Untreated Diabetes Mellitus And Respiratory Quotient

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% Carbohydrate Fuel Value per 100 Grams (Calories)

14.9 64

0.7 712

1.0 599

1.0 268

0.4 733

26.4 609

18.0 570

73.4 372

1.0 230

23.6 600

17.7 101

1.0 340

15.6 702

cent of the weight.Therefore, the fat of one pat of butter mixed with an entire helping of potato sometimes contains as much energy as the potato itself.

Average Daily Requirement for Protein Is 30 to 50 Grams.

Twenty to 30 grams of the body proteins are degraded and used to produce other body chemicals daily. Therefore, all cells must continue to form new proteins to take the place of those that are being destroyed, and a supply of protein is needed in the diet for this purpose. An average person can maintain normal stores of protein, provided the daily intake is above 30 to 50 grams.

Some proteins have inadequate quantities of certain essential amino acids and therefore cannot be used to replace the degraded proteins. Such proteins are called partial proteins, and when they are present in large quantities in the diet, the daily protein requirement is much greater than normal. In general, proteins derived from animal foodstuffs are more complete than are proteins derived from vegetable and grain sources. For example, the protein of corn has almost no tryptophan, one of the essential amino acids. Therefore, individuals in economically disadvantaged countries who consume cornmeal as the principal source of protein sometimes develop the protein-deficiency syndrome called kwashi-orkor, which consists of failure to grow, lethargy, depressed mentality, and edema caused by low plasma protein concentration.

Carbohydrates and Fats Act as "Protein Sparers." When the diet contains an abundance of carbohydrates and fats, almost all the body's energy is derived from these two substances, and little is derived from proteins. Therefore, both carbohydrates and fats are said to be protein sparers. Conversely, in starvation, after the carbohydrates and fats have been depleted, the body's protein stores are consumed rapidly for energy, sometimes at rates approaching several hundred grams per day rather than the normal daily rate of 30 to 50 grams.

Methods for Determining Metabolic Utilization of Proteins, Carbohydrates, and Fats

Nitrogen Excretion Can Be Used to Assess Protein Metabolism.

The average protein contains about 16 per cent nitrogen. During metabolism of the protein, about 90 per cent of this nitrogen is excreted in the urine in the form of urea, uric acid, creatinine, and other less important nitrogen products. The remaining 10 per cent is excreted in the feces. Therefore, the rate of protein breakdown in the body can be estimated by measuring the amount of nitrogen in the urine, then adding 10 per cent for the nitrogen excreted in the feces, and multiplying by 6.25 (i.e., 100/16) to determine the total amount of protein metabolism in grams per day. Thus, excretion of 8 grams of nitrogen in the urine each day means that there has been about 55 grams of protein breakdown. If the daily intake of protein is less than the daily breakdown of protein, the person is said to have a negative nitrogen balance, which means that his or her body stores of protein are decreasing daily.

"Respiratory Quotient" Is the Ratio of CO2 Production to O2 Utilization and Can Be Used to Estimate Fat and Carbohydrate Utilization. When carbohydrates are metabolized with oxygen, exactly one carbon dioxide molecule is formed for each molecule of oxygen consumed. This ratio of carbon dioxide output to oxygen usage is called the respiratory quotient, so the respiratory quotient for carbohydrates is 1.0.

When fat is oxidized in the body's cells, an average of 70 carbon dioxide molecules are formed for each 100 molecules of oxygen consumed. The respiratory quotient for the metabolism of fat averages 0.70. When proteins are oxidized by the cells, the average respiratory quotient is 0.80. The reason that the respiratory quotients for fats and proteins are lower than that for carbohydrates is that a large share of the oxygen metabolized with these foods is required to combine with the excess hydrogen atoms present in their molecules, so that less carbon dioxide is formed in relation to the oxygen used.

Now let us see how one can make use of the respiratory quotient to determine the relative utilization of different foods by the body. First, it will be recalled from Chapter 39 that the output of carbon dioxide by the lungs divided by the uptake of oxygen during the same period is called the respiratory exchange ratio. Over a period of 1 hour or more, the respiratory exchange ratio exactly equals the average respiratory quotient of the metabolic reactions throughout the body. If a person has a respiratory quotient of 1.0, he or she is metabolizing almost entirely carbohydrates, because the respiratory quotients for both fat and protein metabolism are considerably less than 1.0. Likewise, when the respiratory quotient is about 0.70, the body is metabolizing almost entirely fats, to the exclusion of carbohydrates and proteins. And, finally, if we ignore the normally small amount of protein metabolism, respiratory quotients between 0.70 and 1.0 describe the approximate ratios of carbohydrate to fat metabolism. To be more exact, one can first determine the protein utilization by measuring nitrogen excretion and then, using the appropriate mathematical formula, calculate almost exactly the utilization of the three foodstuffs.

Some of the important findings from studies of respiratory quotients are the following:

1. Immediately after a meal, almost all the food that is metabolized is carbohydrates, so that the respiratory quotient at that time approaches 1.0.

2. About 8 to 10 hours after a meal, the body has already used up most of its readily available carbohydrates, and the respiratory quotient approaches that for fat metabolism, about 0.70.

3. In untreated diabetes mellitus, little carbohydrate can be used by the body's cells under any conditions, because insulin is required for this. Therefore, when diabetes is severe, most of the time the respiratory quotient remains near that for fat metabolism, 0.70.

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