Colon Health - Is Sugar of Milk The Long Sought Remedy?
( Originally Published Early 1925 )
What bids to be a true and long sought corrective for both uncomplicated, acute and chronic constipation is a result of very recent studies on the reactions of lactose (sugar of milk) and dextrine to conditions in the intestinal tract. The subject is important enough to require a historical review.
After much wandering in the wilderness the feet of investigators struck what seemed to be the right path in 1886, when Escherich, a German investigator, found that the intestinal tract of a newly-born infant is sterile (with a total absence of micro-organisms), and remains so until the digestive products of the first mother's milk enter it. This work was effectively carried forward by Tissier (a French investigator) and Moro (German) in 1900-1905. Tissier found that two bacilli, bif'idus and ac-id-oph'-il-us, then became predominant among the micro-organisms present. (Note these two bacilli care-fully as they are frequently referred to.)
The first of these is a strict anaerobe (living without air) isolated by Tissier not only from the stools of nursing infants but from the superficial milk ducts of the mammary glands of mothers. It is in shape a slender rod, that in cultures develops split ends (bifid). Its most important characteristic as a vegetable micro-organism is that it produces acids freely but no gas from a carbohydrate, lactose (which is sugar of milk), and other sugars.
The second one with a long name, acidophilus, is a Gram-positive (that can be stained), non-spore-bearing bacillus, characterized by its tolerance of acid, frequently forming chains in cultures and producing acids freely from carbohydrates (represented by sugars, starches and cellulose). A very important fact is that this benign organism is primarily of intestinal origin and not milk borne and the only reason it is so frequently absent in the intestine of man is the same that causes vegetables in the ill-kept kitchen garden to lose out in a contest with weeds.'
It was also found that this simple flora (plant life) is not characteristic of bottle-fed infants. Instead of the bifidus being predominant, there is a more varied and less constant flora as a result of bottled milk.
This new and inviting field attracted numerous competent observers, but it was not until another decade had passed that numerous individualistic observations and theories began to evolve important generalizations.
Hull and Rettger (1914) observed that mixed grain feed tends to transform the flora of the rat, but that no profound change takes place until milk or lactose (milk sugar) is added to the diet. The preponderance of the bacillus acidophilus over other organisms was brought about within three days after a diet of vegetables and bread was followed by one of mixed grain and milk. When lactose was fed in appreciable amounts the trans-formation period was very short and the change in type of bacteria was practically 100 per cent. It was noted, however, that the b. acidophilus phase was often more or less temporary, this organism giving away to b. bifidus. By 1917 Hull and Rettger found that 2 or 3 grams of lactose are sufficient to establish characteristic flora in the white rat (that is bifidus and acidophilus) within three days. It required a longer time to transform the flora by milk-feeding than by the use of lactose and the change was not nearly so complete. Meat, or a high protein diet, caused an increase of the relative numbers of putrefactive bacteria, which could be again reduced by the addition of lactose to the diet.
Further interesting conclusions of these competent observers were that lactose fed either dry or in solution promptly reduced the bacteria of the white rat to the aciduric (acid-forming) type; that this condition remained as long as the lactose was fed; that the dry sugar reached the colon effectively while in the fluid condition it could not be demonstrated below the ileo-cecal valve (beginning of the colon) ; that a rich meat diet could be neutralized in the matter of putrefaction by lactose, the daily amount of sugar varying in individual rats from 2 to 3 grams. Weiss, of Germany, had demonstrated as early as 1904 that a diet of milk resulted in colonizing the intestines with large percentages of acidophilus. He also noted that malt soup effected the same result, while sucrose (a general name for sugars identical with cane sugar) did not. When milk was reinforced with lactose (the sugar element in milk) he found that bacillus bifidus became predominant as it did when mother's milk was fed, and attributed the result in both cases to the presence of the lactose.
An additional fact of great value was demonstrated by the Rettger experiments, that the well-advertised sour milk bacillus bulgaricus, of Metchnikoff, could not be successfully implanted in the intestines of man. It was impossible to recover bulgaricus from the feces of rats that had been fed as much as 2 cubic centimeters of living bulgaricus suspension (solution) together with 2 grams of lactose. But the acidophilus was easily distinguishable when lactose was alone added to the food. And curiously when milk was soured by the use of bulgaricus, isolated from preparations of five different strains put on the market by as many different laboratories, the bacillus recovered from the feces was not bulgaricus but acidophilus. This was a confirmation of previous experiments that, however, had not been conclusive.
