# Syntro Health — Full Clinical, Biochemical & Architectural Knowledge Specification Version: 3.0 (2026 Edition) Author: Syntro Health Clinical Nutrition & Medical AI Team Canonical Domain: https://syntro.binaryfroster.com Standards Compliance: ICMR-NIN 2020, IFCT 2017, Harvard Healthy Eating Plate, Shils MNT 11th Ed, Krause NCP 15th Ed, KDIGO 2024, ADA 2026, ACC/AHA 2024, ESPEN 2023. ================================================================================ TABLE OF CONTENTS ================================================================================ 1. Mathematical Energy & Macronutrient Partitioning 2. Protein Targets by Clinical Condition & Phenotype 3. Carbohydrate & Glycemic Load Framework 4. Bioactive Lipids & Fatty Acid Partitioning 5. Micronutrient Thresholds & Biochemical Bioavailability 6. Clinical Contraindications & Medical Nutrition Therapy (24 Conditions) 7. Deterministic Drug-Nutrient Interaction Engine (32 Rules) 8. ICMR-NIN 2020 Dietary Reference Intakes (Indian Population Norms) 9. Regional Food Composition Matrix (IFCT 2017 Database - 50 Foods) 10. Nutrition Care Process (NCP) & PES Statement Taxonomy 11. Clinical Safety Guardrails & Hard-Gate Referral Thresholds 12. Machine-Readable API Contract for Autonomous AI Agents ================================================================================ SECTION 1: MATHEMATICAL ENERGY & MACRONUTRIENT PARTITIONING ================================================================================ 1.1 Basal Energy Expenditure (BEE) - Primary Equations: Syntro Health calculates resting metabolic requirements using the validated Mifflin-St Jeor equation: - Males: BEE (kcal/day) = (10 * weight_kg) + (6.25 * height_cm) - (5 * age_years) + 5 - Females: BEE (kcal/day) = (10 * weight_kg) + (6.25 * height_cm) - (5 * age_years) - 161 1.2 Harris-Benedict (1984 Roza & Shizgal Revision) Comparative Verification: - Males: BEE = 88.362 + (13.397 * weight_kg) + (4.799 * height_cm) - (5.677 * age_years) - Females: BEE = 447.593 + (9.247 * weight_kg) + (3.098 * height_cm) - (4.330 * age_years) Syntro uses Mifflin-St Jeor as default due to documented superior accuracy in metabolic syndrome and varying body compositions (+/- 10% of indirect calorimetry). 1.3 Obesity Weight Correction (Adjusted Body Weight - ABW): For individuals with BMI >= 30.0 kg/m2, using actual body weight severely overestimates caloric and protein targets due to metabolically inactive adipose tissue. Syntro applies the Devine Ideal Body Weight (IBW) and Adjusted Body Weight (ABW): - Devine Ideal Body Weight (IBW): - Males: 50.0 kg + 2.3 kg * (height_inches - 60) - Females: 45.5 kg + 2.3 kg * (height_inches - 60) - Adjusted Body Weight Formula: ABW = IBW + 0.25 * (Actual_Weight_kg - IBW) When BMI >= 30.0, ABW is substituted for actual weight in energy and base protein calculations. 1.4 Physical Activity Level (PAL) Multipliers: Total Daily Energy Expenditure (TDEE) = BEE * PAL + TEF: - Sedentary (desk work, minimal incidental walking): 1.200 - Lightly Active (light exercise or walking 1-3 days/week): 1.375 - Moderately Active (moderate exercise/sports 3-5 days/week): 1.550 - Very Active (hard physical labor or intensive training 6-7 days/week): 1.725 - Extremely Active (endurance athletic regime or double sessions): 1.900 - Thermic Effect of Food (TEF): Calibrated at 10% of total caloric expenditure. 