New Generation Survival Ration: A Brief Report (1991)

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ALL-PURPOSE SURVIVAL RATION cent fat was more effective in promoting nitrogen utilization than one containing 10 percent,"® an extensive review of the literature indicated that there is essentially no difference between carbohydrate and fat in this regard. All food items of the ration should be of uniform composition because energy and protein must be available simultancously for maximum utilization.” This arrangement also prevents dietary imbalance resulting from individual taste preferences or from the need for subdividing a ration. | COMPONENTS OF THE PROTOTYPE RATION Drafting the specification for a prototype ration demands the inte- gration of all military requirements. So far we have dealt only with nutritional design. This design must be converted into components of sufficient acceptability, stability, and military utility to permit the ration to be used successfully. For this ration, some compromise with the concept of nutritional adequacy has been made; it is probable that a similar compromise in the area of palatability can be accepted. The technologists concerned with developing the ration cannot, however, escape the requirements of stability and utility. The Quartermaster Food and Container Institute for the Armed Forces was instructed to produce a variety of survival items that would have the maximum feasible caloric density; not provoke undue thirst; meet the designated approximate composition and contain about 0.7 to 1.4 percent salt; fit into a small rectangular can; withstand storage in the range of —80° to 160° F; and taste in part like food rather than confection. Six bars were created, 4 of which were packed in the can with some soluble coffee and sugar, vielding 937 calories in less than one-half pound of food weight. This prototype ration was then field tested for palatability and utility. In the 3 tests conducted with U.S. Air Force and Army personnel, 1 or 2 rations were issued per day for 4-, 7-, or 10-day periods of simu- lated survival.” Water was unlimited, or restricted to ] ml per calorie of issue. No physiologic measurements were recorded. Two of the bars—the meat flavored and the potato flake—were so uni- versally disliked that their exclusion from the ration was recommended. Rejection of these bars increased at the higher calorie level and in the presence of water restriction. Average rejection of the other bars was only § percent. Among men issued | ration daily for 10 days, there was no rejection of the 4 palatable bars at cither level of water. The Royal Canadian Air Force evaluated the prototype ration in comparison with their own AFFP III] Survival Ration.? Body weight losses were similar in both groups. Some food rejection occurred in APRIL 1960 $13

U.S. ARMED FORCES MEDICAL JOURNAL both groups, but the Canadian ration was rated more acceptable over-all. Chicken soup was a popular component. of that ration, emphasizing that hot drinks are highly desirable in survival conditions, It was believed that the addition of a small amount of salt to the U.S. ration would be an improvement. RECOMMENDED MODIFICATIONS Because of poor field acceptance, 2 of the bars of the prototype ration are being replaced by 2 new bars for which improved acceptance is predicted. This is a straightforward modification. Various means of supplying additional salt have been considered. For Navy use prebably no more salt is wanted, because of the amount inadvertently consumed from exposure to sea-water spray. In- creasing the salt level of the bars is not feasible. Sodium chloride tablets were shown to be poorly tolerated, saline solution was nauscous, and enteric-coated pills were found intact in the feces of some of the subjects at Minnesota.” A packet of bouillon (soup and gravy base or chicken-soup mix), which contains about 3 grams of sodium chloride, would appear to be a most acceptable carrier of additional salt: the soup need not be consumed if the salt level is to be kept low, the item is already in normal supply channels, the packet requires little space, and the soup fulfills the need for a hot beverage. Some additional minerals are naturally contained in the bars. Insufficient evidence is available on which to base a recommendation for fortification with potassium or other salts. We would be grateful if one of our colleagues would determine the absolute requirement and the desirable ratios of minerals for survival conditions, but the need does not seem critical for the short haul. Reappraisal of physiologic findings thus far acquired does not inspire us to modify our recommendation with regard to protein content of the ration. Unless an ample supply of water can be ab- solutely assured the risks produced by high protein seem unnecessarily high in proportion to the benefits. If the survivor can “live off the land” at all, his chief supplementary food is likely to be high in pro- tein—fish, flesh, or fowl—and his intake thereby augmented. The question of vitamins has never been raised seriously, nor ts there any need for them when maximum period of ration use is set at 10 davs. Provision of a vitamin pill is a nicety to which there is no objection if the users desire it. The beverages routinely include ascorbic acid, and a certain amount of vitamins A and Bois already provided by the bars. 114 VOLUME 1), NO. 4

ALL-PURPOSE SURVIVAL RATION Table 2. All-Purpose Survival Ration, 1959 prototype Weight Carho- Peotas- Component Calories | Jrofein Fat hydrate | Sodinm | sium (grams) | (grams) | (grama) (mg) (me) (oc) \(greme) Cercal bar no. ! 1.05 88.2 282 4.1 &9 38.9 (298)° (85)° Cereal bar no. 2 1.95 SS.2 258 4.5 9.5 38. 8 228 $58 Cheese bar 1.20 34.0 182 2.7 4.5 25.1 139 132 Racon bar 1.16 33.0 4 2.2 4.2 25.0 314 aa Fruiteake bar 1.6 G3 183 3.6 48 31.4 130 60 Chocolate fudec bar 2.00 $6.7 24 4.8 5.8 41.0 204 176 d average bars 660 | 186.8 816 14.4 25. 2 133.6 922 3:1 Soluble coffee 0. 0A 2.5 4 - trace 0.9 trace 3: Sugar 0. 21 6.0 24 - - 6.0 - - Chicken-soup hase 0. 25 7.0 19 0.6 0.7 2.5 1056 7 Total 7.38 | 272.3 8h3 15.0 25.9 143.0 1y7s°° 418 *valucs imputed from analysis of cerea) bar no. 1. **or $.03 grams sodium chiaride. The All-Purpose Survival Ration, now in procurement and being offered for user testing, consists of 4 bars of uniform composition, supplying about 900 calories, 8 percent of which are derived from protein, and 2 grams of sodium chloride (see table 2). The Air Force and the Army may issue 1 or 2 rations per man per day with benefit; the Navy may supply 1 ration per man per 2 days without causing damage. Coffee, tea, and bouillon are provided for personal comfort and an additional 3 grams of salt are contributed by the soup. Adoption of this ration will diminish the logistic burden from 5 specialized survival packets to a single unit and will also eliminate the necessity for changing survival gear when operations shift from one geographic area to another. SUMMARY Recent research studies bearing on the need for and composition of | a universal survival ration have been reviewed. Jt is concluded that a minimal supply of food is required under survival conditions to aid morale and to ameliorate the sequclac of starvation—ketosis, dehydration, and reduced work efficiency. To assure that the food will not impair water economy, the following composition is recom- mended: 1) a maximum of 7 to 8 percent of total calorics as protein; 2) a minimum of 75 to 100 grams of carbohydrate; and 3) epproxi- mately 4.5 grams of sodium chloride. The components of a proto- tvpe All-Purpose Survival Ration are described. APRIL 1960 415

