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Intermittent fasting can be an effective temporary therapeutic measure in obesity refractory to conventional methods of weight reduction. The patient is hospitalized for the initial 7 to 14 day period of total fasting. Then a low-calorie diet is allowed and the patient fasts on one day of each week. Later the periods between fasts are extended to two weeks and a month. Preliminary observations based on a series of 890 patients are presented. About half of the patients have continued to progress favorably in their weight reduction program since the initial fast and indoctrination.

Intermittent total fasts of 10 to 12 days in obese diabetic patients exerted beneficial effects on the results of the glucose tolerance tests. This improvement is attributed to (1) the fasting hyperketonemia, known to occur during total fasts in obese subjects, and which is believed to increase production of insulin plus (2) optimal sensitivity of the insulin probably due to low concentrations of growth hormone. The obese nondiabetic and obese patient with borderline or latent diabetes experienced a deterioration of the glucose tolerance by the end of the fast, presumably caused by decreased insulin sensitivity from increasing amounts of growth hormone. Premature feeding of obese diabetic persons decreased the serum ketones and decreased sugar tolerance.

Excerpt An arginine derivative, gamma-guanidinobutyramide (Augmentin®) was investigated with W. J. H. Butterfield of Guy's Hospital Medical School and Sir Charles Dodds, London. No significant hypo...

To the Editor:— The goitrogenic effect of prolonged sulfonylurea therapy in some diabetic patients recently has been reported. 1 The incidence of hypothyroidism induced by sulfonylureas was dependent on duration of treatment rather than dosage, increasing from 8% at six months to 20% after five years of drug therapy. Symptoms of lethargy and cold intolerance usually diminished after discontinuing the sulfonylureas with previously low tests of thyroid function returning towards normal. Appreciation of this possible drug-induced form of hypothyroidism is of clinical importance since increasing weight in the adult-onset diabetic patient will further complicate proper control of the disease. Case Report:— A 58 year-old white man, weight 183 lb, height 68 inches, was a diabetic of ten years' duration. Dietary measures had resulted in good control and his weight had remained stable for a period of more than one year. An office visit on March 5, 1965, revealed the postprandial