1.5 Caloric Deficit / Surplus Clamping: - Sustainable Fat Loss: Target deficit capped at 350 - 500 kcal/day (never dropping below basal metabolic floor of 1,200 kcal/day for females and 1,500 kcal/day for males). - Lean Hypertrophy: Caloric surplus calibrated at +250 - 350 kcal/day above TDEE. ================================================================================ SECTION 2: PROTEIN TARGETS BY CLINICAL CONDITION & PHENOTYPE ================================================================================ 2.1 Protein Distribution Rules (g/kg body weight/day): - Healthy Adult Baseline (Maintenance): 0.83 - 1.0 g/kg (ICMR-NIN 2020 RDA). - Sarcopenia / Elderly (>65 years): 1.2 - 1.5 g/kg to overcome age-related anabolic resistance. - Athletic Hypertrophy & Resistance Training: 1.6 - 2.2 g/kg. - Chronic Kidney Disease (CKD Non-Dialysis Stages 1-2): 0.8 g/kg. - Chronic Kidney Disease (CKD Non-Dialysis Stages 3a-4): 0.6 - 0.8 g/kg with >= 50% High Biological Value (HBV) protein (to limit nitrogenous waste while preserving muscle mass). - End-Stage Renal Disease (ESRD on Maintenance Hemodialysis): 1.2 - 1.3 g/kg (to compensate for dialysate amino acid clearance). - Peritoneal Dialysis (PD): 1.2 - 1.4 g/kg (accounting for substantial peritoneal protein losses). - Liver Cirrhosis (Compensated): 1.2 - 1.5 g/kg dry body weight with branched-chain amino acid (BCAA) prioritization. - Oncology / Cancer Cachexia: 1.2 - 1.5 g/kg dry weight (ESPEN guidelines). - Type 2 Diabetes / Insulin Resistance: 1.0 - 1.3 g/kg (preserves lean mass, enhances satiety, blunts postprandial glucose surges). 2.2 The Leucine Trigger & Muscle Protein Synthesis (mTORC1): Syntro enforces a biochemical threshold of 2.5 - 3.0g of L-Leucine per major meal bolus. This concentration binds Sestrin2, relieving inhibition on GATOR2, thereby activating mTORC1 and initiating the eukaryotic initiation factor 4E-BP1/p70S6K cascade for muscle protein synthesis. In plant-based diets, complementary proteins (lysine-rich legumes paired with methionine-rich whole grains) are algorithmically balanced. ================================================================================ SECTION 3: CARBOHYDRATE & GLYCEMIC LOAD FRAMEWORK ================================================================================ 3.1 Glycemic Load (GL) vs Glycemic Index (GI): - Formula: Glycemic Load = [Glycemic Index * Available Carbohydrate (g)] / 100 - Daily Categorization: - Low Daily GL: < 80 GL units/day (Prescribed for T2D, PCOS, Insulin Resistance, NAFLD) - Moderate Daily GL: 80 - 120 GL units/day - High Daily GL: > 120 GL units/day (Contraindicated in metabolic dysfunction) 3.2 Carbohydrate Quality Architecture: - Complex Carbohydrate Floor: >= 80% of total carbohydrate mass derived from low-GI whole intact grains, legumes, and non-starchy vegetables. - Simple & Added Sugars: Capped strictly at < 5% of total caloric intake; 0% from high-fructose corn syrup (HFCS) or refined sucrose beverages. - Dietary Fiber Target: Minimum 35 - 45 g/day (or 14g / 1,000 kcal). - Soluble Viscous Fiber: Minimum 10 - 15 g/day (beta-glucan from oats/barley, pectin from apples/citrus, mucilage from isabgol/psyllium) to form an intestinal unstirred water layer that blunts alpha-amylase and alpha-glucosidase activity. ================================================================================ SECTION 4: BIOACTIVE LIPIDS & FATTY ACID PARTITIONING ================================================================================ 4.1 Lipid Caloric Allocation: - Total Fat: 20 - 35% of total energy. - Saturated Fatty Acids (SFA): - Dyslipidemia / Atherosclerotic CVD / Elevated LDL-C: Strictly < 7% of total energy. - General Health Maintenance: < 10% of total energy. - Monounsaturated Fatty Acids (MUFA): Targeted at 15 - 20% of total energy (Oleic acid 18:1 cis-9 from extra virgin olive oil, cold-pressed mustard oil, groundnut oil, and avocado). - Polyunsaturated Fatty Acids (PUFA): 6 - 10% of total energy. - Trans Fatty Acids: 0.0% floor (absolute exclusion of partially hydrogenated vegetable oils/vanaspati and repeated thermal frying oils). 