Comparison of Metabolic Changes in Fasting Obese and Lean Patients

Abstract

Most of the preceding information has dealt with fundamental aspects of nutrition, hormone or enzyme changes in a maize of organs in a spectrum of species. This paper deals primarily with intact people with hormones, enzymes, and nutritional elements working in harmony in our patients. Thus what we present will be the result of infinite reactions subject t o infinite variations. Nevertheless the physician's responsibility is to decipher the total response.Thus with temerity we would present very simple metabolic studies of people, men and women, fat and lean. Our interest in this area was prompted by the fact that women (during the child bearing years) partake of food comparable in composition and in similar amounts t o that consumed by men. Somehow these women escape the vascular disease frequently found in the men. Inquiry into differences in the two sexes other than those charming superficialities indicated definite hormonal contrasts but few metabolic differences. Two previous observations were challenging: 1) the historical absence of long term fasts by women; 2) Devel and Gulicks' observation that women are more ketogenic than men during fasting.Examination of the data generally accepted t o support the concept of increased feminine ketogenesis revealed that studies were limited to urine excretion.' This historical set prompted us to do something often considered pass6 in this space age-to repeat the earlier experiments on fasting and obtain blood as well as urine levels of ketones. Men and women, obese and lean were compared in the study. The ketone values of the obese have been published previously* but have been re-analyzed in this study. MethodFourteen lean subjects, seven men and seven women with normal body weight (within 10 per cent of the accepted norm for the age, sex, and height of the patient) were admitted t o the hospital for this study. The patients were kept a t rest with activity being limited to their hospital room. They were allowed to sit in the chair, go to the bathroom, but otherwise remained at rest. They were allowed water a d lib, tea and/or black coffee unsweetened. Twenty-four hour urine collections were obtained and daily venous blood specimens were taken each morning. The hospital is air conditioned and the temperature maintained a t 72'F. with constant humidity.Total ketones were determined by the method of Bloom3 as modified by Lyon andResults of all ketone determinations were expressed as 623

Influence of Acute Fasting and Refeeding on Glucose Utilization in Healthy Women

“…This observation is in keeping w ith the findings of Deuel et al [10] and others [7] according to whom ketonaeinia during fasting is much more m arked in women th an in men. This does not apply to obese women [8,32]. Similarly, in keeping w ith d ata reported in the literature, in our experim ental subjects the m orn ing blood sugar level declined on an average by cca one-third.…”

Influence of norepinephrine, growth hormone and fasting on FFA mobilization and glucose metabolism in lean and obese subjects

“…Although this difference was not significant, the role of sex in lipid mobilization can reasonably be considered in the view of a report showing a higher degree of fasting ketosis in female than in males subjects [2].…”

Effects of a 48-h fast on heart rate variability and cortisol levels in healthy female subjects

“…3 Fasting as a medical and scientific tool came to life during the 1950s and 1960s and was widely recommended for rapid weight loss in obese patients. 1 Studies by Bloom, 4 Bloom et al, 5 Drenick and Smith, 6 Cahill et al 7 and Cahill 8 developed a framework for 'therapeutic starvation'. Later, in the 1990s, a second wave of interest came in connection with the increased incidence and public and scientific awareness of eating disorders such as anorexia nervosa (AN), bulimia and obesity.…”