This paper is a review of the oscillations in authoritative opinion regarding the proper protein content of the diet for patients with liver disease that have characterized the period since 1937. This period began with enthusiasm for a high-protein diet and ends with uncertainty as to the degree of concern which one should have over the recent re-discovery of the role of toxic effects of protein in relation to hepatic coma. Here one may gain insight into the complexities which surround clinical investigation of what may appear to be a simple question. A series of tentative conclusions, unsupported by adequate controlled studies, became successively generally accepted as authoritative opinion. The author cautions that the recent interest in toxic effects of protein in patients with hepatic coma should not be extended uncritically to all patients with liver disease, some of whom may receive benefit from high-protein intakes without risk from harm of toxic effects on the brain. He makes a plea for the conduct of meticulously controlled therapeutic trials to guide us in the selection of the proper protein intake for patients with various forms of liver disease.
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