Aging, longevity, and diet: history of CR

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Hi All,

The below hardly appears to require an introduction.

The history of CR seems to have been given greater

early life.

Schafer D.

Aging, longevity, and diet: historical remarks on calorie intake

reduction.

Gerontology. 2005 Mar-Apr; 51(2):126-30.

PMID: 15711080 [PubMed - in process]

Key Words

Nutrition W Diet W Longevity W History of medicine

Abstract

Background: The link between longevity and diet is of

great interest to biological and gerontological research.

The fact that relevant knowledge has generally been

available for many centuries is often not remarked upon.

Objective: This article examines three aspects of early

modern Western medicine which thematize the follow-ing

links between the elderly, longevity and caloric

intake: (1) the question of a diet specifically tailored to

old age as background to certain theories of aging;

(2) the transfer of these dietetic concepts to younger

patients in order to improve health and extend life, and

(3) the promotion of dieting in order to avoid the conse-quences

of plethora and to retard the aging process.

Methods: A number of Latin texts from premodern medi-cal

and health literature will be examined and their con-tents

will be analyzed for material relating to diet for the

elderly and longevity in their historic contexts. Results:

We will clearly indicate fundamental parallels as well as

differences between historic and modern scientific

thought. We will thereby show that although a modern

understanding of hormones and molecular genetics was

obviously lacking, basic knowledge of the influence of

nutrition on old age was prevalent. In contrast, the early

modern lay concept of longevity through calorie reduc-tion

was based on coincidental observation. Conclusion:

These premodern, but nonetheless rational ideas must

be integrated into the socio-cultural setting and the ques-tion

must be raised as to the link between contemporary

research aims and social reality.

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Biological and gerontological research into the link

between longevity and diet has increased over the last 20

years. The effect of caloric restriction has been proven in

various species, although its exact causes remain unex-

plained [1, 2]. It is important to note that this topic has

interested other researchers as well. As early as the 1930s

Clive M. McCay (1898 –1967)ran extensive trials with

rats. He used ideas based on previous experimental work

by Osborne et al. [3]. Although in principle correct and

visionary, his results were dismissed after the Second

World War ostensibly on account of methodological

weaknesses [4].

This article delves more deeply into the past, back to a

time when the terms `geriatrics '(first used in 1909 by

Nasher [5])and `gerontology '(first used in 1929 by Ryb-

nikov [6])were unknown. Despite this lack of nomencla-

ture, serious medical discussions about the links between

diet, age and longevity did take place in earlier epochs. In

particular we observe:(1)the development of a special

geriatric dietetics as far back as classic antiquity; (2)the

establishment of a paramedical concept which was biased

toward the link between the quantity of the food con-

sumed and the quality of life in old age as well as longevi-

ty, and (3)the medical connection between disease in old

age (or `old age 'as an illness itself)and an excessively rich

diet.

These three themes played particularly important roles

in the early modern period and will thus be identified,

discussed and then compared with contemporary re-

search. A chronological list of the cited authors in this arti-

cle is given in table 1.

Table 1. Chronological list of cited authors

------------------------------------------

Date Author Original short title English short title

------------------------------------------

About 400 BC Corpus Hippocraticum Aphorismoi Aphorisms

44 BC Marcus Tullius Cicero Cato Maior De Senectute On Old Age

About 180 AC Galen Hygiene (De sanitate tuenda)On Health

About 1000 Avicenna (Ibn Sý ¯na ¯)Canon Medicinae Canon of Medicine

1558 –1562 Alvise Cornaro Discorsi della vita sobria Discourses on

the Sober Life

1561 Girolamo Cardano De utilitate ex adversis capienda On the

Benefit of Hostiles

1606 Aurelio Anselmi Gerocomica The Care of Old Persons

1614 Santorio Santorio De medicina statica On Medical Measurement

1614 Leonardus Lessius Hygiasticon A Treatise on the Means of Health

and Long Life

1627 François Ranchin Gerocomice The Care of Old Persons

1632 René Descartes L'Homme Treatise of Man

1718 Friedrich Hoffmann Medicina rationalis systematica System of

Rational Medicine

1750 A. E. Buchner/G. E. Gorn De plethora senum On Plethora of Old

Persons

1909 Ignace L. Nasher Geriatrics

1919 T. B. Osborne et al. The Effect of Retardation

1929 Nikol. . Rybnikov K voprosu o psikhologii starosti The

Problem of Psychology of Age

1934 Clive McCay et al. Prolonging the Life Span

Dietetic for the Elderly – Why and in What Form?

