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[Carbohydrate intolerance during complete fasting].

H Göschke, H Thölen

    Schweizerische Medizinische Wochenschrift
    |December 10, 1977
    PubMed
    Summary
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    Fasting impairs glucose tolerance more in lean than obese individuals due to hormonal changes. Fructose metabolism is also affected by fasting, contrary to prior beliefs.

    Area of Science:

    • Metabolic research
    • Human physiology
    • Endocrinology

    Background:

    • Glucose tolerance can be affected by fasting and body composition.
    • Hormonal factors play a role in regulating glucose metabolism.
    • The impact of fasting on fructose metabolism is not fully understood.

    Purpose of the Study:

    • To investigate the differential effects of prolonged fasting on glucose tolerance in lean versus obese individuals.
    • To compare glucose and fructose tolerance after fasting in normal subjects.
    • To examine the metabolic response to fasting and substrate infusion.

    Main Methods:

    • Oral glucose tolerance tests (GTT) and insulin tolerance tests (ITT) were conducted on lean and obese non-diabetics before and after prolonged fasts (≥6 days).

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  • Plasma levels of glucagon, growth hormone, free fatty acids, and ketones were measured.
  • Glucose and fructose tolerance were assessed via 4-hour infusions in normal subjects before and after 4-day fasts.
  • Main Results:

    • Lean individuals showed greater glucose tolerance deterioration after fasting compared to obese individuals.
    • Fasting lean subjects had higher plasma glucagon, growth hormone, free fatty acids, and ketones than fasting obese subjects.
    • After fasting, both glucose and fructose infusions resulted in higher plasma hexose levels and delayed lactate/pyruvate rise, contradicting previous assumptions about unimpaired fructose metabolism.

    Conclusions:

    • Prolonged fasting disproportionately affects glucose tolerance in lean individuals, linked to hormonal changes and reduced insulin sensitivity.
    • Fasting impairs the body's ability to metabolize both glucose and fructose, challenging the notion of fructose's resilience during starvation.
    • These findings highlight the complex metabolic adaptations to fasting and suggest a need to re-evaluate fructose metabolism research.