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Scott Isaacs Part 2, Low Calorie vs Very Low Calorie Diets

In part 2 of this Exclusive Interview, Scott Isaacs talks with Diabetes in Control Medical Editor Joy Pape about the difference between low calorie and very low calorie diets using meal replacements.

Scott Isaacs, MD, FACP, FACE is the medical director for the HMR Program for Weight Management at Atlanta Endocrine Associates and a faculty member at Emory University School of Medicine.

Transcript of this video segment:

Pape: And you mentioned the different types of calorie diets. Can you tell me the difference between low calorie diets and very low calorie diets using meal replacements?

Isaacs: Okay, yes. So, a low calorie diet is generally above 800 calories but low enough that enables someone to lose weight, what we call getting someone into negative caloric balance. A very low calorie diet by definition is less than 800 calories a day. And so, the weight loss is more rapid and more substantial. There are other definitions of a very low calorie diet. Some people like to calculate the resting metabolic rate and then use 50% of that as the number for a very low calorie diet. And that does have some merits because not everybody is the same. And so, an 800 calorie diet in a small person with low metabolism may be very different than an 800 calorie diet in someone that may weigh 300-400 pounds. And so, it’s probably better to customize this based on the individual person.

Pape: So, how would you explain the medical management of patient losing weight rapidly on low calorie diets with meal replacements?

Isaacs: So, first, we look at the patient and we do the history and physical, and we look at what medications they’re taking, and any potential pitfalls. Many medications do need to be either reduced or just discontinued. Even at the start of a diet, we know that on very low calorie diet, blood pressure drops even before weight drops. And so, we need to reduce the medications or stop medications. Same goes for diabetes medications, we see a really significant fall in blood sugar even before substantial weight is lost. So, medications that make your blood sugar go low like a sulfonylurea, that’s going to be stopped. Insulin, we oftentimes cut it in half. And then as the patients are progressing with the diet, we need to continue making more adjustments and we may need to further reduce diabetes medicines or blood pressure medicines. And it’s a good thing to do. I mean, we love it when we can do that. People like being on less medication and it’s certainly a big benefit of losing weight.

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