The Therapeutic Value of a Thermo-Labile Factor Found in Fats, Particularly the Lecithins, in Dermatoses

Though we speak in general of fats, carbohydrates, and proteins as if they were single entities, each term represents only classes of protoplasm which are further broken into groups and sub-groups by their constituent parts and by their space chemistry. Much study of the various amino acids has shed light on protein metabolism, while a similar study of the various sugars and starches has, in turn, led to a better understanding of carbohydrate metabolism. A comprehensive review of the fats by Burr and Barnes’ shows, too, that there is a marked biological difference in the value of fats, depending on their composition, stereochemistry, melting point, and chemical state.

The effect of processing cereals with the accompanying loss of minerals and the vitamin B complex has received much attention. However, the loss of the important fats in the processing of our vegetable oils and our cereals has not received due consideration. The removal of the fats would appear to be as deleterious as the removal of the water soluble parts of the germ.

Pottenger and Simonsen^6,7,8 and, more recently, Schultz, Gray, and Robinson¹¹ have pointed out the effect of the heat processing of meat on cats. It is noticeable in every system of the body: the vascular tree, the skin, the nervous system, the gastrointestinal tract, the respiratory tract, the genitourinary tract (disturbed reproduction), skeletal growth, and manifestations that stimulate human allergy.

Pottenger^9,10 showed that a similar condition developed when cats and rats were fed heat processed milk. Wagtendonk and Wulzen¹³ report the isolation of a factor from raw cream destroyed by pasteurization that prevents changes in the skeletal muscles of guinea pigs.

Though Schultz, Gray and Robinson¹¹ believe that meat contains a new vitamin, and though we suggested that possibility in 1939,⁶ we have not yet felt certain as to the actual material destroyed. We have found that the heat labile factor is present in all raw meat but especially in brain, liver, fat, and heart. It is present in high grade raw milk and raw butter from pasture-fed cows, but it is not present in appreciable amounts in the raw milk of dry-fed cattle. It is apparently present in seeds, sprouts of all kinds, and in rapid-growing young green grasses. The best vegetable source commercially available that we have found is the solvent-processed soybean lecithin^a in which the heat of processing is not excessive. The factor is largely destroyed when milk or cream is pasteurized, when meat is cooked, or when soybean lecithin has been produced by methods using high heats.

The factor is readily destroyed by all processes of canning and pasteurizing and by most methods of crushing or grinding seeds and cereals, as the temperatures evolved in these processes usually run from 150°F to 250°F or more. It is also removed from our food by the usual procedures of clarifying and refining.

Our experimental work suggested that a variety of clinical conditions might be benefited by the application of the principles learned in our research. It suggests the effect is vasomotor to a large degree. Our results with allergies, sterility, low energy, development of the face, and nervous and mental disorders have been encouraging. In this communication, however, we wish to stress the effect of the treatment on skin lesions.

We have been carefully investigating habits of diet of the patients, especially with reference to the preparation of the proteins and fats. In this group of patients who show allergies and skin lesions, it is surprising to find how few actually consume any appreciable amount of fat; and when fat is consumed to any degree, it is either a purified vegetable fat or is meat fat that has been subjected to very high heat. There seems to be a prevailing opinion among the patients we see that there is something undesirable in meat fats. Likewise, we have found that most of our patients prefer their meats well done. In gathering facts on the infantile eczemas, with which we have had our most extensive experience, we note that the mother usually expresses a dislike for fats and may state that she never eats butter or cream and avoids all other forms of fat in order to preserve her figure. Two infants kept by Von Groer¹² on a very low fat diet grew fairly well, but one developed a generalized eczema. Of three infants maintained on a fat-tree diet by Holt and co-workers,⁴ one developed an eczema which was cured by feeding fat.