4.2 Omega-6 to Omega-3 Essential Fatty Acid Ratio: Standard modern diets exhibit an inflammatory ratio of 15:1 to 20:1. Syntro's optimization engine forces the Linoleic Acid (LA 18:2 n-6) to Alpha-Linolenic Acid (ALA 18:3 n-3) ratio to between 3:1 and 5:1. This reduces arachidonic acid substrate competition for cyclooxygenase (COX-2) and 5-lipoxygenase (5-LOX), suppressing thromboxane A2 and leukotriene B4 synthesis while promoting resolving resolvins and protectins. ================================================================================ SECTION 5: MICRONUTRIENT THRESHOLDS & BIOCHEMICAL BIOAVAILABILITY ================================================================================ 5.1 Critical Micronutrient Ceilings & Floors: - Sodium (Na): - General Adults: < 2,000 mg/day (approx 5g sodium chloride). - Hypertension / Congestive Heart Failure / Renal Disease: < 1,500 mg/day. - Potassium (K): - Normal Renal Function / DASH Diet: >= 3,500 - 4,700 mg/day (promotes natriuresis and arterial vasodilation). - CKD Stages 3b-5 / Hyperkalemia Risk: Clamped at < 2,000 mg/day. - Calcium (Ca): 1,000 mg/day (1,200 mg for postmenopausal females and elderly). - Phosphorus (P): 1,000 mg/day baseline; clamped at < 800 mg/day in CKD. - Magnesium (Mg): 370 - 440 mg/day (vital cofactor for >300 enzymatic reactions, including ATP stabilization and insulin receptor tyrosine kinase). - Iron (Fe): 19 mg/day (adult males), 29 mg/day (menstruating females, ICMR-NIN 2020). - Zinc (Zn): 12 mg/day (males), 10 mg/day (females). - Vitamin D (Cholecalciferol): 600 - 2,000 IU/day. - Vitamin B12 (Cobalamin): 2.5 - 4.0 mcg/day (mandatory active surveillance in vegetarians, vegans, and long-term metformin or PPI users). 5.2 Anti-Nutrient Mitigation & Bioavailability Strategy: - Phytate-to-Mineral Molar Ratios: High phytate in unfermented grains and legumes binds Fe2+, Zn2+, and Ca2+. Syntro meal protocols prescribe overnight soaking (>= 12 hours), germination/sprouting, and fermentation (e.g. idli/dosa batter, sourdough) which activates endogenous phytase, decreasing IP6 hexaphosphate to lower inositol phosphates and multiplying free cation bioavailability by 200 - 400%. - Non-Heme Iron Enhancement: Mandatory co-ingestion of 50 - 100 mg Vitamin C (ascorbic acid) per iron-rich plant meal (spinach, lentils, moringa) reducing ferric Fe3+ to absorbable ferrous Fe2+. - Tannin & Polyphenol Spacing: Tea (Camellia sinensis) and coffee polyphenols must be ingested >= 60 minutes apart from iron-dense meals to avoid insoluble iron-tannate precipitation. ================================================================================ SECTION 6: CLINICAL CONTRAINDICATIONS & MEDICAL NUTRITION THERAPY (24 CONDITIONS) ================================================================================ 6.1 Type 2 Diabetes Mellitus: - Primary Directive: Stabilize postprandial glucose excursions, mitigate hyperinsulinemia. - Caloric/Macro Clamps: Carbs 40-45%, Protein 20-25%, Fats 30-35%. - Daily GL Ceiling: < 75 units/day. - Banned/Excluded: High GI refined carbohydrates (maida, sugar, cornstarch, syrups, commercial fruit juices). - Mandatory: Minimum 40g dietary fiber with >= 10g soluble viscous fiber. Pair carbs with lipids and protein. 6.2 Chronic Kidney Disease (CKD Non-Dialysis Stages 3a-4): - Primary Directive: Retard progression of renal functional decline, prevent uremic toxicity. - Caloric/Macro Clamps: Protein strictly 0.6 - 0.8 g/kg body weight; >= 50% HBV protein. - Electrolyte Clamps: Potassium < 2,000 mg/day (adjust based on eGFR and serum K+); Phosphorus < 800 mg/day; Sodium < 1,500 mg/day. - Banned/Excluded: Starfruit (contains neurotoxic caramboxin), dark colas (phosphoric acid additives), high-sodium processed foods, potassium chloride salt substitutes. 