Torrey in 1919 found that 50 grams of lactose or dextrine when added to a meat and rice diet for dogs caused the ordinary mixed flora to be changed to a simpler one dominated by acidophilus. Also that bread and milk produced a growth of micro-organisms consisting almost entirely of acidophilus. Saccharose (the ordinary pure sugar of commerce), maltose (produced from starch paste by the action of malt or diastase) and glucose (a group of sugars less sweet than ordinary sugar, the two best known being malt sugar and fruit sugar) exercised a doubtful influence, if any.
Two years before the publication of Torrey's observations Rettger had reached similar results with different instrumentalities.
This bacillus acidophilus, discovered by Moro, of Germany, in 1900, is now found to be a common inhabitant of the alimentary tract of the white rat. It is equally a natural, benign and desirable inhabitant of the alimentary tract of man. Given the normal media to thrive in it not only creates the intestinal conditions of good health but seems to be the long-sought-for remedy for constipation. The reports from many quarters on behalf of intelligent lay observers are of enthusiastic approval. A score or more of bacteriologists, principally in Germany and America, conducting patiently their investigations over more than a score of years, have reached practically the same results. That these results are not absolutely uniform (there is one exception), is because no two observers were dealing with exactly the same factors. The exception was that Torrey was the only one that investigated the influence of lactose in the food of typhoid fever patients. Nevertheless the fact that he easily succeeded in introducing the bacillus acidophilus in relatively large numbers into the feces of patients has a strong confirmatory effect on the experiments of Rettger with several thousand chicks and over 1200 rats, where the same results were produced.
The present authors requested an intelligent layman who had been bedeviled with constipation for 30 years to furnish the readers of this book a report on his use of lactose upon prescription. He replied as follows:
"My case was diagnosed as that form of intestinal stasis commonly known as constipation, that is associated with excessive acidity of the digestive juice of the stomach. I was instructed to avoid acid foods and use olive oil and butter as neutralizing agents freely. This excess of hydrochloric acid in the gastric juice seems to increase its activity as a digestive agent. At least the colon contents were too small in bulk and apparently overdigested. I came to thoroughly believe that this excess of acid and overdigestion was the cause of my condition. To increase the bulk of the intestinal refuse I depended almost wholly on bran and to relieve the dryness I depended on water drinking, to the extent of about 8 glasses (64 ounces) a day, or more. For quite a while the bran was not effective but this I found was because the quantity was too small. When it was increased to nearly a glassful a day, partly by admixture with cereal and partly by being stirred into two glasses of water within an hour after each meal, the results were very satisfactory. The residue, instead of being small, dark and compact, was loose and lighter in color, with a strong tendency to disintegrate. In support of the bran I commenced upon direction and practiced daily abdominal exercises and deep abdominal breathing. The exercises are taken early in the morning or any time during the latter part of the night in bed when I happen to be awake after first emptying the bladder. They never consume over fifteen minutes but increase the abdominal circulation to such an extent that the brain is left with a lessened blood supply. That induces ready sleep. Either late in the night or 80 or 90 minutes before breakfast, after the exercises, I start the day off with three glasses of water. I find the abdominal exercises are very valuable in making the compressor muscles of that region efficient in effecting the emptying of the colon. With this regimen, which is really very simple, I use a follow-up wash-out with a quart of water up to the splenic flexure as directed, first in the sitting posture, the fountain syringe being hung above the bathtub, and then lying on the left side, the water being at a low temperature of from 75° to 80°. The effect of this is very satisfactory, as the food in the upper part of the colon is not interfered with except intentionally on rare occasions when conditions are bad. This regimen has been hygienic and agreeable to the self-consciousness of cleanliness.
"When I took up the lactose combined with dextrine, which is not agreeable to the taste, particularly on account of the dextrine, unless properly prepared, I was not much prepossessed. I looked upon it as one more fad to be added to the long list that had been tried and found wanting. Although I used only about one half the prescribed amount of four heaping tea-spoonfuls after each meal yet the result thoroughly astonished me. The action became normal as to concentration, color, freedom of passage and odor. I used but six pounds and with it I continued the old regime. But I had gone far enough to know that a new Warwick is in the field that I am convinced will knock out our old foe in a large percentage of cases, provided there is no organic impediment or weakness that can only be cured by surgery. I found that the lactose if secured from the right source (a reliable wholesale producer) will answer the same purpose without the addition of the dextrine., Four to six heaping teaspoonfuls a day, taken with the bran, is the minimum amount that will produce any effect at my weight of 140 pounds. It should be regarded as a food not as a medicine and can do no harm in forming a habit.
"If you will pardon me, my theory of the action of this wonderful remedy in my case is that the lactose is very difficult of digestion and is thus able to reach the colon. When ice cream becomes `sandy,' a frequent experience with manufacturers who use lactose in the milk, it is found that the grit complained of is lactose, which forms after the cream is manufactured. This fact illustrates the persistence of lactose in maintaining its identity."
