Kelsey Kinney: Let’s get started with our first presubmitted question, and there are actually quite a few questions along the lines with this particular question, I’ll kind of do them one at a time, but let’s start with—
“Is a protein-sparing modified fast appropriate for people with gallbladder removal?”
Okay, so with this I would say yes. First of all, I’ll start off by saying that I don’t really use the protein-sparing modified fast in my own practice. It’s just something I chose not to do really. Because it is really a low-calorie diet, it should be highly supervised, and as dietitian working in virtual private practice, I don’t feel like I have as much of the ability to really stay on top of my clients in that regard. I often will recommend that people interested in doing something like this are working with a doctor in person to put this into practice, but other practitioners have totally different views on this. They see no problem with it, so that’s just my personal opinion and my personal risk tolerance, I guess, speaking here. I just wanted to start off by saying that I don’t really use this much in practice, but I am familiar with it and can give you at least some guidance here.
In terms of whether it’s appropriate for people who have had their gallbladder removed, I’d say yes, because it is low fat really. That’s really the biggest concern you would have, especially someone immediately post gallbladder removal. If someone who has had their gallbladder removed for many years and eats a relatively normal diet by this point, I would certainly say it shouldn’t be a problem. I don’t know exactly what this question is asking whether you’ve got a client who is just coming out of gallbladder removal surgery, in which case I would still say this probably would be appropriate. The protein-sparing modified fast diet tends to be low fat, like I mentioned, and relatively higher in fiber considering how many calories it typically involves.
Overall, it’s a yes, the protein-sparing modified fast could be appropriate for somebody with gallbladder removal.
Then the next question, going back to the protein-sparing modified fast here is, “Have you had that kind of patient experience and can you please share it?”
I guess, I sort of answered that before actually, which is that, of course, I don’t really use this much in my own personal private practice, and within that, I have not really worked with it with somebody with their gallbladder removed.
Okay, next question which again goes back to the protein-sparing modified fast is, “In your experience, does it work for weight loss without adding physical activity into a person’s lifestyle?”
Again, I’m going to speak outside of my experience with what I know about the protein-sparing modified fast. Because it’s a low-calorie approach, for most people I actually wouldn’t really recommend that they’re doing any intense physical activity while they’re doing it, and again, this is just me personally. I think there are probably other practitioners who practice differently, but because it’s so low in calories, I would not feel comfortable recommending that someone is doing intense physical activity while eating that low of a calorie regimen. So, to answer your question, I would say yes, it would still absolutely work for weight loss without adding physical activity into a person’s lifestyle.
The next question is again going back to protein-sparing modified fast. “What contraindication does this type of diet have if any?” Then specifically asked about adolescence, elderly, osteoporosis, hypothyroidism, IBS, etc.
This is something I’m a little bit less familiar with just because again I haven’t really worked with it much in practice, so this would be a question I would certainly pose to Chris and Amy as well just to see if they’ve got any other opinions, but this is not something I would do with like the vast majority of your clients. I would say obviously if someone has metabolic disease or is overweight or obese, they’re probably a good candidate, but if they have other issues going on like, for example, if they’ve got HPA axis dysregulation, I wouldn’t consider it as much, but it depends on the type of HPA axis dysregulation that they’ve got. Sometimes you can see HPA axis dysregulation that’s related more to hypothyroidism or insulin resistance, in which case addressing some of the issues that maybe play a role in that. For example, if someone is insulin resistant, they’re overweight, and you put them on a protein-sparing modified fast, that could improve their insulin sensitivity and thus improve their HPA axis functions. In a case like that, it actually may make sense to do a protein-sparing modified fast despite someone having HPA axis dysregulation. It kind of depends on the case, of course, but if someone has just like low HPA axis function, like they’re just really having trouble, putting them on a really low-calorie diet I think it’s not the right approach. I also personally would not do this in adolescents. I wouldn’t do it with the elderly either. IBS, I think you probably could do this, especially, of course, if the IBS patient is overweight or obese. You have more of a reason, of course, to do this in the first place. Depending on what they’re eating on the protein-sparing modified fast, that could be potentially triggering to their IBS. I know there’s a company called ProLon that has a protein-sparing modified fast kit. I think from what I remember its lot of legumes and things like that, so depending on the person with IBS, that could be potentially problematic for them. I wouldn’t say it’s a no-go across the board for IBS, but for certain people, the diet and they end up being on could be a little bit triggering for them.
Okay and then the last question along the lines is, “In what situations do you recommend it to patients and for how long do you recommend using it?”
I’m going to refrain from answering that one just because, again, I don’t really use this in practice. I feel like I wouldn’t give you probably a good answer here, and I’m going point you to Chris and Amy to ask if it’s something that they have a little bit more insight on.