Teaching packet

Diego, 58

58-year-old man with type 2 diabetes, obesity, and hypertension on metformin; finding the plan hard to keep up with.

58 years old, male, BP 146/90, eGFR 78, A1c 8.1%, LDL 132 mg/dL

Conditions

Medications

The plan the engine produced

Key nutrient targets

Food guidance

Other vegetables, Leafy greens, Fruit, Whole grains, Legumes, Nuts and seeds (Hypertension - sodium reduction & DASH pattern)
Other vegetables, Legumes, Whole grains, Nuts and seeds, Fruit (Type 2 diabetes nutrition therapy)
Other vegetables, Leafy greens, Fruit, Legumes, Whole grains (Overweight / obesity - nutrient-dense pattern)
Other vegetables, Leafy greens, Cruciferous vegetables, Fruit, Berries, Whole grains, Legumes, Nuts and seeds, Olive oil (Plant-forward foundation)

High sodium food, Ultraprocessed food, Processed meat (Hypertension - sodium reduction & DASH pattern)
Sugar sweetened beverage, Added sugar, Refined grains, Processed meat, Ultraprocessed food (Type 2 diabetes nutrition therapy)
Sugar sweetened beverage, Ultraprocessed food, Refined grains, Fried food (Overweight / obesity - nutrient-dense pattern)
Red meat, Processed meat, Sugar sweetened beverage, Refined grains, Ultraprocessed food, High sodium food (Plant-forward foundation)

1. Long-term metformin can lower which vitamin?

2. A patient takes atorvastatin. Which food should they avoid?

3. A patient on warfarin asks about leafy greens. The best advice is to:

4. Stage 3b CKD plus an ACE inhibitor. A high-potassium dish should be:

1. C. Vitamin B12

Long-term metformin is associated with lower vitamin B12; periodic testing is suggested.

2. B. Grapefruit

Grapefruit blocks intestinal CYP3A4, which can raise levels of atorvastatin and simvastatin. Pravastatin and rosuvastatin are not affected.

3. B. Keep vitamin K intake consistent week to week

Warfarin needs steady vitamin K, not avoidance. Big swings in intake change the dose response; consistency is the goal.

4. B. Limited or set aside

Reduced kidney function plus an ACE inhibitor raises hyperkalemia risk, so high-potassium foods are limited and potassium is matched to serum levels.

American Diabetes Association. Standards of Care in Diabetes-2026. Section 9: Pharmacologic Approaches to Glycemic Treatment. https://diabetesjournals.org/care/article/49/Supplement_1/S183/163934/
American Heart Association. How much sodium should I eat per day?. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day
National Heart, Lung, and Blood Institute (NIH). DASH Eating Plan. https://www.nhlbi.nih.gov/education/dash-eating-plan
U.S. Departments of Agriculture and Health and Human Services. Dietary Guidelines for Americans, 2025–2030 (10th Edition). https://www.dietaryguidelines.gov/about-dietary-guidelines/dietary-guidelines-2025-2030
American Diabetes Association. Standards of Care in Diabetes-2026. Section 5: Facilitating Positive Health Behaviors and Well-being. https://diabetesjournals.org/care/article/49/Supplement_1/S89/163932/
American Heart Association. 2026 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001435

Demo data. Educational use, not medical advice.