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Abstract
[...]I suggested that in view of the deaths, liquid-protein diets, as well as very-low-calorie diets consisting solely of solid protein, should be restricted to investigational use.10 In the five years since the appearance of the initial reports, the popular appeal of the liquid-protein diets has all but vanished. First of all, among the 17 deaths previously reported by the Centers for Disease Control,9 two patients used regimens containing high-quality protein, two patients supplemented the low-quality liquid-protein diets with protein foods of high biologic value, and at least six took some calcium supplements. [...]marked variations in urinary nitrogen excretion have been observed in patients on very-low-calorie diets, and overall nitrogen balance is not consistently more positive with proteins of high biologic value than with collagen hydrolysates.22 Thirdly, the patients in whom electrocardiographic arrhythmias developed during a liquid-protein regimen did not have greater nitrogen or mineral losses than those who remained free of arrhythmias while on the diet.16 Finally, the mortality rate of 0.3 per cent observed with a mineral-supplemented, carbohydrate-containing, high-quality-protein regimen that is not sold over the counter and is administered only under medical supervision,4, 17, 26 may not be significantly lower than that reported for the liquid-protein products (0.6 per cent). [...]patients should be warned (by product labeling and by their physician) that very-low-calorie diets are potentially dangerous.