Ask Lyle McDonald #12

Subject: Protein and overtraining

Mr. McDonald,

Good morning! Is there a maximum amount of protein that is absorbed in one sitting?

I’ve never found anything to suggest that this is the case. While there is probably a maximum rate that protein can be digested, it should all eventually get absorbed. If it didn’t, you’d be pooping big pieces of undigested protein, which just doesn’t happen.

Also, it seems that I keep having a recurring cold every couple of months, I believe it might be do to over training and the resultant immune depression that over training causes. I ingest plenty of vitamin. C approx.1000mg a day, any more and it goes right threw me. I was wondering if there are any tell tale signs of over training such as a raise in body temperature or pulse rate.

There are a number of measures that can be helpful. Pulse is probably the most easily (and commonly) measured. In general, an increase in heart rate 5-10 beats above normal would indicate that one was not recovering from their training. Back when I was endurance training, an increase of 5 beats over my normal meant I would do an easy day, 10 beats over required a day off. Some other possible symptoms of overtraining are insomnia, loss of appetite, weight loss, chronic soreness and I’m sure there lots of others.

Perhaps one of the best is your attitude towards training. If you are to the point that you just dread going to the gym, chances are you’re overtrained and need to take some time off.

Subject: Indispensable amino acids

Mr. McDonald

I have read articles over the years which suggest greater amounts of protein be ingested by mass building/strength training athletes. This has raised the question, if the body produces what it needs, in this case I mean the manufacture of non essential amino acids from the foods we eat, wouldn’t it stand to reason that providing I ingest enough calories, all that would be required is the ingestion of the complement essential amino acids that would produce the right human amino acid profile needed.

Yes and no. Although I covered this in brief in the series of protein articles I wrote, this specific question wasn’t answered in any one place so I’ll address it here. First and foremost, folks have to understand that the body has a requirement for both:

1. indispensable amino acids

2. total nitrogen (usually estimated by total protein)

As discussed in my articles, the total amount of protein which is required to come from indispensable (aka essential) amino acids varies from about 40% when we are babies to perhaps as little as 11% when we are adults (though some question this last value as being too low). that means that, really, the body doesn’t need a whole lot of indispensable aminos.

So you could almost get by eating only small amounts of indispensable amino acids, which would fulfill requirement #1 above. However, since this would only be 11-40% of your total protein requirement, it wouldn’t fulfill requirement #2 (for the body’s requirement of nitrogen per se). Now, I suppose one could fill their whole protein requirement with indispensable aminos (I’m frankly surprised that no company has tried this yet) but it would be extremely wasteful. Recall also from my series that indispensable AA’s in excess of what is required (requirement #1) are burned off.

Subject: IGF-1B

Dear Lyle,

I have purchased a supplement called IGF1-B,which is supposed to be a very strong supplement. The ingredient on it is basically gynema Chirantia acid, The daily dose equals 0.3 cc of traditional IGF-1. Can you tell me the risks, side effects ,of taking such product? Is IGF really capable of producing consistent gains on muscle mass? It is said to work best when taken with GABA, so I also bought that. How good/dangerous product is that also?

Thank you in advance,

Carlos

The only real risk I can think of is that you are out a lot of money on a worthless supplement. When you consider that even injectable IGF-1 doesn’t seem to do much (unless you stack it with anabolics, GH, and insulin), I can’t imagine that this product will do anything, even if it really does increase IGF-1 levels. Beyond that, recent research has highlighted that blood IGF-1 levels have very little to do with muscle growth. Rather, it’s the IGF-1 released from the muscle itself (from muscle damage) that is important for growth. So even if this stuff is raising blood IGF-1 levels (which I highly doubt it is in the first place), blood levels appear to have little impact on muscle growth. Bottom line: I think you got scammed.

Subject: My background

I’ve read you’re Q&A on the Mesomorphosis website. You’ve given some thought provoking answers. I’d like to hear a bit about your background and credentials. This note is not meant to be confrontational in any way, I’m just curious.

Oh yeah?!? Not confrontational, huh?!? Well, I’ll…I’ll…..umm, never mind.

I was a fat little kid until I got involved in mandatory athletics in high school. I got involved in swimming, martial arts, triathlon and gymnastics as well as others and started to shape up. This was pretty cool. AT the end of high school, I was coaching boy’s gymnastics a bit, and decided I wanted to be an overworked, underpaid gymnastics coach.

