A RATIONAL DIABETIC FLOUR. 
BY 
HEINRICH STE&Nt.-Ph.D., M.D., 
of neWyork city; 
MEMBER OF THE NEW YORK COUNTY MEDICAL SOCIETY, THE MANHATTAN CLINICAL 
SOCIETY, THE MEDICO-LEGAL SOCIETY, ETC. 
FROM 
THE MEDICAL NEWS, 
J une 8, 1895. [Reprinted from The MEDICAL NEWS, June 8, 1895.] 
A RATIONAL DIABETIC FLOUR} 
By HEINRICH STERN, Ph.D., M.D., 
OF NEW YUWTWFY; 
MEMBER OF THE NEW YORK COUNTY MEDICAL SOCIETY, THE MANHATTAN 
CLINICAL SOCIETY, THE MEDICO-LEGAL SOCIETY, ETC. 
“ Give us our daily bread ”—this utterance of the 
faithful shows that bread is the recognized, most es- 
sential, and most important foodstuff to civilized 
man. In health and disease it forms his foremost 
nutriment. Thus by nature, habit, and custom hu- 
manity asks for bread and thrives on it, and when 
this article of food has been withheld or withdrawn 
from a person by famine, by high taxes, or by an 
over-zealous physician, that person might get along 
with other nourishment for a time, but will perish at 
the end from lack of proper food. The bodily con- 
stitution of civilized man demands some kind of 
breadstuff of which, it is true, it might be deprived 
temporarily and partially, but never for a long pe- 
riod or completely. 
This fact has been recognized by some modern 
physiologists and observers who do not object to 
bread in small quantities as a part of the diet in 
diabetes mellitus. The complete and sudden de- 
privation of the system of breadstuffs it has hereto- 
fore been accustomed to, undoubtedly produces 
1 Read before the Manhattan Clinical Society, April 16,1895. 2 
more harm in a diabetic patient than a moderate 
use of that article of nutriment. (To stop wholly 
the saccharine supply is also not what is wanted, for 
were we to do so we would finally arrest every func- 
tion of animal life.) Neither on its duration nor 
upon the percentage of sugar depends the severity 
of diabetes mellitus, but upon the general power of 
resistance of the body and the vitality of the non- 
affected organs; and the power of resistance and 
vitality must be sustained, even if an additional one- 
tenth of i per cent, of diabetic sugar may be de- 
monstrated in the urine. 
With the view of supplying properly adapted 
and suitable breadstuffs for diabetes the so-called 
“ Diabetic Flours” have sprung into existence ; and 
it is claimed that they are free, or nearly free, from 
carbohydrates. All these flours contain, however, 
large quantities of starch—from 30 per cent, to 70 
per cent., as Purdy puts it. The widely advertised 
gluten flour of one health-food company, for in- 
stance, for which it is claimed that it is entirely free 
from starch, contains 66.18 per cent, of that article. 
It seems beyond our means at the present day to 
extract to a sufficient degree the carbohydrates of 
the marketable grains; in fact, if a complete ex- 
traction of the starchy principles of our grains could 
be accomplished, there would be very little left to 
make a satisfactory article of food. Bouchardat’s 
gluten flour is obtained by washing wheat flour. It 
is evident that only small quantities of starch can 
be extracted by this process. A method of extract- 
ing the starch from bread was recommended by 
Liebig. Thin slices of bread were treated with an 3 
extract of malt to convert the starch into sugar, 
which could be dissolved out by maceration and 
washing. The bran-bread of Prout, which contains 
a great percentage of cellulose, has not proved to be 
a desirable food for diabetics on account of its indi- 
gestibility and of its irritative action on the mucous 
membranes of the intestinal canal. The Soya bread 
and the aleuronaut bread of Ebstein have also been 
used in the dietetic treatment of diabetes without 
having achieved universal recognition and employ- 
ment. The proportionally best substitute for wheat 
or rye to-day yet is the almond. Almond-bread was 
first introduced by Pavy. The almonds having been 
ground into small pieces undergo a process of mace- 
ration with acidulated water for the extraction of 
their sugar. If some butter and eggs be added to 
this almond-meal, a good-tasting bread can be baked, 
which, if not properly prepared, is very hard and 
oily, and not fit for digestion. Almonds, however, 
are very expensive, and this is one of the reasons 
that bread made from them is not more universally 
employed by diabetics. 
A long time since I recognized the fact that a 
completely decarbohydrated meal at a price conveni- 
ent to every one cannot be obtained from any of the 
cereals; that such a completely decarbohydrated 
meal is not essential, but is even a drawback in a 
rational diet of the diabetic; and that a meal like 
that of the almonds, partially unoiled and with a 
small percentage of carbohydrates, at a mere nomi- 
nal cost, is the desideratum. After a series of ex- 
periments I came to the conclusion that such a meal 
can be obtained from the peanut. 4 
The peanut1 (Arachis hypogce), also known as 
ground-pea, ground-nut, earth-nut, goober, and 
pindar, is an annual, growing from one to two feet 
high; it has the peculiar habit of wintering dts 
fruit underground. It is not a nut at all in the true 
sense of the term, and should be with' more pro- 
priety called ground-pea. After the fall of its flower 
the peduncle elongates and bends downward, push- 
ing several inches into the ground, where the ovary 
at its extremity begins to enlarge and develops 
into a pale-yellowish, wrinkled, slightly curved pod, 
often contracted in the middle, and containing from 
one to three seeds. When fully grown the pods are 
from one to two inches long and of a yellowish 
color. 
