoroscope and electrocardiograms, found them to be enlarged and sufficiently abnormal as to be diagnosed as heart disease. When adequate vitamin BI was given, the symptoms disappeared in three to six days.

In a similar experiment at the Mayo Foundation, volunteers were given a diet containing the amount of vitamin BI found in surveys to be that consumed by the general population of our country (0.22 mg. per 1,000 calories). Their report states,’ “The foods were exclusively those which commonly appear on the American table.” The diet consisted of white bread, beef, corn flakes, potatoes, polished rice, sugar, skim milk, cheese, butter, gelatin, egg white, canned fruits and vegetables, cocoa and coffee. To make sure the diet was otherwise adequate, these persons were given brewers’ yeast to supply the vitamins of the B group but with the vitamin BI destroyed by heat. The diet was supplemented with iron, calcium, and phosphorus and with cod-liver oil to furnish vitamins A and D. Such a diet, therefore, was superior to that eaten by millions of Americans.

All of the volunteers showed personality changes. They became irritable, quarrelsome, unco-operative, inefficient, forgetful, mentally sluggish, and depressed. (Do they sound like anybody you know?) These symptoms gradually became more exaggerated. In time the volunteers developed extreme fatigue, sleeplessness, constipation, and sensitiveness to noise; their hands and feet frequently became numb. They developed low blood pressure, anemia of moderate severity, and low basal metabolic rate (see p. 13). They suffered from heart palpitation and shortness of breath; electrocardiograms showed that their hearts were abnormal and, in several cases, enlarged. Their capacity to work, measured by an exercising machine, fell progressively as the diet continued; all symptoms were made more severe both by exercising and by cold weather. In time, they became unable to work because of exhaustion. Pain (neuritis) developed in the calves of their legs. It was found that they had little hydrochloric acid in their stomachs, and in some cases this valuable acid was completely absent. By the twenty-first week, they experienced such severe headaches, nausea, and vomiting that the experiment had to be stopped.

Vitamin B1 was then given; within a few hours the volunteers became cheerful, the fatigue left them, and they” reported a feeling of mental alertness and unusual well-being associated with marked stamina and enterprise. Other symptoms disappeared more slowly. The flow of hydrochloric acid became normal in 12 days; their hearts in 15 days.

When volunteers have stayed on diets lacking vitamin B2, the skin of the nose, chin, and forehead has taken on an oily appearance; tiny fatty deposits, like whiteheads, have accumulated under the skin. Cracks and fissures, like those formed at the corners of the mouth, have sometimes appeared in the corners of the eyelids; the lashes may stick together with an oily secretion, particularly on waking in the morning. Cracks and oily scabs may form at the base of the nose. I have rarely seen these symptoms or perhaps have failed to recognize them.

Such widely different animals as dogs, ducks, rats, chickens, monkeys, geese, and even fish, when put on diets lacking vitamin B2, develop cataracts. If the vitamin is given early enough, the cataracts disappear. When the deficiency is allowed to progress until it becomes severe, however, the damage can be arrested but not repaired. Blindness results if no vitamin is given. Whether or not an undersupply of vitamin B2 causes cataract in humans is controversial. Dr. Sydenstricker of the University of Alabama Medical School studied cataracts and opacities in the eyes of persons showing symptoms of multiple vitamin-B deficiency. When vitamin B2 was given in generous amounts together with an adequate diet, the eyes became normal, usually in about two weeks.

Bloodshot eyes and lip and tongue. abnormalities, characteristic of vitamin-B2 deficiency, have been produced in persons deficient in anyone of several amino acids or in vitamin Be. Animals lacking any one of these nutrients develop cataracts. These conditions can be corrected by supplying, not vitamin B2, but the missing nutrient. At first these facts were puzzling indeed. It must be remembered, however, that vitamin B2 in itself is of no importance; it is merely part of the structure of a number of enzymes. These same enzymes are largely protein made of essential amino acids, the lack of anyone of which can limit their production. It is now known that vitamin B6 is necessary to help combine the amino acids into the protein part of these enzymes. The reason symptoms usually disappear when vitamin Bs is given is that this vitamin is more often lacking than is adequate protein; vitamin B6 is usually given with the vitamin Bs. Conversely, if the symptoms do not disappear after vitamin Bs is made adequate, deficiencies of protein and/or vitamin B6 should be suspected. The deficiency symptoms are caused by a lack of enzymes rather than of any single nutrient. Such is the intricate relationship of many nutrients in the body and of multiple overlapping deficiencies. Milk or yogurt, supplying vitamin Bs, also furnishes vitamin B6 and essential amino acids; the yogurt offers protein in predigested form and a “factory” of hardworking bacteria willing to produce B vitamins for future needs.

I have had many persons report that, after their nutrition was improved, their glasses seemed no longer suited to their needs. On going to an oculist, they have been told that their eyes were much stronger than formerly. Such an improvement can be brought about only by a completely adequate diet, although vitamin Bs undoubtedly plays an important role. Good nutrition, however, cannot correct conditions for which glasses are needed.

Among elderly persons visual difficulties caused by multiple nutritional deficiencies are almost the rule rather than the exception. In all probability, such deficiencies are often responsible for failing vision so frequently accepted as .an inevitable part of growing older. I gave a series of lectures at a Women’s Club where most of the audience consisted of women sixty to eighty years old. On several occasions I tried without success to find one person in the audience who did not show symptoms of vitamin-Be deficiency. In this group was a sweet old lady of eighty whom I shall remember; her lower eyelids were so swollen that there appeared to be a half teaspoon of tears poised on each. She had given up reading, sewing, movies, and even television. Only two days after she improved her diet, she could read the newspaper. Later her delight at being able to sew for her grandchildren was touching.

It is important to realize that eyes can be improved during the later years when many activities are denied elderly persons. Under no circumstances should dim vision be accepted without making every effort to keep the nutrition adequate. Years ago Dr. Spies made a study of children whose families were too poor to buy milk. He found marked “oldage” symptoms including watery and burning eyes and failing vision which cleared quickly when the nutrition was made adequate and milk was supplied. The worst case I have seen was that of a three-year-old who had been given only soy milk. These visual symptoms are usually corrected in young and old alike by an increased intake of yogurt and/or milk, yeast, and liver. In cases of severely bloodshot eyes, it may be wise to ask your physician about taking vitamin B2 temporarily. Milk sugar, or lactose, appears to increase the need for vitamin B2 unless fat is adequate in the diet (p. 45). If a fat-free diet must be adhered to, the use of powdered milk and especially powdered whey should be restricted, particularly when symptoms of a vitamin-Be deficiency occur.

The signs of multiple nutritional deficiencies, perhaps most often caused by lack of vitamin B2, should not be taken lightly. The woman who may be proud of such high color that she need not wear rouge would be wise to inspect herself carefully in the mirror. Probably she should improve her diet with all possible speed.

Vitamins B1, B2, and niacin have long been made synthetically and are the cheap B vitamins. Liver is the richest natural source of vitamin B2, or riboflavin; yeast runs a close second. Since these foods are rarely eaten, for all practical purposes milk is the most reliable source. This vitamin is found in leafy vegetables but can be absorbed only after they are cooked; it is not available from salads.

According to many authorities, a lack of vitamin B2 is the most widespread deficiency in America. Dr. Henry Borsook, studying workers in defense plants during World War II, found approximately 60 per cent showing advanced deficiency symptoms. It has been my experience that symptoms of this deficiency are to be found in almost every person who drinks less than one quart of milk a day.

The symptoms of vitamin-Be deficiency are fairly well understood; studies have been made of human volunteers living on diets adequate in all nutrients except this vitamin. The most universal sign is a magenta or purplish tongue, caused by stagnant blood held in the taste buds. Changes in the lips, however, usually occur earlier, the lower lip apparently being affected first. Perpendicular lines or tiny wrinkles may be seen; later these disappear, and the lip becomes crinkled and rough, often feeling as if it were chapped; tiny Hakes of skin may peel from it. All too often these symptoms can be seen merely by studying yourself in the mirror.

When the deficiency becomes acute, the corners of the mouth split or crack. These cracks do not heal readily and repeatedly break open; although they do not bleed, they become quite sore. They may extend half an inch into the outer cheek and an equal length or more on the inside of the mouth. These cracks appear or disappear depending upon the vitamin-Be intake.

In case the deficiency continues, wrinkles appear radiating from the mouth in much the same direction as is seen when the mouth is puckered for whistling. These wrinkles, which I call whistle marks, may extend half way to the nose. Lipstick gradually creeps up these whistle marks, giving an irregular and ridiculous appearance. Since most of us are vain enough to smile pleasantly at ourselves in the mirror, whistle marks are rarely noticed by the individual who has them; they are visible only when the face is relaxed.

If the deficiency is slight but of long standing, cracks may never appear; instead, the upper lip becomes progressively smaller. In many cases, the upper lip practically disappears. ‘Women with this symptom usually wear their lipstick far above their upper-lip line. The disappearance of the upper lip is common among elderly persons, who invariably blame their false teeth; persons having their own teeth, however, show the same symptoms. I see whistle marks and atrophied upper lips daily, often in persons thirty years of age or even younger.

An early symptom of vitamin-Be deficiency is that the eyes become sensitive to light; like persons deficient in vitamin A, such people usually feel more comfortable wearing dark glasses. If the nutrition is adequate in vitamins A and E, a person’s night vision will be normal, but his vision in dim light or twilight is faulty; he feels confused in dim light. If he comes into a room where others are enjoying the twilight, he usually demands irritably, “Why are you sitting in the dark?” and quickly snaps on the lights. Even though his eyes are sensitive to bright light, he cannot work or write with ease unless the lights are bright. As the deficiency becomes more severe, his eyes may water, the lids may itch and burn and he occasionally feels as if grains of sand are under the lids or particles of dirt are in his eyes. You can notice such a person frequently rubbing or wiping his eyes.