Hippocratic medicine generally recognized that a

proper diet was essential to wellness and the treatment of

illnesses [7]. A few passages deal with old age as regards

the connection between obesity and an early death:per-

sons who are naturally very fat are more apt to die sud-

denly than those who are slender (Aphorisms 2:44). It is

further emphasized that gluttony leads to disease; in such

cases appropriate treatment is obvious (Aphorisms 2:17).

Finally, of particular interest are references to the fact that

the elderly fast more easily than the young and that they

require less fuel; in fact if they consume too much they

exhaust themselves, just as a fire is put out by too much

wood (Aphorisms 1:13 and 14)[8].

The theoretical condition for this view was a detailed

physiological conceptualization of old age, developed es-

sentially from the work of the late Roman physician Ga-

len following Hippocratic writings [9]. Galen first postu-

lated that over time a person 's body `heat 'diminishes.

Thus the `coldness 'of the elderly is fundamentally a `defi-

ciency of old age '(senectus defectus)[10]. This deficiency

especially effects digestion which in ancient medicine was

seen as a multi-stage, warmth-dependent process of `cook-

ing '(coctio)in the stomach, the liver and all internal

organs nourished by blood. Thus the elderly are generally

less able to digest as a result of their constitutional cold-

ness; they live in constant danger of accumulating raw,

excess food in their stomach or blood which due to putre-

faction could cause various diseases. From ancient times

through to the early modern period the diet of the elderly

was thus carefully chosen and proportioned. Easily digest-

ible and `warm ' food were recommended – `warm ' in the

humoral sense of the ancient theory of qualities which

relates each thing or being to the four qualities:warm, dry,

cold and wet (compare the `hot 'spices pepper and mus-

tard). In the same way baths or exercises before meals

were designed to increase one 's inner warmth thus easing

digestion [11]. The older and more frail a person becomes

the less he should eat at any single meal so as not to over-

tax his stomach. For this reason in about 1000 AD the

Persian physician Avicenna advised the very elderly to

eat less than they had previously been accustomed to as

they were less able to make good use of it [12]. Ranchin

[13], Chancellor of the Medical School at Montpellier in

the early 17th century, believed at least three or four

meals per day were required.

A milestone in the history of dietetics, On Medical

Measurement , was published in 1614 by the Italian physi-

cian Santorio Santorio. This treatise is known for its

detailed description of perspiratio insensibilis which the

author discovered by means of careful measurement ex-

periments [14]. Santorio supposed that old age was a con-

sequence of reduced perspiration, that is, insufficient

excretion led to the accrual of `excrement 'within the body

which then promoted old age (Aphorisms 1:83). Addition-

ally, obesity contributes to premature aging (Aphorisms

1:37 and 83). On the other hand, an aging body is increas-

ingly less able to put on weight on account of the indura-

tion of its fibers (Aphorisms 1:80). Santorio thus replaced

the 1, 500-year-old theory of the old person 's `weak stom-

ach 'and proposed instead a mechanistic basic disposition

which, after 1700, was developed into a fundamental

explanatory model for old age. Yet dietetic prescription

remained unchanged, albeit without quantification:phy-

sicians promoted a low body weight in order to slow the

aging process and recommended a gradually reduced diet

in old age.