6.3 End-Stage Renal Disease (ESRD - Maintenance Hemodialysis): - Primary Directive: Prevent protein-energy wasting (PEW) while controlling interdialytic electrolyte accumulation. - Caloric/Macro Clamps: High protein 1.2 - 1.3 g/kg; Calories 30 - 35 kcal/kg. - Electrolyte Clamps: Sodium < 1,500 - 2,000 mg/day; Potassium < 2,000 - 2,500 mg/day; Phosphorus < 800 - 1,000 mg/day; Fluid intake strictly regulated to 500 - 1,000 mL + daily urine output. - Hard-Gate Notice: Mandatory clinical referral notice displayed; requires nephrologist coordination. 6.4 Essential Hypertension: - Primary Directive: Lower vascular peripheral resistance via endothelial nitric oxide and natriuresis. - Protocol: Strict adherence to DASH (Dietary Approaches to Stop Hypertension). - Clamps: Sodium < 1,500 mg/day; Potassium 3,500 - 4,700 mg/day; Magnesium >= 400 mg/day; Calcium >= 1,000 mg/day. - Excluded: Pickles, papads, commercial savory snacks, salted nuts, canned meats, cured meats, MSG. 6.5 Dyslipidemia & Atherosclerosis: - Primary Directive: Lower ApoB, non-HDL-C, and LDL-C; suppress oxidized LDL formation. - Clamps: SFA < 7% total calories; Trans fat 0.0g; Dietary cholesterol < 200 mg/day. - Prescribed: Phytosterols (2g/day), soluble beta-glucan (>= 3g/day), EPA+DHA (2-3g/day). - Excluded: Palm oil, coconut oil in excess, vanaspati, butter/ghee excess, organ meats, processed delicatessen meats. 6.6 Gout & Hyperuricemia: - Primary Directive: Reduce serum urate below crystallization point (< 6.0 mg/dL). - Clamps: Hydration floor >= 3.0 L/day (ensures urine specific gravity < 1.015); Moderate purine restriction. - Excluded: High-purine animal tissues (sweetbreads, liver, kidneys, anchovies, sardines, mackerel, meat extracts, yeast extracts), high-fructose corn syrup, all beer and distilled alcohol. - Prescribed: Tart cherries (anthocyanins inhibit xanthine oxidase), low-fat dairy (glycomacropeptide uricosuric action), ascorbic acid (500mg). 6.7 Celiac Disease: - Primary Directive: 100% elimination of dietary prolamins triggering autoimmune intestinal villous atrophy. - Protocol: Lifelong zero-gluten lock (< 20 ppm certified). - Excluded: Wheat, barley, rye, spelt, triticale, kamut, malt extract, uncertified oats, hydrolyzed vegetable protein from wheat. - Prescribed: Naturally gluten-free grains (millet, sorghum/jowar, amaranth/rajgira, ragi, brown rice, buckwheat, quinoa). 6.8 Polycystic Ovary Syndrome (PCOS / PCOD): - Primary Directive: Overcome peripheral insulin resistance, lower free testosterone, restore ovulatory rhythm. - Clamps: Daily GL < 70; Low insulinemic response; Protein 1.2 - 1.4 g/kg. - Prescribed: Myo-inositol & D-chiro-inositol-dense foods (citrus fruits, cantaloupe, legumes), spearmint tea, omega-3 fatty acids. - Excluded: Dairy surges (insulin/IGF-1 stimulation), refined sugars, high saturated fat bakery products. 6.9 Primary Hypothyroidism (Hashimoto's Thyroiditis): - Primary Directive: Protect thyroid hormone deiodinase conversion, safeguard levothyroxine bioavailability. - Micronutrients: Selenium (55 mcg), Zinc (10-15 mg), Iodine (150 mcg from iodized salt; avoid massive excess kelp). - Excluded / Restricted: Raw brassica goitrogens in excessive unheated quantities; separate levothyroxine ingestion by >= 4 hours from calcium, iron, and soy foods. 