This led me to attend UCLA to get a degree in kinesiology (human movement sciences) although the major changed to physiological sciences about halfway through my program. This meant a healthy amount of basic science (chemistry, organic chemistry, biochemistry, physics, etc) as well as lots of physiology (general, cardiovascular, exercise, etc). On top of that, I took several of the offered nutrition courses as part of my program. There was also the random biomechanics class as well.

After I decided that coaching gymnastics didn’t interest me anymore, I got interested in physical therapy, mainly because of a knee injury I sustained tripping UP some stairs (I figure any idiot can trip down a flight of stairs, only a king-idiot can trip up a flight). The PT’s had all the cool torture toys and I got geared on that.

Also during college, I got involved in in-line skating and competed in a number of 10k races and one marathon (hellish). During the entire time (actually since high school), I was involved in weight training, primarily to support my endurance training. My involvement in sports got me interested in human performance from an exercise and nutrition point of view. As well, since I had been reading bodybuilding magazines for a few years (and gotten sucked into a lot of products) I started spending my weekends in the biomed library looking up research. This is when I came out of the closet and realized I was a full on science-geek.

After college, I got involved in personal training and attained several certifications. As well, I read voraciously, everything I could put my hands on. This meant books, textbooks, magazines, research, etc, etc. I probably learned more after college than I did in college (though my physiology classes gave me the background to understand everything else).

Up until about 1996, I was primarily an exercise physiology geek until I got involved with the Bodyopus diet. During that summer, I was bored (and had gotten onto the internet a few years early) and wrote the now infamous 20-week Bodyopus experience. Over the last 3 years, I have really gotten away from exercise physiology so much (in terms of staying abreast of the real nitpicky details, though I still try to keep up with general trends) as I have become far more interested in nutritionally related stuff. As you probably know, I recently finished research/writing a reference manual for the ketogenic diet, which was a culmination of 18 months of work and reading.

At some point (basically, when I get off my ass and fill out the applications), I’m gonna get into graduate school, probably in a nutritionally related field.

Well, as long as society doesn’t collapse from the Y2K bug.

And now you know…….the rest of the story.

Subject: Protein cycling

What do you think about protein cycling as suggested in Muscle Media by that scientist with the weird name?

See my article in the March 1 update of this site.

Subject: Afraid of Becoming Too Muscular…

Dear Lyle,

First I would like to thank you for the good advice you provide in your column. It is always a fascinating reading.

I am trying to help a female friend lose some weight. She is 46, about 5’6″, 170 lbs. Except for an occasional walk, she is sedentary. I tried convincing her to join a gym, but she is afraid of quickly developing excessive muscularity, which in her case may be warranted: She is a pronounced mesomorph, and has quite muscular legs without any training. In fact, as a youth she used to be a competitive swimmer but quit because she felt she was becoming too muscular.

While I would normally dismiss this type of question (too muscular, yeah right), your friend probably has a point. Her success as a swimmer indicates that she probably has good genetics for athletically related stuff so she may be one of those rare women who truly does get too muscular. About the only thing you might mention to her is that nobody gets too muscular overnight. That is, you don’t go into the gym, finish your workout and wake up too muscular the next day. In that respect, she has all the control she wants over how muscular (or not) she becomes in the gym. She may find that she likes the gain of some initial muscle (when she starts training) but can then back off (by not increasing her weights or using higher reps) if she feels that she’s gaining more muscle than she wants.

Subject: HCA (hydroxycitric acid)

I have carefully read the recent articles on Mesomorphosis regarding sympathomimetics, but Ephedrine is classified as a drug here in Israel and not available as a supplement, so ECA is impossible, as is Yohimbine; and even if they were available, my friend is prone to anxiety and I would not really consider this course. I was thinking about HCA; can I have your opinion about it? Is it true that it is synergetic with chromium? What dosages would you recommend? Any other advice would be appreciated.

To be honest, I’m not terribly impressed with HCA (hydroxycitric acid) in humans. While some have hypothesized that it will increase fat utilization in humans, I just tend to doubt it. The most recent study (in the Journal of the American Medical Association) found no benefit of adding HCA to a low-calorie diet. Chromium appears to have small effects on body composition, but nothing magical.

