Nutrition for Transgender and Gender-diverse Individuals

New Knowledge Pathway Alert: Nutrition for Transgender and Gender-diverse Individuals

The latest knowledge pathway (KP) added to the PEN System is the Nutrition for Transgender and Gender-diverse Individuals KP. We expect this KP to expand as more research becomes available. Here is the current content:

• What are the considerations for nutrition assessment when working with transgender and gender-diverse (TGD) individuals?
• What role, if any, do foods, herbals or dietary supplements facilitate in medical transition?
• Nutrition for Transgender and Gender-diverse Individuals Background

• Nutrition for Transgender and Gender-diverse Individuals Summary of Recommendations and Evidence

• Nutrition for Transgender and Gender-diverse Individuals Related Tools & Resources

Gout: Are You Up to Date?

Do you know the answers to these questions?

Do any specific foods or dietary patterns decrease the risk of developing gout or reduce the recurrence of gout attacks?

Does a diet high in purines increase the risk of developing gout? Does a diet low in purines reduce the recurrence of gout attacks?

Does alcohol intake increase the risk of developing gout? Does reducing alcohol intake decrease the recurrence of gout attacks?

Does the consumption of sugar-sweetened beverages (SSBs) increase the risk of developing gout or the recurrence of gout attacks?

Does the consumption of cherries reduce the recurrence of gout attacks?

Does increasing dietary or supplemental vitamin C decrease the risk of developing gout or decrease the recurrence of gout attacks?

What is the effect of weight loss on gout attacks in adults with higher weights (BMI >25)?

To find out, click on each practice question above or for a condensed version, see the Gout Summary of Recommendations and Evidence.

Pediatric Intractable Epilepsy - Is a Ketogenic Diet an Effective Treatment?

All types of ketogenic diets (classic, medium chain triglyceride (MCT), low glycemic index treatment (LGIT) and modified Atkins diet (MAD)) have been shown to reduce seizure frequency and improve the likelihood of achieving seizure freedom in children with intractable epilepsy.  

The classic ketogenic diet (KD) and MAD have been studied most rigorously. The classic KD may have a larger effect than the MAD, while the MAD may have fewer side-effects. The MCT and LGIT are less well studied but appear efficacious, with the MCT having shown similar efficacy to the classic KD. 

In infants <2 years, the classic KD has been recommended. Adolescents may do better with the MAD or LGIT, which are easier to follow and have better adherence.

A 2022 systematic review and meta-analysis of eight RCTs (n=453) found that children and adolescents with intractable epilepsy who followed a KD were more likely to reduce their seizure frequency by >50% than those who did not follow a KD. Only the classic KD and the MAD were examined. 

A 2020 Cochrane review of 13 RCTs/quasi-RCTs (n=932) found that KDs could be effective in reducing seizures and achieving seizure freedom in children with intractable epilepsy, although the evidence is low or very low quality. Specifically, the classic KD and MAD showed potential efficacy, with a larger effect associated with the classic KD (seizure freedom in up to 55% of individuals compared to 25% for MAD, and reduced seizure frequency in up to 85% of individuals compared to 60% for MAD). However, fewer side-effects were associated with the MAD. Only one study compared the classic KD to the MCT, which found no significant differences in seizure reduction between the two diets. The LGIT was not examined in any included studies.  

A 2018 expert consensus statement noted that the classic KD was most appropriate in children <2 years, while the MAD or LGIT were more appropriate in adolescents due to increased adherence. Although no studies have compared the LGIT to other ketogenic diets, it has shown promise in children with intractable epilepsy, especially those with Angleman syndrome. The MCT appears equivalent in efficacy to the classic KD while allowing for higher carbohydrate and protein intakes and a larger variety of food choices. 

Grade of Evidence C

The classic KD is defined as a diet with high lipid to non-lipid ratio. The MCT is defined as a diet with 60% of calories coming from MCT oil; alternatively, if this is not tolerated due to gastrointestinal side-effects, a lower dose of MCT oil (30-50% calories) may be used. 

The MAD is a high fat, low carbohydrate diet focusing on fat and carbohydrate targets rather than ratios. The LGIT allows 45-60 grams of carbohydrate daily but requires that all carbohydrates have a glycemic index <50.

If a child requires a special dietary formulation, ketogenic liquid formula can be provided. Liquid diet formulations can be used in infants or in children with feeding tubes and have the benefit of increased compliance compared to whole food KDs.

See Additional Content: Nervous System – Pediatric/Paediatric Epilepsy: Ketogenic Diet Background.

Blood Donation and Iron Deficiency - Do Diet and Supplementation Help?

Did you know that it takes approximately 24 weeks to replete the amount of iron lost after one 10-minute blood donation if diet is not augmented by supplements? Iron deficiency occurs in 25-35% of blood donors, with risk factors including female sex, younger age, frequent donation and recent donation. To read more on this topic, see the practice question: What dietary or supplementation strategies can help prevent or treat iron deficiency among regular blood donors?

Check out these additional updated practice questions:

What is the impact of calcium or dairy product intake on non-heme iron absorption and is there an effect on iron status among healthy adults?

What is the impact of tea and coffee consumption on non-heme iron absorption and is there an effect on iron status among healthy adults?

What foods/nutrients facilitate iron absorption and improve iron status?

What foods and nutrients decrease iron absorption and inhibit iron status?

What dietary strategies can support the treatment of iron deficiency in non-pregnant adults, and when is supplementation warranted?

What type of iron supplement is recommended for the treatment of iron deficiency in non-pregnant adults?

What dietary or supplementation strategies can help prevent or treat iron deficiency among regular blood donors?

For more information on anemia and/or iron, search the PEN website or click on these Knowledge Pathways:

Hematology/Haematology - Anemia/Anaemia: Folate and B12 Deficiency

Hematology/Haematology - Anemia/Anaemia: Thalassemia/Thalassaemia

Hematology/Haematology - Anemia/Anaemia: Sickle Cell Disease

Hematology/Haematology - Anemia/Anaemia: Pediatric/Paediatric

Hemochromatosis/Haemochromatosis

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