Dr. Sadaf Mustafa
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 49-year-old female with a height of 164 cm and a weight of 97 kgs. Ten years back, I had a gastric bypass, so I lost up to 50 kgs. But now I have gained 30 kg. I have been concerned about my weight for the past 25 years. I do not have co-morbidities but have a congenital issue on my knee due to my weight. I tried many diets, and they did not help. Finally, I came across the keto diet, which suits my appetite. But my doctor said the keto diet might damage the kidneys and gallbladder. So I will not eat fat and unhealthy foods but consume carbohydrate-rich foods and sugar. I eat tablet Amitriptyline 50 mg once daily, tablet Tranexamic 500 mg thrice daily during periods, and tablet Mefenamic 500 mg as and when required to manage menstrual pain. Recently I had an iron infusion for my anemia. My hemoglobin level has been normal for the past two months. All my other reports are normal. I have attached the reports. Please help.
Hi,
Welcome back to icliniq.com.
Your condition requires a multi-systemic approach. First, we should identify the secondary cause of unhealthy weight. From the reports attached (attachment removed to protect the patient's identity), you have elevated serum ferritin and C-reactive protein. Are you suffering from an autoimmune disorder, blood disorders, or obstructive sleep apnea? Do thyroid function test, cortisol test, lipid profile, HbA1c (glycated hemoglobin), vitamin D, and vitamin B12 levels. Are you taking tablet Amitriptyline for depression or neuropathy? Do you want me to give a diet plan and treatment plan to recover from knee pain? Are you involved in physical activities like swimming or walking? Where do you want to see yourself in 6 months?
Patient's Query
Thank you doctor for the reply,
I do not have an autoimmune disorder. I think the elevated ferritin level is due to my earlier iron infusions. My doctor told me that a high platelet count was due to a COVID infection I had a couple of weeks before. But my gynecologist told me it was due to very heavy periods. I use a hormonal IUD and estrogen gel to help with my peri-menopause symptoms and heavy periods. I can do a blood test after three months only. I do not snore and do not have central sleep apnea. I have taken the tablet Amitriptyline for several years to aid in sleeping. But I lose sleep around 3 AM every day and cannot sleep further. I did not know that it causes obesity. I prefer the keto diet to lose 30 kg without starving. I am hungry often. As I am turning 50 this year, there is likely to get diabetes. Should I be concerned?
Hi,
Welcome back to icliniq.com.
Tablet Amitriptyline stimulates appetite, and it is a strong anti-depressant as well. I would suggest reducing the dosage to see if it can help with the cravings. I suggest a tablet Melatonin 25 mg for sleep. Do you feel depressed? There are other medications for sleep that could be tried but causes obesity. Carvings can also be controlled by increasing the proteins in your diet. I recommend 90 to 12 grams of proteins per day. The keto diet increases the fat but contains low carbohydrates of 20 gms per day. So it could be challenging for you to stop your cravings. If you do not have high blood pressure issues, I suggest tablet Phentermine to reduce your cravings. Also, check your blood sugar level to rule out diabetes which is strongly associated with increased sugar cravings. Make a diet plan by writing on paper or using online applications. Make a note for one to two weeks about your total protein intake of 90 to 120 gms per day. Limit your carbohydrate intake to 120 gms per day, depending on your age. Measure your weight today and one week later. For a proper diet plan, I want the information about the type of food and amount per serving, including total calories, total proteins, and total carbohydrates but not the total sugar.
Patient's Query
Thank you doctor for the reply,
I do not have depression. Should I opt for a different medication without significant side effects? My doctor asked me to reduce the dosage instead of stopping the medication. My blood test report showed me that I am anemic but do not have diabetes or high cholesterol. I used a hormonal IUD coil last month, producing intermittent pain for three weeks. It requires six months to settle down. I am starting a new job in another two weeks, and I also have to do household work. I have a get-together with my family after four months, so I cannot avoid carbohydrates. I use olive oil for cooking. I do not have cravings for fats. I am not using sugar for hot drinks. I drink unsweetened soya milk. I dance well. I will note my diet, but I do not want to make changes in my diet plan now. Tablet Phentermine is not available here, so I got it imported. I have attached the picture of it. I can start a diet plan after four months.
Hello,
Welcome back to icliniq.com.
Yes, your doctor is right. I suggest you reduce the dosage of tablet Amitriptyline and add tablet Melatonin 5 mg once daily. For the keto diet, you must eat a fat-rich diet of more than 30 % of your daily intake. It is a short-term diet and should not be maintained for life. There are various phases, and the most challenging is the maintenance phase. My suggestion would be not to go for dramatic weight loss altogether but instead do a lifestyle change. Your total calorie intake should be 1500 to 1800 kcal per day, total carbohydrate intake should be 100 to 120 gms per day, and protein intake should be 9 to 12 gms. I can do that with minor changes in your diet, so you do not have to wait four months. Remember, this is a sustainable way of doing it, and I have many years of experience in doing it, and we can maintain their weight. From the image attached (attachment removed to protect the patient's identity), it is a tablet Phentermine with a regulated, controlled substance. Make sure it is not a fake product. Take an EKG (echocardiography) to confirm that you have no cardiac illness and high blood pressure before taking the drug. Because it has side effects like palpitations, high blood pressure, nervousness, and increased heart rate, but it does not happen to everyone. Take a blood test if possible. I suggest a kidney function test and electrolyte test at least two to four weeks before starting a keto diet. Make a note of your keto diet. Avoid alcohol and drink adequate water.
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Internal Medicine
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