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"Wear and Tear" Protein-Reply

Arthur J. Merrill, M.D.
JAMA. 1961;175(5):414. doi:10.1001/jama.1961.03040050070026.
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To the Editor:—  Dr. Wishnofsky is correct in that "wear-and-tear protein" is not scientific terminology but rather a figure of speech, and the amount of protein does not refer to an irreducible minimum with a diet which contains any protein. Gamble showed in studies of a week's duration that the protein-sparing action of more than 100 gm. of carbohydrate was negligible. However, Kolff found that after 12 to 20 days on a Borst diet, patients did have a slow reduction in nitrogen excretion, indicating a diminution in protein breakdown and an increase in protein-sparing action (probably mostly by carbohydrate) beyond the amount found by Gamble in his short-term experiments. A proteinfree diet, as Doctor Wishnofsky points out, would be of value in cases of acute renal failure but not in chronic cases, except in brief acute exacerbations.


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