If the eyes are severely strained, they become bloodshot.

Enzymes containing vitamin B2 normally combine with oxygen from the air to supply the cells in the cornea, or tissue covering the eye; when this vitamin is inadequate, the body forms tiny blood vessels in this tissue, thus supplying it with oxygen. After these blood vessels are formed, the blood will drain from them when vitamin B2 is adequate and they are not needed, but the blood vessels remain; hence blood can . quickly enter them again whenever a deficiency recurs. The person whose eyes have once been bloodshot, therefore, often suffers quick recurrences whenever his diet becomes deficient.

A condition similar to bloodshot eyes frequently occurs in the skin of the cheeks. Tiny blood vessels are formed in the outer layers of skin which normally would not contain blood vessels. Such blood vessels can be seen on close examination with the naked eye, and even at a distance they give the cheeks a high color. This abnormal coloring, called acne rosacea, may occur high in the cheeks under the eyes, over the lower jaw or far back on the face in the lateral line near the ears. In severe cases, most often seen in alcoholics, these blood vessels form in the skin over the nose and sometimes the entire face.

These symptoms disappear when the nutrition is completely adequate, the length of time depending upon the severity of the condition, the amount of vitamins given, and the completeness of absorption. I have seen severely bloodshot eyes appear normal again in 24 hours. The tiny blood vessels in the cheeks usually become invisible within two to four weeks after dietary improvement, but they are sometimes maddeningly persistent.

It mazy not be mere happenstance that one person is gay and another grumpy. The grumpy one may have far more to be happy about but may be unable to enjoy his potential happiness because of a niacin deficiency. This B vitamin is variously known as niacin, niacin amide, or nicotinic acid. Pellagra, which has caused the death of thousands of Americans, results predominantly from a lack of this vitamin; hence severe deficiencies have been thoroughly studied. Far less is known about mild deficiencies, but there are telltale signs which are indicative.

The sources of niacin are not only yeast, liver, and wheat germ but also fish and kidneys, which are particularly rich. Nuts and eggs are fair sources. Aside from these foods, niacin is difficult to obtain. None occurs in milk, for example. For this reason, niacin deficiency is extremely common in babies and may cause severe diarrhea. Frequent diaper changing can often stop within a day after niacin amide is given. A wise mother saves herself a great deal of work merely by adding yeast or desiccated liver to her baby’s formula or drinking water.

When volunteers have stayed on a diet adequate in all respects except in niacin, the first symptoms noticeable are psychological. The entire personality changes. Persons who were formerly strong, courageous, forward-looking, and unafraid of life become cowardly, apprehensive, suspicious, and mentally confused. They worry excessively and are emotionally unstable, moody, forgetful, and unco-operative. Such persons become depressed; their depression may range from “blue Mondays” to the point where they feel it is impossible to carryon. They lose their ability to keep going when the going is tough. In fact the effect of this vitamin upon personality caused it to be labeled for a time the “morale” vitamin. Fortunately these experimentally produced unpleasant personalities can be eliminated within a few hours after niacin is added to the diet, but such is not the case outside the laboratory. Whenever I hear of the petty politics not unusual in P.T.A.’s and Women’s Clubs, I long to pass a bottle of niacin amide tablets. Would you care to offer some to your neighbors or in-laws?

In a mild niacin deficiency the tongue is usually “strawberry tipped,” or bright red at the tip. Even in social conversations these days I find myself watching tongues; if I am stuck with a person lacking charm, a strawberry tip makes me somewhat more tolerant and understanding. Farther back, the tongue is most often coated with bacterial growth. In fact, a coated tongue probably indicates a mild niacin deficiency. The tongue may be so covered with bacterial debris that the mouth has an unpleasant odor. The mouth often becomes sore, the gums are swollen and painful, and the inside of the cheeks is red and raw. Canker sores and small ulcers may appear on the cheeks or under the tongue, but these ulcers may be so covered with the coating of bacteria that they cannot be seen. Such a person is susceptible to Vincent’s disease, or trench mouth. In a study made in a Boston hospital, it was found that trench mouth was cleared up more quickly by niacin amide than by any other of several dozen treatments tried. Although this infection was formerly considered to be quite contagious, no infection resulted when attempts were made to transmit it to mouths of persons whose diets were adequate.

Even in a mild deficiency of niacin, abnormalities occur in the digestive tract. Too small amounts of digestive juices are secreted; the stomach fails to produce enough hydrochloric acid or perhaps can secrete none at all. Many digestive disturbances result (p. 65). Since the lack of hydrochloric acid prevents the absorption of calcium and iron, nervous disorders and anemia often occur. Whenever the digestion is faulty, food cannot be well absorbed; putrefactive intestinal bacteria live on the undigested food, causing gas and flatulence. Constipation is most often an early symptom, but as the deficiency becomes more severe, constipation and diarrhea may alternate; eventually only diarrhea occurs and may become extremely severe. A niacin deficiency can thus cause psychological disturbances and diarrhea simultaneously; the diarrhea is usually thought of as a result of the psychological upset itself, which indeed it may be. The conclusion that nutrition plays no part in these disturbances, however, is not justified until the diet is made completely adequate and every possible step is taken to assure complete absorption.

In a more advanced deficiency, the entire intestinal tract becomes sore and inflamed; such inflammation may be most noticeable in the rectum and vagina and around the anus. Persons undersupplied with niacin often suffer from a feeling of strain and tension, insomnia, dizziness, nervousness, irritability, and frequently recurring headaches. When niacin in the form of yeast is given to such persons, their intestinal inflammation clears, and digestion is normalized; they become noticeably relaxed, and their sleeping habits improve within a few days.

1£ the deficiency is allowed to become more severe, mental dullness, depression, hostility, or suspicion may grow in intensity. Sometimes such a person feels like crying frequently without knowing what he is crying about. In pellagra, these symptoms gradually give way to actual violence, disorientation, and delusions, such persons often becoming violently insane. In one of the mental hospitals in the South, every incoming patient must eat a completely adequate diet for two months before being put into a general ward. During this time a large per cent of the patients recover completely and are sent home.

Niacin is a vitamin which can be made in the body from the amino acid, tryptophane, provided adequate protein and other B vitamins are generously supplied. It is known that an enzyme containing vitamin B6 (deaminase) is necessary for the conversion of tryptophane to niacin. Babies suffering from severe nutritional diarrhea, for example, are usually tiny ones who can drink little milk, whose formulas are mostly sugar and water, and/or who are given no source of vitamin B6. The reason thousands of persons in our Southern states have died from pellagra is that the diet of the poorer people has been and still is notoriously deficient in adequate protein as well as B vitamins. Cornmeal, their principal food, lacks tryptophane.

Brewers’ yeast has been used successfully in treating pellagra since the early 1920’s; often lh cup or more is given daily. Few persons, regardless of how healthy they consider themselves, can take this amount of yeast without noticing a marked pickup in both cheerfulness and well-being. If already deficient in the B vitamins, however, they will probably blow up with gas.

The fact that food cannot be efficiently digested when a niacin deficiency has existed means that recovery is usually slow. Yogurt, which supplies valuable acid, hard-working bacteria, and predigested protein, is probably the best food to take in large amounts at first. Yeast, liver, and other sources of niacin should be added gradually.
There is great personal value in keeping the diet adequate in niacin. No one enjoys irritable, unpleasant persons; we probably dislike ourselves even more when we are irritable and unpleasant. Conversely, there is great satisfaction in the buoyant feeling of “Come what may, I can take it.”

Cases of epilepsy are sometimes equally spectacular. A few months ago I first saw a delightful little boy of five who had epileptic seizures daily and, although he was being given large doses of barbiturates and dilanton, it seemed impossible for him to relax a single moment. Now that his diet contains vitamin B6 and the natural sources of these vitamins, he is amazingly calm and has had few seizures despite the fact that the drugs were discontinued.

The relief to persons who have nervous tics or tremors is so dramatic that it is tempting to write dozens of case histories. For example, I was giving a lecture series recently where a woman, sitting in the front row, suffered from a tic which caused her mouth to draw up, her cheek to contract, and one eye to wink. To the next lecture I brought vitamin B6 and asked her if she would take it; she did, and by the time the lecture was over, the tic had stopped; it has not returned. Late one afternoon a girl of seven was brought to me who winked both eyes every few seconds, her shoulders simultaneously jerking forward in a convulsive movement. This child had been thus afflicted for two years. I gave her 150 milligrams of vitamin Bs immediately and asked her to eat nothing except foods rich in the B vitamins for a few days. The mother phoned at two o’clock the following day to say that the convulsive movements had stopped; the tic has not returned. Another case was that of an extremely alert high-school boy who had convulsive movements of his entire face, his eyes simultaneously rolling upward. His mother told me the condition had been noticed at birth, even in the delivery room. In spite of such a history, the condition was relieved when vitamin B6 was given together with an adequate diet.

Cases in which tremors have been almost instantly relieved are equally dramatic: the high-school girl who was unable to write or type and, although popular, refused to date for fear the boys would notice her trembling hands; a photographer who was giving up his livelihood because he could no longer hold a camera without a tripod; an engineer who felt he must seek a new occupation because his hands were too unsteady for drafting; a man of seventy-six who told me his hands had trembled for 40 years; the accountant who, every time I saw him, brought samples of his work before and after taking vitamin B6; the minister whose lower lip and chin trembled to the extent that it distracted his congregation. Each of these persons was immediately relieved by an adequate diet supplemented with vitamin B6.