10. 11. 12. 13. 14. 15. 16. 416 U.S. ARMED FORCES MEDICAL JOURNAL REFERENCES . Soutn, O. P.: Arctic Survival and Rescue Reports. North Atlantic Area. Documentary Research Division, Air University, Maxwell Air Force Base, Ala., July 1949. . Wickert, J. C. and Buss, J. Q.: Survival Feeding Trial of R.C.A.F. Seat Pack Ration, Report I.A.M. No. 52/4. Institute of Aviation Medicine and Defense Research Medical Laboratories, R.C.A.F., Toronto, 8 Dec. 1952. . Henscue., A., Tarvor, H. L. and Keys, A.: Performance capacity in acute starvation with hard work. J. Appl. Phystol. 6: 624-633, April 1954. . Tayrzor, H. L., HENSCHEL, A. and Kers, A.: Some effects of acute starvation with hard work on body weight, body fluids and metabolism. J. Appl. Physiol. 6: 613-623, April 1954. . Tayvor, H. L., Brozex, J.,. HENSCHEL, A., MICKELRES, O. and Keys, A.: Effects of successive fasts on ability of men to withstand fasting during hard work. dm. J. Physiol. 143: 148-155, Jan. 1945. . Guetzxow, H., Tayuor, H. L., Brozex, J. and Krys, A.: Relationship of speed of motor reaction to blood sugar level during acute starvation in man. Fed. Proc. 4: 28, March 1945. . Youna, D. R.: Effect of food deprivation on treadmill running in dogs. J. Appl. Physiol. 14: 1018-1022, Nov. 1959. . SarGcent, F. L., Sarcent, V. W., Jounson, R. E. and Stoire, S. G.: The Physiological Basis for Various Constituents in Survival Rations. Parts I-IV. Wright Air Development Center Technical Report No. 53-484, 1954-1957. . GamsBie, J. L.: Physiological intormation from studics on the life raft ration. The Harvey Lecture Serics 42: 247-273, 1946-1947. GRANDE, F., Taytor, H. L., ANDERSON, J. T., Buskirk, E. and Nevys, A.: Water exchange in men on a restricted water intake and a low calorie carbo- hydrate diet accompanied by physical work. J. Appl. Physiol. 12: 202-210, Mar. 1958. Minarp, D. and Scuuanea, H. A.: Effects of simulated survival conditions on water balance and metabolism in human volunteers, in Proceedings of the Survival Ration Conference. Quartermaster Food and Container Insti- tute for the Armed Forces, May 1951. Actirities Report 3: 160-165, Oct. 1951. Coyne, J. P.: A Report of Survival Equipment Trials, 29 May 1958-5 Junc 1958, Report No. 58/5, Institute of Aviation Medicine, R.C.A.F., Toronto. 20 Oct. 1958. | Dyme, H. C.: Arctic Ficld Trial of USAF Survival Rations, Blair Lake, Alaska, January 1950. U.S. Air Force Technical Report No. 6019, Aug. 1950. Ciacve, J. A.: Exposition of desired characteristics by services, in Proceed- ings of the Survival Ration Conference, Quartermaster Food and Container Institute for the Armed Forces, May 1951. Activities Report 3: 165-167, Oct. 1951. PROPOSAL FOR A PROTOTYPE SURVIVAL RATION, summary of the round table discussion, in Proceedings of the Survival Ration Conference, Quartermaster Food snd Container Institute for the Armed Forces, May 105). Actimities Report 3: 172, Oct. 195). Tayzor, H. L.: Conference Notes, Coordination Meeting on the Assignment VOLUME 11, NO. 4

——_— nt ae ee a ALL-PURPOSE SURVIVAL RATION to the Army of Primary Responsibility for Research & Development in the Field of Food, 21-22 May 1957 at Natick, Mass., pp. 14; 32, Oct. 1957. 17. Tavior, H. L., Buaxir«, E. R., Brozex, J.. Axprrson, J. T. and Granne, F.: Performance capacity and effects of caloric restriction with hard physical work on young men. J. Appl. Phystol. 10: 421-429, May 1957. 18. Schwimmer, D. and McGavack, T. H.: Protein Metabolism Studics on Reduced Caloric and Water Intakes. Committee on Food Research, Quarter- master Food and Container Institute, File N-1112, Report No. 5, Aug. 1948. 19. Scnwiewer, D., McGavack, T. H., Born, L. J., Rua, S. H. and Pearson, S.: Protein Metabolistin at Low Caloric Intakes. Quartermaster Food and Container Institute Contract, File N-1124, Report No. 4, 1953. 20. Quinn, M., KuEeman, C. R., Bass, D. E., and HENscHEL, A.: Nitrogen, water and electrolyte metabolism on protein and protein-free low-calorie diets in man; water restriction. Afelaboltsm 3: 49-67, Jan. 1954. 21. Quinn, M., Kuzeman, C. R., Bass, D. E. and Hrnscnez, A.: Nitrogen, water and clectrolyte metabolism on protein and protcin-free low-calorie diets in man; adequate water intake. Afctabolism 3: 68-77, Jan. 1954. 22. Drury, H. F., Vaucnan, D. A. and Hannon, J. P.: Some metabolic effects of a high-fat, high-protein diet during semi-starvation under winter field conditions. J. Nutrition 67: 85-97, Jan. 1959. 23. Fours, O. and Dents, W.: On starvation and obesity, with special reference to acidosis. J. Biol. Chem. 21: 183-192, Jan. 1915. 24. Vaveuas, D. A., Drury, H. F., Hannon, J. P., Vatcuas, L. No and Larson, A. M.: Some biochemical effects of restricted diets during successive field trials in winter. J. Nuértlion 67: 99-108, Jan. 1959. 25. Cattoway, D. H. and Srecror, H.: Nitrogen balance as related to caloric and protein intake in active young men. 4m. J. Clin. Nutrition 2: 405-411, Nov.—Dec. 1954. 26. Muxro, H. N.: Carbohydrate and fat as factors in protein utilization and metabolism. Physiol. Rev. 31: 449-488, Oct. 1951. 27. Curnrertson, D. P. and Munro, H. N.: Relationship of carbohydrate metabolism to protein metabolism, roles of dictary carbohydrate and of surfeit carbohydrate in protein metabolism. Btochem. J. 33: 128-142, Jan. 1939. 28. Kamen, J.: Preliminary Field Evaluation of All-Purpose Survival Ration Prototype. Quartermaster Food and Container Institute Report No. 29-58, Dec. 1958. 29. Brozex, J., Granpoz, F., Tayvtor, H. L., ANpERsoN, J. T., Buswirw, E. R. and Keys, A.: Changes in body weight and body dimensions in men per- forming work on a low calorie carbohydrate dict. J. Appl. Physiol. 10: 412- 420, May 1957. A TRIBUTE TO MARIE CURIE When Marie Curie died some 35 years ago, none other than Albert Kinstein paid her the tribute of a tear, for he lamented the passing of ‘‘one whose soul was never corrupted by power, and whose mind was never sullied by envy.”—James Gear: ‘And let us now praise famous men .. .’’ South African Practitioner, October 1959. APRIL 1960 417 541487 O—60-———-4

