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Original Articles

Nitrogen Metabolism and Insulin Requirements in Obese Diabetic Adults on a Protein-Sparing Modified Fast

  1. Bruce R Bistrian, M.D., Ph.D.,
  2. George L Blackburn, M.D., Ph.D.,
  3. Jean-Pierre Flatt, Ph.D.,
  4. Jack Sizer, M.D.,
  5. Nevin S Scrimshaw, Ph.D., M.D. and
  6. Mindy Sherman, B.A.
  1. Cancer Research Institute, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215 Department of Nutrition and Food Science, Massachusetts Institute of Technology Cambridge, Massachusetts 02142
  1. Address reprint requests to Dr. Bruce R. Bistrian, Cancer Research Institute, 194 Pilgrim Road, Boston, Massachusetts 02215
Diabetes 1976 Jun; 25(6): 494-504. https://doi.org/10.2337/diab.25.6.494
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Abstract

A protein-sparing modified fast (PSMF), which is a total fast modified by the intake of 1.2–1.4 gm. protein per kilogram ideal body weight (IBW), fluids ad libitum, and vitamin and mineral supplementation, allows effective control of carbohydrate metabolism and hunger. It reduces serum glucose and insulin concentrations in obese diabetic patients and increases free fatty acid and ketone body concentrations; ketonuria appears within 24–72 hours. When this fast was applied to seven obese adult-onset diabetics who were receiving 30–100 units of insulin per day, insulin could be discontinued after 0–19 days (mean, 6.5). In the three patients who had extensive nitrogen-balance studies, balance could be maintained chronically by 1.3 gm. protein per kilogram IBW, despite the gross caloric inadequacy of the diet. The PSMF was tolerated well in an outpatient setting after the initial insulin-withdrawal phase had occurred in the hospital. Significant improvements in blood pressure, lipid abnormalities, parameters of carbohydrate metabolism, and cardiorespiratory, symptoms were associated with weight loss and/or the PSMF. For diabetics with some endogenous insulin reserve, the PSMF offers significant advantages for weight reduction, including preservation of lean body mass (as reflected in nitrogen balance) and withdrawal of exogenous insulin.

  • Accepted February 18, 1976.
  • Copyright © 1976 by the American Diabetes Association

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June 1976, 25(6)
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Nitrogen Metabolism and Insulin Requirements in Obese Diabetic Adults on a Protein-Sparing Modified Fast
Bruce R Bistrian, George L Blackburn, Jean-Pierre Flatt, Jack Sizer, Nevin S Scrimshaw, Mindy Sherman
Diabetes Jun 1976, 25 (6) 494-504; DOI: 10.2337/diab.25.6.494

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Nitrogen Metabolism and Insulin Requirements in Obese Diabetic Adults on a Protein-Sparing Modified Fast
Bruce R Bistrian, George L Blackburn, Jean-Pierre Flatt, Jack Sizer, Nevin S Scrimshaw, Mindy Sherman
Diabetes Jun 1976, 25 (6) 494-504; DOI: 10.2337/diab.25.6.494
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