Beyond that, one point that I’d like to make is that people were losing fat long before ECA or yohimbe or anything else. It is readily possible to lose fat without supplements, although some of them may be helpful. If you can get your friend into some regular activity (perhaps weights twice weekly and cardio 3-4 times weekly) and make some dietary modifications, she should be able to lose fat quite readily. Good luck.

Subject: Yo-be-lean

I have a question about using Yo-BeLean while on the Bodyopus diet. Should it help me lose fat where I really want (stomach love handle area)? Please help.

First I would refer you to Elzi Volk’s informative articles on alpha-adrenoreceptors and yohimbe found *here*. Ok, back?

In theory, yes, topical yohimbe should be able to cause localized fat loss in conjunction with a below-maintenance calorie diet and exercise. The question about this particular product is whether the yohimbe is truly penetrating the skin and getting to the fat cells where it needs to be. This depends on the carrier being used as well as some other factors that I’m not expert on. I think the ideal way to use Yo-be-lean (in fact, any yohimbe product) would be in the morning, before eating, during low-intensity cardio. If the Yo-be-lean is truly causing local fat mobilization, you want to be involved in some aerobic activity to burn the free fatty acids for fuel, otherwise they are just re-esterified (re-stored) in the fat cells.

Please let me know how well (or poorly) it works for you.

Subject: What’s a Bolus?

in one of the weeks of your Bodyopus journal, I think it was week 8, you said your friend told u that 200g of BOLUS carbs may upregulate thyroid hormone. What the heck are bolus carbs?

Ok, you ever watch the TV show ER (my favorite show right now)? You’ll sometimes hear them say “Give a 10 milligram bolus and then 10 milligrams/hour” or something like that.

All bolus means is a bunch of stuff given all at once. So when I said take a 200 g bolus of carbs, I meant that you would consume all the carbs at once, as opposed to stretching them out over a full-day’s diet.

Subject: SIZE

I am a competitive bodybuilder and trying to find the right routine. I wonder about the THE concept of gaining size? I compete on the international level and have some concerns about the one bodypart a week routine as far as size is concerned, especially when you add cardio in. I know that it is extremely hard to get mental focus everyday along with trying to train heavy every workout day in and day out. I also am concerned about the grouping of bodyparts.

So what’s your question?

Personally, I disagree with the idea of training every day but training a single bodypart. One of the reasons is the one you mentioned: mental focus. I would find it difficult to devote total mental intensity to my workout if I was training every day.

Beyond that, there is some research showing that daily intense training negatively affects hormone levels. Testosterone levels go down and cortisol goes up. Of course, if someone is taking steroids, this is a non-issue, which is probably why you always see the suggestion to train 7 days/week, one bodypart/day from pro-bodybuilders.

I personally think that the most a trainee should lift is 2 days in a row followed by a break. Some lifters do better taking every other day off and I’m making nice gains training twice a week.

I hope this helps!

Subject: CKD & yohimbe

I remember reading that Dan Duchaine said to stay away from yohimbe like the plague while on the low carb diet. Do you have different ideas on this? Thanks, Rick

I don’t remember him saying this, but then again my memory is failing me at the tender age of 29. As Elzi Volk pointed out in her articles on adrenoreceptors found *here*, yohimbe will work best in a low-insulin state. And insulin don’t get much lower than on a low-carb diet. So, if anything, I would expect yohimbe to have it’s greatest effects in someone following a low (or even lowered) carb diet.

Subject: Creatine mixing

I am currently cycling creatine. I have used it before and have read many things on how it should be cycled and taken. I have not found any material on a good way to ingest it though. Everyone says to dissolve it in grape juice—-IT DOESN’T DISSOLVE!!! It just floats to the bottom. I have began to just put 5 grams on my tongue and then wash that down with grape juice…will this work? Will the creatine take up in my body by ingesting it that way? I don’t want to waste my time and money doing it this way, so your input is greatly appreciated.

Nope, sorry, if you put the creatine in your mouth and then just swallow it, it will magically disappear and you won’t absorb any of it.

Ok, sorry, I’ll be serious now (I shouldn’t do this column late at night, when I’m punchy). I see absolutely no problem with taking creatine in the way that you are doing it. In fact, I think it’s a much easier (and cheaper) solution to the problem of creatine dissolution than micronizing, or effervescing, or liquefying, etc. As long as it gets into your gut, I don’t see why it wouldn’t be absorbed. Everything mixes into a fairly homogenous gruel in your stomach anyhow.