Original communications An evaluation of various survival rations” Raymond E. Davenport, B.A., Joanne K. Spaide,‘ M.S., and Robert E. Hodges,’ M.D. Since ancient times man’s ability to sur- vive has depended heavily upon the availa- bility of water, food, and shelter. Although modern society usually is able to protect itself against such primitive hazards, this security may be suddenly disrupted by war, accident, or natural calamity. Assuming the physical shelter is extraneous to this discussion, the remaining major con- siderations are water and food. Human star- vation, when tempered by adequate supplies of water, is compatible with survival for pro- longed periods of time. Indeed, Thomson re- cently described deliberate fasting for 249 days by a patient under treatment for obesity (1). Military and civil defense authorities as- sume that provisions for a period of 3 weeks should be adequate for most emergencies and it appears that water alone could ensure sur- vival by a majority of persons for this period of time. Accordingly, all other nutrients as- sume a secondary role and any measure that would materially increase the need for water must be considered objectionable. On the other hand, total starvation results in ketosis, hypoglycemia, physical weakness, and mental lethargy (2-5). Furthermore, there is an op- timal quantity of solutes that will actually conserve water supplies rather than waste them (6); hence it is reasonable to assume that, in addition to calories, some salt would be desirable in a survival ration. The advantages of providing an allowance of food include conservation of water, pre- vention of ketosis, avoidance of hypoglyce- mia, maintenance of mental alertness, preser- vation of physical strength, and satiation of hunger (7-9). There are ample reasons to surmise that the addition of even small quan- tities of food to a basal allowance of water might increase both the rate and duration of survival in any group of people subjected to a calamity. Many of the standards of adequate nutri- tion, as related to normal living conditions, must be temporarily abandoned; hence pal- atability of rations and satiety are of sec- ondary importance. Similarly, maintenance of body weight and of nitrogen balance is neither essential nor necessarily desirable, since to maintain these levels would increase requirements for water. The question of whether to add or to omit essential vitamins and trace elements is not readily answered. With the exception of beriberi, classical de- ficiences will not develop within a period of 21 days (10), especially in the presence of semistarvation. Theoretically, however, certain vitamins and minerals might be ad- vantageous as components of a survival ra- tion. Yet Tollenaar (11) found no apparent benefit from supplements given to rats fed one-third of the average daily ration. __ Although much is known about require- ments for survival, there still remains a substantial divergence of opinion regarding optimal rations for civilian and military emergencies as well as food for space travel. Accordingly, the following study was de- signed to evaluate the physical and biochem- ical health of normal men living under con- stant imprisonment and given restricted quantities of water and food. A comparison 1 Supported by a grant from the National Vita- min Foundation, Inc. *From the Department of Internal Medicine, University Hospitals, University of Iowa, Iowa City, Iowa 52240. *Research Associate. sor. ‘Dietitian. *° Profes- The American Journal of Clinical Nutrition 24: May 1971, pp. 513-523. Printed in U.S.A. 513