GENERAL THERAPEUTIC METHODS

All patients have received a high protein diet with the liberal use of raw brain and liver. The use of the raw beef sandwich and sprouted seeds as salad has been encouraged. In the last six months, as difficulties in obtaining meat have arisen, we have supplemented the meat diet with the use of the soybean lecithin. Each patient reported here received a daily ration of either 3 ounces of raw brain and 1½ to 3 ounces of raw liver, or from 6 to 18 grams of soybean lecithin when mentioned. The report below is based on clinical experience over the past ten years.

CONDITIONS OBSERVED

1. Keratoses.—The keratoses on the dorsum of the arm, thighs, and buttocks have long been ascribed to the lack of vitamin A in the diet. This condition usually clears in from two to six weeks. However, there are many stubborn cases that take over a year; usually they are those showing the bronzing of the skin described below.

2. Bronzing.—There is a bronze cast to many skins that differs from sun tan. Individuals showing this bronzing of the skin acquire a deeper tanning from exposure to the sun than does the average individual. Further, the sun tan in these individuals disappears more slowly than it does in the average person. It is frequently associated with a markedly purplish discoloration (vasomotor in nature) of the skin of the extremities in dependency. As a rule, these two changes of color respond to treatment with about equal rapidity. It is not apparent whether the vasomotor disturbance is responsible for the bronzing of the skin, or whether the latter condition represents a disturbance that is responsible for the vasomotor change. We see some patients who present the bronzing without any evidence of vasomotor disturbance of the skin, while many more with marked purplishness do not present the bronzing. This bronzing is not associated with other metabolic disturbances in which bronzing is found, such as pellagra and diabetes, but seems rather to indicate disturbance in fat metabolism. Likewise, the purplishness of dependency seems to be a strictly vasomotor phenomenon, independent of any evidence of cardiac disturbance. We have noted that people who present bronzing are usually refractory to treatment, are of low energy, are frequently very irritable, do not “feel well,” and are sometimes sterile. These pigmentary changes may or may not be accompanied by other skin disturbances. However, when skin lesions are present, the most common are the keratoses about the buttocks, thighs, and dorsa of the arms; occasionally the skin is very dry, and ichthyosis of the legs may be found. The bronzing is present not only in the skin but may be seen in the hair. Frequently its disappearance in the emerging hair is accomplished long before depigmentation of the skin is visible.

Female, aged forty-two seen on 1/8/43. The patient had been a chronic invalid for many years. She has experienced great difficulty in reproduction, was of a low energy level and highly unstable.

She showed some pigmentation about the face and a bronze cast to the skin over the entire body. There were numerous flat moles over her body. The hair was very dry and also possessed the bronze cast. The tongue showed some edema. There was a yellowish cast to the vault of the mouth. The patient showed marked hypochromia about the nipples, almost as deep as one would expect with a pregnancy. There was considerable edema to all of her skin, which was very thick over the entire body and possessed a peculiar odor. She showed markedly increased hyperchromia about the anus –a deep bronze surrounded by a zone of yellowish discoloration. There were many comedones about the anus. Keratoses were present on both arms and thighs.

On 2/27/43, the patient’s skin was becoming soft, and she was losing the keratotic lesions on the arms and upper thighs.

By 10/12/43, she had begun to lose the facial bronzing about the eyes, giving her a harlequin-like appearance.

3. Infantile Eczema.—Infantile eczema has become so common today that it is almost taken as a normal part of the growth and development of a child. It is frequently passed off as unimportant, and the mother is assured that the infant will outgrow it. It is common to the bottle-fed baby and almost equally so to the nursed infant. Representative of the former type is the following case history:

Male, aged seventeen months, first seen on 10/2/43. The mother stated that she did not like fat or fat meat and ate very little butter. She lost her first infant, aborting at three months, and vomited severely during the first three months of the pregnancy with this child. The patient was nursed two days. Much difficulty was experienced in adjusting his formula. At eight weeks of age scales were noticed by the mother throughout his scalp. A rash beginning on the face was noted at four months of age. Diagnosis of eczema was made. From then on there were periods of exacerbation. The child had apparently been shown to be sensitive to orange juice, wheat, eggs, spinach, and peas. He was a mouth-breather.