Never shall I forget a little woman of seventy-eight who had been bedridden for three years with paralysis agitans. After taking only brewers’ yeast as a source of this vitamin, she walked into my office still shaking in every muscle, her step faltering, but a glow on her face as though she were walking as rhythmically as a dancer. In every case these persons tell of feeling tremendously relaxed and of experiencing a sense of peace and tranquillity together with soundness of sleep such as they had not enjoyed in years. Medical journals have often reported failure in treating such cases with vitamin Btl; it is my experience that results cannot be expected unless generous amounts of all the B vitamins are given, together with a completely adequate diet.

Such cases are fortunately rare. Almost every person, however, experiences tension, nervousness, and irritability; a large per cent of our population is unable to sleep without drugs. I strongly suspect that these abnormalities are, in part at least, subtle deficiencies of vitamin Btl. Surely a nutrient which can sometimes bring relief to such serious conditions as epilepsy, paralysis agitans, and chorea must play an important role in maintaining nerve and muscular relaxation. The extent of that importance is still to be learned.

Another B vitamin, pantothenic acid, undoubtedly plays an important role in maintaining health, although deficiencies in humans are not recognized, and little is known about the quantity needed daily.

When black animals are given a diet adequate except for pantothenic acid, their hair turns gray; anemia and eczema (dermatitis) develop; even though the animals are young, they have the appearance of extreme age. Autopsy frequently reveals stomach and duodenal ulcers; hemorrhage in and damage to the heart muscles; pathological changes in liver, gators a beefy, furrowed tongue indicates that a deficiency of this vitamin predominates over the lack of other B vitamins. A few studies have been made of gray-haired persons who were given this vitamin; the restoration of the natural color has sometimes occurred, but results have been inconsistent. During W orId War II, American prisoners in the Orient developed painful, burning feet; the pain became increasingly more severe toward evening and was almost unbearable after days of forced labor. When the men were liberated, American physicians gave injections of various B vitamins which brought no relief until pantothenic acid was given; the relief was then immediate and marked. This condition has been frequently reported 10 over a 50-year period and is known to be associated with multiple deficiencies of the B vitamins.

I am convinced that this symptom of pantothenic-acid deficiency is extremely common. For a time I became so enthusiastic about gardening that I spent hours daily doing hard physical work; 5 milligrams of pantothenic acid per day was then considered adequate, whereas my requirement was probably nearer 50 milligrams daily. For weeks on end my feet hurt, the pain often excruciating. A friend suggested that I was deficient in pantothenic acid, which I felt was impossible; when I took 100 milligrams of this vitamin, however, the pain magically disappeared. Since then I have found this symptom in most persons showing multiple Bvitamin deficiencies. Time and again they have reported that pain was relieved when pantothenic acid and foods naturally rich in B vitamins were obtained. Persons who stand or walk a great deal, such as dentists, postmen, or anyone doing hard physical work, often become aware of this symptom. If your feet hurt, my advice is to take pantothenic acid; your corns, calluses, and bunions may be less painful than you think.

Eczemas caused by a pantothenic-acid deficiency predominating over the lack of other B vitamins is apparently not unusual (ref. 10, P: 87). When eczemas occur in persons who complain of painful feet and have large beefy tongues, pantothenic acid taken with foods rich in all the B vitamins seems to speed recovery. Such eczemas occur first around the genitalia. In men it may cover the entire scrotum; itching is extremely severe. If the eczema becomes serious, it is usually found also on the hands, face, and ears.

Since animals deficient in pantothenic acid frequently develop duodenal ulcers and inflammation of the intestines and stomach, a study 11 was made of the completeness of digestion and absorption in humans with and without added pantothenic acid. Their diets appeared to be adequate in all the B vitamins; when pantothenic acid was given, however, it was found that digestion was improved by 51 per cent and absorption by 37 per cent. Pantothenic acid has been found to relieve the pain of neuritis which had not responded to other B vitamins; such patients also reported increased energy, an ability to think more clearly, and a marked improvement in memory.

Damage done to the outside of the adrenal glands during pantothenic-acid deficiency is thought by some investigators to be the cause of Addison’s disease. Dr. Gordon 12 points out that this disease is rapidly increasing. Addison’s disease is characterized by extreme fatigue, early aging, and dark pigmentation of the skin. In severe cases, patients have been kept alive only by injections of adrenal-cortex hormones. This disease has been considered incurable.

About a year ago a woman in her thirties consulted me because she frequently blacked out. She was suffering from Addison’s disease and looked prematurely old. Her hair was almost white, her skin wrinkled and her complexion a deep olive. She told me that prior to her illness she had been fair but that since her illness Mexicans often stopped her on the street and spoke to her in Spanish. She suffered such extreme fatigue that she had been forced to give up her work. Her physician told me that her blood sugar tests, taken repeatedly, had been no higher than 40 milligrams at any time, whereas it should be at least 90.

Since this woman’s adrenals were known to be damaged, she could be expected to produce little or no cortisone. The purpose of cortisone is to form sugar from body tissues when glucose is not supplied from other sources; blackouts occur when the blood sugar drops too low. I concluded, therefore, that the blackouts might be prevented if this woman were maintained on a diet which supplied a steady source of sugar at all times. Her diet was made extremely rich in foods supplying pantothenic acid, cholin, and other nutrients known to be needed by the adrenals. To keep the blood sugar normal, I recommended high protein and moderate fat to slow down the absorption of natural sugars.

After she began this diet, she suffered no more blackouts.

In time her fatigue was replaced by unusual energy, and her blood sugar increased to normal. I did not see her again for perhaps eight months. This time I did not recognize her. She seemed 20 years younger; her skin was fair, her wrinkles had disappeared, and her hair had regained much of its natural color.

It appears that adequate pantothenic acid can offer rewards of positive health and perhaps can help to extend youthfulness. Yet some people think that enough of all of these vitamins can be obtained from ordinary foods.

There is still much to be learned concerning the relation of cholin to the utilization of cholesterol in the body. An undersupply of this vitamin, however, appears to be responsible for dim vision resulting when arteries in the eyes become so plugged by cholesterol that circulation can no longer be normal. Circulation to the legs and feet may be so decreased by cholesterol being deposited in the blood-vessel walls that pain and leg cramps occur. In diabetics, where a high-fat diet without cholin or any good source of B vitamins may be adhered to for years, cholesterol deposits may shut off circulation to the legs so completely that gangrene and death occur. “Senile softening of the brain” is probably the result of decreased circulation caused by cholesterol deposits in the blood vessels in the brain. Studies have shown that men put on high-fat diets (unintentionally lacking in B vitamins) because of diabetes, stomach ulcers, or a desire to gain weight 1 often develop fatal coronary occlusion or thrombosis in so short a time as three months; some of the men studied were only thirty-five years old. Persons kept on high-fat diets because of diabetes have been reported dying from atherosclerosis when as young as eighteen years of age. Atherosclerosis, therefore, is not a disease of the aged only. Cirrhosis of the liver in humans, or so-called fatty degeneration of the liver, has been treated successfully with cholin. This disease is also becoming increasingly common 8 as our national diet becomes increasingly deficient in cholin.

The assumption is that we get all the vitamin B6 we need from our diets too. Only recently have vitamin-B, deficiencies been produced in humans.” Hospital patients, given a diet adequate except for vitamin B6, developed mental depression, sore mouths, lips, and tongues and, in time, insomnia, extreme weakness, nervousness, dizziness, nausea, and vomiting. The most striking abnormality, however, ‘was eczema (seborrheic dermatitis) which appeared first in the scalp and the eyebrows, around the nose, and behind the ears. One patient, already suffering from eczema, rapidly became worse. When vitamin B6 was given these patients, their condition quickly became normal. The investigators were then surprised to discover that similar eczemas had appeared in other patients during their hospitalization, while they were eating the “adequate” hospital diet. Since vitamin B6 is known to be part of enzymes necessary for the utilization of both fat and protein, these investigators suggest that eczema appears because the oil glands of the skin cannot function normally without the vitamin.

When experimental animals have been kept on diets adequate except for vitamin B6, eczema does not occur readily unless the diet is also deficient in linoleic acid. However, the animals do develop anemia, extreme irritability, nervousness and insomnia; they often have convulsions not unlike epilepsy. Many animals develop tremors and have difficulty in walking; if the diet is not improved, they eventually become paralyzed. When vitamin B6 is given early enough, health is regained; if not, nerve damage occurs, and the tremors, convulsions, or paralysis cannot be corrected. On autopsy, the heart muscles of these animals are found to be severely damaged.

Dr. Tom D. Spies studied a group of patients who had been given vitamins Bi, B2, and niacin but still complained of extreme nervousness, weakness, excitability, insomnia, irritability, and difficulty in walking. The relief was dramatic when vitamin B6 was given. The patients felt unusually relaxed; they slept soundly; their strength so increased that several, formerly unable to walk more than a few steps, walked a mile or more the day the vitamin was given. Persons with anemia which had not responded to iron, adequate protein, or the B vitamins already given showed marked improvement in five days.

Since animals develop tremors and epileptic-like seizures, physicians have given vitamin B6 in the treatment of paralysis agitans (popularly called palsy), epilepsy, and chorea, or St. Vitus’ dance. Excellent results have been obtained in some cases, despite the fact that epilepsy and paralysis agitans have been considered incurable. In other cases, especially when vitamin Be has been given without a dependable source of the remaining B vitamins, the results have been disappointing. Chorea, however, has been completely cured, the seizures of epilepsy have decreased, and palsy has been corrected except in cases where irreparable nerve damage appears already to have been done.

