Question

A 25-year-old female heard about the ketogenic diet and stopped eating carbohydrates, including fruits, vegetables and all grains for about the last 3-4 months. She has noticed redness around her mouth, cracking in the corners of her mouth and her tongue appears big and red.

What vitamin(s) deficiency may be present? What led to your conclusion? (5 points)

She still wants to lose more weight and is not willing to stop the ketogenic diet. What recommendations would you make? (5 points)

Answer 1

Our patient of 25 years old having the vitamin B2 ( riboflavin ) deficiency , Folate (B9) and Biotin ( B7 ) and also with the water soluble vitamin C and A deficiency . Their symptoms are redness and swelling on the mouth , cracks or sores on the outsides of the lips and at the corners of the mouth , inflammation and redness of the tongue as well as moist ,scaly skin inflammation . and fatigue

These deficiency are seen on the patient on the ketogenic diet , The diet which not only restrict the carbohydrates but also the proteins ,which leads to the breakdown of fat into fatty acids and become as a fuel for the cells to provide energy instead of glucose .This leads to the deficiency of the many vitamins and nutrients .

As it seems to be like that the she is suffered from Anorexia nervosa , It is characterised by a distorted body image ,with an unwarranted fear of being overbeight .   which leads to patient in loosing their wieght it is common in the young females ,

we recommended her to follow the following instruction ;-

If she is on no- carbohydrate or extremely low- carbohydrate diet then make sure she is eating 1 or 2 portions of leafy green vegetables such as kale, chard , and spinach every day .

Add to take the supplementation of vitamins and nutrients in a diet schedule .

the first goal of the treatment is getting back to a healthy weight and learning proper nutrition , we will supervise her to what calorie should she take daily and develop behavioural strategies to help her in returing the healthy weight .

For getting back to the regular patterns of eating we including , providing specific meal plans and calorie requirements that help her in meeting the to fulfill the difciency of vitamins and nutrients in her body .

Providing psychotherapy which include family based therapy and individual therapy ;-

family based therapy helps in mobilizies the parents to help her with re- feeding and weight restoration until she can make the good choices about the health .

In the individual therapy ,which specifically enhanced the cognitive behavioral therapy .The main goal is to normalize the eating patterns and behaviours to support weight gain .The second goal is to help change distorted beliefs and thoughts that maintain restrictive eatings .