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Good Health and Bad Medicine:
 Obesity - Part 3

 Nervousness

 Insomnia

 Fatigue, Weakness, Poor Appetite And Tonics - Part 1

 Fatigue, Weakness, Poor Appetite And Tonics - Part 2

 Sexual Weakness, Impotence And Frigidity

 Stimulants-coffee, Alcohol, Tobacco And 'pep' Pills

 Physical Therapy

 Arthritis And Rheumatism

 Feet

 Read More Articles About: Good Health and Bad Medicine

Fatigue, Weakness, Poor Appetite And Tonics - Part 1

( Originally Published 1940 )

HUNDREDS of years ago, before the advent of scientific medicine, doctors treated many ailments with fantastically compounded mixtures. The causes of disease were not known and treatment was blundering and haphazard. Pure drugs had not been isolated from their crude plant form. Herbs, roots and various animal secretions and organs were used singly or in imaginative blends.

We have come a long way since those days. The diagnosis and treatment of disease has become to a considerable extent a science. The preparation of pure, potent drugs from crude plants, and their synthesis in the laboratory, as well as their administration, have become to a large extent exact sciences. Unfortunately, however, society is still burdened with medicaments fantastically compounded and crudely advertised. Potions and elixirs$ pills and tablets, yeast cakes and prepared foods—all are advertised today with claims no less fantastic than those formerly attributed to a witch's brew. Many of these materials are called tonics. There are on the market "tonics" for poor appetite, insomnia, anemia, underweight, lack of pep, easy fatigue, sexual weakness, "lost manhood," "female disorders," and a host of other ailments.

Fatigue, like the other symptoms for which tonics are advertised, has many causes. Fatigue that follows physical exertion yields to rest. If the exertion is moderate and per-formed in some sport activity, the sensation of fatigue is not unpleasant, particularly when it can be treated by a bath or shower and a brisk rubdown. Too few of us, however, experience the fatigue of pleasurable exertion. Even if we do, it is too often limited to the warm seasons. Physical play of some kind, performed all year round and several times weekly, is one of the best tonics available. Skating, hiking, bowling, or handball and other available winter sports also should not be neglected.

Pleasurable exertion is one thing; excessive occupational exertion is another. The coal miner, the textile worker, the salesman, all expend hundreds of foot-pounds of energy every day at work and come home dead tired with a tiredness not even remotely resembling the glow of pleasant fatigue. Working activity is unavoidable and desirable, but too often the only satisfaction is economic. When work is done under unsatisfactory working conditions, when it is done in speed-up tempo, or associated with a feeling of insecurity, it will produce a dispiriting, unhealthy kind of fatigue.

Work in which one finds no satisfaction, or for which one is not suited either by inclination or training, is also a common cause of fatigue. In such "social fatigues," there is a large element of "nerves" and jitteriness. Unfortunately, there is very little that can be done about it. Very few of us can be choosy about jobs. The only remedy for the others is to try to make the best of it. Spending money on pep tonics or rejuvenators will only make matters worse.

While the daily work activity—or lack of activity—is a common cause of fatigue, it must not be accepted as the fundamental cause of a chronic state of fatigue, until organic ailments have been ruled out by careful medical examination. Even though Fleischmann's Yeast advertising doesn't say so, chronic fatigue and that run-down feeling may be due to any one of a hundred or more ailments, ranging from amoebic dysentery to tuberculosis. It is true that easy fatigability may be due to poor nutrition, to a lack of adequate vitamins and minerals in the diet; but one takes a risk in accepting an advertiser's word for it. For the price of a few weeks' supply of vitamin capsules you can get a medical examination which may disclose that you need something much more fundamental than a half-dozen assorted vitamins. There have been instances in which all the vitamin needs were satisfied by "Yahoo's Vitamin Compote," but the patient died of neglected tuberculosis. A physician is the only one who can determine whether fatigue, weakness, or a run-down feeling is due to a vitamin deficiency or to other, organic ailments. If it is due to poor nutrition, a proper diet will be the first requisite for proper treatment.

Fatigue is a rather common symptom of certain nervous disorders. When it is severe and associated with nervousness, jitteriness or depression, it is called nervous exhaustion or neurasthenia. As a rule, a deep-seated psychological or emotional maladjustment is at the root of the symptoms. A frank discussion with a physician may help a great deal. And if that isn't enough, treatment by a psychiatrist may be necessary to disclose the nub of the trouble. Fatigue may be associated with a lack of satisfaction in sexual performance, or with other difficulties which a psychiatrist will know best how to treat.

Fatigue is thus, a very complicated problem. The ingenuity and resources of a physician may be severely taxed before the cause is found and proper treatment prescribed.

Even the fatigue caused by muscular exertion is not entirely understood. At one time it was thought to be due to the conversion of glycogen present in muscle (muscle sugar) to lactic acid. Alkalizers such as bicarbonate of soda were given to athletes on the assumption that accumulated acid would be neutralized and thus improve their performance. Quite the contrary happened, however. In ordinary experience, it has been shown that the neutralization of lactic acid is very efficiently carried out in the muscle itself by muscle protein. Only in very strenuous exercise does lactic acid pass out from the muscles into the blood, and it was found that oxygen was more essential to recovery than alkalizers.

