Fat and carbohydrates and albumin differ in relation to fat-for mation in the body, in this way, that the proportions of these food stuffs are equivalent or isodynamic which produce the same quantity -of heat during the process of oxidation into carbonic acid. Conse quently 100 grams of fat replace 211 grams of albumin, 232 grams of starch, 234 grams of cane sugar, 256 grams of grape sugar, or a mean average of 240 grams of carbohydrates. Since one part of fat represents an isodynamic mean average of 2.4 parts of substances comprised under the term carbohydrates, we can always supply the body with more than twice the quantity of these substances until an amount equivalent to one part of fat is reached. The possibility of exceeding the limits prescribed by the diet is consequently less when carbohydrates instead of fats are given.
The body stores up fat if more than 118 grains of albumin and 259 grains of fat, a total of 377 grams (2,894 calories) are taken in. On the other hand 110 grams of albumin and 600 grains of starch, a total of 710 (2,944 calories) may be given without producing a de posit of fat. With mixed diet the limit lies near 118 grams of albu min, 100 grams of fat, and 368 grains of starch, a total of 586 grams (2,023 calories). Consequently we have a rather large choice in the selection of a diet, as well in quantity as in the quality of fat-forming substances. If we want to bring about decomposi tion of the fat already accumulated in the body, we do so best by diminishing the supply of fat and by permitting a certain quantity of carbohydrates.
If we take into consideration the different forms of obesity and their various stages, viz., those different conditions of nutrition, pleth ora, anfemia, and hydriemia, the amount of heart insufficiency and of circulatory disturbances, the general state of the constitution and what is left of the working power of the muscular apparatus, the kind of nourishment or fattening material, the ability to digest and absorb, the adaptation of the digestive system to a certain diet, and the numerous complications, it will become clear that it is impossible to formulate a regime or diet which holds good for all cases and at all times. We have to consider every case by itself and regulate the dietetic-mechanical treatment according to the results of examination and observation during the course of treatment.
The diet to be ordered in the treatment of obesity will therefore not be according to a general formula or a pattern, as it were, holding good for every case, but our efforts will consist only in fixing the limits as regards the supply of albuminous and fat-forming sub stances, and as regards the quantity of the one or the other to be allowed in a given case according to the general indications above set forth, and according to the special indications in each individual case.
In the first edition of my work upon the therapeutics of circula tory disturbances, where I took occasion to discuss fat reduction in patients whose circulatory apparatus was disturbed, I have already considered these points and formulated two diet tables. The latter are not to be considered as two sets of cast-iron rules or patterns, but indicate merely the limits within which the prescription of diet must move to adapt itself to each case, whether moderate in intensity or extreme.
This diet, which has given me good results in all cases during the past twenty years, and which, consequently, I have no reason for giv ing up, fixes the quantity of albumin, fat, and carbohydrates at the following figures, which I have found by calculating the diet in a very large number of observations : Since the number of calories may rise during exercise from 2,500 to 3,500 and over, the difference of 1,320 and 892 or of 2,320 and 1,892 must be met by the burning up of the fat of the body.
Soppy of Liquids.—Not only the decrease of weight but also the reduction of the patient's fat depends materially upon the reduction of liquids iu the body, the increased excretion of water, and the de crease iv the supply of liquids in food and drink.
We have already discussed above (see Etiology) the influence of a diminished supply of water. Wherever there is a lowered heart ac tion and circulatory disturbances exist, the success of treatment goes hand in hand with a diminution of the supply of liquids, accord ing to the individual case, because by freely supplying the body with liquids, especially in the form of drinks, the heart action is at once considerably increased during a period of muscular activity.
The insufficiency of the heart muscle, the starting-point of most of the dangerscof adiposity, is very considerably diminished by low ering the supply of liquids.
The production of forcible contractions of the heart is only possi ble where the resistance in the circulation is abolished as far as pos sible, where there is no overdistention of the vessels by increased fluid supply, where the circulation is not overburdened, and finally if the heart is able to force along the rush of blood.