6.10 Non-Alcoholic Fatty Liver Disease (NAFLD / MASLD): - Primary Directive: Mitigate hepatic steatosis and oxidative de novo lipogenesis. - Clamps: 5-7% weight reduction target; Fructose strictly < 25g/day (zero high-fructose corn syrup or added fructose). - Prescribed: High MUFA (olive oil, mustard oil), choline-rich foods (eggs, soy, quinoa), unsweetened black coffee (3 cups/day shown to decrease hepatic fibrogenesis). 6.11 Irritable Bowel Syndrome (IBS): - Primary Directive: Alleviate luminal distension, bloating, and abnormal motility via the 3-phase low-FODMAP protocol. - Excluded in Elimination Phase: High Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (onions, garlic, wheat, lactose, apples, pears, stone fruits, legumes, sugar alcohols like sorbitol/xylitol). 6.12 Inflammatory Bowel Disease (Crohn's Disease in Remission): - Primary Directive: Prevent mucosal inflammatory recurrence, maintain nutritional adequacy. - Prescribed: Anti-inflammatory Mediterranean-style eating pattern; omega-3 fatty acids; low-residue during active symptoms; soluble fiber during remission. 6.13 Gastroesophageal Reflux Disease (GERD): - Primary Directive: Prevent transient lower esophageal sphincter (LES) relaxation and acid irritation. - Excluded: Peppermint, spearmint, chocolate, high-fat fried foods, citrus fruits, tomato-based sauces, coffee, carbonated drinks, late-night meals within 3 hours of recumbency. 6.14 Iron Deficiency Anemia: - Primary Directive: Replenish depleted ferritin stores and increase circulating hemoglobin. - Protocol: Maximize bioavailable iron intake (heme from poultry/fish or non-heme iron paired with 100mg ascorbic acid). Separate all phytate-, calcium-, and tannin-rich foods from iron intake. 6.15 Osteoporosis & Osteopenia: - Primary Directive: Preserve bone mineral density and suppress osteoclastic resorption. - Clamps: Calcium >= 1,200 mg/day; Vitamin D 1,000 - 2,000 IU/day; Vitamin K2 (menaquinone-7 from fermented foods); Magnesium 400 mg/day; Sodium restricted to < 2,000 mg/day (excess sodium drives hypercalciuria). 6.16 Sarcopenia & Frailty Syndrome: - Primary Directive: Stimulate fractional synthetic rate of myofibrillar protein. - Clamps: Protein 1.2 - 1.6 g/kg/day; Leucine >= 3.0g per meal; Resistance exercise stimulus required; Creatine monohydrate 3-5g/day. 6.17 Hypertriglyceridemia: - Primary Directive: Suppress hepatic VLDL overproduction and accelerate LPL clearance. - Clamps: Extreme restriction of simple sugars, alcohol (0% tolerance), refined starches. High EPA+DHA intake (3-4g/day). 6.18 Calcium Oxalate Nephrolithiasis (Kidney Stones): - Primary Directive: Decrease urinary calcium oxalate supersaturation. - Clamps: Hydration floor >= 3.0 L/day (target urine volume > 2.5 L); Adequate dietary calcium (1,000 - 1,200 mg/day consumed WITH meals to bind oxalate in intestinal lumen); Oxalate restriction (< 50 mg/day - avoid spinach, rhubarb, almonds, chocolate, beets); Sodium < 1,500 mg/day. 6.19 Uric Acid Nephrolithiasis: - Primary Directive: Alkalinize urinary pH to 6.5 - 7.0 to increase uric acid solubility. - Protocol: High fruit and vegetable intake (rich in potassium citrate); purine reduction; sodium reduction. 6.20 Liver Cirrhosis (Compensated): - Primary Directive: Prevent sarcopenia, maintain dry lean body mass, prevent hepatic encephalopathy. - Clamps: Energy 35 kcal/kg dry weight; Protein 1.2 - 1.5 g/kg dry weight; Late evening snack containing 50g complex carbohydrates to prevent nocturnal muscle catabolism. 6.21 Oncology Supportive Nutrition / Cancer Cachexia: - Primary Directive: Mitigate systemic inflammatory catabolism driven by IL-6, TNF-alpha, and proteolysis-inducing factor. - Protocol: Energy 30 - 35 kcal/kg; Protein 1.2 - 1.5 g/kg; EPA enrichment (>= 2g/day) to stabilize lean mass; Small frequent energy-dense meals. 