In 1941, Dr. Benjamin P. Sandler, M.D., published “The production of neuronal injury and necrosis with the virus of poliomyelitis in rabbits during insulin hypoglycemia,” a largely ignored report of his experiments which demonstrated that the poliovirus can only attack neurons suffering from insulin-induced hypoglycemia.
In the introduction of this paper, Sandler wrote:
“While engaged in a clinical study of chronic hypoglycemia inpatients of all ages I was impressed with the fact that several patients gave histories of attacks of poliomyelitis with residual paralysis. It occurred to me that a disturbance in carbohydrate metabolism could be a factor in susceptibility to infection with the virus of poliomyelitis, especially since, during hypoglycemia, cellular oxdation will be reduced.”
Sandler went on to cite investigations that have shown that the nervous tissues of the young of any species consume more oxygen than the adult and that makes them more vulnerable to hypoglycemia and any ill effects it may have.
Sandler noted that rhesus monkeys are extremely vulnerable to poliovirus whereas rabbits display complete resistance. He made investigations into the literature on glucose tolerance in these two species, and found reports that the monkeys blood glucose dips to as low as 50 mg per deciliter, whereas investigators never observed a blood glucose under 100 mg/dL in healthy rabbits. He himself performed glucose tests on rabbits on 25 occasions and never saw the level fall below 100 mg.
As an aside here, I have noticed that some internet diet gurus have claimed that low carbohydrate diets produce “hyperglycemia” in some people because these individuals exhibit a fasting blood glucose of 100 mg/dL to 110 mg/dL. First of all, 100 to 110 mg/dL is not hyperglycemic nor diabetic. In an individual on a low carbohydrate diet, a fasting blood glucose at this level reflects efficient hepatic gluconeogenesis providing constant supplies of glucose to the nervous system. Secondly, as you will see, Sandler’s research indicates that a fasting glucose around 100 ± 10 probably provides protection from viral infection of neural cells.
He therefore came to his experimental design: He used insulin to induce hypoglycemia in rabbits, and simultaneously exposed them to poliovirus. The type and route of virus administration varied as follows:
I. Injection with monkey cord virus suspensions, either (a) intracerebrally, or (b) intranasal instillation.
II. Injection with rabbit cord virus suspensions, either (a) intracerebrally, or (b) intranasal instillation.
All of these rabbits developed typical polio lesions of the neurons after very short incubation periods, and eight of eleven rabbits died from the infections.
For controls, he had the following groups:
A. Insulin alone (no virus) – no neuronal lesions although several rabbits died from insulin shock.
B. Monkey virus suspensions alone (no insulin) – no neuronal lesions despite direct intracerebral injection of the virus.
C. Innocuous monkey cord suspensions and insulin – no deaths and no lesions in any rabbits given this combination.
D. Normal rabbit cord suspensions and insulin – no deaths and no lesions.
E. Innoculation of monkeys with suspensions of rabbit cord virus – all of these monkeys developed lesions.
These results pretty conclusively demonstrated that rabbit neurons remain resistant to poliovirus infection so long as they have blood sugar at about 100 mg/dL, but under conditions of hyperinsulinemia and hypoglycemia the neurons can’t defend themselves against the virus.
Dr. Sandler concluded:
“It is suggested that disturbance in carbohydrate metabolism, especially hypoglycemia, may be an important factor in determining susceptibility to the virus of poliomyelitis, both in man and in the monkey. Hypoglycemia reduces cellular oxidations, causing a cellular asphyxia of mild, moderate, or severe degree depending on the degree of hypoglycemia. That this asphyxia lowers the resistance of the individual cell and of the organism in general to invasion by the virus may be the mechanism of increased susceptibility.”
Practical Application
Dr. Sandler took this information into his practice in Asheville, N.C. In his book Diet Prevents Polio (available online at Selene River Press Historical Archives under Lee Foundation Nutritional Research) he recounts his attempts to get “authorities” to apply his findings:
“My experimental work with rabbits had been published in January, 1941, in the American Journal of Pathology. Polio has been prevalent every year since then and it reached epidemic proportions in 1944 and 1946. In the summer of 1944 I wrote to a public health agency and suggested that the people in epidemic areas be advised to adhere to a sugarless and starchless diet for the duration of the epidemic. However, no action was taken.”
Sounds like just like the response Dr. Cannell has gotten from the CDC et al regarding vitamin D and the flu. Dr. Sandler continues:
“The summer of 1948 presented an opportunity to test the diet. I was living in the city of Asheville, N. C., which had a population of 55,000. In May and June it was evident that the state of North Carolina was headed for a major polio epidemic. Asheville was having many cases for a city its size. The number of cases increased during July. State and local health officers, after meeting with the Buncombe County Medical Society, finally recommended strong restrictive measures. Churches, theaters, swimming pools, parks, and recreation areas were closed. Public gatherings were discouraged. Children were not permitted to ride in buses. They were kept at home all day long, their activities confined to the home and front yard. Families that could do so, quit the state.”
As the epidemic continued to spread, and on August 1, 1948 Dr. Sandler decided to take the matter directly to the Asheville press. On August 4, 1948, the Asheville Times, an afternoon paper, carried a detailed article recounting Sandler’s nutrition research and experiments with rabbits and monkeys. The article contained the following statements made by Sandler:
"The crisis is here and hours have become precious," he said. "I have been impelled to bring this directly to the newspapers because of my profound conviction that, through community cooperation and general acceptance of a diet low in sugars and starches, this epidemic can be got under control in about two weeks time.
