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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.
Merrill AJ. "Wear and Tear" Protein-Reply. JAMA. 1961;175(5):414. doi:10.1001/jama.1961.03040050070026