514 of four different types of diets was made in order to ascertain the advantages of each. Special attention was paid to evidence of dehydration, physical weakness, or psycho- logical disturbance. : Methods The subjects Arrangements were made with the officials of the Iowa State Prison at Fort Madison, Iowa, to con- duct a study of a group of 20 healthy volunteers within the prison walls. These men were selected from volunteers in the prison population of approx- imately 1,200, on a basis of height, weight, and age, as well as absence of any apparent physical or emo- tional illnesses. Physical facilities A separate wing or “range” was reserved for this study. All of the cells were in a straight row wherein each man occupied a separate unit. There were five subjects in each dietary group, housed in five adjacent cells with an empty cell between each group in order to prevent exchange of food or water. All water supplies, including toilet facilities, were shut off from outside the cells for the entire period of 21 days. The indoor temperature averaged 72 F and the relative humidity was 20%, but both fluctuated moderately. Personnel and procedures Additional guards were hired to maintain a con- stant 24-hr watch, thus assuring that the only food and drink received by the subjects was that supplied by us. The only persons permitted in this range were these special guards, the dietitian, and the medical and technical personnel conducting the study. Urine was collected at 24-br intervals for measurement and analyses, fecal samples were collected in plastic bags (using a stool converter) and weighed before being discarded. Washing and shaving facilities were provided each morning in the form of 2 quarts of water, strongly denatured with liquid green soap. DAVENPORT ET AL. The authors personally ascertained that this mix- ture was not potable; vomiting was promptly in- duced by a single swallow. Every morning each subject was weighed before eating and after empty- ing his bladder. Twenty-four hr samples of urine were preserved for later analyses by adding 2 mi of a toluene and glacial acetic acid mixture (1:2) per liter and then frozen. Each man was examined daily in order to ascertain his emotional condition and the state of his health, as well as his temperature, pulse, respiratory rate, and blood pressure. The men were not permitted to leave their cells during the entire 21-day period. The diets Four separate diets were employed (Table 1). The first diet was a virtually pure carbobydrate con- fection made from corn syrup, sugar, starch, cream of tartar, sodium citrate, and natural and artificial flavorings and colorings. These gelatinous candies were supplied by the Lucy-Ellen Candy Company (811 S. Hamilton, Sullivan, Illinois) in packages containing four flavors (lemon, lime, orange, and cherry). Each jelly bar provided 200 kcal and eight bars/day per man were fed. The second diet, which resembled a graham cracker, was a “biscuit” com- pounded from wheat, corn, and soya flours, cane and corn sugars, partially hydrogenated cottonseed oil, salt, and leavening, supplied by Dr. John Browe, New York State Department of Public Health. The biscuits provided 30 kcal each and approximately 53 (352 g)/man per day were fed. The third and fourth diets were similar in that they were milk- based formulas containing added fats and carbohy- drates. They were composed of Alacta (powdered half-skimmed milk), and Dextri-Maltose #1 (mix- ture of maltose and dextrins), both supplied by Mead Johnson and Company, Evansville, Indiana, plus dextrose, corn oil, and water. They differed, however, in the amount of protein; the third diet contained 5% calories as protein, whereas the fourth contained 12% calories as protein. As can be seen in Table 1, not only did the protein con- tent of these four diets vary from essentially 0 to 12%, but the mineral content also differed. Each subject, regardless of which ration he was TABLE 1 | | % of calories from: ' Total Number | Total | Total ' Total Number daily Diet of | keal/day | ‘ potassium, | sodium, of allowance subjects | | Protein | Fat Carbo. mEq i mEq subjects ot HO, ‘ ' \ ee I Jelly bar 5 ' 1,6007 0 | 0 | 100 5 21 5 1,0C0 IT Biscuits 5 1 , 600: 7.30 47.5! 75.1 13+ 69 3 1.0c0O ; 8 69 2 111 54, Formula 5 1,600 5 40 55 54 50 2 1. 5X) 85 2 IV 126, Formula 5 1 ,.6C0 12 40 ;, 48 5C 54 2? 1d | 89 3 : « Allowance provided but not always consumed. raised potassium level. ee ee ee +e oe ¢ Manufacturing process of incorporating thiamin

EVALUATION OF SURVIVAL RATIONS given, received a water allowance of 1,000 ml daily; thus the men who were assigned to Groups Ill and i (the two formulas) received 1 liter of water plus the amount (500 ml) of liquid contained in the for- mula. In order to evaluate any possible effect of udding thiamin, two men in each group were given none, whereas the remaining three in each group were given 1 mg thiamin hydrochloride daily. To compare the effects of added salt, two of the five men in each of the two groups of men consuming the formulas received an additional 2 g salt; the other three in each group received an additional 4 g salt daily. All diets were otherwise similar in that they supplied 1,600 kcal and were fed in three equal portions daily. Although the men were supposed to cat all of the food supplied, we later found that a few of the jelly bars and some of the biscuits were not consumed. This was taken into consideration in our calculations. Conduct of the study Once each week,.a detailed physical ex- amination was conducted by one of us (REH) and blood was collected for chemical exam- inations. These included determinations of hemoglobin (12), hematocrit (13), -erythro- cyte sedimentation rate (14), total nitrogen (15), serum sodium,® potassium,® ascorbic acid (16), total protein (17), and protein clectrophoresis (18). Urine was examined for specific gravity (19), pH, blood, glucose, protein,’ ketone bodies,® nitrogen (15), so- dium,® potassium,® thiamin (20), riboflavin (21), pyridoxine (22), and pantothenic acid (23). Samples of urine later were measured for osmolarity® and a correction was made for the effect of the acetic acid and toluene that had been added as a preservative at the time of collection. Clinical observations and measurements Acceptance. At first all of the diets were well accepted and complaints were few. Be- fore long, however, it became apparent that some of the men did not relish their diets. The jelly bar group. The chief complaint among these men was of monotony and ex- cessive sweetness. At the close of the study, a “shake-down” of the cells disclosed a total of 47 candy bars hidden by the five men, ranging from a high of 19 for one man to a low of 0 for another man. This represented about one day’s ration per man Or an average of approximately 5% of the total ration for five men for 21 days. Seldom did any man in this group complain of 315 hunger, nor was thirst a complaint. There was no clinical evidence of dehydration. All of the men in this group remained well and seemed to have neither physical nor mental deterioration. The biscuit diet. This diet was also well accepted, although all of the men complained of the dryness and hardness of the biscuits and of monotony. The “shake-down” re- vealed that three of the five men left 11 meals uneaten. This represented slightly less than one day’s ration per man or approxi- mately 3% of the total ration for five men for 21 days. All the subjects in this group felt that they would have liked more water and two of the men had definite thirst at times, but hunger seldom occurred. None of these men manifested signs of dehydration and all of them remained physically well and mentally alert throughout the study. The 5% protein formula diet. This diet was very well accepted at first. Indeed, all of the men considered it palatable, but af- ter 10 days they began to complain of mo- notony. Various artificial flavors (chocolate, Strawberry, cherry, and vanilla), which did not significantly change the chemical com- position, were then used to alter the taste. Complaints of hunger occurred most often in this group and were unrelated to the level of salt intake. It soon became apparent that those subjects who were receiving 4 g salt daily were experiencing greater thirst than those who received only 2 g daily. Com- plaints of thirst occurred after 5 days with an intake of 4 g of salt daily and after 10 days with 2 g daily. Definite physical evi- dence of dehydration (inelastic skin, dry- ness of lips and tongue) appeared in four of these five subjects. Paradoxically, the one subject who showed no clinical signs of dehydration was receiving 4 g salt daily. The 12% protein formula diet. Initially, this diet was very well accepted and all sub- jects considered it palatable. After 10 days, *Coleman Flame Photometer, Catalog No. 21- 900, Coleman Instrument Corp., Maywood, Illinois. * Hema-Combistix, Ames Co., Division of Miles Laboratory Inc., Elkhart, Indiana. * Acetest Reagent Tablet, Ames Co., Division of Miles Laboratory Inc., Elkhart, Indiana. * Osmette, Fisher Scientific Co., 1485 N. Damon Avenue, Chicago, Illinois.