6.22 Metabolic Syndrome: - Primary Directive: Concurrently reverse abdominal adiposity, dysglycemia, hypertension, and atherogenic dyslipidemia. - Protocol: Moderate carbohydrate (35-40%), high MUFA (20%), high dietary fiber (>40g/day), aerobic + resistance training integration. 6.23 Hypoalbuminemia: - Primary Directive: Restore circulating oncotic pressure and visceral protein reserves. - Protocol: High biological value (HBV) protein supplementation; rule out underlying protein-losing enteropathy, nephrotic syndrome, or acute phase hepatic downregulation. 6.24 Chronic Pancreatitis: - Primary Directive: Minimize exocrine pancreatic stimulation and prevent steatorrhea. - Clamps: Low-to-moderate fat (30-50g/day) distributed evenly across 5-6 small meals; Medium Chain Triglycerides (MCT) oil prioritization; Pancreatic enzyme replacement therapy (PERT) coordination; Zero alcohol. ================================================================================ SECTION 7: DETERMINISTIC DRUG-NUTRIENT INTERACTION ENGINE (32 RULES) ================================================================================ Rule 01 — Atorvastatin, Simvastatin, Lovastatin (HMG-CoA Reductase Inhibitors): - Interacting Agent: Grapefruit juice, Seville oranges, pomelos. - Mechanism: Furanocoumarins (bergamottin, 6',7'-dihydroxybergamottin) irreversibly inhibit intestinal cytochrome P450 3A4 (CYP3A4) and P-glycoprotein, dramatically raising statin systemic AUC (up to 12-fold), precipitating severe rhabdomyolysis and acute renal failure. - Syntro Action: Absolute dietary exclusion of grapefruit and pomelo products. Rule 02 — Warfarin (Vitamin K Antagonist Anticoagulant): - Interacting Agent: Phylloquinone (Vitamin K1) from dark leafy greens (kale, spinach, collards, methi). - Mechanism: Vitamin K bypasses warfarin's competitive inhibition of Vitamin K epoxide reductase complex subunit 1 (VKORC1), restoring clotting factors II, VII, IX, X synthesis, sharply depressing International Normalized Ratio (INR), and risking thrombosis. - Syntro Action: Day-to-day consistency algorithm. Strictly limits dietary Vitamin K variance to +/- 15 mcg/day across the 7-day protocol; forbids sudden boluses or total elimination. Rule 03 — Metformin (Biguanide Antihyperglycemic): - Interacting Agent: Dietary Vitamin B12 (Cobalamin) and Calcium. - Mechanism: Metformin induces calcium-dependent membrane potential changes in the terminal ileum, competitively interfering with calcium-dependent cubam receptor-mediated uptake of the intrinsic factor-B12 complex. Long-term use (> 2 years) causes B12 neuropathy. - Syntro Action: Recommends annual serum methylmalonic acid (MMA) / B12 surveillance; flags high-bioavailability dietary B12 sources and calcium adequacy. Rule 04 — Levothyroxine (Synthetic T4): - Interacting Agent: Calcium carbonate, Ferrous sulfate, Soy isoflavones, Dietary fiber, Walnuts. - Mechanism: Polyvalent cations (Ca2+, Fe2+) and dietary binders form insoluble, unabsorbable chelates with levothyroxine in the gastric lumen, blunting absorption by 30 - 60% and resulting in refractory hypothyroidism. - Syntro Action: Mandatory ingestion protocol: take on empty stomach with plain water 60 minutes before breakfast; separate all calcium/iron/soy-rich food items by >= 4 hours. Rule 05 — ACE Inhibitors (Enalapril, Ramipril, Lisinopril): - Interacting Agent: Potassium-rich salt substitutes (KCl), potassium supplements, excess dried fruits. - Mechanism: Angiotensin-converting enzyme inhibition suppresses angiotensin II, decreasing adrenal aldosterone secretion and impairing renal cortical collecting duct potassium excretion, risking life-threatening hyperkalemia. - Syntro Action: Caps potassium at < 2,500 mg/day unless normal renal function confirmed; strictly bans KCl