Protein Milk

Protein Milk, a dietary product for treating diarrhea in infants. Proposed in 1910 by Prof. Finkelstein and L. F. Meyer, protein milk proved to be a powerful means for treating diarrhea and created an era in pediatric dietetics. Created on the basis of theoretical considerations related to the analysis of the pathogenesis of diarrhea, protein milk in turn served as the foundation for the doctrine of the significance of the alimentary factor in this pathogenesis, in terms of the relationship between food and the body's ability to assimilate it. Diarrhea most often results from pathological fermentation in the intestine. To combat diarrhea, one must first determine: 1) which components of food serve as the substrate for fermentation, 2) which correlation promotes fermentation, and 3) which correlation suppresses it. In this regard, Finkelstein and Meyer came to the following conclusions: 1) the substrate for fermentation consists of the carbohydrates in infant food; 2) whey, i.e., the salt complex, plays an essential role in the occurrence of diarrhea: fermentation arises and reaches a significant degree more easily the higher the salt concentration of the food; 3) the significance of fat is secondary; although it participates in fermentation, it only after fermentation has encompassed the carbohydrates; 4) as for protein, in contrast to previous views (Biedert), Finkelstein and Meyer conclude that increasing its content in food leads to the cessation of diarrhea and the formation of firm so-called fatty-soap-like stools. At the same time, it must be emphasized that this action of protein (casein) manifests itself especially strongly when it is present in a) a very finely divided state and b) in combination with calcium [calcium (para)-caseinate, as opposed to pure casein]. All these conclusions led Finkelstein and Meyer to create a therapeutic food specially designed for treating diarrhea, which they called protein milk. Protein milk is prepared from cow's milk; it is an acidic (up to 4° T) liquid; when left undisturbed, casein precipitates in it, curdled in the finest clumps. Above the casein is a greenish-yellow whey. The composition of protein milk: protein - about 3%, fat - 2.5%, carbohydrates - 1.5-2%, salts - 0.4%. Caloric value - about 430; high content of CaO (up to 0.14%, in whole milk - 0.16%) is noted. Thus, protein milk contains all the elements that characterize therapeutic food. The relative content of protein in it is high, the content of sugar and salts is low, and fat is present in a moderate amount. The casein is given a state of fine division, and the reaction of the food is acidic. At present, Finkelstein and Meyer prepare protein milk by coagulating milk with calcium chloride. (Their original method - coagulation with rennet - proved completely unsuitable for use in a milk kitchen, and even Finkelstein and Meyer for a long time used a product not of their own but of factory manufacture.) A certain amount of milk is boiled and cooled to 30°. After adding calcium salt (2 g per 1 liter of milk), the milk is heated, and curd precipitates from it. It is strained and the curd is passed through a sieve. The ground curd is dissolved in buttermilk, which is taken in half the amount of milk that was taken, and then boiled water is added to the suspension to obtain the original amount of milk. At present, quite a few methods for preparing protein milk have been proposed. They are essentially all the same, representing deviations only in details. They all prove to be suitable insofar as they give good curds. Protein milk gives good practical results if it is prescribed when there are actually indications for it and if the technique of its application is correct. The indication for prescribing protein milk is diarrhea that has developed on the basis of fermentation. Therefore, this includes acute nutritional disorders with diarrhea of mild or severe degree of primary food origin. In diarrhea of secondary origin (infection), protein milk is given in cases when functional disorders accompanied by fermentation appear. Protein milk manifests its action most vividly in decomposition and intoxication, especially when the disease originates from nutritional disturbances. Protein milk finds no application in cases where catarrhal-inflammatory phenomena predominate over fermentation. It can be prescribed here only as an easily digestible food. For feeding, protein milk is not a fully suitable product, since its preparation itself is accompanied by denaturation of the original milk, although many successful cases of feeding with this food have been described. Protein milk is directly contraindicated in those cases of dystrophy in which the processes in the intestine proceed in an alkaline direction and are accompanied by the formation of fatty-soap-like stools, cessation of weight gain, and other symptoms of nutritional disturbance from excess protein in the diet. The technique of applying protein milk is very simple. This remedy is prescribed according to a specific scheme. It is always given with sugar (at least 3% at the beginning of application); starting with approximately 300 cubic cm (in 5-6 portions), the amount of the product is quickly increased to 180-200 cubic cm per 1 kg of the child's weight (not exceeding, however, 1 liter per day). At the same time, the amount of carbohydrates is increased to 5-7-10%. Only when toxic phenomena are present is feeding started with very small amounts (for example, 5 cubic cm 10 times a day) and they are increased more cautiously. Protein milk is used to treat diarrhea as a means of creating conditions in which fermentation is suppressed. In this regard, another biological process occurring in the intestine - putrefaction - plays an essential role, which, provided it reaches a significant degree, acts antagonistically on fermentation. Protein milk aims to cause putrefaction in the intestine. In this sense, above all, protein acts from its components. The breakdown products of protein are a good medium for the activity of putrefaction-causing bacteria. On the other hand, protein enhances the secretion of alkaline intestinal juice, which is a typical substrate for putrefaction. In other words, protein causes putrefaction in the intestine both directly and indirectly. In this regard, the fat of protein milk also has great significance, which also promotes the secretion of intestinal juice and thus increases putrefaction indirectly. Finkelstein and ascribe a large role in the process of suppressing fermentation to calcium as well. However, the latter should not be overestimated. Ca neutralizes acids and thereby worsens the conditions for the development of fermentation. In addition, Ca converts soluble and intestine-irritating alkaline soaps into insoluble and indifferent calcium soaps. Such phenomena occur only when Ca remains within the large intestine for a time long enough to act on acids, which takes place when peristalsis is not increased, i.e., after improvement has occurred. As for carbohydrates, their presence in protein milk as a strong water recipient, i.e., as a factor contributing to weight gain, is necessary. Their negative influence is paralyzed in protein milk by the favorable properties of the medium, i.e., the reduction in salt concentration and the relatively high protein content. Thus, the therapeutic action of protein milk finds explanation in its correlation. There are two more factors that play a very significant role in this regard: the content of lactic acid in protein milk and the finest division of protein found in it. Lactic acid has long been considered a very effective remedy against diarrhea; observations confirm that the presence of acid in milk increases the intestine's ability to absorb and assimilate it (for details, see Milk Mixtures). Similarly, experience confirms the significance of the state of division of casein. The larger the curds in the product, the worse it acts. There is as yet no direct explanation for this phenomenon. Perhaps here lies the area of physicochemical relationships, and questions are touched upon that are related to the state of the colloid. As Schade indicates, the degree of assimilability increases in parallel with the degree of colloidal division. Means used for the purpose of preventing coarse curdling in the stomach belong to the area of colloids. One very effective means of preventing coarse curdling of milk in the stomach consists in giving the colloidal precipitation outside the body a particularly suitable form and introducing milk into the stomach only after fine division of the curds has been achieved in this way. Such preparation explains the circumstance that buttermilk, kefir, curd, and apparently protein milk are so easily assimilated. At present, reports expressing disappointment in protein milk are encountered more often than before. This is explained by many reasons. First of all, in order not to be disappointed, protein milk must be applied strictly following the indications (see above). In addition, a perfectly prepared product must always be used.

One cannot deny that the latter is very often absent, and surrogates are used instead of the actual product. Furthermore, it is necessary that the physician master the technique of applying Protein Milk. If all these requirements are observed, then Protein Milk will for a long time retain its significance as a reliable therapeutic agent.