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November 17, 1978, Vol 240, No. 21 >
ARTICLE | November 17, 1978

Clinical Use of a Protein-Sparing Modified Fast FREE

Bruce R. Bistrian, MD, PhD
[+] Author Affiliations

Reprint requests to Department of Medicine, Harvard Medical School, New England Deaconess Hospital, Boston, MA 02215 (Dr Bistrian).


JAMA. 1978;240(21):2299-2302. doi:10.1001/jama.1978.03290210081040
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Article
References

OBESITY is notoriously resistant to treatment. Short-term weight reduction of greater than 18 kg occurs in fewer than 5% of outpatients.1 Possible explanations for noncompliance and ineffectiveness of conventional diet therapy include hunger and the disappointingly slow rate of weight loss. Total fasting reduces hunger and induces rapid weight loss,2 but half the weight loss in the first month and one fourth to one third thereafter is from muscle tissue,3 and hepatic, renal, and endocrine function is affected. For these reasons fasting regimens are generally recommended only for inpatients.

Long-term follow-up of persons who previously fasted has demonstrated a high rate of recidivism5 due to obligate regain of lean tissue or the lack of a weight-maintenance program or both. When a fast is supplemented by small amounts of protein in the form of egg albumin,6 casein,7 casein with glucose,8 or amino acids with

REFERENCES

1 +
Stunkard A, McLaren-Hume M:  Results of treatment for obesity: Review of literature and report of series . Arch Intern Med 103:79-85, 1959;.
2 +
Thompson TJ, Runcie J, Miller V:  Treatment of obesity of total fasting for up to 249 days . Lancet 2:992-996, 1966;.
3 +
Ball MF, Canary JJ, Kyle LH:  Comparative effects of calorie restriction and total starvation on body composition and obesity . Ann Intern Med 67:60-67, 1967;.
4 +
Bistrian BR, Blackburn GL, Flatt JP, et al:  Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast . Diabetes 25:494-504, 1976;.
5 +
Harrison MT, Harden RMG:  The long-term value of fasting in the treatment of obesity . Lancet 2:1340-1342, 1966;.
6 +
Bollinger RE, Lukert BP, Brown RW, et al:  Metabolic balance of obese subjects during fasting . Arch Intern Med 118:3-8, 1966;.
7 +
Apfelbaum M, Boudon P, Lacatis D, et al:  Effects metaboliques de la diete protidique chez 41 sujets obeses . Presses Med 78:1917-1920, 1970;.
8 +
Genuth SM, Castro JH, Vertes V:  Weight reduction in obesity by outpatient semistarvation . JAMA 230:987-991, 1974;.
9 +
Baird IM, Parsons RL, Howard AN:  Clinical and metabolic studies of chemically defined diets in the management of obesity . Metabolism 23:645-657, 1974;.
10 +
Bistrian BR, Winterer J, Blackburn GL, et al:  Effect of a protein-sparing diet and brief fast on nitrogen metabolism in mildly obese subjects . J Lab Clin Med 89:1030-1035, 1977;.
11 +
Blackburn GL, Bistrian BR, Flatt JP, et al:  Role of a protein-sparing modified fast in a comprehensive weight reduction program , in Howard A (ed): Recent Advances in Obesity Research . London, Newman Publishing Ltd, 1975;.
12 +
Bistrian BR, Blackburn GL, Stanbury JB:  Metabolic aspects of a protein-sparing modified fast in the dietary management of Prader-Willi obesity . N Engl J Med 296:774-779, 1977;.
13 +
Lindner RG, Blackburn GL:  Multidisciplinary approach to obesity utilizing fasting modified by protein-sparing therapy . Obesity Bariatric Med 5:198-216, 1976;.
14 +
Currey H, Malcolm R, Riddle E, et al:  Behavioral treatment of obesity: Limitations and results with the chronically obese . JAMA 237:2829-2831, 1977;.