Attempts to duplicate in man the results obtained in the intestine of white rats with b. acidophilus were, to use Rettger's exact words, "in a very large measure successful."
Subjects C and 1 were kept under observation for ten or fifteen days during which periods they were found to have the ordinary complex flora. Acidophilus was present but in very small numbers. Subjects A and D, who were habitual users of milk to the extent of a quart a day each, were instructed to continue its use. These subjects upon examination were found to carry a relatively high proportion of acidophilus and the amount of gas was considerably less than in the cases of C and 1. Upon removal of the milk the percentage of acidophilus dropped gradually until there was a complete reversal of the condition. This last experiment showed that acidophilus is a natural inhabitant of the human intestinal tract.
In all these experiments either lactose or dextrine was employed. They were administered three times daily in 100 gram quantities (3.2 ounces) except where the total amount was but 150 grams, when it was consumed in one dose. The lactose was taken between meals in the form of a heavy aqueous suspension (carried in water) while the dextrine was used in a 50 per cent solution by boiling. The dextrine was flavored with a little orange juice to overcome its unpleasant taste. This sugar was administered to six persons and the results were fairly uniform, effecting a radical change of flora in from four to eight days. One subject who weighed nearly 200 pounds required 400 grams per day which brought about a complete simplification and aciduric flora within four days.
This simplification of the intestinal flora was characterized by an enormous increase in the number of acidophilus and the almost complete elimination of the ordinary bacterial types. Similar results were achieved whether lactose or dextrin was used. Some subjects are much more responsive to the treatment than others and require smaller amounts of these carbohydrates. In every case simplification of the intestinal flora (bacterial condition) was accompanied by a decrease in the amount of gas. All these results are in perfect harmony with those achieved with white rats.
A successful attempt was made to change the form of the lactose to milk cultures, that can be drunk like buttermilk. Owing to the fact that acidophilus is not a milk borne organism this change was not easily accomplished. In one subject after two days of sour milk feeding to the extent of 500 cubic centimeters a day (one-fourth of a gill over a pint), at intervals, acidophilus became dominant and was practically the sole visible organism in the stools. After discontinuance of the sour milk the simplified flora gradually gave away to the ordinary mixed type, requiring about five days.
Two other subjects required a liter of sour milk a day (1/2 gill over a quart) to effect the desired change in the flora. Five additional subjects gave the same results.
One subject had a long history of the most obstinate constipation, only controlled by the use of drugs. An-other was afflicted with diarrhea acquired in the tropics, with offensive stools. Both of these subjects responded readily to acidophilus milk. The first named had normal stools for 35 successive days on which they were examined. He said his general condition had improved. The diarrheal subject returned to what appeared to be a normal condition with complete elimination of the offensive odor.
The sour milk of acidophilus and bulgaricus differ in that the former never attains the degree of acidity in old cultures that bulgaricus does. The former acquires a creamy but never a sticky or stringy consistency, while the bulgaricus culture has a thicker and at times a more or less slimy character, depending upon the particular strains used. Acidophilus milk has a decidedly perceptible aroma and taste which materially adds to its palatability.
Method of Preparation—Sweet skimmed milk is sterilized by the Rettger method at 15 pounds steam pressure for 20 or 30 minutes or longer when more than 1,000 cubic centimeters, a little over a quart, are sterilized in a container, which in the present case were Pyrex Florence flasks. The cooled milk is inoculated with a pure culture of acidophilus, preferably mixed strains, and incubated (grown) at 35 to 37 C. temperature, normal temperature of the body, for 12 to 24 hours. The inoculum (milk al-ready inoculated) should not be over 72 hours old. Recently isolated strains of acidophilus are slow and in-effective. Therefore it is necessary to employ strains that have grown in milk for at least two or three weeks and which have been transplanted from milk to milk every day. The amount of inoculum should be large, not less than one half to one per cent (that is 5 to 10 cubic centimeters or units to 1000 of milk,) in order to obtain maximum development within 24 hours. The transfers are made in sterile pipettes, from sections of glass tubing (boiled in water) drawn out and closed at one end, but the open end must be large enough to admit coagulated milk.
As soon as the milk has undergone coagulation it is placed in a refrigerator, clean and free from odors. Thus kept the milk changes very little in the course of a few days but should be used very soon.
If it is desired to reinforce the milk with lactose it can be added at the time the milk is used as food. The milk should then be well shaken and allowed to stand in a cool place. This will permit a goodly percentage of the lactose to be dissolved and thus reduce the gritty character of the lactose-enriched milk. For those who crave sugar the addition of the lactose greatly adds to the richness of the milk.