Examination showed large areas of the body to be involved with eczematous lesions excoriated by scratching, particularly the frontal bosses and lateral aspects of the cheek extending down over the zygomas. There was a large patch running between the superciliary ridges and the external auditory canal both sides. The upper lip and nose were relatively free. There was a great deal of elephantine-like skin about the neck. The skin was very heavy and thickened in both axillary folds, but they showed no apparent eczema. There were eczematous lesions in the elbow creases, about the forearms (particularly the inferior surface), on the dorsum of the hands, and between the thumbs and first fingers. There were cracks on the thumbs, particularly severe on the left. Lesions over the entire abdomen, geographic in character, extended up over the thorax anteriorly. In this area in particular were many old, excoriated scars but few fresh lesions. There were large eczematous areas posteriorly, on the left buttock in particular. A large rosette of lesions about the anus extended into both gluteal folds. Lesions about the knees and on the upper legs were more extensive on the upper left leg than on the upper right. There were excessive fat pads over the lower legs. Some eczema and marked excoriation were present in the external auditory canals on both sides. Both the scrotum and the penis were involved in the eczematous processes, and the scrotum was markedly thickened. The penis was thickened and indurated.

By 11/2/43, with the exception of the cheeks and face, which the child rubbed on his sheets, the eczematous lesions had largely disappeared. The thickened, indurated character of the skin of the neck, folds of the buttocks, creases of the elbows, and about the penis and scrotum had largely disappeared.

It is our impression that infantile eczema in the nursed infant represents a heat labile factor deficiency in the mother. A brief resume of a case history shows the following:

Female, aged seven weeks, first seen 9/16/43. The mother had previously given birth to a very severely eczematous child. She herself was showing the extreme bronzing of the skin. She brought her second infant for examination, stating that the baby was beginning to show the same eczematoid tendencies that had been so crippling to the older child.

Examination of the baby showed definite evidence of improper fat metabolism. She was irritable. She lacked proper fat pads of the axillae, thighs, and sucking pads of the cheeks. There was an inflamed, papular eczema about the face, upper chest, and buttocks, and a seborrhea was seen throughout the scalp. The mother was placed on a combination of brain, liver, and soybean lecithin.

By 10/4/43, the proper fat distribution was apparent throughout the subcutaneous areas. The child showed only a slight scaliness over the scalp and about the eyes. Tissue turgor had entirely changed. The mother had lost the bronze pigmentation of her skin.

4. Severe Eczema.—Extreme eczematoid lesions which cover the entire body, not only in infants but in adults and adolescents, respond gradually. Oftentimes in these individuals there are marked sensitivities which can not be overcome. It is therefore necessary to use restricted dietaries with these patients. Our experience has not shown any of these individuals to be sensitive to raw beef, beer liver, or beef brain. However, lamb produced sensitivity relatively rapidly in one individual. One of the most difficult and profound of these eczemas was an infant of eighteen months who, at the time of examination, appeared almost as though she had a pemphigus. The child was edematous. There were large bullae of the skin, which had ruptured, and many areas of skin were exposed in sheets. The child could scarcely open her eyes. During a three and a half year period her diet has been confined almost entirely to raw beef, liver, and brain, with very few other foods added. Each time other foods have been tried, the patient has become sensitive to them in a relatively short period of time.