I have yet to see eczema which has not cleared up when the diet was made adequate and especially rich in linoleic acid and all of the B vitamins. A most spectacular case was that of a man fifty-three years old who had suffered from eczema since he was twenty. His entire body was covered; the eczema was so sore and weepy that, on the extremely hot day when I first saw him, he not only wore long underwear, but his arms and legs were wrapped in yards of gauze, like a mummy. I planned an adequate diet for him and asked him to take a heaping tablespoon of yeast with each meal and between meals. Two weeks later, his skin had completely cleared; in the 10 years since that time, the eczema has not returned.

Somewhat more is known about cholin, vitamin B6 (pyridoxin), and pantothenic acid than of the B vitamins already discussed; compared with what must still be learned, however, little is known about them. The best sources again are liver, yeast, wheat germ, and rice polish.

Cholin is another B vitamin found particularly in liver; wheat germ is also rich and contains more cholin than does yeast. Brains, kidneys, and egg yolks are excellent sources, but the amount per egg is small. A similar substance, betaine, found especially in sugar beets, liver, wheat germ, and certain fish, can pinch-hit for cholin in the body, but most people obtain even less betaine than cholin. The amino acid, methionine, can be changed into cholin in the body; a deficiency of cholin, therefore, can be produced when too little protein is eaten.

Cholin is needed to help the body utilize fat. If health is to be maintained, the more fat eaten, the larger must be the intake of cholin. Animals lacking cholin have abnormally large deposits of fat in their livers. This vitamin is thought to be part of an enzyme which combines fat and phosphorus, a combination necessary before fat can be carried into the tissues. Even a small accumulation of liver fat prevents the liver from functioning normally. For example, the vitamins which are usually stored there can no longer be stored efficiently, and less glycogen can be held in the liver cells.

If a cholin deficiency becomes severe, the liver cells degenerate, and clumps of dead cells are found; the muscles of the heart are damaged; hemorrhages are found in the kidneys and throughout the heart tissues; severe hemorrhages occur in the adrenal glands; and stomach ulcers are frequently apparent.

In young animals, a cholin deficiency causes particularly severe hemorrhages to occur in the kidneys; the tiny tubes ( tubules), which carry urine, degenerate and become filled with “casts,” or dead cells; nephritis and nephrosis can thus be produced. Dr. Charles H. Best of the University of Toronto Medical School has shown that young animals, kept on a diet low in cholin, later developed high blood pressure; the height of the blood pressure is proportionate to the severity and duration of the early cholin deficiency.

Cholin appears to play some role in the transportation or utilization of cholesterol in the body. When certain experimental animals, particularly rabbits, are put on a diet lacking cholin, large amounts of cholesterol are held in the walls of the arteries, causing a condition apparently analogous to that spoken of as hardening of the arteries, or arteriosclerosis. Atherosclerosis is the medical term for this abnormality. Experimental atherosclerosis produced in animals can be prevented or cured by giving either cholin or lecithin 1 separated from soybean oil. Lecithin contains cholin and essential fatty acids and is produced by the liver, provided these raw materials are supplied.

Heart attacks known as coronary occlusion and coronary thrombosis are the result of atherosclerosis. This disease is not only the first cause of death in America but also the first cause of sickness; it is responsible for more invalids than any other illness. Autopsies 2 of hundreds of men indicate that the American male has advanced atherosclerosis by the age of forty-nine, that the condition becomes progressively worse up to the age of fifty-eight or sixty and then appears to be stationary or to decrease in severity. It is also known that the cholin requirements decrease with age because of decreased activity.

Dr. Lester M. Morrison,” working at the Los Angeles County Hospital, has studied 600 patients who survived attacks of coronary occlusion or coronary thrombosis. Alternate patients were given cholin but no medication; their diets were inadequate in many respects. Later they were allowed to work if they chose. The other patients were given standard medical treatment, such as phenobarbital, digitalis, nitroglycerin, and, when it seemed expedient, bed rest. Patients given cholin reported a feeling of well-being and general improvement in health; many returned to work. The amount of cholesterol in their blood decreased. Among the cholin group there were fewer recurring heart attacks and fewer deaths than in the medical-care group.

Dr. Morrison,’ realizing that the action of all the B vitamins is synergistic, or “co-operative,” extended his studies by giving the cheaper and less toxic betaine together with cholin, inositol, vitamin B12, and a liver concentrate supplying all the B vitamins. His results were far better than when cholin was given alone. Patients reported a marked decrease or absence of shortness of breath and pain around the heart and an increase in sex interest, morale, and general well-being. The patients who had been invalids before treatment returned to work or to their normal activities, many saying they had “never felt better in their lives.” Blood cholesterols dropped.

Few patients suffered recurring heart attacks. In spite of the fact that many of these patients were elderly, deaths were reduced to one-third the number expected for the age groups studied.

A later report tells of 40 patients suffering from coronary thrombosis, their average age fifty-six years, who were given the B vitamins and compared with a control group receiving standard medical care. Not only did they experience great physical improvement, but no deaths occurred during a year’s observation; deaths took 25 per cent of the group which Dr. Morrison describes as receiving “treatment by neglect,” the method “currently in use by various fatalistic physicians.”

Medical treatment for atherosclerosis has now run the gamut of diets containing no eggs, no liver, almost no fat, and no cholesterol to diets supplying all the calories from vegetable oils 6 (the latter so unappetizing that they had to be given by stomach tube), high in liver, eggs, and even cholesterol. In a study at the Alameda County Hospital, patients were given fat from egg yolks equivalent to 36 eggs daily, and in no case did the blood cholesterol rise above normal; this fat supplied cholin, lecithin, and cholesterol. Each form of treatment has resulted in a drop in blood cholesterol but not always in a drop in death rate. It is to be hoped that diets adequate in every respect, especially in all the B vitamins, lecithin, and linoleic acid, will soon be recommended to persons suffering from this form of heart disease.

Para amino benzoic acid, or PABA, is another B vitamin about which little is known. Deficiencies recognizable in humans have resulted only from the administration of sulfanilamide. This drug prevented PABA from being used as an enzyme; the deficiency thus produced causes extreme fatigue, anemia and a skin rash, or eczema. These PABA-deficiency symptoms were often so severe that the use of sulfanilamide was discontinued in favor of less toxic antibiotics.  A man whom I have seen over a period 1)£ 10 years has suffered from recurring eczema which disappears whenever his diet is adequate. At one time he was given sulfanilamide; a day later eczema covered his entire body and was so severe that his ears were swollen to twice their normal thickness. The condition cleared like magic when he took PABA. I have, therefore, often recommended this vitamin for eczemas similar to his. The number of cases which have shown improvement leads me to believe that deficiencies of this vitamin are not unusual.  PABA has been publicized as an antigray-hair vitamin; black animals lacking it become gray. Dr. Benjamin Sieve studied the hair of persons given PABA; some hair was restored to natural color in 70 per cent of the cases. Several women who had wanted children for years conceived after this vitamin was added to their diets. Dr. Sieve also reported that persons whose skin lacked pigmentation developed normal skin color and that heavier spots of pigmentation faded during the experiment. To date these findings have not been confirmed, and further research is needed.  Deficiencies of at least four B vitamins, PABA, biotin, folic acid, and pantothenic acid, appear to affect hair color. One scientist who had conducted years 9f research on these B vitamins and has repeatedly produced gray hair in dark mice, rats, silver faxes, and black dogs even states that all gray hair is probably a symptom of multiple nutritional deficiencies.  I have never seen the color of any person’s hair restored by the taking of synthetic B vitamins. I have, however, seen a dozen or more cases of persons whose hair color has been remarkably restored after they began to take adequate diets unusually rich in these vitamins. One was a fairly young woman whose hair was white; she became so enthusiastic in applying sound nutrition that a year later she had almost no gray hair. Recently I saw a man of 76 whose hair had been white for years; after he followed a good nutrition program for a decade, his hair is black. An elderly woman told me not long ago that her hair had changed so much that her friends accused her of dyeing it. The most remarkable restoration I have seen was in a man of 65 who had thick white hair. His arms were covered with a heavy growth of white hair. After only three weeks we could not find one white hair on his arms, and the hair on his head was salt and pepper color.  

This man, however, soon reverted to faulty eating habits, and his hair is again white.

 Little is still known about two other B vitamins, folic acid and vitamin B12; both help to promote general health and to prevent certain types of anemia. Judging from experimental work with black animals, a deficiency of folic acid appears to be the major cause of the graying of hair. At the present writing, however, no studies have been made with people. Folic acid is produced by intestinal bacteria, which presumably supply all the folic acid we need, whereas vitamin B12 comes largely from foods. That either source is adequate for all persons is only an assumption. Liver is the richest source of both vitamins, but yeast, wheat germ and kidney are also good sources. Although folic acid is found in green leaves, 97 per cent is destroyed by heat when vegetables are cooked. Fortunately, it is retained when yeast, liver, and kidney are heated.  When deficiencies of these vitamins predominate, the tongue becomes bright red around the edges; if the deficiency is chronic, the taste buds largely disappear, making the tongue smooth, clean, and shiny. The entire mouth may become extremely sore. Changes take place in the bone marrow where the red corpuscles are produced. The lack of folic acid results in a certain type of anemia (macrocytic anemia), which is fairly widespread and not correctable by iron. The anemias often associated with pregnancy, sprue, celiac disease, and pellagra clear up when this vitamin is given, as do the blood abnormalities of pernicious anemia.  A subtle lack of folic acid prevents the stomach from producing adequate hydrochloric acid; in a severe deficiency, none of this valuable acid can be produced. Without hydrochloric acid, protein digestion cannot occur in the stomach; minerals such as iron and calcium do not dissolve well enough to be absorbed; and the vitamins which are acids are largely’ destroyed before reaching the blood. Since this acid protects the body by destroying harmful bacteria obtained through food, a person lacking folic acid is susceptible to intestinal parasites and attacks of food poisoning. When folic acid is given to persons lacking it, the tongue and mouth heal, and the bone marrow becomes normal; except in pernicious anemia, the production of a stomach acid is resumed.  