516 however, the men began to complain of monotony. This was unrelieved by attempts to alter the taste of the formula with various flavors. Hunger occurred in two of the five subjects and was unrelated to salt intake. After the first 5 days, thirst was persistently present in all three subjects who received 4 g salt daily. The other two subjects who received 2 g salt daily did not develop thirst until after 10 days. All five subjects in this group had inelastic skin and dryness of their lips, tongue, and skin from the 11th day on- ward One man each in Groups Ill and IV complained of dizziness occurring intermit- tently throughout a single day of the Ist week. In both instances this complaint dis- appeared and did not recur. In the 3rd week of the study, one of the men in Group IV developed an upper respiratory infection and quickly manifested fever, dehydration, and tachycardia. He was promptly trans- ferred to the prison hospital where he was DAVENPORT ET AL. given fluids intravenously and then allowed to resume a normal diet. His recovery was rapid and uneventful, but we felt he might not have survived if he had continued the study. All 20 of the men lost weight during their 3-week period of participation in the study (Fig. 1). We estimated that, on the average, - the caloric deficit should account for a weight loss of approximately 6 lb. in this period of time. Presumably any greater average weight loss would result from dehydration, whereas failure to lose weight might result from re- tention of salt and water. Actually there was a wide range of weight loss, from a minimum of 4.5 to a maximum of 19 Ib., with an aver- age of 10.3/man. These differences in weight loss among the groups were not statistically significant. The average weight loss for the men consuming the jelly bar diet was 12.2 Ib. (range 7.5 to 16.0); for the biscuit diet the average was 10.1 lb. (range 4.5 to 19.0); for the 5% protein formula the average was 0 -2 N p> GN 4 -4 _— ‘ oe > 4 a @ o Ls. - Ny 6 ° e eo -8 Ss : 5% Formula -IOr 2 Biecult 12% Formula ‘ 4 -|2- Jelly bare . __. 2 Poeereeheee 2 . | . + = . . 4 i 7 14 2l DAYS Fic. 1. Weight loss.

EVALUATION OF SURVIVAL RATIONS §.5 lb. (range 6.5 to 11.0); and for the 12% protein formula the average was 10.6 lb. (range 7.5 to 18.0). Of course, the average caloric needs of the men in each group were not identical. Biochemical findings Although most physiologists believe that a urinary output of 800 to 900 ml daily approaches the maximal concentrating abil- ity of the kidneys of healthy man, we found thut our men excreted considerably less than this amount. After the first few days of the experiment there was a sharp decrease in their output (Fig. 2), but there were obvi- ous differences between the averages of the four groups. The men in the group receiving the jelly bars and those receiving the bis- cuits excreted approximately 450 ml daily, whereas those receiving the 5% protein formula (Group IID) excreted an average of 517 about 750 ml daily, and those fed the 12% protein formula (Group IV) averaged 650 ml of urine daily. It should be recalled that these two formulas supplied 500 ml more fluid intake daily than did the two dry diets. Urinary osmolarity was determined only at the beginning, middle, and end of the study, not before or after. In Group II, consuming tthe biscuit diet, urinary osmolarity values ranged from 800 to 1,050 milliosmols/day (Fig. 3). The next highest levels were ob- served in Group IV, the 12% protein for- mula (750 to 850 milliosmols/day), followed by Group III, the 5% protein formula (550 to 600 milliosmols/day). The men consum- ing the jelly bars (Group ID had the lowest urinary osmolarity with values of 500 to 550 milliosmols/day. These differences, al- though rather large, are not statistically sig- nificant. Urinary nitrogen excretion suggested a 1st 5 L4} 12 lor LITERS? ° ° ° ° ° ° ° OS F ° e e 5% Formule © — e . ° e eo os ° e e °° ¢ ° . o——2@ 12 % Formule @ e > o o 4 o a @ 4 3 a RE - see ce) ost 3 ° 5 . 4 Jelly bers 4 , A o2/- 7 14 21 DAYS Fic. 2. Urine volume.

518 DAVENPORT ET AL. 1200 - o o oe" gp FesS—S—SSSS o Biscuit ° e ee 12% Formule 600- o ee ™ “” at S o ° © 600 - 4s *, 9 8 5% Formule 3 . = a Jelly bors = as a 400 - 200 - 2 a a a a a A a 2 s A a a 2 a - . i T° 14 21 DAYS Fic. 3. Urinary osmolarity. negative balance even though fecal nitrogen was not determined (Fig. 4). The difference between dietary intake and urinary output disclosed that the least amount of nitrogen was lost by Group IV who were fed the 12% protein formula, whereas intermediate values were obtained for Groups II and III and the greatest loss occurred in Group I, who consumed the protein-free jelly bar. Actual nitrogen losses reflected urinary os- molar load, and here the order was reversed for the 12% formula and biscuits. Urinary creatinine losses were not signifi- cantly different among the four groups, but it is of interest that they declined from an initial median value of about 1.75 g/day to a final value of approximately 1.5 g/day, the lowest value being achieved by the group consuming the jelly bars, which supplied no dietary nitrogen. Diminishing excretion of vitamins in the urine provided evidence that the diets were deficient in many respects. As anticipated, the men who received thiamin supplementa- tion of their diet excreted considerably more of this vitamin in their urine than did those whose diets were unsupplemented (Fig. 5). The values were highest in the men who con- sumed the 12% protein formula or the bis- cuit diet and were intermediate for those consuming the 5% protein diet. The lowest urinary excretion levels for thiamin were ob- served in the men who consumed the jelly bar diet. In the subjects who received no thiamin in their diet, urinary values quickly fell to less than 100 »ng/day and were lowest in those who ate the jelly bars. Uninary pantothenic acid excretion ini- tially ranged from 1.5 to 5 mg daily and de- creased somewhat in three of the four groups. Similarly, riboflavin excretion decreased pro- gressively, in all the subjects, but there was es- sentially no difference in the amount of ribo- flavin excreted by subjects whose diets were supplemented with thiamin as compared with those who did not receive the supplement. Pyridoxine in the urine varied consider- ably from one man to another at the onset but there was an overall decrease, the magni- tude of which paralleled the height of the initial value. During the first four days, urinary sodium excretion declined sharply in all the men, then leveled off at a fairly constant rate (Fig. 6) (24). The men consuming the jelly bar diet had the lowest salt intake and their