The development of knowledge of the metabolism of carbohydrate or sugar led to the impression that it is the universal fuel of muscular activity. It is true that in intense exercise of short duration, carbohydrate is the chief source of energy, but that is because it is more readily mobilized from the body depots and because it is quickly convertible into energy. Unusual quantities of sugar or starch are unnecessary for everyday activity and muscular exercise; the body stores derived from a well-balanced diet will supply adequate fuel.

Besides glycogen or muscle sugar, there is present in muscle a substance known as phosphagen or creatine-phosphate. During muscle contraction, phosphagen is broken down into creatine and phosphate and it is likely that this reaction is an essential part of muscular contraction. But it is another thing to assume that feeding phosphates or creatine, or both, will enhance muscular efficiency and prevent or relieve fatigue.

But one doctor, a German physiologist named Emden, thought it would. During the World War he gave soldiers sodium acid phosphate on the assumption that the phosphate would replenish that supposedly lost in physical exertion. He reported wonderful effects. Later, more careful investigations showed that sodium acid phosphate was a mild laxative and urinary acidifier and no more.

In the past decade a good deal of clinical work on muscle disorder has centered about amino-acids. These acids are the building stones of the protein material of the body. About 22 amino-acids have already been isolated and at least to are absolutely indispensable for growth and proper nutrition. One of the amino-acids which is not indispensable for proper nutrition is known as glycine or glycocoll or aminoacetic acid. It has, however, been found useful in the treatment of a rare muscular affection known as myasthenia gravis. This affection is characterized by an abnormal fatigability of the muscles, causing weakness and even paralysis. The ad-ministration of 1/2 to i ounce of aminoacetic acid daily was found to be of great benefit to some patients with myasthenia gravis, even if it was not a cure. Many doctors also used aminoacetic acid to relieve other fatigue states, temporary and chronic. It has been tried for the fatigue associated with rheumatic-like pains, the fatigue of muscular exertion, and even the fatigue caused by emotional factors. The effect of aminoacetic acid in these conditions has been negligible.

Advertisements for Knox and Cox's gelatine have appeared almost daily in the lay and medical press. A recent advertisement said: "That a simple, familiar food like gelatin should be the key to increased human efficiency was the amazing outcome of a recent series of scientific experiments on human subjects. Every man tested was able to do considerably more work with much less fatigue when plain, unflavored `Knox Gelatine' was added to his diet. . . . Taking the gelatin every day builds up an energy reserve which means an ability to work harder and play harder."

Here is the story of these "scientific experiments":

In February, 1939, there appeared in a worthy scientific journal, The Proceedings of the Society of Experimental Biology and Medicine, a report entitled, "Effect of Gelatin on Muscular Fatigue," by three New York doctors--Drs. Ray, Johnson and Taylor. This investigation purported to prove that when men are given i to 2 ounces of gelatin daily, the amount of work that could be performed before fatigue set in was markedly increased—according to them, from 37% to 240%. Gelatin consists of 25% of glycine or aminoacetic acid, and so the remarkable results in this experiment were naturally attributed to the richness of gelatin in aminoacetic acid. This work is the basis of the advertising campaign for Knox and Cox's gelatins.

It is unfortunate that not all investigations appearing in scientific journals are scientifically performed. Scientific authorities with whom CU has discussed these researches are agreed that the work was poorly controlled.

Dr. Russell M. Wilder, head of a section of the Mayo Clinic and a member of the Council on Foods of the American Medical Association, participated in some of the early experiments with aminoacetic acid. He reported his results in 1934. The following letter to the author speaks for itself:

Dear Doctor Aaron:

I am pleased that you found no ambiguity in my statement relative to glycine in the Proceedings of the Staff Meetings of the Mayo Clinic of October 3, 1934. The New York workers commented in their paper that I had said that glycine improved my tennis game, which I very definitely did not say.

We have published nothing more on this subject, al-though other experiments were conducted. I tried the effect of glycine on a group of 63 healthy young men who were Fellows working in the Clinic, and i healthy young women who were for the most part employees of the Clinic. Each received one unlabeled package of a powder which they were asked not to attempt to identify, half of them getting a mixture of lactose and saccharose, which in taste and appearance very closely resembled glycine, and the others getting glycine. Of the women, nine received glycine, and when they reported after a period of five weeks, six reported positive benefit with less fatigue at the end of the day's work. In one the benefit was questionable. Two of the women received the sugar mixture, and one of them reported question-able benefit.

Eighteen men received the glycine, and of them only two reported benefit and three questionable benefit. Thirty-four men received sugar, and of them five re-ported benefit and two questionable benefit.

The results of this experiment were not such as to encourage belief either that glycine appreciably affects the feeling of well-being of normal, healthy men or women of this age group, or significantly delays or mitigates the normal sense of fatigue.

With cordial regards,

Sincerely,

[signed] Russell M. Wilder, M.D.

Gelatin is a wholesome food. It is useful occasionally in the dietary treatment of ulcer of the stomach and duodenum. But it is not an essential food, and it lacks many indispensable amino-acids. As flavored or pure gelatin, it can provide a pleasant, healthful dessert. But don't be misled by advertising hand-outs even when they appear in the best news-papers and magazines or are ballyhooed over the best radio stations.

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