Persons suffering from pernicious anemia have damaged nerve cells, especially in the spinal chord. Such damage causes difficulty in walking, a spastic or jerky gait, swaying of the body, muscular spasms, lack of co-ordination, and loss of a sense of balance, position, and elevation. These symp~ toms can be corrected by giving vitamin B12, but if folic acid is given alone, such conditions become markedly worse.

 Children whose growth is stunted often grow rapidly after vitamin B12 is given them, a fact indicating that this deficiency exists and may be widespread. Almost 30 years ago Dr. Agnes Fay Morgan of the University of California showed that giving children two tablespoons of wheat germ daily in the form of a luncheon roll brought about superior growth, fewer behavior problems, and improved mental alertness. These 30-year-old facts can hardly be called findings hot off the medical griddle, although the wide publicity given to the growth-promoting quality of vitamin B12 would indicate as much. Recently a mother told me that her fifteenyear-old son, whose growth had been stunted, not only showed a rapid spurt of growth after taking three tablespoons of yeast daily but had raised his grades from a D to almost a straight A average.  Since an undersupply of vitamin B12 causes a lack of muscular co-ordination, I often wonder if a deficiency of this vitamin is responsible for the awkwardness and jerkiness one sees frequently in children. Last year a teacher and I were watching a group of six-year-olds skipping rope; we were discussing a child whose nutrition was markedly superior to the others. “Watch him as he runs,” the teacher remarked.  “He’s as graceful as a deer.” By comparison, the other children showed a pitiful lack of muscular co-ordination. Particularly at adolescence, when vitamin requirements are tremendously increased by rapid growth, awkwardness becomes a problem embarrassing to parents and children alike. I suspect an undersupply of vitamin B12 is partly the cause. Only future research will show how valuable these vitamins actually are.

Through the years I have been consulted by persons so depressed that they were panicky; sometimes they could think of little except a desire to destroy themselves. On their records I have often written, “Problem definitely psychological.” Later they came in so cheerful that I was amazed and puzzled, wondering what had brought about such a change. Since biotin deficiencies have been produced in volunteers, I ask panicky persons if they ever wished to commit suicide. The stories I have been told are so incredible that I hesitate to write them. A minister’s wife cried heartbrokenly, repeating again and again, “I’m a Christian, Miss Davis. I would never take my life,” but her words showed her underlying fear. One young girl had a compulsion to commit suicide so great that she felt safe only around people; since she was ashamed to discuss her problem with her family or friends, she spent most of her time in a cafeteria sitting at tables with strangers. Another was a father who sobbed out his fear that he would lull not only himself but his three children. Still another was a wealthy woman who kept crying, “Why? Why? Why?” Between sobs she explained that she had a marvelous husband, wonderful children, and everything to live for.

Each of these persons and several not unlike them I have known for at least three years. Although most had suffered from depression for months, in no case did the depression return after their nutrition was improved. Their histories, however, show several interesting facts. In most cases they had been given antibiotics which had destroyed valuable intestinal bacteria, perhaps their only source of biotin. Several were taking mixed vitamin preparations; the other B vitamins may have increased their need for biotin, which was not supplied. Some were taking raw eggs beaten into orange juice, thus preventing biotin from being absorbed. Multiple nutritional deficiencies they certainly had, but panic was their outstanding symptom. Improved nutrition apparently gave them strength to cope with their psychological problems. It is said that there are no biotin deficiencies in America; I wonder every time I read of a suicide in the newspaper.

Inositol is another B vitamin about which too little is known. The assumption is that we get all of this vitamin we need from food. In addition to liver, yeast, and wheat germ, its sources are whole-wheat bread, oatmeal, and corn. The richest source is blacks trap molasses. This vitamin is a byproduct of cornstarch manufacture; tons of it are added to the gray paint used by our Navy. Since inositol is not cheap, this paint may account for part of our high taxes.

When animals are put on a diet lacking inositol, their hair falls out. If the vitamin is then added to the diet, their hair grows in again. Male animals lose their hair twice as quickly as do females, indicating that the male requirement is higher than that of the female. A deficiency also causes constipation, eczema (dermatitis) and abnormalities of the eyes. Inositol is particularly concentrated in the lens of the human eye and in the heart muscles, perhaps indicating that it plays some role in normal vision and in heart action. A hundred times more inositol than any other vitamin except niacin is found in the human body.

Dr. Gustav Martin and co-workers at the Warner Institute of Therapeutic Research studied the effects of different B vitamins on the intestinal tract. Separate vitamins were given with barium, and contractions of the stomach and intestines were studied by fluoroscope. Only inositol caused a marked increase in the movements; poor appetites became normal, and previously existing constipation was relieved. Greater activity in the intestine is known to increase absorption. Blackstrap molasses is certainly more laxative than any other food. The millions of dollars spent annually on cathartics in America may result from inositol deficiency.

A few years ago I became interested in the possibility that a lack of inositol might be one cause of baldness in men. For a time I recommended inositol together with other sources of B vitamins to all the bald men who consulted me. In almost every case they soon reported that their hair was no longer falling out. Wives or mothers particularly mentioned that, whereas loose hair had formerly covered pillows and washbasins, they now had no loose hair to clean up. In some cases new hair growth was obvious in a month. One man of forty-eight, who had been bald for years, grew hair so thick that it looked like rabbit fur; surprisingly enough, he was extremely proud of it. One white-haired man of sixty-five had a bald spot far back on his head; the entire spot filled in with black hair, and a distinguished streak of black hair in the white appeared above his forehead. One man, who had been bald since he was twenty, grew so much hair that no bald spot remained. Some of the men, however, grew not one encouraging wisp.

Loss of hair often occurs in animals deficient in anyone of several B vitamins or certain amino acids. Since I recommended for baldness a teaspoon of pure inositol daily added to a quart of tiger’s milk (p. 114) unusually rich in all these vitamins and proteins, new hair growth may have been brought about by increased amounts of nutrients other than inositol. At each meeting of the American Academy of Nutrition I am impressed that most of the doctors who have been active in the organization for years have healthy luxuriant hair, in marked contrast to the sparse strands of younger men whose diets are less adequate. Hereditary tendencies and other causes of baldness undoubtedly exist. Family albums showing our elderly forefathers with luxuriant hair growth makes me suspect, however, that baldness is becoming more common and is developing at a younger age than it did a hundred years ago.

So much is known about the B vitamins that entire volumes are written about them. If the known facts were universally applied, the improvement in world health would probably be beyond imagination. Yet knowledge of many of these vitamins is so limited that it can only be described as a state of ignorance.

This group of perhaps 20 or more vitamins is called the vitamin-B complex because it is complex. Every month or two a new substance is separated from liver, yeast, and/or wheat germ. One, pan gamic acid, spoken of by some investigators as vitamin B15, promises to be important in energy production. Another, lipoic acid, is being written about. Vitamins B13 and B14 are now reported. Others can be expected.

The last three B vitamins to be well established are variously called the anti-fatigue, antitoxic, or anti-stress vitamins. These three appear to be unnecessary under normal conditions or to be needed in such small amounts that they can be made in the body or perhaps by bacteria in the intestines. Even though a diet contains all previously known nutrients and is adequate to support health under normal conditions, it can still be inadequate during conditions of stress unless these anti-stress vitamins are supplied. Stress is anything which puts an extra load on the body. Conditions of stress are produced by drugs, chemicals, infections, surgery, noise, excessive fatigue, psychological upsets, resentments, hatreds, and. hundreds of other factors. It now appears that all nutrients are needed in larger amounts during stress than under normal circumstances.

When animals on seemingly adequate diets are submitted to stress, widespread damage occurs in their bodies. If these animals, however, are given fresh or dried liver or a crude liver concentrate, little harm is done. For example, when the strength of animals was tested by making them swim in ice water, the animals on “normal” diets could swim only three to ten minutes before drowning; animals given the same diet fortified with liver swam two hours or longer and lived to swim again.

When liver is given, the harmful effects of such stressor agents as atabrine, excessive amounts of the thyroid hormone or milk sugar, extreme heat or cold, lack of oxygen, X-rays, and various drugs have been prevented or decreased. Animals subjected to stress but not given liver often die unexpectedly, apparently of heart failure,’ although they may have all the outward appearances of good health. Liver of all varieties appears to be the richest source of the anti-stress vitamins; kidney, soybean flour, and brewers’ yeast contain some.

A number of other B vitamins have been so little studied that their distribution in foods is largely unknown, the amount needed is a mystery and, if deficiencies of them commonly occur, they are not recognized. Since the deficiencies produced experimentally are not recognized in humans, the assumption is that these vitamins are amply supplied by food or by intestinal bacteria, an assumption which I believe is not always true.

The richest source of the B vitamin, biotin, is yeast. Animals lacking this vitamin develop eczema, or dermatitis; their hair falls out; they are particularly susceptible to heart abnormalities and lung infections. If cancers are transplanted, they grow rapidly in biotin-deficient animals. Growth is extremely stunted in young animals; adults become emaciated; death comes quickly to both.

