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In spite of numerous studies in the literature, it is still questionable as to whether the isocaloric exchange of carbohydrate and fat, in the form of a diet, leads to different degrees of weight loss. In comparative studies, obese patients given a low-carbohydrate (4.14 MJ [1000 kcal]) formula diet (diet Ia) lost 14.0 +/- 1.4 kg and those given an iso-energetic high-carbohydrate diet (diet Ib) 9.8 +/- 0.9 kg. The degree of weight loss was significantly different. Daily weight losses were 362 g and 298 g respectively. Comparative studies of high and low-carbohydrate (7.83 MJ [1900 kcal]) formula diets (diets IIa and b) with a greater number of calories did not show any significant difference. However, there was a greater mean weight loss with the low-carbohydrate diet (351 g/day) compared with that under the high-carbohydrate diet (296 g/day). Evaluation of 117 patients treated with formula diets resulted in a weight loss of over 9 kg in 102 obese patients and over 18 kg in 52 patients. The good response to the low-carbohydrate diet was partly responsible for the successful therapy.

Therapeutic problems with low-carbohydrate diets in the weight reduction of the obese are summarized presenting results of the literature and results of the own group. The small number of patients and the short periods of treatment do account to the controverse results observed by other authors with low-carbohydrate diets. Also studies performed under ambulant conditions should be interpreted carefully. The therapeutic effect of the low-carbohydrate formula diet tested, satisfied even in comparison with a diet discribed in other studies. Concentrations of plasma triglycerides and cholesterol elevated in part turned to normal during therapy. There were no side effects of the gastro-intestinal tract. Hypocaloric diets with reduction of carbohydrates are discussed to have a good therapeutic effect for the following reasons: High value of satiety and increase of the metabolic rate.

Diamine oxidase (DAO, histaminase), according to Schayer, is an essential enzyme in histamine metabolism. It metabolises also a variety of diamines such as putrescine and cadaverine and is generally accepted to be identical with histaminase. Lipoproteinlipase (LL) is assumed to play an essential role in lipid metabolism. In vertebrates, parenterally applied heparin causes a marked dose-dependent rise of the plasma level of both enzymes mainly due to the release from the enzyme containing organs. The plasmatic level changes of DAO and LL after heparin application (200 U/kg b.wt., i.v.) have been studied in 30 patients suffering from 20 different, predominantly inflammatory diseases. In all cases the release of postheparin diamine oxidase (PHD) and of post-heparin lipoproteinlipase (PHLA) was found to be markedly decreased. There existed a highly significant correlation between the degree of the release of both enzymes (r=0.843, p less than 0.0005). In all patients normal levels of plasma insulin were detected. No correlation was found between PHLA and plasma triglycerides levels. Decrease of PHD respectively PHLA was a more sensitive biochemical parameter than were changes of serum glutamic pyruvic transaminase in acute hepatitis and of C reactive protein (CRP) in chronic inflammatory kidney diseases. This finding is most likely a general phenomenon in inflammatory diseases. Besides hormonal regulation inflammation-dependent effects on PHLA have to be discussed.