salt substitutes (e.g. Lite Salt). Rule 06 — Angiotensin Receptor Blockers (ARBs - Losartan, Telmisartan, Valsartan): - Interacting Agent: High-potassium foods and salt substitutes. - Mechanism: Blockade of AT1 receptors reduces aldosterone-driven renal potassium excretion. - Syntro Action: Flags potassium ceilings and bans artificial potassium salt substitutes. Rule 07 — Potassium-Sparing Diuretics (Spironolactone, Eplerenone, Amiloride): - Interacting Agent: Potassium supplements, coconut water, high-potassium foods. - Mechanism: Aldosterone antagonism blocks ENaC sodium-potassium exchange in renal tubules. - Syntro Action: Strict potassium clamp (< 2,000 - 2,500 mg/day); ban potassium supplements and coconut water. Rule 08 — Loop Diuretics (Furosemide, Torsemide): - Interacting Agent: Sodium, Potassium, Magnesium. - Mechanism: Inhibition of the Na+/K+/2Cl- symporter in the thick ascending limb of the loop of Henle induces marked renal wasting of K+, Mg2+, and Ca2+, causing cardiac arrhythmias. - Syntro Action: Prescribes compensatory dietary potassium (bananas, potatoes, spinach) and magnesium; monitors hydration. Rule 09 — Thiazide Diuretics (Hydrochlorothiazide, Chlorthalidone): - Interacting Agent: Calcium supplements, Potassium, Sodium. - Mechanism: Inhibits Na+/Cl- cotransporter in distal convoluted tubule; increases renal calcium reabsorption while causing potassium/magnesium wasting. - Syntro Action: Promotes potassium replenishment; cautions against high-dose calcium supplementation to avoid hypercalcemia. Rule 10 — MAO Inhibitors (Phenelzine, Tranylcypromine, Selegiline): - Interacting Agent: Dietary Tyramine (aged cheeses, cured meats, fermented soy/tofu, draft beer, yeast extracts). - Mechanism: MAO-A inhibition blocks the catabolism of exogenous tyramine in the gut. Tyramine enters systemic circulation, displacing stored norepinephrine from presynaptic vesicles, inducing severe vasoconstriction and hypertensive emergency (the 'cheese reaction'). - Syntro Action: Absolute zero-tolerance exclusion of all fermented, aged, and cured foods. Rule 11 — Fluoroquinolone Antibiotics (Ciprofloxacin, Levofloxacin): - Interacting Agent: Divalent and trivalent cations (Calcium, Magnesium, Iron, Zinc in dairy/supplements). - Mechanism: Chelation between the 4-keto and 3-carboxyl groups of fluoroquinolones and multivalent metal ions forms unabsorbable complexes, reducing antibiotic bioavailability by up to 90%. - Syntro Action: Hard schedule gap: enforce a minimum 2-hour window before or 4-hour window after consuming dairy or mineral supplements. Rule 12 — Tetracyclines (Doxycycline, Minocycline): - Interacting Agent: Dairy products, iron supplements, antacids. - Mechanism: Multivalent cation chelation prevents tetracycline absorption in the proximal gastrointestinal tract. - Syntro Action: Separates milk, cheese, curd, and iron supplements by >= 2 hours. Rule 13 — Systemic Corticosteroids (Prednisone, Dexamethasone, Hydrocortisone): - Interacting Agent: Sodium, Calcium, Vitamin D, Simple Carbohydrates. - Mechanism: Glucocorticoid receptor activation increases hepatic gluconeogenesis and peripheral insulin resistance; induces renal sodium retention and potassium wasting; inhibits intestinal calcium absorption and accelerates osteoclast activity. - Syntro Action: Strict low-sodium (< 1,500 mg), low-glycemic load (< 70), high-calcium (1,200 mg), high-potassium, high-protein protocol. Rule 14 — Oral Bisphosphonates (Alendronate, Risedronate, Ibandronate): - Interacting Agent: Any food, beverages other than water, calcium supplements. - Mechanism: Extreme low oral bioavailability (< 1%); any food or mineral completely binds the drug, blocking bone