A substance in egg white, avidin, can combine with biotin in the intestinal tract and prevent it from reaching the blood. Dr. V. P. Sydenstricker of the University of Alabama studied, biotin deficiencies produced in human volunteers on adequate diets containing egg white. The first symptom noticed was mental depression. In time the subjects developed dry peeling skin, extreme fatigue, muscular pain, nausea, and distress around the heart. The mental depression became intensified to what Dr. Sydenstricker described as “panic.” All the symptoms disappeared in three to five days after biotin was added to the diet.

I know a physician, too overworked to follow nutritional research, who tells mothers to add beaten raw egg to their baby’s formula, starting at the third month. I have seen nine of these children covered with severe eczema which promptly cleared when the egg was withdrawn, and yeast and yogurt were added to the diet. The many recipes calling for uncooked egg white should be discarded. Eggs should be cooked until the white is firm, especially for persons “allergic to eggs.”

In a general way you can tell how adequate your intake of B vitamins has been by looking at your tongue.” It should be moderate in size, an even pink in color, and smooth around the edges without coating or indentations showing where it has rested against your teeth. The taste buds should be uniformly small and cover the entire surface and edges. If you can find a healthy child, you may see what the normal tongue should look like.

When the B vitamins are undersupplied, many changes take place in this organ. The first change appears to be enlargement of the buds at the front and sides of the tongue. Later these buds become small or even disappear, making the tip and sides smooth, whereas the buds farther back will progressively enlarge. These buds have a fiat appearance, like button mushrooms. As the deficiencies of these vitamins become more severe, clumps of taste buds fuse and grow together, pulling apart from other clumps and thus forming grooves or fissures. The first groove usually forms down the center of the tongue. In a severe B-vitamin deficiency, the tongue may be so cut by grooves and fissures that it looks ‘like a relief map of the Grand Canyon and the surrounding territory or a Hank steak run through a tenderizing machine.

When the deficiencies are still more severe, the taste buds literally disappear. First the tip and edges become smooth and shiny; then the buds disappear progressively from front to back. This extreme condition is found most often in elderly persons whose diets have been inadequate for years; they complain that their food has little flavor. In some cases such tongues are intensely sore. In other cases, persons having extremely abnormal tongues are surprised to find that they differ from normal.

The size of the tongue also indicates deficiencies of these vitamins. The tongue may be large, beefy, and full of water (edematous). Often such a tongue shows scallops around the edges where it has rested against the teeth. The beefy tongue is so named because it has the appearance of beef and is usually an intense deep red. On the other hand, it may become too small, or atrophied. Other tongues may have a purplish, or magenta, cast, and still others may be a brilliant red. Often the tongue shows a combination of colors with perhaps a red tip and a magenta center. The color and texture vary depending upon which B-vitamin lack is most prominent. For example, a magenta tongue (the color seen most often) indicates that a deficiency of vitamin Bs predominates over the other B-vitamin deficiencies. A beefy tongue is thought to show that pantothenic acid is particularly undersupplied. When deficiencies of vitamin B12 and folic acid are most prominent, the tongue becomes strawberry red and smooth at the tip and sides; it is often shiny and not coated. If the deficiency is predominantly the B vitamin, niacin, the tongue may be fiery red at the tip and may appear to be either too small or too large and so coated that it is fuzzy with debris. The heavy coating is caused by the growth of undesirable bacteria; it usually indicates much putrefaction in the intestine. Since valuable bacteria in the intestine produce B vitamins, such coating probably never occurs if bacteria growth is normal.

I asked a professor in medical school if he thought it wise to include a description of abnormal tongues in this book; I feared that people would worry excessively about their tongues. To my amazement he answered, “You never see them anyway. I’d omit it.” He does not see them because he does research, but I have examined hundreds of tongues and have found only three normal ones in two years. I still chuckle every time I remember an occasion when, lecturing before a small group, I was requested to examine the tongue of everyone present; not one normal tongue had come to the lecture. The group sat like so many panting collies, astonished at each other’s deficiencies. When the diet is made adequate, however, the tongue gradually becomes normal again, the recovery time depending upon the severity of the deficiency and the completeness of absorption.

Studies indicate that 60 to 100 per cent of the persons showing severe tongue changes are unable to produce sufficient amounts of hydrochloric acid in their stomachs; their output of digestive enzymes is far below normal. In such cases, digestion is so faulty that unless tablets of hydrochloric acid and digestive enzymes are taken temporarily (p. 233), much gas, flatulence, digestive disturbances, and discomfort may be experienced. In fact, if your digestion is so faulty that you have intestinal gas after you add foods rich in the B vitamins to your diet, you can be sure you have been deficient in these vitamins.

All the B vitamins dissolve in water and for this reason cannot be stored in the body. Just as a sponge can be slightly moist or dripping wet, however, so can the cells hold little or much of each B vitamin, depending on the amount offered. To maintain ideal health, the offering of B vitamins should be sufficient for each cell to take all it can use to advantage. Any B vitamins not needed are excreted in the urine.
It appears that all B vitamins work together; this cooperation is called the synergistic action of the B vitamins.

The taking of one or more B vitamins increases the need for the others not supplied, probably because anyone B vitamin alone can increase the activity of each body cell. The group in its entirety can be obtained only from such foods as liver, yeast, and wheat germ.

To discuss the deficiencies of the B vitamins separately is as unrealistic as to believe in men from Mars. Such deficiencies exist only in an experimental laboratory. A deficiency of one, however, often predominates over others. If the first symptoms of that deficiency are recognized, they can serve as a warning that unless your nutrition is improved, greater deviations from health can be expected.

The 15 or more B vitamins are so meagerly supplied in our American diet that almost every person lacks them.

Dr. Norman Jolliffe has pointed out that a few generations ago even the paupers received a diet rich in these vitamins. They were better off than the wealthiest are today.

The reasons for this drastic decrease are numerous. Formerly every bite of bread, cereal, and foods prepared from grain supplied B vitamins. Since there was no refrigeration or canning and there were few fruits and vegetables, the mainstay of the diet was breadstuffs. In 1862 machinery was invented which refined grains in such a way that most of the nutrients were discarded. Molasses, rich in certain B vitamins, was once the only sweetening. No refined foods and few sweets of any kind were available. Now the consumption of sugar has increased tremendously; all the original nutrients are discarded; it quickly destroys the appetite and greatly augments the need for certain B vitamins. Whereas no nutrients were formerly discarded, two-thirds of our calories are now supplied by foods from which the original nutrients are largely or wholly discarded. Furthermore, we lead such sedentary lives that our food intake is small compared with that of our grandparents. Seventy years ago, men consumed approximately 6,000 to 6,500 calories daily; women 4,000 to 4,500. Today the average is 2,400 to 2,800 for men and 1,800 to 2,200 for women.

The advantage of using whole-grain breads and cereals was shown during World War I when shortages caused the Danish government to forbid the milling of grains; nutrition in Denmark was so improved that during the war years the death rate fell 34 per cent. The incidence of cancer, diabetes, high blood pressure, and heart and kidney diseases dropped markedly, and evidences of positive health greatly increased. Much the same improvement occurred in England during and after World War II when grains were only slightly milled. Although the English diet was deficient in many respects, surveys showed that the national health did not suffer during this period.

Now that our breadstuffs are refined, no food rich in the B vitamins is ordinarily eaten daily. In fact, there are only four good sources of these vitamins: liver, brewers’ yeast, wheat germ, and rice polish. A few foods are high in one or two B vitamins, but to obtain our daily requirement of all of them from such foods is impossible.

A source of B vitamins perhaps more important than any other is that synthesized by valuable bacteria in the intestine; the amount from this source cannot be easily measured. Studies of B vitamins found in the blood and urine of persons on diets lacking these vitamins show that intestinal bacteria can produce large amounts of certain B vitamins, which disappear from the blood and urine if the bacteria are destroyed. For reasons not understood, other persons on a B-vitamin-deficient diet have been found to have little or none of these vitamins in their blood and urine.

It appears that these bacteria grow best on milk sugar and cannot grow unless fat is supplied them; milk-free and/or fat-free diets, therefore, may be dangerous. The taking of sulfonamides and antibiotics, such as streptomycin and aureomycin, completely destroys these valuable bacteria; symptoms of multiple B-vitamin deficiencies may quickly appear unless food which promotes the growth of desirable intestinal bacteria, such as yogurt, is eaten. This food, sometimes spoken of in America as a fad, has been eaten for centuries in countries from Turkey to Lapland, Iceland to China. A study made by Dr. Seneca 1 of the College of Physicians and Surgeons of Columbia University points out that when yogurt is eaten over a long period, no other bacteria except those from yogurt are found in the stools.

The B vitamins appear to be needed equally by every cell in the body. For example, if a well-fed animal is killed and its tissues are analyzed separately, these vitamins are found to be evenly distributed throughout the tissues. Conversely when animals are kept on a deficient diet, then killed, and separate tissues are analyzed, each tissue is uniformly deficient. Most of the other vitamins are needed more by certain tissues than by others. Dr. Roger J. Williams (ref. 1, p. 35) has pointed out that because these vitamins are needed equally by all cells, a deficiency can produce severe damage before the condition can be noticed. The damage is nevertheless real. Instead of one organ showing abnormalities, as do the eyes during a vitamin-A deficiency, the entire body degenerates into a one-hoss-shay collapse. This overall abnormality is difficult to recognize in an adult, but severely stunted growth makes it markedly noticeable in the young.

