Negative balance: the body eats itself
Negative nitrogen balance happens two ways β too little protein coming in, or too much breakdown going out. The intake side is malnutrition, starvation, or prolonged fasting. The breakdown side is stress catabolism β severe illness, infection, major burns, surgery, uncontrolled diabetes, and the slow muscle loss of aging. Either way the result is the same and grim: with amino acids in short supply, the body starts dismantling its own muscle protein to get them β wasting. It's why serious illness costs you muscle, and why nutrition is part of the treatment.
