Dietary restriction

Obesity is a difficult condition to treat. Dietary restriction of caloric intake is the first line therapy and is optimally combined with an exercise program to promote loss of fat relative to lean body mass (17). For the grossly obese (BMI > 40), invasive mechanical measures such as jaw wiring, gastric banding, and gastric by-pass have been attempted with at least limited success (18). 

Appetite suppressants have been widely used as an adjunct to dietary restriction and sympathomimetic amines have traditionally been used for this purpose. These agents have not proven particularly useful and frequentiy cause unacceptable side effects, hence their popularity has been waning for several years. The most promising newer dmgs work through a serotoninergic mechanism and hold considerable promise at least for certain obese patients. 

D Anxiety related to diagnosis, tear ot giving own injections, dietary restrictions, other factors (specify)... 

The clinician must identify potential reversible causes of HF exacerbations including prescription and non-prescription drug therapies, dietary indiscretions, and medication nonadherence. Non-adherence with dietary restrictions or chronic... 

Therapeutic lifestyle changes should be the first approach tried in all patients (Table 9—7).3 An adequate trial of TLC should be employed in all patients, but pharmacotherapy should be instituted concurrently in higher-risk patients. This includes dietary restrictions of cholesterol and saturated fats as well as regular exercise and weight reduction. In addition, therapeutic options to enhance LDL cholesterol lowering such as consumption of plant stanols/sterols (which competitively inhibit incorporation of cholesterol into micelles) and dietary fiber should be encouraged. These therapeutic options collectively may reduce LDL cholesterol by 20% to 25%. 

No specific dietary restrictions are recommended for patients with IBD, but avoidance of high-residue foods in patients with strictures may help to prevent obstruction. Nutritional strategies in patients with long-standing IBD may include use of vitamin and mineral supplementation. Administration of vitamin B12, folic acid, fat-soluble vitamins, and iron may be needed to prevent or treat deficiencies. In severe cases, enteral or parenteral nutrition maybe needed to achieve adequate caloric intake. 

At each encounter, ask the patient specific questions about adherence to prescribed therapy, dietary restrictions and cessation of alcohol intake. 

Treatment of chronic pancreatitis is aimed at removing the cause (ethanol abuse or biliary stones), providing analgesia, supplementing with pancreatic enzyme preparations, and implementing dietary restrictions. 

Hyperphosphatemia is generally benign and rarely needs aggressive therapy. Dietary restriction of phosphate and protein is effective for most minor elevations. Phosphate binders such as aluminum-based antacids, calcium carbonate, calcium acetate (PhosLo , Nabi), sevelamer (Renagel , Genzyme), and lanthanum carbonate (Fosrenol , Shire) may be necessary for some patients.43 If patients exhibit findings of hypocalcemia (tetany), IV calcium should be administered empirically. 

Each antidepressant has a response rate of approximately 60% to 80%, and no antidepressant medication or class has been reliably shown to be more efficacious than another 22 MAOIs may be the most effective therapy for atypical depression, but MAOI use continues to wane because of problematic adverse effects, dietary restrictions, and possibility of fatal drug interactions.22,28 There is some evidence that dual-action antidepressants, such as TCAs and SNRIs, may be more effective for inpatients with severe depression than are the single-action drugs such as SSRIs,22,28 but the more general assertion that multiple mechanisms of action confer efficacy advantages is quite controversial.33... 

MAOI Phenelzine 15 45-90 Antidepressant effects Dietary restrictions drug... 

MAO Is have not been evaluated systematically for treatment of PD under the current diagnostic classification and generally are reserved for patients who are refractory to other treatments.48,49 MAOIs have significant side effects that limit adherence. Additionally, patients must adhere to dietary restriction of tyramine and avoid sympathomimetic drugs to avoid hypertensive crisis. 

The MAOI phenelzine and the RIMAs brofaramine and meclobemide are effective in SAD. Phenelzine is effective in 64% to 69% of SAD patients.58 It is generally reserved for treatment-refractory patients owing to dietary restrictions,... 

Lee, J., Duan, W. and Mattson, M. P. Evidence that brain-derived neurotrophic factor is required for basal neurogenesis and mediates, in part, the enhancement of neurogenesis by dietary restriction in the hippocampus of adult mice. /. Neurochem. 82 1367-1375, 2000. 

Effective treatment of maple syrup urine disease involves the restriction of dietary branched-chain amino acids. Long-term treatment entails the dietary restriction of the BCAAs. This is accomplished by administration of a special formula from which these amino acids are removed. The outlook for intellectual development is favorable in youngsters in whom diagnosis is made early and who do not suffer recurrent, severe episodes of metabolic decompensation [17]. 