Dr. Williams also points out that only when the deficiency becomes quite severe does one group of cells show greater damage than another. For example, when a person feels below par, he automatically decreases his activity and may spend much time sleeping; thus most of his cells do less work, and their need for B vitamins decreases. The heart, however, works continuously from birth until death; even though the deficiency is already severe and every cell has been equally damaged up to this point, the first deficiency signs may now appear in the heart.

It has become increasingly clear that since the B vitamins occur together in food, no person is deficient in anyone B vitamin without being deficient in all of them. There are, however, as many degrees and variations of B-vitamin deficiencies as there are different individuals. Formerly the disease beriberi was thought to be caused by a deficiency of vitamin B1, and pellagra by lack of the B vitamin, niacin. When human volunteers have stayed on diets lacking vitamin B1 or niacin, however, neither beriberi nor pellagra has been produced. These diseases actually result from multiple deficiencies of all the B vitamins, the lack of vitamin B1 or niacin being only more prominent.

In the small intestine, both vitamin A and carotene must combine with bile salts before they can pass into the blood. If the diet is low in fat, little or no bile reaches the intestine, and 90 per cent of both carotene and vitamin A may be lost in the feces. Not all the carotene which reaches the blood is changed into vitamin A. Unless the vitamin-E intake is adequate, any vitamin A reaching the blood is destroyed, and any already stored is quickly used up. Vitamin A cannot be stored if the B vitamin, cholin, is undersupplied. When one considers all of these points, one wonders how people have obtained enough vitamin A to stay alive.  If you plan carefully, however, you can probably buy 50 times more vitamin A with the same amount of money this week than you did last; some of it will certainly be absorbed, and there may even be an excess for storage. Select your fruits and vegetables for their yellow or green color. Serve liver, kidneys, cheese dishes, or an egg souffle more often than roasts, chops, and steaks. Use storage butter and eggs rather than winter products. Grow carotene-rich vegetables in your garden and freeze them for winter.  Since carotene and vitamin A dissolve in fat, and since fat can be stored in the body, this vitamin is stored, provided an excess is absorbed and not destroyed. The vitamin is stored largely in the liver; the amount can be doubled if the intake of vitamin E is adequate. This stored vitamin A can be called upon to meet your needs whenever your diet is inadequate. Experimental animals, given an excess of the vitamin A, store a hundred times more than is necessary to produce all appearances of good health. Analysis of human livers indicates that the same is true of people. Animal experiments show that a generous storage of vitamin A is advantageous during both health and disease.  Toxicity to massive doses of this vitamin has been reported when halibut-liver oil has been taken by tablespoon rather than by drops. The toxic amount appears to be approximately 10,000 times the daily need. Physicians have frequently recommended curative doses of 200,000 units daily for months, and children have been given 300,000 units daily 5 over long periods without apparent harm. Even when toxic doses are taken, the damage can be prevented or corrected by an increased vitamin-C intake (ref. 2, p. 36). The only food known to contain a toxic amount of this vitamin is polar-bear liver. (If you are served polar-bear liver, watch yourself.)  There is little if any evidence that vitamin-A deficiencies can be more quickly overcome by taking amounts larger than 100,000 units daily; much research indicates that no more than 50,000 units per day can be well utilized. The addition of vitamin E in amounts of 100 units (not milligrams) daily has been found to double the curative effect of vitamin A.  Doses of vitamin A are also more effective if taken in small amounts twice or three times daily rather than at one time. The Council on Pharmacy and Chemistry of the American Medical Association 6 has approved the following therapeutic doses: 25,000 units three times daily for prolonged or chronic deficiency; 25,000 units twice daily for two months for general treatment. They have not approved any single dose larger than 25,000 units.  The amount of vitamin A needed by healthy persons varies widely with each individual. Adults require more vitamin A than do children because the vitamin is needed in proportion to body weight; men usually require more than do women. Aged persons often utilize their food less well and therefore appear to need more of most vitamins than do younger adults. The requirements also vary with intensity of light, use of eyes, season, source, amount absorbed, and intake of vitamin E. One individual may thus require two or three times more than another of the same weight and degree of health. Moreover, when the vitamin is supplied by carotene, twice as much is needed as when it is supplied by vitamin A itself. Obviously no exact rules can be laid down. Since an excess can be stored to great advantage and only massive doses are toxic, it seems wiser to err by obtaining slightly too much rather than too little.  Dr. Henry C. Sherman, when at Columbia University, carried on experiments to determine the amount of vitamin A used advantageously by animals. A certain quantity of the vitamin allowed the animals all the appearances of goqd health. When that quantity was doubled, tripled, and quadrupled, signs of greater health, greater resistance, and greater vigor were evident, and with each increase the life span was lengthened. Beyond that point, increases brought no further improvements. Based on these experiments, Dr. Sherman recommends 20,000 units of vitamin A daily for adults, or four times the amount which usually gives the appearance of good health.  Considering that the vitamin-A content of foods varies widely and that the absorption is undependable, I see no way by which one can be reasonably sure his vitamin-A intake is adequate without taking a supplement. I believe that recurring symptoms of vitamin-A deficiency can be expected in the majority of persons who fail to take this precaution. Any fish-liver-oil concentrate should be taken immediately after the meal containing the largest amount of fat. Capsules of vitamin-A acetate are now available which can be absorbed without the presence of fat; these may be superior to other forms. The amount of vitamin E needed to prevent the destruction of vitamin A is not known; I have recommended 50 units of vitamin E as mixed tocopherols for each 25,000 units of vitamin A. I usually recommend capsules of fish liver-oil supplying 25,000 units each; they are economical and can be taken daily, every other day or even every fifth day, depending on the amount of vitamin needed. You alone must make the choice, depending upon how high your ideals for health are.  

In many books on nutrition including my own, there are tables of food analysis, giving quantities of nutrients in standard servings. Years ago I read a criticism of such tables; the writer held that they should not be published because foods grown on different soils and under different conditions, harvested, handled, and processed by different methods contained different amounts of nutrients. At the time I disagreed violently with the writer; now I agree as violently with him. When I read the statement that apricots or other foods are rich in such nutrients as vitamin A, iron and copper, my only reaction is: Which apricot? Grown where?

Studies have been made of the mucous membranes of animals fed different amounts of vitamin A. It was found that harmful bacteria were always present. The animals deficient in this vitamin had millions of bacteria feeding off their dead cells, however, and 98 per cent showed infections; those fed adequate vitamin A harbored few bacteria and showed no infections. Microscopic studies of the mucous membranes of hundreds of humans dying from accidental death or infection show similar correlations; there is freedom from an accumulation of dead cells and from infections; or the number of dead cells parallels the severity of the infections. Furthermore, the liver tissue of adults meeting accidental death has been found to average 20 times more vitamin A than that of persons dying from infections or infectious diseases.

The absorption of adequate vitamin A will correct deficiency symptoms, the length of time depending on the amount of vitamin given, the severity of the deficiency, and the tissues affected. Studies have shown that improvement in mild eye symptoms has occurred in as little as one hour after 50,000 to 100,000 units of vitamin A have been given. On the other hand, when the deficiency is severe and the vitamin dosage small, normal night vision may not be recovered for weeks or even months. In correcting mild visual abnormalities, the vitamin need merely be absorbed into the blood and carried to the ocular fluid. Recovery from corneal ulcers or changes which have occurred in the skin and mucous membrane, however, means that new tissue must be grown to replace the unhealthy tissue produced during the deficiency. It has been reported that the dryness of skin has disappeared and the lubricating oils have returned in as short a time as two weeks after dietary improvement; it has been my experience, however, that a longer interval is needed for recovery.

Some years ago a physician referred to me a woman whose face was covered with hundreds of large warts. A number of reports had pointed out that warts often disappeared when the diet was made adequate in vitamin A. I therefore planned a nutrition program for her, making it as adequate in all nutrients as I possibly could, and suggested that she take 100,000 units of vitamin A daily. When her skin showed no change after four months, we both became discouraged. A week later she came to see me, greatly excited. Not a wart remained, nor has one returned since then. This case convinced me that it takes approximately four months for unhealthy tissue to be replaced by healthy tissue, although probably wide individual variations should be expected.

Aside from helping to maintain normal vision and resistance to infections, adequate vitamin A is essential to the development of bones and the tooth enamel, good appetite, normal digestion, reproduction, lactation, and the formation of both red and white blood corpuscles. It appears to delay the onset of senility and to promote longevity. Vitamin A also has a profound influence upon development before birth.”

The National Research Council has recommended that an adult have 5,000 units of vitamin A daily to maintain health. A table of food analysis would show that the richest sources of carotene, averaging about 12,000 units per serving (100 grams), are green leaves such as chard, kale, spinach, and other greens. Even one serving of string beans, broccoli, carrots, yellow squash, apricots, sweet potatoes, or yams would supply 5,000 units, all one supposedly needs for a day. A serving of tomatoes, peas, unbleached celery, lettuce, and asparagus averages nearly 2,000 units. Except for apricots, most yellow fruits offer little more than 400 units per serving. Vegetables which have lost their color or have never been green lack this vitamin.

Such a table would show that liver may be extremely rich in vitamin A and that kidneys and sweetbreads contain appreciable amounts. Since this vitamin is not stored in muscles, such meats as roasts, chops, and steaks lack vitamin A. Eggs and butterfat contain it, the amount depending upon the animals’ food. Whole milk varies from 500 to 7,000 units per quart but usually averages 2,000 units. Most of the vitamin A may be destroyed by oxygen when milk is homogenized, although this problem appears not to have been studied. Winter butter, produced when the cows are given dry feed, may contain only 2,000 units per pound, whereas summer butter averages 12,000 units. Butter substitutes usually have 12,000 units of the vitamin added per pound.