More or less abundantly scattered over the roots 
of the peanut plant are warts of about the size of a 
pin-head. These so-called tubercles are of great 
importance to the life of the*plant. Within them, 
while in a fresh or growing state, immense numbers 
of minute organisms can be detected. These or- 
ganisms live partly on the substance supplied from 
the roots, and at the same time they take from the 
air and elaborate for the use of the plant considera- 
ble quantities of nitrogen. In this manner a quan- 
tity of nitrogen is often acquired by the plant far in 
excess of the amount of that element contained in 
the neighboring soil. The peanut, though it has been 
cultivated for centuries in Eastern countries—in 
China, Japan, the East Indies, and Africa—seems to 
1 The following data and points of information are obtained 
from Farmers’ Bulletin, No. 25, published by the U, S. Dept, of 
Agriculture, 1895. 5 
be a native of Brazil. Thus America, which gave 
to the world cotton, Indian corn, the potato, and 
tobacco, is also the home of an additional plant of 
commercial importance. The merits of the peanut, 
however, had been recognized much earlier in other 
parts of the globe than in its native country, and 
virtually only since 1866 has the crop become of 
importance in some parts of this country. Virginia, 
North Carolina, and Tennessee produce most of the 
peanut crop of the United States, which, on account 
of a wrong method of culture, is not so plentiful 
now-a-days as it has been in years past. 
The most interesting point for us to consider is 
the chemic composition of the peanut. I abstain 
from giving the food-constituents of all the different 
parts of the peanut plant, the kernels being the only 
portion of the plant concerning us. We find in the 
Alabama peanut-kernel 10.88 per cent, of water, 
and in the water-free substance of the kernel 4.26 
per cent, of ash, 35.37 per cent, of protein, 2.66 
per cent, of fiber, 19.33 Per cent, extract-free of ni- 
trogen, 55.37 per cent, of fat, and 5.50 per cent, of 
nitrogen. The average of all available analyses of 
peanut-plants of different crops and different sec- 
tions of the earth shows 29 per cent, of protein, 49 
per cent, of fat, and 14 per cent, of carbohydrates 
in the dry material. 
Peanut-meal (as known in commerce) is the re- 
maining part (the residue) of the peanut after the 
oil has been extracted. The oil is extracted on a 
large scale in European countries and utilized as a 
substitute for olive-oil, for lubricating purposes, and 
in the manufacture of soap. The meal contains, as 6 
the averages of 2000 analyses show, about 52 per 
cent, of protein, 8 per cent, of fat, and 27 per cent, 
of carbohydrates, and is therefore a most concen- 
trated and valuable animal food. The peanut-meal, 
or peanut-cake as it is commonly called, is of a 
quite agreeable taste and not very hard to digest. 
Following this is given a comparison made by Pro- 
fessor KSnig, based on the price in Germany of the 
following twelve principal foods reduced to “units 
of nutrition:” 
Comparison of the Nutritive Value and Cost 
of Twelve Principal Foods. 
Nutritive units 
per pound. 
Cost per 1000 
units in cents. 
Skimmed milk . 
. 98.20 
10.4 
Skimmed-milk cheese 
. 870.00 
II.O 
Full milk . 
• ISS-SO 
II-5 
Bacon 
. 1257.70 
i5-5 
Butter 
. 1186.30 
20.4 
Veal . 
. 525-90 
22.2 
Beef . 
• 530-90 
26.0 
Peas . 
778.60 
4.2 
Potatoes . 
. 138.20 
5-i 
Rye-flour . 
. 603.60 
6.0 
Rice . 
- 534-6o 
10.0 
Peanut-meal 
. 1425.00 
3-o 
This shows that peanut-meal is the most nutritious 
and the cheapest of this list of foodstuffs. 
Satisfied that the peanut is one of the most per- 
fect, and at the same time one of the cheapest food- 
stuffs known to us, a foodstuff abundant in nitrog- 
enous and fatty matter, but very deficient in car- 
bohydrates, I began to utilize it with diabetic 
patients, and my method of preparing what I call 
the “diabetic peanut-flour” is a very simple and 7 
empiric one, and only destined to be employed 
domestically. I do not intend to give in the fol- 
lowing a process of manufacture on a large scale; 
but no doubt, if this peanut-flour should prove to 
be a permanent success in the dietetic treatment of 
diabetes, the proper means to obtain the flour in 
large quantities can be easily devised. 
