Individuals with recent myocardial infarction should be referred to a cardiologist todetermine suitability for modified fasting.Individuals receiving medication for diabetes, hypertension, hyperlipidaemia or those on lithium therapy may require a reduction in dose or withdrawal of treatment whilst undergoing modified fasting. Such individuals should be monitored carefully in the first weeks of an OPTIFAST® VLCD™ Program.Individuals with a history of gout, porphyria, or hepatic, renal or gall bladder disease should also be monitored carefully by their healthcare professional. Individuals on lithium therapy require more frequent monitoring of blood lithium levels. Alcohol should not be consumed when using the OPTIFAST® VLCD™ ProgramMONITORINGAt the commencement of the program, individuals should be checked for normal renal and hepatic function and thereafter regular checks for weight, blood pressure and urinalysis by their doctor.ADVERSE REACTIONSInitial transient effects have been observed: sensitivity to cold, dry skin, temporary rash, temporary hair loss, postural hypotension, fatigue, diarrhoea, constipation, muscle cramps, halitosis, irritability, menstrual disturbances. These are generally insufficient in magnitude or duration to warrant cessation of the program but check with your GP.IN some rare cases, numbness and the appearance of previously unsuspected gallstones have been reported. Rapid weight loss occasionally leads to higher serum uric acid levels and might precipitate an acute attack of gout in a predisposed individual. This may be ameliorated by ensuring adequate fluid intake and including one teaspoon of vegetable oil with the 2 cups of additional vegetables consumed daily. Always check any adverse symptoms with a doctor. Although the OPTIFAST® VLCD™ Program contains adequate electrolytes for the needs of most individuals, some individuals may become hyponatraemic or hypokalaemic, especially if they are receiving diuretic therapy. In such circumstances, electrolyte supplements may be required as directed by your healthcare professional.