How do Ketogenic Diets work, and what effects do they have on Sodium, Potassium and Uric Acid Levels?
Low carbs induces fat breakdown for fuel (ketones).
Initially, this induces a diuretic effect potentially leading to hypokalemia and hyponatremia. This diuretic effect explains the initial rapid weight loss.
No effect on uric acid levels
What Dietary Strategy helps avoid stringent rules or calorie counting, which many patients with a history of eating disorders or obsessive-compulsive disorder may struggle with?
Mindful Eating
Which Nutrients play a role in hair loss following MBS / Weight loss?
Zinc (common with Iron)
Iron (microcytic anemia)
Biotin (rare compared to top 2)
Protein (muscle wasting, edema)
What is Telogen effluvium?
Temporary Hair loss associated with rapid weight loss or stressors, leading to synchronization of hair follicles.
What other nutrient deficiency closely mimics B12?
Copper!
Copper Deficiency Triad?
Neutropenia, Anemia (macro usually), Myeloneuropathy
Vitamin E is associated with what type of Anemia?
Hemolytic (elevated LDH)
Folate Deficiency is similar to B12 but different, how?
Macrocytic anemia WITHOUT neurologic findings
Vitamin B6 deficiency symptoms?
Microcytic anemia with neuropathy
Low Carb/Keto Effects on TG’s, LDL/HDL, A1C?
Decreased TG’s, Increased LDL/HDL, Improved A1C
Low Fat Effects on TG’s, LDL/HDL, A1C?
Increased TG’s, Decreased LDL/HDL, Improved A1C
What is the most common cause of hypothalamic Obesity?
Craniopharyngioma
Masses in the ventroMedial hypothalamus lead to More weight
Lesions in the Lateral hypothalamus lead to Less weight.
bilateral hemianopsia, central hypothyroidism, and hyperphagia
hypothalamic obesity
Why Does Vitamin C increase Iron Absorption ? And when is the best time to take an Iron Supplement?
By reducing Ferric Iron (Fe3+) to Ferrous Iron (Fe2+).. the absorbable kind by small intestine
2 hours before or 4 hours after acid reducer, on an empty stomach (especially avoid calcium)
Why Is Vitamin C important in plant-based diets?
Because non-heme iron from plant sources is less bioavailable than heme sources from animals.
What types of patients should generally avoid ketogenic and intermittent fasting diets?
T1DM or Insulin Dependent T2
Patients on SGLT-2’s
AMDR (Acceptable Macro Distribution Range)
(AMDR) are the percentage of energy intake associated with a reduced risk of chronic disease yet providing adequate amounts of essential nutrients.
Carbs: 45-65%
Fats: 25-35%
Protein: 15-35%
Very Low Calorie Diet (VLCD) definition and Indications?
DEFINITION
< 800 calories per day
Caloric intake often less than RMR
INDICATIONS
Short term weight loss
Pre surgery to reduce liver size
Can VLCD improve metabolic parameters?
Yes, in ALL the ways !
Decreased Glucose, Insulin, TG, LDL, BP
Increased HDL
VLCD risks?
Gallstones (if low fat, Gout, Electrolyte Disturbance (hypokalemia/hypomag), Cardiac, Post menopausal bone density decrease
VLCD Contraindications
- Prolonged QTC or Arrhythmia
- Hx of eating disorder
- Elderly (sarcopenia)
- Pregnancy / breastfeeding
- Severe organ dysfunction (CKD)
- Gallbladder Dz
- T1 DM
- T2 on hypoglycemic agents / SLGT-2
How to maximize protein intake for Vegetarians?
Dairy-based combinations like cottage cheese and Greek Yogurt … Black beans and Lentils are a close 2nd
Vitamin K Deficiency Sxs?
Excessive bleeding / easy bruising.
Fatigue, Persistent Diarrhea, cardiomyopathy, metabolic bone disorder?
Selenium Deficiency