However, our usual treatment disregards sensitivity. The following case is typical:

Female, aged seventeen, first seen on 8/6/42. The patient was a premature infant at 6½ months, weight three pounds. She was not nursed. There was a great deal of difficulty during the first two months of life. Her health as a child was fair. At two years of age she developed severe eczema, and she developed asthma at four or five. The childhood eczema was finally relieved by the elimination of orange juice, spinach, and cow’s milk. Only mild eczema and asthma occurred spasmodically until the age of twelve. Between the ages of twelve and fifteen she was apparently free from both. Just before her fifteenth birthday, eczema began to appear on the hands and armpits and back of the knees. During the spring semester following her birthday, it became noticeable to her companions, and she became very self-conscious. She began to lose sleep because of the itching. School work became very difficult for her. Friction at home also produced a restless, unsettled mental condition. During the summer of 1940 she became very unhappy because of her condition and dreaded going back to school. In August, 1941, X-ray treatment partially cleared her skin for a short period of time. She went to the beach to complete the cure on the advice of a dermatologist, but the condition became steadily worse and the lesions spread to the neck. When she went home in September, the condition became acute with loss of sleep. The eczema spread to her arms. At that time, the patient was hospitalized for three weeks. Many medications were applied to her skin, but the only relief obtained was by the use of crude petroleum with starch and zinc ointment. At the hospital she was placed on a diet of lamb and chicken, Ry-Krisp, certain vegetables and fruits; milk, milk products, wheat, and eggs were eliminated. She went home in October and her condition became more acute than before. There was a marked loss of sleep. Tar gave relief for a few days, but the condition again became more acute than ever. By this time the lesions covered the entire body. The diet established in the hospital was continued. In November of the same year she went to the mountains for a change of environment and then entered another hospital. Sedatives were given without effect. The patient was sleeping only two to four hours. Short baths gave her some relief. She remained in the hospital till December 12. She proved sensitive to many sedatives. Scratch tests showed her to be sensitive to karaya gums; injection tests showed sensitivity to dog and cat hair. Rides, excitement, or fatigue of any sort bothered her greatly. The skin had been kept greased for several months. She could not stand the touch of clothing. During this period she had been seen by many physicians.

At the time of examination there was a bran-like desquamation of the entire epidermal surface from the soles of the feet to the scalp. Areas over the entire body showed evidence of mechanical abrasion, excepting over the abdomen and between the shoulder blades. The skin was very dense and thick over the entire body. The nearest normal skin was on the abdominal wall and the upper thigh, from about two inches below the inguinal ligaments to just above the umbilicus. The entire body was hot. The patient was unable to straighten either her arms or legs, because of lymph adenopathy. There was complete exfoliation of the skin of the external auditory canals. It was difficult to see the drum membrane. The eyebrows were missing. There was purplish discoloration at the junction between the hard and soft palates and marked swelling of the buccal membranes, which showed a yellowish cast. The labia were very edematous.

The patient began to show improvement relatively quickly. Although she gave a history of having received sedatives almost continuously prior to her admission to our hospital, we did not find it necessary to administer them except on a rare occasion. By February, 1943, there was a marked change in her disposition, and the skin, instead of showing a hard, gray, bran-like surface, had become more pliable and a fiery red. The periodic temperatures of 100° to 102°, which the patient had been running, were gradually subsiding, so that by February only occasionally would she have any fever. It was not until August, 1943, that she began to sweat normally. At that time her general condition had improved to such a degree that she was discharged as an in-patient. Most of the skin over her back and abdomen was relatively normal. There was still some thickening in the neck and a sclerodermatitis-like condition of the face.

On 11/1/43, her skin was practically normal except that the skin of the neck was still weeping occasionally when it became warm and the skin of the face was a little thickened. She is now able to sweat normally except on the face and neck. The eyebrows have not yet returned.

There has been a marked change in the personality of the individual during the period of observation. She has changed from a person afraid to face life to a happy, normal girl living and acting as any eighteen-year-old should. From an individual whose school record had always been questionable, she has become one of the superior members of her class. Though she still has a few patches to scratch when she is nervous, the skin is largely free.

5. Scleroderma.—Scleroderma, which has been noted in conjunction with arthritis and other conditions, responds relatively quickly. Here, the glazed, lifeless, easily-broken skin soon becomes soft and normal, especially in the elderly patient. The addition of physiotherapy, particularly hydrotherapy, in the form of hot applications and baths, is highly beneficial.