Subject: Ketosis and supplements

Hi Lyle,

Been reading up on all your research and data on CKD. You might be pleased to know that the people from Atkins referred me to your site. I am in the process of using the Atkins Induction Diet to get myself used to the idea of eating that way – and also to drop a few quick pounds (instant gratification).

I would then like to start on the CKD. My question is this. Will certain supplements affect the Ketosis part of my cycle? I take some “greens” supplements to keep my fiber up – because the low fiber diet during this phase wreaks havoc on my bowels. I also continue to take my creatine – I use EAS Betagen – it has the HMB as well as the creatine – the carbs are minimal, and it has aspartame.

The creatine I could do without if necessary – but the greens are pretty crucial for me – but I do want to get the best results on this program.

Any comments?

Unfortunately, there’s not a huge amount of data out there to know what supplements will affect ketosis. The only ones that seem to reliably interrupt ketosis (that we’ve found at least) are vanadyl (seems to affect liver glycogen status) and citrimax (Hydroxycitric acid). Citric acid (found in many diet sodas) kicks some people out of ketosis, but doesn’t affect everybody. Aspartame also seems to affect some people but it isn’t consistent. The anti-oxidant n-acetyl-cysteine can give a false positive for ketosis but that’s all that occur to me. I can’t imagine any reason that a ‘greens’ supplement (if it’s what I’m thinking of) would affect ketosis.

Basically, the only way to really negatively affect ketosis are by raising blood glucose, or affecting liver metabolism. Since I can’t imagine your ‘greens’ supplement doing either, I can’t imagine that you’ll have problems. Of course, experimentation is always your best bet. You should check for the presence of ketones (with Ketostix), then take your supplement, and check for ketosis for a few hours afterwards. If it affects you, you’ll know, and if it doesn’t (as I suspect it won’t), you’ll know that too.

Subject: Ketogenic ratios

MCT Fuel is that nasty tasting orange stuff (I wish I knew that before I purchased it). IAE, I only asked Twinlab what the calorie count was per serving. At 68 calories and 8 grams of MCT, that’s 8.5 cal/g ( close to 9). I guess the other ingredients have negligible caloric content.

On another note, I’ve been doing the CKD thing for about 3 weeks now. Unfortunately, I have had no loss (or gain) of bodyfat. Your last Q&A may have pointed out the error of my ways. I was forcing the ketogenic ratio to be no less than 1.5:1 and that was pushing my daily caloric intake to approximately 16 cal/lb. The last few days, I have dropped to a daily caloric intake of 13 cal/lb and we’ll see how it goes. I thought that, in previous postings, you mentioned that it was difficult to achieve ketosis on a ratio less than 1.5:1. In your last Q&A you implied that even at a ratio of 1:1 (12 cal/lb/day), ketosis could still be achieved. Is time to reach ketosis a function of this ratio?

Actually, no. The 1.5:1 ratio (of fat:protein + carbs) is critical for the ketogenic diet in epileptic children but has turned out not to be important for everybody else. The difference is that, for some unknown reason, the success or failure of the epilepsy diet hinges upon attaining a very deep degree of ketosis, which mandates a super high fat:protein ratio. In ketogenic dieters, all we have to establish is trace ketosis, so the ratio isn’t that critical.

Ultimately, the development of ketosis (in general) is determined by carb intake and to a lesser degree by protein intake. Any carb intake over 100 grams will prevent ketosis from developing, and some people have to go to much lower levels to attain levels of ketosis which will show up on ketostix (i.e. at 100 g carbs/day, you could pick up ketosis with a blood test but not with ketostix). Excess protein can also prevent ketosis in that it can convert to glucose.

With that said, my current paradigm for setting up fat loss keto diets is this:

1. Set calories: typical starting point is 12 cal/lb

2. Set protein intake: typically 0.9 g/lb. Protein has 4 cal/gram

3. Set carb intake: figure 10 g/day at the minimum. Carbs have 4 cal/gram

4. Set fat intake: add protein and carb calories and subtract it from total calories, then divide by 9 to get grams of fat.

In practice, most folks end up eating about 1 gram of fat for every gram of protein. Ketosis almost always establishes just fine and fat loss is better to boot.

