TABLE III 



Showing optimal food combinations when G = 100 gm. (in the equation G = C -j- .58 

 P 4. .IF) ; when F A = .46 P + .9 F; when F A : G = 1.5; and when the protein 

 is 0, 25, 50, 75 and 100 gm. (i. e., 0; 0.5; 1.0; 1.5; and 2.0 gm. per kg., if the 

 body weight is 50 kg.). 



* No. 1 is hypothetical and could only be considered as the non-protein fraction of 

 a larger combination. 



For each gram of glucose that can be utilized in the body there are some 18 

 calories in the "optimal" food combination. Each gram of protein in the food supply 

 is seen to subtract 3 calories from the optimal. For rapid mental calculatioH know- 

 ing that a patient can actually utilize a certain number of grams of glucose, take 

 the number times 17 as the approximate number of calories that he will probably 

 be capable of using without glycosuria or acetonuria. 



the storage of part of the fat ingested. In assigning values to terms of the 

 equation, it will be found generally preferable whenever possible to 

 measure the material actually catabolized. Thus for the term .58 P the 

 total urinary N X 3.65 will be preferred to the protein of the diet X .58. 

 An estimation of the total calories produced minus the calories derivable 

 from the protein catabolized may give a truer idea of the fat catabolized 

 than will be obtained from the dietary figures alone, and so on. Some of 

 the above discrepancies disappear when this is done, but not all. The equa- 

 tion illustrates a method of thought rather than a set of fixed rules. Some 

 cases which tolerate dietary ratios higher than 1.5 for considerable lengths 

 of time without ketonuria may later show ketonuria on the same diet and 

 it is well not to permit patients to pass from close observation with ratios 

 exceeding this figure even if it seems advantageous or necessary to employ 

 them at times. Possibly the ratio of 1.5 is too high for the long run in 

 some cases. 



The practice of withholding all food, or of permitting only broth and 

 green vegetables for the purpose of stopping glycosuria and acidosis is 

 unnecessary, and, unless other effects of starvation are desired besides 

 these, one may secure all the advantages and none of the drawbacks by 

 a diet containing up to 2.0 grams of fat per kg. of body weight ; to which, 

 except in the most difficult cases, 0.5 to 1 gram of protein per kg. and a 

 little carbohydrate may be added. It is needless to say that an "optimal" 

 diet is not necessary in milder cases, nor one to be recommended when the 

 extra calories are not needed. 



