Complications of very low energy diets:
(1) cardiovascular: postural hypotension, cardiac arrhythmias, myocardial atrophy, cardiomyopathy, sudden death
(2) gastrointestinal: constipation, diarrhea, abdominal discomfort, biliary stasis, cholelithiasis, cholecystitis
(3) genitourinary: menstrual abnormalities, uric acid nephrolithiasis, loss of libido
(4) nutritional: loss of lean body mass (protein, muscle), vitamin deficiency, mineral deficiency
(5) other: general malaise, fatigue, cold sensitivity, xerosis, hair loss, halitosis, hunger, electrolyte derangement, acute gout, cramps, paresthesias
Contraindications to the use of very low energy diets:
(1) recent myocardial infarction
(2) unstable angina
(3) malignant arrhythmias
(4) cerebrovascular disease
(5) serious underlying disease, including cancer, liver failure or renal failure
(6) type I diabetes mellitus
(7) pregnancy
(8) certain drug regimens, including corticosteroids and antineoplastic agents
(9) untreated metabolic cause for obesity
(10) hypothyroidism and other endocrine disorders
(11) cosmetic motivation with body weight < 20% above ideal weight
Patients receiving insulin, oral hypoglycemics or anti-hypertensive agents should have their medications monitored and may require dosage reduction during use of a very low energy diet.