15 +
Bistrian BR, Sherman M:  Results of the treatment of obesity with a protein-sparing modified fast . Int J Obesity , to be published.
16 +
Nutritive Value of Foods, Home and Gardens bulletin No. 72. US Dept of Agriculture, US Government Printing Office, 1971.
17 +
Bowes A, Church C: Food Values of Portions Commonly Used , revised by Church CF, Church NH (eds). Philadelphia, JP Lippincott, 1970;.
18 +
 Deaths associated with liquid protein diets . Morbidity Mortality Weekly Rep 26:383, 1977;.
19 +
Munro HN:  An introduction to nutritional aspects of protein metabolism , in Munro HN, Allison SB (eds): Mammalian Protein Metabolism . New York, Academic Press Inc, 1964;, vol 2.
20 +
Rudman 0, Millikan WJ, Richardson TJ, et al:  Elemental balances during intravenous hyperalimentation of underweight adult subjects . J Clin Invest 55:94-104, 1975;.
21 +
Van Itallie TB:  Liquid protein mayhem . JAMA 240:144-145, 1978;.
22 +
Molnar Z, Larsen K, Spargo B:  Cardiac changes in the potassium-depleted rat . Arch Pathol 74:339-347, 1962;.
23 +
Vertes V, Genuth SM, Hazleton IM:  Precautions with supplemented fasting . JAMA 238:2142, 1977;.
24 +
Lecoq FR, McPhaul JJ:  The effects of starvation, high fat diets and ketone infusions on uric acid balance . Metabolism 14:186-197, 1965;.
25 +
Sapir DG, Owen OE:  Renal conservation of ketone bodies during starvation . Metabolism 24:23-33, 1975;.
26 +
Sigler MH:  The mechanism of the natriuresis of fasting . J Clin Invest 55:377-387, 1975;.
27 +
Blackburn GL, Bistrian BR, Hoag C:  Hair loss with rapid weight loss . JAMA 236:252, 1976;.
28 +
Bistrian BR, Blackburn GL, Scrimshaw NS, et al:  Cellular immunity in semistarved states in hospitalized adults . Am J Clin Nutr 28:1148-1155, 1975;.
29 +
Fried PI, McClean PA, Phillipson EA, et al:  Effect of ketosis on respiratory sensitivity to carbon dioxide in obesity . N Engl J Med 294:1081-1086, 1976;.
30 +
Blackburn GL, Sizer JS, Rogers JF, et al:  Effects of modified starvation on Balke performance in well trained subjects , abstracted. Clin Res 24:357, 1976;.
31 +
Bistrian BR, Blackburn GL, Scrimshaw NS:  Effect of mild infectious illness on nitrogen metabolism in patients fed a hypocaloric diet . Am J Clin Nutr 28:1044-1051, 1975;.
32 +
Miller J, Bistrian BR, Blackburn GL, et al:  Failure of post operative infection to increase nitrogen excretion in patients maintained on peripheral amino acids . Am J Clin Nutr 30:1523-1527, 1977;.
33 +
Bistrian BR, Winterer J, Blackburn GL, et al:  Failure of yellow fever immunization to produce a catabolic response in individuals fully adapted to a protein-sparing modified fast . Am J Clin Nutr 30:1518-1522, 1977;.
34 +
Blackburn GL, Flatt JP, Clowes GHA, et al:  Protein-sparing therapy during periods of starvation with sepsis or trauma . Ann Surg 177:588-594, 1973;.
35 +
Blackburn GL, Flatt JP, Clowes GHA, et al:  Peripheral intravenous feeding with isotonic amino acid solutions . Am J Surg 125:447-454, 1973;.
36 +
Hoover HC, Grant JP, Gorschboth C, et al:  Nitrogen-sparing intravenous fluids in postoperative patients . N Engl J Med 293:172-175, 1975;.
37 +
Mason EE, Printen KJ, Hartford CE, et al:  Optimizing results of gastric by-pass . Ann Surg 182:405-414, 1975;.
38 +
Society of Actuaries: Build and Blood Pressure Study . Chicago, Chicago Society of Actuaries, 1959;, vol 1 and 2.
39 +
Blackburn GL, Greenberg I, Maini BS:  Obesity: A comprehensive approach , in Rechcigal M (ed): CRC Handbook of Human Nutrition . Cleveland, CRC Press, 1978;.