Saintly Sobriety – Cornaro and the Consequences

In several papers written between 1558 and 1566 the

Venetian nobleman Alvise (=Luigi)Cornaro wrote on the

sober life [15, 16]. There are indications that he did so at a

very old age (over 83!), although there is no hard evidence

of this. In his Discourses he laid out the advantages of a

radically reduced diet based on personal experimentation.

He undertook this project on the advice of his physicians

after several illnesses between the ages of 35 and 40. Evi-

dently he developed the diet himself, however. In contrast

to the traditional emphasis on quality and serving sizes,

Cornaro stressed a strong `quantifying principle ':he per-

mitted himself only 12 oz of food (about 350 g; including

bread, egg yolk, meat and soup)and 14 oz of wine (about

410 g)each day. His great-granddaughter later reported

that he reduced this even further at the end of his life until

he ate only a single egg yolk at each meal [17]. Cornaro

was convinced that his longevity and (richly described)

health, vigor and contentment were attributable solely to

this diet.

Reaction to his writings was overwhelming:numerous

editions of his book appeared in many European lan-

guages. Cornaro influenced subsequent treatises on health

through to the 19th century [18]. His most important con-

tribution was a true reconceptualization of old age. As late

as the Renaissance it was largely the negative aspects of

this phase of life which were emphasized; youth, beauty

and immortality had been given priority by the Greeks

and Romans. Cicero 's much read On Old Age did nothing

to change this attitude [19]. Cornaro 's method offered the

possibility for the first time not only of a long but also a

worthwhile life. His diet was very simple when compared

to the complex prescriptions of academic physicians. Its

presentation worked in its favor:a new lifestyle was pleas-

antly described by a medical layman for medical laymen.

Clergymen were particularly attracted to this concept of

saintly sobriety (sancta sobrietas)which seemed to fit well

with the religious ideal of asceticism. For this reason they

were also initially the first important supporters of Corna-

ro 's writings [20]. In contrast, academic physicians largely

tried to ignore Cornaro or modified his ideas. Thus the

well-known Italian doctor and mathematician Girolamo

Cardano suggested in 1560 that the quantitative reduc-

tion should be fixed to the patient 's health:as one is

afflicted with ailments –particularly those of the stomach

–one should eat less [21]. Rather than measure and quan-

tity, feeling (sensus)and benefit should be the determin-

ing factors [22].

Subsequent writings very often refer only to Cornaro 's

ideas as being relevant to old age but, in contrast to con-

temporary medical diets for the elderly, they were actually

designed as a life-long diet without regard to age. They are

in principle the same approach McCay takes and current

thinking is increasingly approaching this ideal.

`Old Age as Illness' and the Problem of the `Fat Old People'

One hundred and fifty years later, in about 1700, medi-

cal doctrine, which had been based on Hippocrates, Galen

and Avicenna, began to be supplanted by various rival

systems. These included animism and iatrochemistry, a

15th to 18th century medical doctrine which emphasized

the chemical properties of organic functions and the use

of alchemy to create medicines. Most importantly, me-

chanistic theories began to become more influential.