The outlook for patients who are treated at an early age is favorable. Affected babies are normal at birth but almost all will be impaired unless they receive dietary restriction by age 3 months. Mass screening has largely eliminated the untreated PKU phenotype of eczema, poor growth, irritability, musty odor (caused by phenylacetic acid) and tendency to self-mutilation. Progressive motor dysfunction has been described in children with longterm hyperphenylalaninemia. 

The clinical utility of dietary restriction of phenylalanine (200-500 mg/day of phenylalanine) is clear. Well-controlled patients have normal intelligence, although there may be an increased risk of perceptual-learning disabilities, emotional problems and subtle motor difficulties [23]. Diet therapy must probably be maintained throughout adolescence and perhaps indefinitely. Performance may deteriorate after the diet is discontinued. 

Management of the pyridoxine nonresponsive patient is difficult. Dietary restriction of methionine would seem logical, but this often is unpalatable, especially to an adult patient who has adapted to a diet that has not been purposefully restricted in protein. 

Most, and possibly all of these changes result from the tissue accumulation of phytanic acid. Phytanic is of dietary origin exclusively, and dietary restriction of phytanic and plasmapheresis are of clinical benefit. The defective gene and pathogenic mutations have been identified. The clinical manifestations can also be mimicked by defects of PEX7. 

HE is a common complication of cirrhosis and requires clinical vigilance and treatment with dietary restriction, elimination of CNS depressants, and therapy to lower ammonia levels. 

Treatment approaches include (1) reduction of blood ammonia concentrations by dietary restrictions, and drug therapy aimed at inhibiting ammonia production or enhancing its removal (lactulose and antibiotics) and (2) inhibition of y-aminobutyric acid-benzodiazepine receptors by flumazenil. 

Phenelzine, an MAOI, is effective, but is reserved for treatment-resistant patients because of dietary restrictions, potential drug interactions, and adverse effects. 

Dietary Restrictions for Patients Taking Monoamine Oxidase Inhibitors0... 

Accordingto the FDA-approved prescribing information for the transdermal selegiline patch, patients receiving the 6 mg/24 hour dose are not required to modify their diet. However, patients receiving the 9 or 12 mg/24 hour dose are still required to follow the dietary restrictions similar to the other monoamine oxidase inhibitors (MAOIs). 

Spontaneous biotin deficiency is unlikely to occur as a result of simple dietary restriction, since biotin has high potency, is widely distributed in foods, and is also synthesized in the intestine. The human requirement for biotin is not known, but subjects on a low-biotin diet recovered in 3-5 days, when 75-300 jxg biotin was administered daily (S23, S24). 

Chapin, R.E., Gulati, D.R. and Barnes, L.H. (1991). The effects of dietary restriction on reproductive endpoints in Sprague-Dawley rats. Toxicologist 11 112. 

Weindruch, R. and Walford, R.L. (1988). The Retardation of Aging and Disease by Dietary Restriction. Charles C. Thomas, Springfield, IL. 

Careful dietary restriction of cholesterol and saturated fat, as well as an increase in exercise, will result in diminution of plasma cholesterol, particularly that carried in LDLs. A prudent diet takes cognizance of this fact. The dietary guidelines of the American Heart Association (AHA) recommend a daily intake of cholesterol of no more than 300 mg. At the same time, restriction of dietary cholesterol tends to... 

Monoamine Oxidase inhibitors (MAOis). There are no controlled studies of MAOIs for the treatment of AN. In addition, the dietary restrictions imposed on patients taking this class of antidepressant and their propensity for lowering blood pressure makes their use in AN inadvisable. In the future, the issue of using MAOis may be reopened with the advent of the so-called reversible MAOis such as moclobemide that apparently do not require a tyramine-restricted diet. 

Monoamine Oxidase Inhibitors (MAOIs). The MAOls work in a unique fashion by blocking the activity of an enzyme that degrades each of three key brain transmitters norepinephrine, dopamine, and serotonin. These widespread effects on several brain transmitter systems make the MAOls a potentially very effective class of medications for a variety of disorders. A few small studies have evaluated the usefulness of the MAOls in the treatment of BPD and found them moderately helpful for the impulsivity associated with this illness. Unfortunately, the requirements for strict dietary restrictions due to a risk of hypertensive crisis severely limit the usefulness of MAOls in the treatment of BPD. These restrictions are a particular concern when treating patients who have problems with impulsivity and are therefore likely to have difficulty maintaining the dietary regimen. For this reason, although they may theoretically be helpful, MAOls should only be used to treat BPD after other more easily tolerated medications have been tried and have failed. In the near future, so-called reversible MAOls that appear to avoid the need for diet restrictions may become available. If so, this will allow us to reconsider their use in the treatment of BPD. For more information regarding the use of MAOls, please refer to Chapter 3. 

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