Fish-liver oils are the richest commercial sources of vitamin A. The vitamin content of livers, however, depends on the animals’ food and age. Aside from polar-bear liver, the richest source ever determined was the liver oil of a python estimated to be 100 years old when killed in a London zoo. Halibut-liver oil is richer in vitamin A than is cod-liver oil because halibut is elderly when marketed, whereas cod is a mere adolescent; the halibut has had more years to eat green sea algae. For the same reason beef and mutton liver usually contains more vitamin A than do calf and lamb liver.

Scientists as well as laymen have been led to the conclusion, from studying tables of food analysis that we easily obtain all the vitamin A we need from foods. Surveys in which thousands of persons have kept records of foods eaten for a month or more, however, show that three-fourths of our population obtains only about 2,000 units of vitamin A daily. In these surveys the assumption has been that all the vitamin A obtained from food is absorbed into the blood.

Unfortunately, there is many a slip between the lip and body cells. Vegetables analyzed in a laboratory perhaps grew on excellent soil and received the optimum amount of rain and sunshine; possibly they contained a hundred times more vitamin A than those grown under less ideal conditions. Carrots, for example, have been analyzed which contain no carotene whatsoever. Losses of the vitamin occur during shipping, storage, freezing, canning, and cooking. Milk from cows feeding on a luxuriant growth of alfalfa has been found to lack vitamin A; the alfalfa, when analyzed, was found to contain no vitamin E, necessary to prevent the destruction of vitamin A in the body. The liver you perhaps ate, believing that you were obtaining vitamin A, may have come from an animal whose only food for months was dried hay.

Even if vegetables are rich in carotene, there is no insurance that it will be absorbed. The carotene in vegetable foods is held inside cell walls made of cellulose, a substance which cannot be digested by humans. Carotene cannot dissolve in water; therefore it cannot pass through these walls. Only when the cell walls have been broken by cutting, chopping, cooking, or chewing is it freed to pass into the blood. Approximately 1 per cent of the carotene from raw carrots has been found to be absorbed,” whereas cooking increases the absorption from 5 to 19 per cent.’ Studies show that the absorption of carotene from most vegetables averages from 16 to 35 per cent; the softer the texture, the larger the amount of carotene which reaches the blood. Presumably all the carotene is absorbed when vegetables are liquefied or juiced, but if the juice is not drunk immediately, much of the vitamin is destroyed by oxygen.

Through the years I have been consulted by dozens of girls whose faces are covered with pimples; often they tell me they have never had skin trouble until recently. Invariably I find they are doing office work, usually under fluorescent lights, and the continuous use of their eyes, together with the glare and reflection from white paper, has greatly increased their need for vitamin A. I can often tell them how long they have been in their jobs-approximately four months previous to the onset of the pimples.  When vitamin A is undersupplied, the hair becomes dry and lacks sheen and luster. Dandruff usually accumulates on the scalp. The nails may be affected and peel easily or become ridged.  Simultaneously with the visual difficulties and the changes in the skin, a vitamin-A deficiency allows abnormalities to occur in the tissues spoken of as mucous membranes. These tissues line the body cavities such as the throat, nose, sinuses, middle ears, lungs, the gall bladder, and the urinary bladder. If the diet is adequate in vitamin A, these membranes continuously secrete a liquid, or mucus, which covers the cells and prevents bacteria from reaching them and also cleanses the surface. Furthermore, bacteria cannot live in mucus, Worn tissues are digested by enzymes, and the wastes are removed; therefore healthy tissues contain no accumulation of dead cells. Because of substances known as antienzymes which counteract the effect of the enzymes produced by bacteria, live cells can protect themselves from bacterial destruction. Millions of bacteria find their way to these healthy tissues but cannot reach the cells because of the mucus covering or are made ineffective by the mucus; they are offered no food and/or are rendered harmless by the antienzymes. Since they cannot get a foothold, no infection occurs.  Individuals deficient in vitamin A allow conditions ideal for bacterial growth to be set up in their bodies; bacteria Can grow only when they are provided with warmth, moisture, and food. Dr. Wolbach of the Harvard School of Medicine points out that during vitamin-A deficiency the cells of the mucous membranes grow more rapidly than usual but quickly die. These cells are crowded forward by other rapidly growing cells which likewise die until there accumulates a cheesy-like surface of layer upon layer of packed, dead cells. Since dead cells cannot secrete mucus or produce antienzymes, their surface is no longer washed and their self-protective mechanisms are gone. Heat, moisture, and a continually replenished food supply combine to set up conditions ideal for bacterial growth; bacteria themselves are ever present. Infections are usually the result.  Changes in the mucous membranes occur early in the bronchial tubes and lungs, where air sacs may be completely plugged with dead cells, and in the middle ears, sinuses, kidneys, urinary bladder, and prostate gland. What has been described as an “accumulation of profuse debris” may cause irritation or obstruct narrow ducts, such as those from the salivary gland or the pancreas; the mouth may become dry; the pancreatic juices may fail to reach the intestine. Dead cells from the uterus and vagina may slough off, causing leucorrhea, often accompanied by profuse menstruation. Cysts may be formed around the accumulated dead cells in almost any part of the body.

One could define vitamins as chemicals essential for the normal function of cells. Usually they cannot be made by the body. Vitamin A is a colorless substance found only in animal foods. It is formed in the animal or human body from a yellow pigment, carotene, found in carrots, apricots, yams, all green vegetables, green pasture crops, and seaweeds, the quantity roughly paralleling the intensity of the color. We get vitamin A itself from such animal foods as liver and fish-liver oils; egg yolks, butter, and cream supply both carotene and vitamin A.

Mild deficiencies of vitamin A are so common that you have probably experienced them. A slight deficiency impairs vision. A substance containing vitamin A, visual purple, is formed in the eyes; any light reaching the eyes breaks down part of the visual purple, and the products of this purposeful breakdown set up nerve impulses which tell the brain what the eyes see. More visual purple is formed and again destroyed. This cycle of regeneration and breakdown continues through life. Vitamin A is therefore somewhat like the film in a camera in that it photographs what you see but the “film” is used up.

Both day vision and night vision require vitamin A, but night vision depends on the vitamin-A mechanism entirely; therefore a subtle vitamin-A deficiency first causes difficulty in seeing in the dark. You can test your vitamin-A adequacy any time you drive at night. The lights of on-coming cars destroy vitamin A in your eyes; if your ocular fluid contains ample vitamin, you can see again almost immediately; if you are deficient, you will be blinded, the length of time depending on the severity of your deficiency. Tests have shown that persons having auto accidents at night are pathologically deficient in this vitamin. When better lighting of highways results in fewer accidents, it is because day vision rather than night vision is used and vitamin A is less relied upon.

There are varying degrees of night blindness. The person with a mild deficiency believes his vision to be normal but sees more efficiently i~ daylight. With a slightly greater deficiency, he experiences eye fatigue after watching television, for example, but he usually assumes that others have similar difficulty. If his need for vitamin A is still greater, he may suffer pain in his eyes, especially after long use, and experience nervousness, headaches, and visual fatigue. A severe deficiency can cause such discomfort and eyestrain that he may refuse to drive at night.

Such a person is sensitive to bright light during the day and feels more comfortable wearing dark glasses; thus less light reaches his eyes and less vitamin is destroyed. The majority of people who wear dark glasses eat too little vitamin A to allow normal vision. I recently interviewed a woman whose eyes were so sensitive to light that she wore dark glasses even in the house; a month after dietary improvement she experienced no discomfort in intense sunlight.

People who work in bright light, which destroys vitamin A quickly, or dim light, which requires night vision entirely, use relatively more vitamin A than do persons working in moderate light. Typists and bookkeepers who face the glare of light on white paper frequently suffer from eyestrain preventable by diets richer in vitamin A; persons who sew, read, or watch television a great deal, miners working in dim light, welders facing flashing fire, photographers working both with bright lights and in darkrooms, and people living on the desert or beach where the sunlight is reflected by white sand often have visual difficulties because their need for vitamin A is unusually great. Perhaps no glare is so destructive to the vitamin A in the eyes as sunlight on clean snow; trappers, hunters, and skiers are often too familiar with this vitamin deficiency.

When the lack becomes severe, burning, itching, and inflamed eyelids, eyestrain, perhaps severe pain in the eyeballs themselves or frequently occurring sties are experienced in addition to nervousness and exhaustion. Mucus may accumulate in the comers of the eyes; ulcers or sores sometimes appear on the covering of the eye, or cornea. Severe deficiencies of this vitamin have been thought to occur only in such countries as India or China, but a survey of low-income families in New York City revealed corneal ulcers in almost half of the cases studied:

Although eye symptoms may be the first to be noticed in a mild vitamin-A deficiency, even earlier changes take place in the skin. Cells in the lower layers of skin die and slough off. They plug the oil sacs and pores, thus preventing oil from reaching the surface; the skin may become so dry and rough that the entire body sometimes itches. The pores plugged with dead cells cause the skin to have the appearance of “goose pimples” although they are unaffected by temperature changes. This roughness usually occurs first on the elbows, knees, buttocks, and back of the upper arm. Pores enlarged by an accumulation of dead cells and oil are spoken of as whiteheads or blackheads. If these cells become infected, pimples may result. The skin is likewise susceptible to such infections as impetigo, boils, and carbuncles. These abnormalities can usually be corrected by increased amounts of vitamin A, provided the diet is adequate in other respects.