Carbohydrate- Fat Ratio. 



109 



These determinations show that concentrations measured by a 

 depression of 13.0 0 , presumably the equivalent of 153 atmospheres, 

 may be found in the tissue fluids of apparently normal leaves. 



51 (1633) 



The carbohydrate-fat ratio in relation to the production of ketone 

 bodies in diabetes mellitus. 



By WILLIAM S. LADD and WALTER W. PALMER. 



[From the Chemical Division, Medical Clinic, Johns Hopkins Uni- 

 versity and Hospital, Baltimore, Maryland.] 



Since relatively large amounts of fats are used in the construc- 

 tion of maintenance diets in the treatment of diabetes mellitus 

 it is important to know the limits within which fat may be em- 

 ployed with safety. The normal composition of fat demands that 

 carbohydrates shall be simultaneously oxidized. Zeller 1 has shown 

 in two normal men and two normal dogs that of the total calories, 

 the protein intake being kept low, 10 per cent, must be yielded by 

 carbohydrate if 90 per cent, arises from fat in order to prevent the 

 production of the ketone bodies. In commenting on these experi- 

 ments Lusk 2 calls attention to the fact that it is possible that for 

 the proper oxidation of fat, the end product of which is B-oxy- 

 butyric acid, the burning of one triose molecule may be necessary 

 for the normal oxidation of one molecule of B-oxy butyric acid. 

 The attempt has been made in this work to establish the proportion 

 of available carbohydrate to fat when ketone bodies appear in the 

 urine. 



Diabetic cases are treated as follows: Freed from sugar and 

 acetone body excretion, sugar tolerance ascertained and then the 

 following experiment. The individual is put on a diet having a 

 protein intake that will enable nitrogen equilibrium to be main- 

 tained with the fat and carbohydrate given. During different 

 periods the protein intake is kept constant and the amount of 

 carbohydrate and fat are varied isodynamically, the proportion 



1 Zeller, Archiv. fur Physiologic 1914. P- 213. 



l Lusk, "Science of Nutrition," third ed., pp. 270-271. 



