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I also noticed (too late) that the 40%:20%:30% calorie ratio did not add up to 100% and regret that this was not caught before final publication. In truth, the additional 10% could be all relegated to carbohydrate or divided, as Ms Stegemann suggests, between carbohydrate and fat or, for that matter, between carbohydrate and protein. The only objection to making the carbohydrate 50% of the calories is the possible effect this may have in stimulating very low density lipoprotein overproduction in patients susceptible to carbohydrate induction. Thus, I would accept the correction of Ms Stegemann with the provision that the type 2 hyperproteinemic patients should have 50%:20%:30% as their ratio, whereas type 4 hyperproteinemic patients might use the ratio 40%:20%:40% to better advantage.
The point raised by Ms Stegemann with regard to the division of carbohydrates is a good one. Simple sugars, particularly fructose, are thought to be
Jones RJ. Dietary Management in the Coronary Care Unit-Reply. JAMA. 1977;238(18):1914. doi:10.1001/jama.1977.03280190016012