"I am willing to state without reserve that such a diet, strictly observed, can build up in 24 hours time a resistance in the human body sufficiently strong to combat the disease successfully. The answer lies simply in maintaining a normal blood sugar."
The newspaper article published Dr. Sandler’s dietary recommendations for prevention of polio, which will look a little familiar to the paleodieter:
"(1) Eliminate from the diet sugar and foods containing sugar, such as: soft drinks; fruit juices (except tomato juice); ice cream; cakes, pastries, pies; candies; canned and preserved fruits. (Saccharin may be substituted for sugar.)
(2) Cut down the consumption of starchy foods, such as: bread, rolls, pancakes; potatoes; rice; corn; cereals and grits.
(3) Substitute for such starch foods and starchy vegetables, the following: tomatoes, string beans, cucumbers, greens, lettuce, turnips, carrots, red beets, cabbage, onions and soybeans.
(4) Do not eat fresh fruits or melons more than once a day, and then only in small quantities.
(5) Eat more protective protein foods, such as: eggs, pork and beef products; fish (fresh or canned); poultry; milk, cream and cheese.
(6) Eat three substantial meals a day. Avoid exertion and fatigue because they are known to be associated with low blood sugar. Avoid swimming in cold water. Rest as much as possible.
(7) The diet should be followed until the polio danger is officially declared over by local health authorities."
The article also contained the following statements by Sandler:
“I am willing to state without reserve that such a diet, strictly observed, can build up in 24 hours
time a resistance in the human body sufficiently strong to combat the disease. Of course, the diet
must be followed throughout the period of the epidemic.”
“One of the puzzling characteristics of polio has been its prevalence in warm weather. Many peoplecut down on protective foods such as meats, fish, and poultry because of a mistaken idea that a“light” diet is better for them in warm weather. And they increase the consumption of coolingfoods and beverages, most of them heavily sweetened. It is this increase in consumption of sugar that produces a lowering of blood sugar and thereby a lowering of the body’s resistance to the poliovirus.”
The Asheville Times released the story to the AP and UP wire services. Coast-to-coast newscasts reported on the story on August 4. Asheville print and radio media picked up on it and the story and recommendations got repeated numerous times in daily and weekly print media over the ensuing weeks. Sandler reports the reception:
“The people of Asheville co-operated to an unexpected degree. They welcomed the opportunity to help themselves. The restrictive measures had been depressing. The confinement of children to home all summer was trying to all concerned. The statements about the diet were made in such strong, positive, and optimistic tone that they were readily taken up and adhered to. Since adults as well as children were being attacked by the virus, many grown-ups followed the diet.
One of the striking effects was the immediate improvement in morale. Parents felt that they were doing something constructive instead of just standing by and hoping the disease would not strike their homes. Store sales of sugar, candy, ice cream, cakes, soft drinks, and the like, dropped sharply and remained at low level for the rest of the summer. One southern producer of ice cream shipped one million fewer gallons of ice cream than usual, during the first week following the release of the diet story. Saccharin sales mounted sharply.”
The campaign appeared to produce results in Asheville:
“Up until August 4, 1948, the city of Asheville had 55 cases of polio. If one assumes arbitrarily that the peak had been reached on that date, one could have expected about 55 cases during the decline until the end of the year, since in general during polio epidemics the number of cases following the peak is about equal to the number of cases preceding the peak. However, instead of 55 cases there were only 21 new cases in Asheville from August 4 to December 31.
Actually, however, in the southeastern United States, polio epidemic peaks are usually reached during early September. If the epidemic had been allowed to run its course without the diet story, there might have been around 75 cases in Asheville by the first week in September (a conservative estimate), with a similar number following the peak. Thus there could have been a total of 150 cases in Asheville for the entire season. Actually, there were 76 cases for the entire season, or about half the expected number.”
The diet campaign also appeared to produce effects cross the country:
“From the week ending May 8 through the week ending July 31, the number of cases by which 1948 was leading 1946 was climbing, so that by the week ending July 17, there were 420 more cases in 1948 than for the corresponding week in 1946. For the week ending July 31, there were 304 more cases in 1948 than in the corresponding week in 1946. Then a sudden change occurred. For the next six weeks 1948 fell behind 1946 by 1581 cases…
If we consider that 1948 is running ahead of 1946 or the average by 250 cases each week for the six weeks from June 26 to July 31, then the total for the six weeks August 7 to September 11, 1948, would have exceeded the total for the corresponding six weeks by 1,500 cases. Actually, the total for the six weeks August 7 to September 11, 1948, is 1,581 cases fewer than for the corresponding six weeks in 1946. Thus, one can estimate that the diet campaign prevented around 3,000 cases during the six week period August 7 to September 11, 1948. This is a conservative estimate.”
The following graph taken from Sandler's book displays the national results:
You can readily see that this campaign had some economic casualties. The processed carbohydrate industry lost sales. The polio vaccine did not receive license until 1962, but once it did, the idea that avoiding high carbohydrate foods could prevent polio (and other viral infections of the nervous system) had two powerful opponents.
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