EVALUATION OF SURVIVAL RATIONS 519 OF e @ -! F- 12% Formuta 8 “2 Fr 5 % Formula Biscuit -3 + GRAMS “4 F Jelly bars °§ —_ 4a -6 - 8 A A A i | A A A ff A A i 7 14 2t DAYS Fic. 4. Urinary nitrogen (intake minus output). excretion rate fell to 15 mEq sodium/day. By contrast, those consuming the biscuits ex- creted approximately 60 mEq/day. Those who received the 12% protein formula ini- tially were excreting 175 mEq sodium/day, but this fell to either 30 or 45 mEq/day de- pending on their intake of salt, 2 g (52 mEq) or 4 g (87 mEq) daily. Similarly, the values for those consuming the 5% protein formula fell to 30 mEq or 60 mEq daily depending on the level of salt in their diet. Urinary potassium excretion was not in- fluenced by the level of sodium chloride in the diet. Men in both formula groups ex- creted approximately 50 mEq daily, whereas those consuming the biscuits and jelly bars excreted 30 mEq and 20 mEq daily, re- spectively. Serum ascorbic acid values initially were in the neighborhood of 0.65 mg/100 ml and decreased by 21 days to approximately 0.42 mg/100 ml. Serum values for sodium and potassium were not significantly altered in any of the four dietary groups. Sodium values remained constant at approximately 130 mEq/liter for the first 2 weeks but began to rise during the final week and reached an average level of approximately 150 mEq/liter. Potassium values initially averaged approximately 5.6 mEq/liter and after the first week fell to approximately 4.7 mEq/liter, only to rise again in the final week to 5.5 mEq/liter. Electrocardiograms. These remained nor- mal until the final week when three of the five subjects on the 12% protein formula had tracings that showed increased T wave am- plitude and depression of the S-T segment suggestive of early hyperkalemia, despite serum potassium values in the high normal range. Discussion Palatability and acceptance of the dicts were weighed highly in favor of the two formula diets, regardless of the salt level. Next in order of acceptability was the bis-

520 DAVENPORT ET AL. wr 2 mg doily r Omg doily 6Fr - o e 12% Formula SF - 05 %Formule - oO Biscult 4 a b 4 Jelly bars wc / OAY or - 2 an o ad el ws —_ 0 7 4 T 14 2! DAYS Fic. 5. Urinary thiamin. cuit diet and last came the jelly bar diet. Indeed, it was obvious that the men ate these slowly and with reluctance. Sometimes they hid a few bars rather than eat them. From the standpoint of physical and mental well-being, the men who received the jelly bar diet were probably in the best con- dition of any and complained of neither hunger nor thirst. By contrast the men re- ceiving the 12% protein diet, especially those who received 4 g salt daily, were con- stantly thirsty after the first few days and all of them showed definite evidence of dehy- dration. There was little difference between the men in the group receiving the biscuits and those in the group receiving the 5% pro- tein formula with a low intake of salt (2 g). Although none of the subjects was in a position to engage in physical activity, it was quite apparent to those of us attending them that the group who ate the jelly bars appeared most alert and active. This is in accord with findings by Consolazio et al. (25-27) in their work on acclimatization to high altitudes by the use of high carbohy- drate diets. Conversely, those men who con- sumed the two formula diets, especially with the 4-g level of salt intake, appeared lethargic and quite unwilling to move about unneces- sarily. The condition of the subjects receiv- ing the biscuits remained good, but they ex- creted a much greater solute load than did those on the jelly bar diet, and hence might have developed dehydration in a longer pe- riod of time. Understandably, there was a marked de- crease in serum or urinary values for all of the vitamins measured, but there was no evidence within this period of 21 days that health was jeopardized in any way. Steven- son (28) reported that although there was no evidence of vitamin deficiency during pe- riods of complete fasting, symptoms did oc- cur during periods of refeeding with adequate caloric intake. Scurvy, as an example, ap- pears within 60 to 90 days in men who have adequate calories but zero ascorbic acid in- take (29). Vitamin deficits could be avoided

EVALUATION OF SURVIVAL RATIONS 180- 160- ; JELLY BAR 140 120- 680- 60- 40- 20- Beppe pp gig g 9 og gg fd del 521 a 6 S$% FORMULA a 6 go 9 go gg 4 5 5 fg h s g pap pp pg pg 9g gp yg yp 3) mEq 160- 160- 140- 120+ SISCUIT 3. 8. 3. 3, 20- (69) Dopp fg gg gg Mel celled 12% FORMULA a 2 8 p f Pf ff f p gp gg gg gg f g g (69) (54) Bop gf og 5 fg Gg | aoe t hag g gg pg 9 4 4 yg 3 yi 7 4 ( )dally Ne intake in mEq 2i 7 4 2i Days Fic. 6. Urinary sodium. very easily by simple inclusion of small sup- pres of multivitamin preparations in survival its. From the standpoint of thirst, hunger, and freedom from dehydration, it was apparent that the men who consumed the jelly bars tolerated the experimental period of 3 weeks best of all. By contrast, all the men who received the 12% protein formula contain- ing 4 g sodium chloride experienced constant thirst and showed clinical evidence of dehy- dration. Those receiving the 5% protein for- mula containing 4 g salt also complained of thirst and four of the five appeared dehy- drated. Those consuming the 5% and 12% Protein formulas with only 2 g salt had Somewhat less thirst and dehydration. The men who received the biscuit diet had about an equal degree of thirst, but there was lit- tle or no clinical evidence of dehydration. The general clinical condition of all 20 men indicated that a moderate amount of dehydration developed in all, as evidenced by weight loss greater than that explainable on the basis of the caloric deficit and by some hemoconcentration as shown by the rising serum levels of potassium and sodium. It was during the final week, however, that three of the men in Group IV showed elec- trocardiographic evidence of hyperkalemia. This observation, plus the fact that one of the men in this group became critically dehy- drated shortly after developing a respiratory infection, suggests that they were perilously close to dehydration. Clinically, and on the basis of biochemi- cal tests and electrocardiographic results, our findings suggest that diets of pure carbo- hydrate fed with small amounts of salt are well tolerated when fed over 3-week periods. Expenditures of physical activity were not required of our men, yet, our results extend and confirm the findings of Gamble (30) and Grande et al. (31). We also found that pure

