V. Distribution Of Losses Over Proteids, Fats And Carbohydrates. Continued

The increase of the albumin ration therefore somewhat reduced the loss of nitrogen, but it did not permanently influence it. In a case of this character one would have been much more successful in protecting the albumin reserves of the body if instead of 30 g of nutrose 100 g of sugar had been added to the milk. This would not have been a difficult undertaking and would have increased the total caloric value of the diet by 410 calories, i. e., to 1627 calories. In this way the caloric deficit would have been almost wiped out and the property so characteristic of the carbohydrates to spare the albumins of the body would have caused the complete or almost complete inhibition of the nitrogen losses.

In cases suffering from severe loss of appetite or other difficulties that render it impossible to avoid undernutrition, I consider it advisable to arrange the diet in such a way that 25% of the energy supplied is furnished by albumen, the balance by non-nitrogenous food constituents. This proportion approximately corresponds to the distribution of nitrogenous and non-nitrogenous pabulum in milk. As soon as conditions become favorable for increasing the nutritive value of the diet and gradually compensating the caloric deficit, then it is easier to accomplish this goal and above all to spare and increase the albumen content of the organism by supplying non-nitrogenous food, specifically carbohydrate, than by adding albuminous food to the diet. Here an important law that has not as yet been sufficiently investigated and that is not generally appreciated becomes manifest, viz., that with an increase of the food intake the nitrogen balance determines towards equilibrium, even towards a positive balance, even when the total food intake remains one-half and even more below the calculated caloric requirement, scil., the maintenance diet. This becomes especially apparent if the small and gradual additions to the diet are supplied by carbohydrates. In such cases the paradox phenomenon is observed of an organism using up its own fat because the caloric intake is insufficient while at the same time building up tissue albumen. So great is the tendency of the cell to rehabilitate its albumen content even after days, weeks, and months of starvation. This also explains the important, well-established and frequently corroborated observation that convalescents regain their strength while they are still being underfed and are still consuming their own fat supply and losing weight. The increase in strength is a result of the energetic building up of tissue albumens.