One more question – Ketostix are showing a maximum reading of between trace (5 mg/dL) and small (15 mg/dL) late Monday evening (leg workout at 5PM) or Tuesday morning. From then on it fluctuates from showing negative to the previous maximum. It’s never shown a reading higher than 5-15. Is this normal? Does this low reading imply that I’m using up most of the ketones produced?

There are some daily fluctuations in ketone levels throughout the day. Typically ketone levels are higher at night, and lower in the day (due to an early morning blood glucose spike called the ‘Dawn phenomenon’ in diabetic literature). As well, hydration state and others can affect the ketone readings on the stix. My typical advice is this: if you’ve established ketosis, and have no done anything that is known to affect it (like eat a bunch of carbs), don’t worry about the occasional negative reading.

Subject: Glutamine and Bodyopus Weekdays

Lyle,

Will using a glutamine supplement during the week on Bodyopus have any benefit to the diet? Would it have any downfall?

Quite possible. Some research has found that glutamine interrupts ketosis, probably by affecting liver glycogen content. While I know of some folks who use glutamine with no problems during the week, others have all kinds of problems establishing and maintaining ketosis if they use glutamine.

DiPasquale recommends it in his book “The Anabolic Diet.” My concern is that it would convert to glucose keeping me from entering ketosis and letting all that dietary fat turn into fat. I have used it on my carb based diet and it makes a huge difference. Want to use it on the high fat but don’t want it to backfire.

All I can say here is experiment. Glutamine keeps some folks out of ketosis, but not others. Please let me know what happens.

Subject: Water retention on lowcarb

Dear Lyle,

I am on the Body Opus diet for 6 weeks now and my fat has dropped to 6% (from 12%) using cytomel and clen+deca+nolvadex+proviron during these weeks. However the problem is I don’t seem to get hard, I hold water, especially after carb loading weekend. During the week 1 drink lots of water and get sodium with my salmon, in the weekend I switch to almost no sodium, restrict water intake to draw it from under the skin to my muscles but no effect. I keep getting bloated (no striations)

First-off, it’s a poor idea to restrict sodium and water during your carb-up. Carbs need sodium to optimally cross the intestinal lumen, so by avoiding sodium during the carb-up during the carb-up, you’re causing more harm than good. Additionally, for every gram of glycogen you store, your body wants to store 3-4 grams of water, so water intake should be kept high for optimal fullness. If you want to get rid of the water under your skin, you should wait until you are done with your carb-up.

The first thing I’d suggest you look at is your carb-up. Anecdotally, some folks seem to hold a lot of water when they carb for 48 hours as opposed to 30-36 hours. Unless you’re just meticulous with your carb-up, chances are you’re gonna spill water under your skin. For most, switching back to lowcarbs causes most of the subcutaneous water to be lost. If necessary, you can use a mild herbal diuretic with something like buchu, dandelion, etc in it. Caffeine also works well in this regard. On average, most folks seem to look their best 2-3 days after they end their carb-up. Between switching back to low-carb, and getting in some training sessions, you should drop most of the water under your skin.

Subject: Bodyopus=bulimia??

Hi Lyle. After having read about body opus and your week by week account back in ’96, it seems as though the mechanisms of both body opus and bulimia are somewhat parallel- Sorry if this is a repetitive comment.

Although we’ve discussed this on various mailing lists, nobody has made the connection here. It’s an interesting question and an important one to boot.

For example,(this seems to be a very common scenario) –Some with eating disorders begin their “new diet” on a Monday- like all “I’m going on a dieters.” During the week, they restrict their caloric intake- yet DO EAT and often take dietary supplements to “increase their metabolism” (ex. Diet Fuel- or that which contains the Ephedra-herbal form). Since Friday is party night, most go out and will have a drink, which turns into many, which often triggers binges. During these binges, most feel out of control and also feel like they can not stop eating. Of course they do not binge on tuna and veggies, but those foods high in carbs and fat. Feeling extremely guilty, they must compensate- (not necessarily purge)- for some this means extreme exercise- which generally begins when the bingeing has ceased and they are “back on track.” Although I realize that CKD’s and bulimic behavior are not completely analogous (emphasis on behavior, not cognitions), I find the similarities quite striking. This comment is not a criticism of

CKD’s, simply an observation that would appreciate any feedback.

L.Scholar, M.S.-experimental psychology.