522 carbohydrate diets did contain adequate, os- motically active material and actually did retard dehydration, as opposed to findings by Sargent and co-workers (32). Our results also show that 1,600 kcal of pure carbohy- drate plus small amounts of salt eliminates the acetonuria found by the United States Navy trials (33), the United States Air Force studies (34), and the Royal Canadian Air Force study (35). It is tempting to speculate that a pure carbohydrate diet supplemented with a mod- est amount of salt (15 mEq/1,000 kcal) might provide optimal conservation of wa- ter, prevention of ketosis and hypoglycemia, with preservation of physical and mental functions during actual survival. Actually, Our experiment compared four diets under sedentary conditions. It is inappropriate to guess whether these comparisons would ap- ply to men under physical and environmental stress facing emergence into an unknown world. It is equally impossible to guess whether the entire spectrum of human life (various ages, both sexes, and varying con- ditions of health) would show the same re- sponses. Summary Twenty healthy prison inmates were con- fined to individual cells for a period of 21 days, during which time they received only 1 liter of water daily and one of four diets, each of which provided 1,600 kcal daily. The diets and groups were: /) a jelly bar, composed almost entirely of carbohydrates, plus a small amount of salt; //) a biscuit com- posed of a mixture of cereal products; ///) a milk-based formula containing 5% calories as protein; and /V) a milk-based formula containing 12% calories as protein. Three of the men consuming each of these formulas received 4 g sodium chloride daily, whereas the other two men in each formula group received only 2 g sodium chloride daily. Three men in each of the four groups re- ceived 1 mg thiamin daily, whereas the re- maining two in each group received none. Clinical evidence of dehydration was least marked in the men receiving the jelly bar diet and became progressively more appar- DAVENPORT ET AL. ent in the following order; the biscuit diet, the 5% protein formula with 2 g of sodium chloride, the 12% protein formula with 2 g of sodium chloride, the 5% protein formula with 4 g sodium chloride and the 12% pro- tein formula with 4 g sodium chloride. Hunger and thirst were absent among the men receiving the jelly bars, but thirst was progressively more common in the sequence listed above. There was no evidence that the addition of thiamin to the diet was of any benefit. Blood levels of ascorbic acid and urinary levels of pantothenic acid, thiamin, pyridox- ine, and riboflavin fell progressively, yet specific deficiencies did not appear. The pure carbohydrate diet with a small amount of salt was the most effective one in preserving water and electrolyte homeostasis, yet it was the least popular of the four diets. References 1. THOMSON, T. J., J. RUNCIE AND V. MILLER. Treatment of obesity by total fasting for up to 249 days. Lancet 11: 992, 1966. 2. ConsoLcazio, C. F., L. O. Matousn, H. L. JOHNSON, R. A. NELSON AND H. J. KRZYWICKI. Metabolic aspects of acute starvation in nor- mal humans (10 days). U.S. Army Med. Res. Nutr. Lab. Rept. No. 299, September, 1966. 3. ASHLEY, B. C. E., anD H. M. WHyTE. Meta- bolic studies in starvation. Australasian Ann. Med. 10: 92, 1961. 4. Scott, S. T., F. M. McCoLium anp V. P. Hotitoway. Starvation, ketosis and uric acid excretion. Clin. Sci. 27: 209, 1964. 5. DRENICK, E. J.. M. E. Swenpserp, W. H. BLAHD AND S. G. TUTTLE. Prolonged starvation as treatment for severe obesity. J. Am. Med. Assoc. 187: 100, 1964. 6. Baker, E. M., I. C. PLOUGH AND T. H. ALLEN. Water requirements of men as related to salt intake. Am. J. Clin. Nutr. 12: 394, 1963. 7. Brozek, J., S. WELLS AND A. Keys. Medical aspects of semistarvation in Leningrad. Am. Rev. Soviet Med. 4: 70, 1946. 8. Taytor, H. L., E. R. Buskirk, J. Brozek, J. T. ANDERSON AND F. GRANDE. Performance ca- pacity and effects of caloric restriction with hard physical work on young men. J. Appl. Physiol. 10: 421, 1957. 9. Rocers. T. A., J. A. SETLIFF, A. C. Buck, J. C. KLOPPING AND M. MatTTe™r, Jr. Amelior::- tive value of carbohydrate and electrolytes in Arctic survival. J. Appl. Physiol. 21: 643, 1966. 10. Ztrortx, Z. Z., W. T. Nunes, R. C. Powe, P. P. WariInG AND H. E. SAUBERLICH. Excretion