Male, aged ten, first seen on 8/11/42. Patient was suffering from Still’s disease but presented cutaneous lesions.

There was a marked thickening, drawing, and pulling of all the skin of the face. It was firm, mask-like, and devoid of expression. Every movement appeared to be painful. The skin over the hands was tightly drawn and shiny, particularly over the joints. There were keratotic lesions over the lateral aspects of the posterior portion of both hands and about the thumbs. The skin over the entire body was shiny and lacked life.

Until June, 1943, this patient was treated with our usual special diet without the addition of the raw brain. During this time he made some very satisfactory progresses in his general problem, but his skin was still similar to what it had been before treatment began. Inasmuch as raw brain had yielded most gratifying results with some older patients who had presented both arthritis and skin lesions, we decided to give this boy three ounces of brain daily because of the arthritic condition alone. His response was rapid in both conditions. The skin began to regain its normal appearance and lost its shininess. It became soft and lost the bound down appearance formerly noted. The extremities, which had always been cold before, began to show an increase in temperature. Marked improvement in the general circulation of his extremities was noted very promptly. By November, 1943, the glassy appearance had disappeared.

6. Psoriasis.—In our experience, the use of the raw brain and liver with the high protein diet has been an effective aid in treating psoriasis. It must be remembered that in treating such a condition, one is treating a generalized metabolic disturbance and not merely the skin. The response of these patients is most interesting. It is characterized by remission, exacerbation and progression; but the general progress of the treated cases seems to be one of satisfactory and consistent healing. The use of the soybean lecithin has been described by Goldman2 and others. We treated the case of psoriasis described below as we treated the other skin conditions under discussion.

Female, aged sixty-three, first seen 10/1/43. The psoriasis was of eight months’ duration. The patient appeared to be eighty. She had had some arthritis since 1932 and had been deaf for thirty-five years. The patient gave a history of preferring her meat well done. She stated that she did not like fat and ate very little butter. Her muscular strength was poor. She developed psoriasis in February, 1943, at the same time she contracted a severe cough. She had had periodic exacerbation of temperature. A rash had broken out over the face and back. She complained of colitis and anemia.

Examination of the skin revealed some epidermaphytosis over the feet. There was much wasting of the tissues about the buttocks and a fine-grained rash over the entire body. The skin was very dry. There was a collar of dry epidermis down to the manubrium and red areas over the shoulders. The skin over the face was scaly, dry, and painful to the patient. There was a nearly total loss of the eyebrows. The scalp was extremely dry, dirty, scaling, and showed yellowish coloration. There were flattened keratotic areas of from two or three mm to as much as a square cm over the lateral aspect of both arms. There were similar areas over the dorsum of the thumb and on the mesial surface of the little finger of the left hand. There was a Dupuvtren’s contracture of the left palmar fascia. There was an area on the mesial surface of the fourth digit of the left hand from an electric burn, which had been a running sore for twelve years. There was considerable loss of the interosseous muscles and subcutaneous tissues. There was a round, erythematous lesion in the pulp of the second finger of the right hand. Around the anus was the same type of reddened lesion. A leucoplakia-like lesion in the perineal fold extended up and involved the lower portion of the labia minora. There was a marked wasting of the vermilion of the lips and a reddened, inflamed, edematous lesion in the vault of the mouth. She showed a geographic tongue.

On 11/1/43, for the first time in twelve years the skin had completely grown over the burn on the little finger of the left hand. The keratotic lesions on the lateral aspect of the arms seem to be disappearing. The patient was feeling materially better. The skin was not quite as dry as before and was beginning to get a soft feeling. The pain had left the face. The dry, scaly condition existing over her body as a whole had largely disappeared, though it was still present on the face. The scalp showed some signs of natural oil. The reddened areas over the back had diminished in size.