The peanut-kernels, including their inner coating, 
which is also nutritious and not very abundant in 
carbohydrates, are put in a tin kettle, into which 
small holes have been previously made. This is kept 
uncovered and placed on or into a pan filled with 
water, and this has to be kept boiling for about 
half an hour to allow partial extraction of the su- 
perfluous oil. After the kernels have been dried 
they are pounded into fine particles with the aid of 
a rolling-pin. The pounded or bruised kernels are 
then placed in boiling water acidulated to some 
degree with tartaric acid or vinegar, preferably with 
the latter. The boiling in the acidulated water has 
to be continued for some time for different reasons: 
1. For the extraction of saccharine elements, oc- 
curring to some amount in nuts of American growth. 
(Peanut-flour naturally contains proportionally small 
quantities of saccharine principles, which have to 
remain to some extent in the flour for reasons given.) 
2. To overcome the smell and taste characteristic 
of the peanut. 
3. To prevent emulsification of the remaining 
oil, which, to some degree, is essential to a rational 
diabetic food, as fats must supply the deficiency of 
the carbohydrate elements. (An emulsifying pro- 
cess will otherwise take place immediately on the 
addition of water, as great quantities of albuminous 
matters are present.) 
It is true that a partial emulsification of the oil 8 
might relieve the pancreatic juice of some work, 
and this might be especially beneficial in such grave 
cases of diabetes mellitus in which the pancreas 
seems to be involved. I leave it to future investi- 
gation to determine whether the oil in peanut- 
flour shall be introduced in its natural state into the 
alimentary tract or in the form of a partial or com- 
plete emulsion. 
Having undergone a thorough boiling with acidu- 
lated water, the ground kernels are subjected to dry 
heat, to effect complete evaporation of that fluid ; 
but great care must be exercised that they do not 
become browned or roasted. An additional treat- 
ment with the rolling-pin will produce nearly as 
fine a flour as the common wheat-flour of com- 
merce.1 
With apparatus such as the household furnishes a 
flour such as the mills are capable of producing on a 
great scale cannot be expected to be produced. 
This is especially true with the hydrocarbonization 
(unoiling) of the flour. From 30 to 40 per cent, of 
the oil I deem necessary for a complete and rational 
diabetic food. More hydrocarbons are not required 
and would interfere with digestion. It is not 
possible to control the unoiling by the described 
domestic process and to determine with any degree 
of certainty the percentage of oil extracted ; if the 
flour is manufactured by mills, however, this could 
be readily controlled and ascertained. The most 
simple process of extracting the oil, when manufac- 
turing the flour on a large scale, is by pressure, 
either by the employment of the cold or the warm 
process; the pressure can be so regulated as to ex- 
tract just the amount of oil that is not wanted. 
1 Samples of the peanut-flour were passed among the audience 
and different tests were applied to it, to the satisfaction of those 
present. 9 
I have made use of the flour in different ways, the 
most simple of which is in the form of a porridge, 
some milk being added to it. Bread and biscuits 
can also be baked from it, but the nicest and most 
easily digestible form in which to utilize it is, I 
think, the German pancake. Every housekeeper 
understands howto make the latter, and a tasty and 
always fresh piece of pastry can therefore be pro- 
duced on short notice. 
I have used this flour with four diabetic and a 
number of other patients of mine. In the non- 
diabetic cases, mostly tuberculous in character, I 
obtained satisfactory results, inasmuch as digestion 
was not to any extent taxed, and in some cases 
the weight of the patient did not decrease, while in 
one instance there was actual gain in weight noticed. 
The first diabetic patient to whom I recom- 
mended the flour was also the first person whom I 
know to have made use of it. Right at the outset 
it turned out to be a complete failure, as the diges- 
tion became very much impaired, thereby aggra- 
vating the general condition of the patient, an old 
man. A more careful and rational preparation of 
the flour, however, and the employment of smaller 
quantities when starting with it, increased its di- 
gestibility, and to-day this patient enjoys, as far as 
circumstances permit, a comfortable state of health. 
The other three patients also thrive well on this 
flour, the German pancake being the usual form in 
which they employ it. In conjunction with eata- 
bles made of this flour I allowed those patients only 
such foodstuffs as are generally recognized as permis- 
sible in diabetes mellitus. I have done this, not TO 
because I am a believer in ihe complete exclusion of 
carbohydrates in diabetes, which I am not (fats and 
even nitrogenous substances are capable of producing 
glycogen), but to investigate the intrinsic value of 
peanut-flour as a food and its ability to reduce the 
glycogenic sugar of the urine. In the last point, 
however, my researches only began at a late date 
and practical results I cannot offer to-day. 
After my bad experience in the very first trial I 
accustomed the patients gradually to the flour and 
started in every instance with 15 grams a day, grad- 
ually increasing the quantity to 25 grams daily in the 
second week, 35 grams in the third week, and so 
forth. I did not experience any more gastric dis- 
turbances or diarrhea by the employment of the 
peanut-flour than is the case when using an absolutely 
animal diet. 
If we accept the theories advanced by modern 
investigators in the dietetic treatment of diabetes 
mellitus, that a suitable and wholesome diabetic food 
must be easily digestible, abundant in fatty and ni- 
trogenous, and deficient in saccharine and starchy 
substances, we have to consider peanut-flour a 
rational and logical foodstuff. 
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