74 OVER-NUTRITION AND UNDER-NUTRITION 



Experience appears to prove that in numerous patients the administration 

 of large amounts of meat— equivalent to a high intake of albumin— is much 

 better than small ones. Meat is not only the most important food for most 

 persons, but also the one most desired. Nevertheless, there are many corpulent 

 persons' especially women, who dislike large amounts of meat, and in whom 

 any antifat diet that consists largely of meat will certainly sufEer shipwreck. 

 Nothing can be more unwise than, for the sake of theory, to force the admm- 

 istration of albumin up to a certain height; the requirements of the individual 

 case and nothing else should be considered. But we must insist on not less 

 •than the minimum of about 100 grams of albumin. Above this, theoretically, 

 the limit cannot be definite. In practice, about 180 grams of albumin per 

 day should rarely be exceeded. 



No less warm than the question of the administration of albumin is the 

 discussion, whether, among the substances free from nitrogen, more fat or 

 more carbohydrate should be given. The important point is, that the total 

 of these, according to their calory values, must be diminished so that the 

 total amount of food reaches the degree aimed at in the antifat diet. But 

 both the fat and the carbohydrates must be reduced below the average amount 

 if the administration of nourishment is to be limited to two-fifths or three- 

 fifths of the average requirement (see above). If only the one or the other 

 is forbidden or limited — whether it be the fats or the carbohydrates — sufficient 

 of the other remains in the diet to render the result dubious. Whether in 

 the simultaneous limitation a little more fat (Ebstein, Hirschfeld) or a 

 little more carbohydrate (Banting, Oertel, Kisch, v. Noorden) remains is of 

 subordinate importance. Only the calory total of both, not the chemical 

 constitution — whether fat or carbohydrates — is of significance. I regard it as 

 only a question of technic how far the limitation of one or of the other is to be 

 carried. The wishes, the manner of life, and the peculiarities of the patients, 

 not the principles of treatment, are the determining factors. But from my 

 own experience I should like to emphasize the fact that, as a rule, we attain 

 better results if the fats are limited as much as possible, and somewhat more 

 of carbohydrates are permitted in the food; for the carbohydrates furnish 

 a larger volume, satisfy more readily, and permit a much greater variation 

 in the diet. 



Alcohol, of course, must not be given with a free hand in antifat cures. 

 As already remarked, it saves fat and in this manner favors its accumulation. 

 Many persons owe their excessive adipose tissue, primarily, to the immoderate 

 use of alcohol. Nevertheless, almost all authors have ascribed to alcohol a 

 subordinate place in antifat cures — and quite properly so, since in practice 

 its stimulating effect cannot always be dispensed with. But where it is possi- 

 ble — particularly in young, robust people — it is wise to exclude alcohol on 

 account of its high calory value. 



In antifat cures the question of the allowance of water is usually discussed. 

 Among laymen, and also among physicians, the opinion prevails that the 

 intake of fluids favors the accumulation of fat. This is unquestionably incor- 

 rect. How easy and cheap would it be for the farmer if the administration 

 of water favored fattening! On the other hand, the statement that antifat 



