DEAR DR. ROACH: I am a 66-year-old male who started Mounjaro a month ago for Type 2 diabetes in the hopes of losing 40 pounds. I keep an online food log. What is the minimum number of calories I should consume in a day? My appetite is definitely suppressed, and I am worried that I may not be getting enough nutrients. — H.C.

ANSWER: Calorie restriction below 800-1,200 calories per day runs the risk of providing inadequate protein, as well as micronutrients such as vitamins and minerals. People getting fewer calories than this should be taking supplements, especially of calcium, iron and vitamin D. Importantly, the calories that a person is consuming with such calorie restriction should be very high, with emphasis on nutrient-rich, calorie-poor foods such as most vegetables and fruits.

Some of the online dietary programs provide highly detailed information on macronutrients (fat, protein, carbohydrates) and micronutrients (fiber) to help you choose the most important foods to eat to keep healthy while on medicines that suppress the appetite, like tirzepatide (Mounjaro). This is also the case in people after bariatric (weight-loss) surgery, where there is a very well-developed nutritional supplement program that is followed.

My experience in my own patients with GLP-1 drugs like Wegovy and Zepbound is that few people decrease their consumption to this very low level, possibly because I tend to recommend lower doses.

DEAR DR. ROACH: I am writing to get your opinion on whether I should get the shingles vaccine. My sister and I somehow managed to avoid contracting chicken pox as children. My sister came down with chicken pox as an adult when she caught the virus from her daughter, and it was nasty. I was given two doses of the chicken pox vaccine at age 40 after my son pushed me to pursue my doctor’s advice.

I’m now 60 and trying to determine whether I need the shingles vaccine since I never actually had the chicken pox virus. Can I actually contract shingles at this point if I’ve never had the virus, only the vaccine? — J.A.

ANSWER: Yes, you can develop shingles. The only chicken pox vaccine licensed is a live, weakened strain of the chicken pox. It is less likely to lead to shingles than the live, strong strain that your sister got from her daughter (technically known as the “wild type”), but it is still absolutely possible to develop shingles.

I would recommend two doses of the recombinant shingles vaccine, Shingrix, which is a subunit vaccine that uses a bacteria-made glycoprotein to teach the immune system how to recognize the virus so that you can fight it off. It is not made from the live virus.

Shingles is not caused by a new exposure to the virus; it happens when the virus is able to evade your immune system and grow, usually in one segment of your body along a nerve root, called a dermatome. (The word “shingles” comes from the Latin cingulatum meaning belt. A shingles outbreak in the abdomen looks like a belt-like band across one half of the body, but in other locations, the resemblance to a belt is less strong.)

The vaccine is more than 90% effective at preventing shingles and even more protective against long-term nerve pain from shingles, called postherpetic neuralgia. The downside of the vaccine is most often a sore arm and a day or two of feeling a bit under the weather. It is indicated by the Food and Drug Administration for people over 50 or for adults with problems with their immune system due to diseases or medications.

The shingles vaccine was recently shown to help protect people against dementia as well, probably by preventing damage to the blood vessels that can occur with shingles.