These latter theories were developed under the influence

of the French philosopher René Descartes who proposed a

machine-like model of man. Even Santorio 's ideas were

eagerly seized upon. Friedrich Hoffmann, professor of

medicine in Halle (about 100 miles south of Berlin),

spread a deterministic model of the mechanistic-hydraul-

ic development of man [23]:the organism originally con-

sists almost exclusively of vessels and fluid. Blood pres-

sure transforms vessels into fixed fibers. In this way

humans grow and achieve necessary stability; simulta-

neously, circulation steadily decreases because resistance

continuously increases. Old age consequently begins at

the moment of birth and is a life-long process of indura-

tion which finally and unavoidably leads to death. Be-

cause all so-called `old age diseases 'were seen as the result

of this process, they were classified (at least from the per-

spective of extreme old age)as pathological. As a result,

many physicians maintained that senescence itself was an

illness [24]. Although this pathologicalization had few

practical consequences for treatment, it did influence con-

siderations as to which factors led to old age. The major

cause was then seen to be an excess of blood in relation to

the size of the circulatory system. Following crude hy-

draulic theory, this excess of blood, traditionally called

plethora , accelerated the transformation process of the

fibers and vessel resistance. The plethoric person aged

more quickly and was more often subject to those diseases

suffered in old age. Once again, the most important cause

of plethora remained lifestyle. Physicians particularly

warned of one too rich in foods compared to physical

activity. In those days it was believed that food was imme-

diately transformed into blood. Like academics who fail

to get enough physical activity, they particularly saw

women as a problem group. Women were allegedly disad-

vantaged in view of their body structure. After meno-

pause they lost the ability to rid themselves of excess

blood.

Eighteenth century academic medical texts on old age

often addressed the problem of the `fat and lazy old folk '.

It is difficult to say which part of the older population was

exactly meant by this. There is no doubt, however, that it

predominantly included the wealthier classes. They had

the means to consult a doctor whenever they wished and,

for financial reasons, doctors were primarily interested

in their needs. The relevant literature naturally recom-

mended a reduced diet, but more strongly recommended

bloodletting. As soon as this therapeutic measure was

developed its ease of application and supervision made it

highly valued. Physicians were then relieved of their (of-

ten frustrating)exhortations to eat well, simultaneously

solving the consequent problem on non-compliance [25].

Conclusion: Old Age and Diet in Medical and Cultural Context

In addition to the three aspects in which diet and old

age directly relate, there were of course many additional

theories and therapeutic suggestions regarding old age and

longevity in the premodern period. The relevant texts

were partly authored by medical men, but more often

were written by non-physicians and charlatans. Specula-

tive astrological and pharmacological knowledge was

widespread within these concepts, although they often

only touched upon diet.

We conclude with a discussion of our subject 's similar-

ities with and differences from present-day concerns.

That diet plays a decisive role in reaching old age has

been general medical knowledge for millennia. This

knowledge was temporarily pushed into the background

by the success of other therapies (surgery, pharmacology,

radiation therapy, etc. )and other theoretical concepts of

aging and obesity (e. g. genetics). There are clear differ-

ences between ancient and modern dietetics, however.

From antiquity until the 19th century only the danger of

overeating was emphasized, at least in relation to an

organism 's ability to adequately and salubriously digest

food. Although there are indeed references to loss of

appetite and the threat of consumption among the elder-

ly, they did not lead to any theoretical modifications.

Modern geriatrics certainly sees this differently:malnu-

trition, both qualitatively and quantitatively, is multifar-

ious and varies considerably amongst the aged. Despite

their low caloric needs, the former proposition that they

fast more easily is likely to have had fatal nutritional con-

sequences for some elderly.

The situation looks different when dietary suggestions

are factored into attaining a long life. In this regard Cor-

naro 's recommendation of a high-quality, calorie-reduced

diet tallies fairly well with modern knowledge, at least in

laboratory research with microorganisms and mammals.

This agreement may be pure coincidence, particularly

because verification via a controlled study of humans is

fraught with ethical and methodological difficulties [1].

Moreover, premodern medicine routinely and distinctly

differentiated between diets for the elderly and those

designed for longevity. Cornaro 's conflation of these two

arises from an unscientific perspective which sometimes

produces surprisingly accurate knowledge and is certainly

particularly worthy of our attention today.

Beyond all factual parallels and differences there is yet

another fundamental link between research strategies and

their socio-cultural environment:the aristocratic Cornaro

wrote for his friends and warned against `feasting and the

vice of gluttony '. He was able to teach his new concept

easily to this elite, rich and well-educated group –but not

to poor Italians. The 18th century academic medical con-

cept of plethora was also effortlessly adopted by the new

middle classes whose women were often physically inac-

tive. Can we not attribute recent medical interest in the

effects of a calorie-reduced diet to the increase in obesity

and eating disorders in Western societies full of food? Is

this not once again medical science 's fascination with the

question of the positive effects of food deprivation?

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