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In subjects with severe renal impairment, the free fraction of cilostazol was 27% higher and both Cmax and AUC were 29% and 39% lower respectively than in subjects with normal renal function. The Cmax and AUC of the dehydro metabolite were 41% and 47% lower respectively in the severely renally impaired subjects compared to subjects with normal renal function. The Cmax and AUC of 4'- trans-hydroxy cilostazol were 173% and 209% greater in subjects with severe renal impairment. The medicine must not be administered to patients with a creatinine clearance ≤25ml/min (see s ection ). There are no data in patients with moderate to severe hepatic impairment and since cilostazol is extensively metabolised by hepatic enzymes, the medicine must not be used in such patients (see s ection ).

A number of studies have reported that vegetarian and vegan diets increase the risk for iodine deficiency. 40, 77, 102, 153 One study from Europe demonstrated that 80% of vegans and 25% of ovo/lacto vegetarians suffered from iodine deficiency. 77 Additionally, a dietary intervention by Dr. Remer and colleagues in 1999 confirmed this epidemiological evidence. 102 After only five days on ovo/lacto vegetarian diets, iodine status and function became impaired in healthy adults. 102 The primary reason why vegetarian diets cause iodine deficiencies is that plant foods (except for seaweed) are generally poor sources of iodine compared to meat, eggs, poultry and fish. Gross deficiencies of iodine cause our thyroid glands to swell producing a condition known as goiter, and in pregnant women result in severe birth defects called cretinism. 141 Because salt is fortified with iodine, most people in the . and Europe rarely develop gross iodine deficiencies. 40, 140, 141 However moderate to mild iodine deficiencies appear in westernized countries, particularly among vegetarians and vegans. 77, 102 Moderate iodine deficiency impairs normal growth in children and adversely affects mental development. 140, 141, 152 A large meta analysis revealed that moderate childhood iodine deficiency lowered . by 12- points. 153 Paleo Diets are not just good medicine for adults, but they also ensure normal physical and mental development in our children because of their high iodine content.

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