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In March 2024, it was announced that Medicare recipients now have coverage for Wegovy if they have overweight or obesity and preexisting heart disease. This decision is based on results of the SELECT trial showing that this drug decreased the risk of heart attack and stroke in people with overweight or obesity and heart disease. While this is exciting news, it feels quite strange that these patients still do not have access to meet with a Registered Dietitian. Currently, Medicare only covers Medical Nutrition Therapy (MNT) for Medicare recipients that have diabetes or chronic kidney disease. While Medicare beneficiaries do technically have an intensive behavioral therapy for obesity benefit, this benefit has many restrictions related to where it can be provided and who it must be billed under. So, unfortunately, most dietitians cannot provide this service, and therefore it a very underutilized benefit. In addition, these visits are also shorter than traditional MNT visits. This makes it difficult for the dietitian or other healthcare professional to do a complete assessment, and the overall therapy may be negatively affected by the time restriction. Medicare limits MNT to three hours for the first year and two hours for every subsequent year. With this restriction, a year's worth of dietitians services costs less than a two-week supply of Wegovy. Please contact your representatives to let them know you support the MNT Act. This would let Medicare beneficiaries meet with a dietitians for overweight and obesity as well as many other nutrition-related health conditions.

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Cancer is one of the greatest Public health challenges worldwide, and in most cases, we still lack of effective anticancer therapies. Nevertheless, There are case reports, in which ketogenic diet have some improvements during variety of cancers. For example, 2 pediatric female patients with brain tumor, experienced improvement after 8 weeks of ketogenic dieting. One of these patients continued the diet and remained disease-free another 12 months. But What connection can have Cancer treatment and Keto diet? CDC estimated that 40% of all cancers are related to overweight and obesity. Cancer is uncontrolled and abnormal cell grow. Such process is not energy efficient. And requires lots of energy. For cancer cells source of energy is glucose. Despite their rapid proliferation, cancer cells use no more oxygen than non-cancer cells for oxidative purposes. Instead, they use about 10 times more glucose and produce about 70 times more lactic acid, than do normal cells. In other words, even with ample oxygen available, most cancer types derive energy from anaerobic glycolysis. This feature is called as Warburg Effect. It is Hallmarks of Cancer. So, Cancer cells consume too much glucose. And cancer fuel is glucose. For humans, The main source of glucose is carbohydrates and proteins. The classic Ketogenic Diet is characterized by high-fat, moderate-to-low protein, and very-low carbohydrate content. This translates into a dietary composition of about 90% fat, 2% carbohydrate, and 8% protein. This ratios varies. But In Keto diets, a ratio between fats and non-fats (carbohydrates + proteins) should be 4:1.; and this process mimics the metabolic effect of starvation. During Keto Diet, liver converts fat into fatty acids then to ketone bodies. So, ketone bodies become, primary source of energy becomes. instead of glucose. Ketogenic diets mimic the fasting state, wherein the body responds to the lack of glucose by producing ketones for energy. Ketogenic diet lowers the level of glucose and insulin in the blood, which are necessary for tumor growth. Thus, the ketogenic diet has emerged as a potential treatment option for a variety of cancers, including breast cancer. This process inhibits aerobic glycolysis and suppresses tumor proliferation, invasion, and migration. So, Keto diet causes to deprive cancer cells of their primary energy source, Glucose. In addition, lack of glucose changes hormonal state of the body and It further interrupts, processes of nutrient sensors which are important for development and proliferation of cancer cells. furthermore, Keto Diet’s beneficial effects have been observed in a range of conditions, including epilepsy and other neurologic diseases, obesity, type 2 diabetes, polycystic ovary syndrome, and cardiovascular disease There are concerns about providing protein to patients who are at risk for renal problems. However, mouse models of diabetic nephropathy showed improved renal function with Keto Diet use. Although preclinical studies suggest that Ketogenic Diet has antitumor effects, prolongs survival, and prevents cancer development, human clinical trials are equivocal. Because of the lack of high-quality clinical trials, the effects of ketogenic Diet on cancer and as an adjunctive therapy are essentially unknown. Adverse effects of keto diet. Kidney stones, gout, and symptomatic hypoglycemia were also potential expected adverse effects. By EmmaWiki2020 - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=90978475

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