356 du bois: basal energy requirement of man 



There are several other diseases in which the metabolism is 

 increased 20 to 40 per cent. Among these may be included se- 

 vere anaemias, cancer, severe cases of heart or kidney disease, 

 high fevers, and perhaps other conditions that have not yet been 

 studied. Patients who are not very ill show little change from 

 the normal in their basal metabolism, and their food require- 

 ments are those of normal men under similar conditions. 



DIABETES 



In the very important disease of diabetes there are profound, 

 changes in the metabolism of all the foods. The study of 

 these changes has thrown an enormous amount of light on the 

 transformations of the food-stuffs which take place in normal 

 individuals, and physiology owes a great debt to the study of 

 this pathological condition. In severe cases the body being un- 

 able to oxidize any carbohydrate food, eliminates it in the urine 

 as glucose. Proteins are incompletely oxidized, and about half 

 of the protein molecule is changed into glucose and eliminated 

 as such. Fats are incompletely metabolized, reaching the stage 

 of beta-oxybutyric acid, which circulates in the blood as a poison 

 in diabetics because the tissues are unable to oxidize it beyond 

 this stage as they do in health. The level of the total heat pro- 

 duction is not much changed in diabetes in spite of this disturb- 

 ance of the intermediary metabolism. Direct evidence of the se- 

 verity of the disease can be obtained by the use of the calorimeter 

 or any other form of apparatus which determines the respiratory 

 quotient. It is the respiratory quotient which tells the exact 

 amount of carbohydrate that the patient is oxidizing. Severe 

 cases can oxidize none; mild cases can derive 20 to 40 per cent 

 of their calories from carbohydrates. 



Quite recently Dr. F. M. Allen, of the Rockefeller Institute, 

 has found that patients with severe diabetes are much bene- 

 fited by periods of fasting and low diet. In almost all cases the 

 sugar can be made to disappear from the urine and stay away 

 as long as the diet is restricted. Several patients so treated have 