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1 +
Stunkard A, McLaren-Hume M:  Results of treatment for obesity: Review of literature and report of series . Arch Intern Med 103:79-85, 1959;.
2 +
Thompson TJ, Runcie J, Miller V:  Treatment of obesity of total fasting for up to 249 days . Lancet 2:992-996, 1966;.
3 +
Ball MF, Canary JJ, Kyle LH:  Comparative effects of calorie restriction and total starvation on body composition and obesity . Ann Intern Med 67:60-67, 1967;.
4 +
Bistrian BR, Blackburn GL, Flatt JP, et al:  Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast . Diabetes 25:494-504, 1976;.
5 +
Harrison MT, Harden RMG:  The long-term value of fasting in the treatment of obesity . Lancet 2:1340-1342, 1966;.
6 +
Bollinger RE, Lukert BP, Brown RW, et al:  Metabolic balance of obese subjects during fasting . Arch Intern Med 118:3-8, 1966;.
7 +
Apfelbaum M, Boudon P, Lacatis D, et al:  Effects metaboliques de la diete protidique chez 41 sujets obeses . Presses Med 78:1917-1920, 1970;.
8 +
Genuth SM, Castro JH, Vertes V:  Weight reduction in obesity by outpatient semistarvation . JAMA 230:987-991, 1974;.
9 +
Baird IM, Parsons RL, Howard AN:  Clinical and metabolic studies of chemically defined diets in the management of obesity . Metabolism 23:645-657, 1974;.
10 +
Bistrian BR, Winterer J, Blackburn GL, et al:  Effect of a protein-sparing diet and brief fast on nitrogen metabolism in mildly obese subjects . J Lab Clin Med 89:1030-1035, 1977;.
11 +
Blackburn GL, Bistrian BR, Flatt JP, et al:  Role of a protein-sparing modified fast in a comprehensive weight reduction program , in Howard A (ed): Recent Advances in Obesity Research . London, Newman Publishing Ltd, 1975;.
12 +
Bistrian BR, Blackburn GL, Stanbury JB:  Metabolic aspects of a protein-sparing modified fast in the dietary management of Prader-Willi obesity . N Engl J Med 296:774-779, 1977;.
13 +
Lindner RG, Blackburn GL:  Multidisciplinary approach to obesity utilizing fasting modified by protein-sparing therapy . Obesity Bariatric Med 5:198-216, 1976;.
14 +
Currey H, Malcolm R, Riddle E, et al:  Behavioral treatment of obesity: Limitations and results with the chronically obese . JAMA 237:2829-2831, 1977;.
15 +
Bistrian BR, Sherman M:  Results of the treatment of obesity with a protein-sparing modified fast . Int J Obesity , to be published.
16 +
Nutritive Value of Foods, Home and Gardens bulletin No. 72. US Dept of Agriculture, US Government Printing Office, 1971.
17 +
Bowes A, Church C: Food Values of Portions Commonly Used , revised by Church CF, Church NH (eds). Philadelphia, JP Lippincott, 1970;.
18 +
 Deaths associated with liquid protein diets . Morbidity Mortality Weekly Rep 26:383, 1977;.
19 +
Munro HN:  An introduction to nutritional aspects of protein metabolism , in Munro HN, Allison SB (eds): Mammalian Protein Metabolism . New York, Academic Press Inc, 1964;, vol 2.
20 +
Rudman 0, Millikan WJ, Richardson TJ, et al:  Elemental balances during intravenous hyperalimentation of underweight adult subjects . J Clin Invest 55:94-104, 1975;.
21 +
Van Itallie TB:  Liquid protein mayhem . JAMA 240:144-145, 1978;.
22 +
Molnar Z, Larsen K, Spargo B:  Cardiac changes in the potassium-depleted rat . Arch Pathol 74:339-347, 1962;.
23 +
Vertes V, Genuth SM, Hazleton IM:  Precautions with supplemented fasting . JAMA 238:2142, 1977;.
24 +
Lecoq FR, McPhaul JJ:  The effects of starvation, high fat diets and ketone infusions on uric acid balance . Metabolism 14:186-197, 1965;.
25 +
Sapir DG, Owen OE:  Renal conservation of ketone bodies during starvation . Metabolism 24:23-33, 1975;.
26 +
Sigler MH:  The mechanism of the natriuresis of fasting . J Clin Invest 55:377-387, 1975;.
27 +
Blackburn GL, Bistrian BR, Hoag C:  Hair loss with rapid weight loss . JAMA 236:252, 1976;.
28 +
Bistrian BR, Blackburn GL, Scrimshaw NS, et al:  Cellular immunity in semistarved states in hospitalized adults . Am J Clin Nutr 28:1148-1155, 1975;.
29 +
Fried PI, McClean PA, Phillipson EA, et al:  Effect of ketosis on respiratory sensitivity to carbon dioxide in obesity . N Engl J Med 294:1081-1086, 1976;.
30 +
Blackburn GL, Sizer JS, Rogers JF, et al:  Effects of modified starvation on Balke performance in well trained subjects , abstracted. Clin Res 24:357, 1976;.
31 +
Bistrian BR, Blackburn GL, Scrimshaw NS:  Effect of mild infectious illness on nitrogen metabolism in patients fed a hypocaloric diet . Am J Clin Nutr 28:1044-1051, 1975;.
32 +
Miller J, Bistrian BR, Blackburn GL, et al:  Failure of post operative infection to increase nitrogen excretion in patients maintained on peripheral amino acids . Am J Clin Nutr 30:1523-1527, 1977;.
33 +
Bistrian BR, Winterer J, Blackburn GL, et al:  Failure of yellow fever immunization to produce a catabolic response in individuals fully adapted to a protein-sparing modified fast . Am J Clin Nutr 30:1518-1522, 1977;.
34 +
Blackburn GL, Flatt JP, Clowes GHA, et al:  Protein-sparing therapy during periods of starvation with sepsis or trauma . Ann Surg 177:588-594, 1973;.
35 +
Blackburn GL, Flatt JP, Clowes GHA, et al:  Peripheral intravenous feeding with isotonic amino acid solutions . Am J Surg 125:447-454, 1973;.
36 +
Hoover HC, Grant JP, Gorschboth C, et al:  Nitrogen-sparing intravenous fluids in postoperative patients . N Engl J Med 293:172-175, 1975;.
37 +
Mason EE, Printen KJ, Hartford CE, et al:  Optimizing results of gastric by-pass . Ann Surg 182:405-414, 1975;.
38 +
Society of Actuaries: Build and Blood Pressure Study . Chicago, Chicago Society of Actuaries, 1959;, vol 1 and 2.
39 +
Blackburn GL, Greenberg I, Maini BS:  Obesity: A comprehensive approach , in Rechcigal M (ed): CRC Handbook of Human Nutrition . Cleveland, CRC Press, 1978;.

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