7. Atrophy.—Much improvement is noted in the senile atrophies of the skin.

Male, aged seventy-six. Patient complained of extreme dryness of the skin over the dorsum of the hand and loss of subcutaneous tissue.

Examination revealed paper thinness, generalized bronzing, and low, flattened, irregular keratotic areas. Patient stated that the condition had developed during the year and a half before, particularly since the advent of meat rationing. He had formerly been a heavy consumer of meat products and fat, and he had always liked his meat rare. Coincident with meat rationing, he had been put on a diet quite low in calories and fats because of a diverticulitis.

The patient was given nine grams of soy bean lecithin daily over a period of six weeks, and his usual diet was resumed. The skin showed evidence of filling out and being softer. The keratoses were becoming smaller, and the bronze pigmentation lessening.

8. Seborrhea, Keloid, Acne.—Most of the cases of seborrhea that have come under my observation have been associated with acne. It has been very interesting to note that the seborrheas respond well to treatment, showing generalized softening of the skin and lessening of the oily excretion. On the other hand, although we have seen apparent beneficial effects with acne, the acne proper does not respond as well as the seborrhea itself. Extensive keloid formations, due to burns, severe acne, cuts, etc., which had formerly treated with thyroid, are found to respond to these dietary changes.

Male, aged eighteen, first seen 10/16/42. Major problems were a failure in development of the face, extremely low energy, exhaustion, seborrhea of the scalp and face, acne, and keloid. At twenty months of age he had received a first, second, and third degree burn over the precordium, and the left side of the face and abdomen.

There was a large appendicial scar with keloid formation, elevated approximately ¼ inch, about 1 inch in breadth and 2½ inches long. On standing there was a marked increase in purplish discoloration of his lower extremities extending up to the upper third of the thighs. It was also apparent over the distal portion of his upper extremities. He showed a marked mottling of the skin over the entire body. On standing for twenty minutes the purplishness increased and extended as high as the umbilicus. There was marked evidence of disturbance in the circulation of the lower extremities. There was a 5 inch scar on the dorsal lateral surface of the arm extending from the head of the radius down. Just mesial to the pap on the left was a scar 1 inch broad and 1¼ inches long. There was a marked keloid tendency below this area, and mesial to it was another scar about 1 inch long. There was a similar scar in the region of the zyphoid, also due to the burns of childhood. Mild acne showed over the face, particularly over the forehead, and there was a fine, silvery scale about the eyebrows.

On 5/15/43, the acne showed a decided improvement and the skin was beginning to lose its oiliness. The keloid was lessening.

By 10/16/43, the scars had practically disappeared. All elevation of the appendicial scar had disappeared. The acne continued to a slight degree but was not marked.

CONCLUSION

We have found experimentally that in the heat processing of food for animals (cats and rats), certain factors that are essential to the proper maintenance of skin tone, vascular tone, reproduction, development of the bones, maintenance of the natural form, and the prevention of allergic-like manifestations are destroyed. Furthermore, we have found that by avoiding the destructive effects of heat in the preparation of food, we have been able to relieve many clinical manifestations. In this communication we are reporting only the effects on the skin.

The factors destroyed apparently occur in all raw meats, particularly in the fats, but they are especially useful as found in brain, liver and heart muscle. Vegetable lecithins that have not been exposed to temperatures exceeding 135°F have also proven useful. These factors are lacking in fats and oils have been subjected to high heat in processing and are not found in therapeutic amounts in pasteurized milk or in butter from pasteurized cream. Although we are reporting the action of these factors upon the skin only, they affect the entire metabolism of the individual.

The therapeutic effects of the heat labile factors found in the lecithin rich foods have proven valuable in the treatment of keratoses, a bronzing of the skin which seems to be indicative of fat deficiency, infantile eczema, the more severe types of eczema, scleroderma, senile atrophy of the skin, seborrheas, and acne and keloid formations.

a We are grateful to the American Lecithin Co. of Elmhurst, Long Island, for Clinical material.

References Cited:

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