(From The Asheville Citizen, August 5, 1948.)

A theory concerning a major cause for human infection with polio has been advanced by Dr. Benjamin P. Sandler, of Asheville, N. C.

Dr. Sandler, a recognized authority in nutrition research, was the first doctor to transmit polio to the rabbit, believed to be immune, a test he completed in 1938.

His theory is two-fold — he believes he has found a major cause for polio in humans, and he believes that preventive measures are simple, easy, and quickly applicable.

Dr. Sandler believes that the major cause is the low blood sugar in the human body, caused, paradoxically as it may sound, by eating too much sweets and starchy food.

The preventive measures? Cut out foods containing sugars and starches.

In 24 hours, according to Dr. Sandler, the body can build up sufficient resistance to the polio virus to prevent disease. The diet would have to continue, of course.

"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."

Here is Dr. Sandler’s program:

(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.

Eat three substantial meals a day, advises Dr. Sandler. And avoid exertion and fatigue because they are known to be associated with low blood sugar content. Avoid swimming in cold water. Rest as much as possible.

Dr. Sandler suggests that the recommended diet be followed until the polio danger season officially is declared over by local health authorities.

"One of the puzzling characteristics of polio," Dr. Sandler said yesterday, "has been its prevalence in warm weather. Many people cut down on protective protein foods— such as meat, fish and poultry — because of a mistaken idea that a ‘light’ diet is better for them in warm weather. And they increase consumption of cooling foods 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 polio virus and other diseases."

Here is the basis for the Sandler theories:

A normal blood sugar content of 100 milligrams in each 100 cubic centimeters of blood is necessary to maintain resistance to bodily infection. Any appreciable lowering of this blood sugar content (say, to from 75 to 55 mg.) can lower the barriers and permit bodily invasion by the virus of polio.

Dr. Sandler offers as the scientific basis for these statements research done with rabbits and monkeys. This research he began at Willard Parker hospital in New York during the metropolitan area’s record polio outbreak of 1931.

Authorities had noted that rabbits normally are resistant to polio virus. Dr. Sandler, observing that studies showed that in rabbits the blood sugar never dropped below 100 mg., began pondering the far-differing case of the rhesus monkey, a notoriously easy prey to poliomyelitis. In monkeys, blood sugar content frequently was observed to fall to abnormally low levels, around 50 mg.

Furthermore, observations on humans who had recovered from polio revealed low blood sugar — hypoglycemia is the technical term — to be frequently present.

From these — rabbits, monkeys and humans — Dr. Sandler first deducted that low blood sugar could be an important factor in susceptibility to the polio virus.

The job was to check this deduction through experiments in which the blood sugar content of rabbits would be lowered and their susceptibility to polio again tested.

In the laboratories of the Morrisania hospital in New York 10 years ago, Dr. Sandler began a series of experiments in which insulin was injected in rabbits to lower the blood sugar for periods of four to six hours. Once the blood sugar content had been thus dropped, the doctor attempted again to transmit the polio virus to the normally highly resistant animals. The rabbits then fell easy victims.

The animals showed evidence of polio infection within eight to 10 hours after intracerebral inoculation with the virus, indicating rapid spread of the disease during the period of hypoglycemia. (Dr. Sandler reported on these studies in the American Journal of Pathology in January, 1941). Some rabbits died within 14 hours after infection. Characteristic nerve-cell destruction with paralysis was in evidence.

Chronic hypoglycemia (low blood sugar) is a common disorder in childhood and adolescence, Dr. Sandler points out, and is readily influenced by diet as well as exertion. This, he believes, serves to explain the high incidence of polio in younger age groups, as well as the frequently reported occurrence of the disease following strenuous physical exertion.

Dr. Sandler received his degree in medicine at New York university in 1931. He interned at Morrisania city hospital in New York city and later was on the staff there as well as Polyclinic and Montefiore hospitals in New York city. From July, 1941, until February, 1947, he was in the U. S. naval medical corps, attaining the rank of commander.

He has done considerable research in polio and the relationship between diet and disease. He has published six papers on the latter subject, as well as papers on other medical subjects. His research includes a period assisting the research staff at Willard Parker hospital in New York city during the epidemic there in 1931, and independent research later, when he "gave" polio to a rhesus monkey, transmitted it to a rabbit, and then to another monkey.

Summarizing the evidence for my contention that low blood sugar is a factor of susceptibility to polio, and that a diet aimed to prevent low blood sugar can prevent polio, I submit the following:

1. Low blood sugar is not present in the rabbit, a non-susceptible animal.

2. Low blood sugar is present in monkeys, a susceptible animal.

3. Inducing low blood sugar in rabbits with insulin renders the animals susceptible.

4. Physical exertion, swimming in cold water, predispose to polio because they may be associated with low blood sugar.

5. The diet campaign aimed to prevent low blood sugar and thereby prevent polio had a significant effect on the number of cases during the 1948 epidemic both locally in the city of Asheville, the state of North Carolina, and in the nearby southeastern states as shown by the earlier peak dates in those states. The diet campaign also had a significant effect on the number of cases throughout the country as shown by the change in the trend of the 1948 epidemic when compared with the trend in 1946.

6. The unique change in the graph comparing 1946 with 1948 is exceptional, in that the change occurred immediately after the release of the diet instructions, and because such a change had never before occurred in the history of polio in this country.

7. Although the 1949 polio epidemic for the country as a whole was more severe than the 1948 epidemic, the city of Asheville and the state of North Carolina experienced the greatest reduction in the number of cases in 1949 in spite of the fact that North Carolina had the second highest case rate in the country in 1948. The state of North Carolina had a case rate of 66.3 in 1948 and a case rate of only 6.3 in 1949. South Dakota had a case rate 153.9 in 1948, the highest in the nation, but showed a reduction in 1949 to only 63.0.

8. Polio epidemics have occurred throughout the world in past years only in those countries with high per capita sugar consumption. Epidemics are unknown in countries with low sugar consumption. The greater the sugar consumption the more severe the epidemic.

"Foods must be in the condition in which they are found in nature, or at least in a condition as close as possible to that found in nature."