At first it will require five or six days and even more than a week for the milk to show signs of acidity and coagulation. But the coagulation time will gradually shorten until three weeks after the first milk culture is prepared coagulation should be obtained within 24 hours. At the end of the fourth week of almost daily transfers the time should be reduced to 12 or 15 hours, where it is likely to stand for many months.
Whether boiled milk may be substituted for the sterilized (above described) and the same satisfactory product obtained has not been determined. Boiled or incompletely sterilized milk must be inoculated immediately, however, before any bacterial change has taken place.
In a personal communication to the authors Professor Rettger expresses the emphatic opinion that tablets are worthless as carriers of the bacilli acidophilus and bifidus.
Embarking on a lactose diet is not always easy sailing. As lactose exists in milk to the extent of 4 or 5 per cent, and as prepared is a white, very fine powder, very much like flour in appearance, with a slightly sweetish taste, one would imagine it to be a food that can easily be taken in one of several forms. And it is. But when a patient's whole digestive tract is upset by intestinal inefficiency, and to this artificial condition is added a natural stomach fastidiousness, and in addition there is an inborn awkwardness of method in going about any mechanical job, one need not be surprised to learn that certain people have difficulties in taking this new food. The mistake generally made, when such conditions exist, is to not go slowly enough in first testing out methods for adding lactose to the diet in the most agreeable form. If it is repugnant with bran and water, perhaps it can be sprinkled over the cereal before the milk or cream is added, thus enriching the milk. A part at first can perhaps be taken with the bran, when the latter is taken in water and promptly swallowed. The amounts to be consumed per diem being fairly large, as we have just seen, this little problem must be thought out and tried out in advance. Some patients can achieve gratifying results within two or three weeks with two heaping teaspoonfuls twice or thrice a day, with meals, or even once a day after being so taken for a week or two. Others require twice this much or dare. If the recommendation of Mc-Collum that every person should drink a quart of milk a day is adopted, then this vehicle could be utilized in carrying a large part or all of the daily amount of lactose consumed divided in three glasses of milk, one with each meal. If so the method of drinking the milk slowly, or sipped as advised by Kellogg, should be practiced. In spite of all care, however, the body may give signs occasionally of having consumed too much carbohydrate food. If so, instead of cutting down the lactose starchy foods may be reduced—for instance bread and potatoes; or, during the period of adaptation the lactose can be omitted for a few days, or taken in quantity of two or three heaping teaspoonfuls at breakfast only, particularly where the object is limited to the eradication of putrefaction. If so, a cumulative effect, indicated by the physiological odor of lactose, should be established in a week or two. Then this result can be made permanent by continued use,-and enlarged or intermittent use, which will insure the steady periodical reinforcement of the anti-putrefactive micro-organisms in the colon. Such limited use of lactose will in many cases require the help to be derived from bran, abdominal exercises, regulated diet, plentiful outdoor exercise and early morning water drinking up to three glasses. One of the great benefits attaching to this last item, as amplified elsewhere, is the dilution of the urine and the relief of the overburdened kidneys.
Writing of the possibility of banishing "wild" bacteria (putrefactive) by the milk diet taken in large quantities (a glassful every half hour, under restrictions), sipped slowly or taken through a straw, the natural lactose in the milk being strengthened by dilution with water and the addition of two ounces of lactose, to the quart of milk, a method we are not concerned with here except in its relation to lactose, Kellogg says the results are gratifying. The tongue becomes clean, the breath sweet, the feces are no longer offensive and usually have a yellow color, little odor, or a slightly sour odor. This change is generally observed within a week or ten days, and even sooner when the bowels move more freely. The skin clears, the blood improves, the patient gains in flesh, often a pound a day, and the old depression, headache, mental dullness and other miseries are replaced by a sense of energy and well being. The transformation of the patient from the poor, emaciated, despairing invalid to a plump, rosy cheeked, bright, forceful person is often so rapid as to seem almost miraculous. This rejuvenating process sometimes continues for two or three months if the regimen is faithfully carried on and modified to meet the patient's changing needs. A gain of twenty five to thirty pounds in six or eight weeks is not uncommon. Some-times a gain of forty pounds is made in as many days. This is accounted for by the large amount of lactose (milk sugar) found in the ration. One ounce of milk sugar absorbed in addition to a full ration may cause an increase of flesh amounting to four ounces. Fats only add their own weight, and proteins, when assimilated to the maximum, add not more than half their weight to that of the body .l
An important reservation on lactose is that it is a diuretic (increases the amount of urine), particularly with elderly people with irritable kidneys. As the purpose of lactose is to develop the micro-organisms acidophilus and bifidus in the colon, the effect will be the same if they are introduced directly by the use of buttermilk inoculated with them.