282 ROLLIN T. WOODYATT 



that in fasting, over 100 grams of fat may be thrown into the metabolic 

 stream and catabolized daily. . It has further been shown that the amount 

 of fat in the fasting organism materially effects the amount of protein 

 burned. In a critical review of the literature of the subject Lusk has 

 said: "Where there was much fat present, little protein was consumed; 

 where there was little fat, much protein burned; and where there was no 

 fat, protein alone yielded the energy for life. In a normal individual the 

 ingestien of fat will not prevent the death of the organism because there 

 is a continual loss of tissue protein from the body, which finally weakens 

 some vital organ to such an extent that death takes place." But the inges- 

 tion of fat may spare tissue fat and thus prevent the protein loss from 

 becoming abnormally great. It may be said that the ingestion of fat 

 spares the individual any such protein loss as will occur if the tissue fat is 

 allowed to become too much depleted. In this sense the ingestion of fat 

 by an emaciated individual spares protein for that individual. In other 

 words fat always spares protein but we do not realize it until the sparing 

 effect is removed. Voit found in a fasting animal that the ingestion of 

 suitable amounts of fat scarcely influenced the protein metabolism. To 

 one dog "which in starvation burned 96 grams of fat, Voit gave 100 grams 

 of fat with the result that it burned 97 grams. The fat ingested simply 

 burned instead of the body fat, but the total amount of protein and fat 

 burned remained the same." (Lusk.) 



Now, if a certain diabetic patient during a fast reacts essentially as 

 a non-diabetic individual in the same state of nutrition ; and if he weighs 

 50 kg., produces 1250 to 1500 calories, and in doing so actually mobilizes 

 and burns 100 to 120 or more grams of fat, the ingestion of an equal 

 quantity of fat should leave his metabolism in the same state as before. 

 The supply of fat would come at one time from the tissues, at another from 

 the diet, but the quantity thrown into metabolism, the quantity presenting 

 itself for disposition in the cells, and the quantity of internal secretion 

 or enzyme that the cells would have to provide would be the same in both 

 cases. The practice of placing a patient on a diet of greens containing not 

 over 18 gm. carbohydrate, 6 gm. of protein and no fat, or on complete fast- 

 ing for the purpose of desugarization, would not seem necessary or rational 

 in the light of these facts. In such cases fasting would be rational if it, 

 would improve the general condition. But for diabetes itself, and particu- 

 larly for diabetes associated with undernutrition, why for the purpose of 

 desugarization should the patient be compelled to draw from his tissues the 

 fat that he might draw from a diet, especially if in drawing from his tissues 

 he lowers his fat reserves to the extent that he increases his protein losses ? 

 The striking results that have been obtained recently by Xewburgh and 

 Marsh with high fat, low protein, diets bear significantly on this point. 

 The practice of starving, or virtually starving, a patient in order to render 

 his urine sugar "free" and then of building up the diet first with carbo- 