First, and don’t take this personally but I gotta ask, if your last name really Scholar? I guess I find it as ironic that an academic type would be named Scholar as that I live on a street called Research Blvd.

The biggest difference I can see between true bulimia and a CKD is that of perception of the dieter (and this gets into psychological issues among dieters). That is, let’s look at two different (but outwardly similar) situations.

1. Dieter one starts their diet on Monday, with the admonition that ‘This time I’m really going to stick with it, no cheating until I reach my goal.’

2. Dieter two also starts their diet on Monday, but with the attitude of ‘Nobody is perfect about anything, and instead of feeling out of control, I’m going to plan a cheat from my diet this Saturday, since I’m going to a party and want to enjoy myself. On top of that, that crazy Lyle guy told me it would help my metabolism if I had a cheat day.’

Ok, 5 days of good dieting have gone by and it’s Saturday night. Dieter 1 goes to the party, and starts feeling deprived. Everyone is giving the person crap about being on a diet. ‘C’mon’ they say ‘just have one drink, it won’t kill you’. After dieter one has their drink, they start feeling guilty about it. I mean, they were weak, they didn’t have the willpower to stick to their plan, etc, etc. They figure that anything worth doing is worth overdoing and binge the whole night away. The pattern starts again the next Monday and continues to repeat itself.

Now, our second dieter went to this party in full-control. They had planned it as part of their diet that they would allow themselves some amount of cheating off their diet. But there is no guilt involved, because it was all part of the plan. The binge doesn’t happen, and the person goes on happily in their way.

Now at first glance the above two situations seem identical. And, in a sense they are in that the same external situations occurred (5 days of dieting followed by a cheat on Saturday). But the psychological impact is vastly different. In the first situation, the person feels out of control and guilty for being unable to *control* their food intake. In the second, since the cheat was consciously planned, the control was never gone, and the psychological impact is far less negative. I always encouraged clients of mine to plan their cheat days, or suggested they apply the 80/20 rule (get everything right 80% of the time, and the other 20% is no big deal). This took away a lot of the negative psychological impacts of cheating on their diets, although the end result was the same. That is, I figure they were gonna cheat no matter what, so they might as well not feel guilty about it.

In a sense, this also describes the Bodyopus diet, or more accurately it *can* describe the Bodyopus diet. Those who understand the basis of the diet know that the carb-up is required for a physiological reason (restoration of muscle glycogen, possible anabolism), it’s not just there as an ‘eat everything that’s not nailed down’ day. On the other hand, a lot of folks seem drawn to the diet by the thought that they can ‘eat all they want’ during the carb-up, and do so freely. In this regard, I think it’s a poor idea for someone who’s had previous food issues/eating disorders, to undertake a CKD lightly, because it may become a mimic of the purge-binge cycle that existed before.

However, to be fair to CKD’s, this is really no different than any highly-restrictive diet. I have had numerous clients (typically female) who tried to maintain super-restrictive diets (of varying kinds), and who failed because a single-cheat (even a snack) caused feelings of guilt and a loss of self-control.

Perhaps the best conclusion to be drawn is that dieters should avoid all super-restrictive diets in favor of more moderate approaches. To a great degree, I am a strong advocate of this attitude. For the great majority of people out there, something as extreme as a CKD isn’t necessary, and probably isn’t appropriate. In this case, making small, manageable changes in food intake (qualitative or quantitative) are usually sufficient. Unfortunately, CKD has become too much of a de-facto diet choice, even when it’s not necessary.

However, keep in mind the population for whom Bodyopus was developed: individuals attempting to attain an extremely low level of bodyfat with minimal muscle loss (i.e. bodybuilders for the most part). That goal doesn’t apply to the majority of individuals in the world.

So I guess my point (after a lot of rambling) is more or less this: although CKD’s and binge/purge cycles have a lot in common (at least externally), there is generally a difference in attitude/mental state in those who do one versus the other. The folks I know going into a CKD are doing so with a specific goal in mind, and with the knowledge that specific things are required to meet those goals. Binge-purge (and eating disorders in general) seems to have a higher guilt component (although there are far more involved psychological issues that I’m not remotely qualified to comment on). But, to reiterate, I don’t think individuals should jump onto a CKD as a default diet, moreso if they have a past history of food control issues.

Thanks for the interesting question.