12. 13. 14. 15. 16. 18. 19, 20. 21. 22. 23. 24. EVALUATION OF SURVIVAL RATIONS of thiamine and its metabolites in the urine of young adult males receiving restricted intakes of the vitamin. J. Nutr. 85: 287, 1965. . TOLLENAAR, D. Effects of mineral and vitamin supplementation on swimming times and other parameters related to performance of rats on a low calorie regime. J. Nutr. 90: 441, 1966. Topp, J. C., A. G. SANFORD AND B. B. WELLS. Clinical Diagnosis by Laboratory Methods (12th ed.). Philadelphia--Saunders, 1953, p. 189. LEVINSON, S. A., AND R. P. MACFartTE. Clinical Laboratory Diagnosis (6th ed.). Philadelphia: Lea & Febiger, 1961, p. 730. Levinson, S. A., AND R. P. MacFate. Clinical Laboratory Diagnosis (6th ed.). Philadelphia: Lea & Febiger, 1961, p. 728. BAUER, J. D., G. ToRO AND P. G. ACKERMAN. Bray’s Clinical Laboratory Methods (6th ed.). St. Louis: Mosby, 1962, p. 263. Interdepartmental Committee on Nutrition for National Defense. Manual for Nutrition Sur- veys. Washington, D.C.: U.S. Govt. Printing Office, 1963, p. 21. . Fatitine, J. F., Jr., M. W. BUCKLY AND B. ZOK. Automatic determinations of serum proteins. Am. J. Clin. Pathol. 33: 83, 1960. Harpina, R. S., G. A. LEVEILLE, E. M. BAKER Ill, Z. Z. ZiporRin AND H. E. SAUBERLICH. Bio- chemical Proceedings. U.S. Med. Res. Nutr. Lab. Rept. No. 304, Denver, Colorado, vol. |, January, 1967, p. 59. Topp, J. C., A. H. SANFORD AND B. B. WELLS. Clinical Diagnosis by Laboratory Methods (12th ed.). Philadelphia: Saunders, 1953, p. 59. Interdepartmental Committee on Nutrition for National Defense. Manual for Nutrition Sur- veys. Washington, D.C.: U.S. Govt. Printing Office, 1963, p. 42. Interdepartmental Committee on Nutrition for National Defense. Manual for Nutrition Sur- veys. Washington, D.C.: U.S. Govt. Printing Office, 1963, p. 46. STROHECKER, R., AND H. M. HENNING. Vitamin Assay, Omnitypie Gesellschaft Nachf. Leopold Lechnall, Stuttgart, Germany, 1966, p. 144. STROHECKER, R., AND H. M. HENNING. Vitamin Assay, Omnitypie Gesellschaft Nachf. Leopold Lechnall, Stuttgart, Germany, 1966, p. 223. SPAIDE, J. K. Urinary excretion of sodium and potassium by men receiving survival diets under controlled conditions (Master’s Thesis). Iowa City, Iowa: Univ. of Iowa, 1963. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 323 ConsoLazio, C. F., L. O. Matousn, H. L. JouNnson, H. S. Krzywicki, G. J. ISAAC AND N. F. Witr. Metabolic aspects of calorie re- striction. Hypohydration effects upon body weight and blood parameters. Am. J. Clin. Nutr. 21: 793, 1968. CONSOLAZIO, C. F., L. O. Matousx, H. L. JOHNSON, H. S. Krzywicki, G. J. Isaac AND N. F. Witr. Metabolic aspects of calorie re- Striction. Nitrogen and mineral balances and vitamin excretion. Am. J. Clin. Nutr. 21: 803, 1968. ConsoLcazio, C. F., L. O. Matousn, H. L. JOHNSON, H. S. Krzywicki, T. A. DAVIS AND G. J. Isaac. Effects of high carbohydrate diets on performance and clinical symptomatology after rapid ascent to high altitude. Federation Proc. 28: 937, 1969. STEVENSON, J. A. F. Survey of survival feeding. Defense Res. Board Rept. No. DR 125. Dept. Natl. Defense, Canada, October 1958. HopcEs, R. E., E. M. Baker, J. Hoop, H. E. SAUBERLICH AND S. C. MarcH. Experimental scurvy in man. Am. J. Clin. Nuir. 22: 535, 1969. GAMBLE, J. L. Physiological information from studies on the lift raft ration. The Harvey Lec- ture Ser. 42: 247, 1946-1947. GRANDE, F., J. T. ANDERSON AND H. L. Taytor. Effect of restricted water intake on urine ni- trogen output in man on a low calorie diet de- void of protein. J. Appl. Physiol. 10: 430, 1957. SARGENT, F., AND R. E. JOHNSON. The physio- logical basis for various constituents in survival rations. Wright Air Develop. Ctr. Tech. Rept. No. 53-484, Part IV. Air Res. Develop. Com- mand, U.S. Air Force, Wright Patterson Air Force Base. Ohio, September, 1957. MINNARD, D., AND H. A. ScHLany. Effects of simulated survival conditions on water balance and metabolism in human volunteers. In: Proc. Survival Ration Conf. Armed Forces Quarter- master Food Container Inst. May, 1951. Ac- tivities Report 3: 160, 1951. Dye, H. C. Arctic field trial of USAF survival rations, Blair Lake, Alaska, January, 1950. U.S. Air Force Tech. Rept. No. 6019, August, 1950. Coyne, J. P. A report of survival equipment trial. Inst. Aviation Med. Rept. No. 58/5. Royal Canadian Air Force, Toronto, Canada, October, 1958.

WADC TECHNICAL REPORT 53-484 PART IV ASTIA DOCUMENT No. AD 142233 THE PHYSIOLOGICAL BASIS FOR VARIOUS’ CONSTITUENTS IN SURVIVAL RATIONS PART IV. AN INTEGRATIVE STUDY OF THE ALL-PURPOSE SURVIVAL RATION FOR TEMPERATE, COLD, AND HOT WEATHER FREDERICK SARGENT. II. S.B. M.D., D.N.B. ROBERT E. JOHNSON, M.D., D.PHIL. (OXON.) UNIVERSITY OF ILLINOIS DECEMBER 1957 AERO MEDICAL LABORATORY CONTRACT No. AF 18(600)-80 Project No. 7156 TASK No. 71805 WRIGHT AIR DEVELOPMENT CENTER AIR RESEARCH AND DEVELOPMENT COMMAND UNITED STATES AIR FORCE | WRIGHT-PATTERSON AIR FORCE BASE, OHIO Carpenter Litho & Prig. Co., Springfield, O. $00 — March 1958

ABSTRACT The problem of an all-purpose survival ration suitable for the healthy young castaway in any environment from cold to hot has been soired by five years' intensive investigation. One and the same nutrient combination can and should be used for all environments, for any daily work loads from light to hard, and for any water supply from limited to abundant. Three separate studies simulating survival were required: temperate conditions, moderate work; winter cold, light and hard work; summer heat, light and hard work. A total of 8698 subject-days yielded results of statisticai reliability. The quantitative characteristics of the all-purpose survival regimen were established by physiological, biochemical, nutritional, and clinical observations on the relative effects of water intake, total calorie intake, osmotic intake, liietosis, and ratio of protein, carbohydrate, and fat, for 20 different experimental regimecs. Numerous systematic observations were made on healthy young men during successive two-week periods of adequate, restricted, and recovery diets. Starvation and an adeyuate 3000-Calorie diet represented the worst and best regimens. Quantitative rank-ordering of regimens was made possible by as many as 27 discriminatory measurements of organ function and body efficiency, together with clinical findings, especially in cases reuuirisg prompt medical attention to avoid serious eventualities. PUSLICATION REVI! Tnis report has veen reviewei end is aroroved. FOR THE COMMAAI‘DER : te BOLLERUD Colonel, USAF (MC) Chief, Aero Medical Laboratory Directorate of Research WADC TR 53-484, Part 4& iii