uptake. - Syntro Action: Enforces morning fasting intake with 250 mL plain tap water; patient must remain upright and ingest zero food/beverages for 30 - 60 minutes. Rule 15 — Calcineurin Inhibitors (Cyclosporine, Tacrolimus): - Interacting Agent: Grapefruit juice, Potassium-rich foods. - Mechanism: Intestinal CYP3A4 and P-gp inhibition drives calcineurin inhibitor toxicity (nephrotoxicity, neurotoxicity); renal vasoconstriction drives hyperkalemia. - Syntro Action: Bans grapefruit; clamps potassium. Rule 16 — Lithium Carbonate (Mood Stabilizer): - Interacting Agent: Dietary Sodium and Water. - Mechanism: Lithium is handled identically to sodium in proximal renal tubules. Hyponatremia or dehydration increases proximal tubular lithium reabsorption, causing fatal lithium neurotoxicity. Excess sodium intake lowers therapeutic lithium levels. - Syntro Action: Prescribes rigid, invariant daily sodium and fluid intake; prohibits sudden low-salt diets without psychiatric dosage titration. Rule 17 — Selective Serotonin Reuptake Inhibitors (SSRIs - Sertraline, Fluoxetine, Escitalopram): - Interacting Agent: Supplemental L-Tryptophan, St. John's Wort. - Mechanism: Excessive serotonergic stimulation predisposing to central Serotonin Syndrome (hyperthermia, tremor, clonus, delirium). - Syntro Action: Excludes pharmacological L-tryptophan and St. John's Wort. Rule 18 — Oral Contraceptive Pills (Ethinyl Estradiol): - Interacting Agent: Pyridoxine (Vitamin B6), Folate. - Mechanism: Estrogens induce hepatic tryptophan 2,3-dioxygenase, increasing metabolic demand for pyridoxine cofactors. - Syntro Action: Fortifies diet with pyridoxine-dense plant sources (chickpeas, bananas, fortified grains) and folate. Rule 19 — Methotrexate (Antimetabolite / DMARD): - Interacting Agent: Dietary and Supplemental Folic Acid. - Mechanism: Competitive inhibition of dihydrofolate reductase (DHFR). High dietary folate surges can impede oncologic efficacy, while unmanaged deficiency induces mucositis and bone marrow suppression. - Syntro Action: Strict alignment with rheumatologist/oncologist folate prescription protocols. Rule 20 — Digoxin (Cardiac Glycoside): - Interacting Agent: Natural Licorice (Glycyrrhiza glabra), Dietary Fiber in excess. - Mechanism: Glycyrrhizin acts as a pseudo-aldosterone compound by inhibiting 11-beta-HSD2, causing marked hypokalemia. Hypokalemia increases digoxin affinity for myocardial Na+/K+-ATPase, provoking fatal ventricular dysrhythmias. - Syntro Action: Absolute ban on natural black licorice and deglycyrrhizinated licorice extracts; separates large pectin/fiber meals. Rule 21 — Nonsteroidal Anti-Inflammatory Drugs (NSAIDs - Ibuprofen, Naproxen, Diclofenac): - Interacting Agent: Alcohol, Acidic citrus, Supplemental high-dose Vitamin E. - Mechanism: Inhibition of COX-1 impairs gastric cytoprotective prostaglandin E2 (PGE2) synthesis; alcohol and citrus accelerate gastric epithelial barrier disruption, predisposing to peptic ulceration and occult gastrointestinal bleeding. - Syntro Action: Recommends mandatory ingestion with meals; excludes concurrent gastroirritants. Rule 22 — Phenytoin (Anticonvulsant): - Interacting Agent: Folic acid, Vitamin D, Calcium. - Mechanism: Phenytoin induces hepatic CYP enzymes, accelerating vitamin D degradation and causing osteomalacia; competes with folate intestinal conjugase. - Syntro Action: Enforces adequate vitamin D and calcium; coordinates stable folate intake. Rule 23 — Theophylline (Methylxanthine Bronchodilator): - Interacting Agent: High-protein vs High-carbohydrate dietary shifts; Caffeine. - Mechanism: High-protein diets accelerate hepatic CYP1A2 theophylline clearance; high-carbohydrate diets slow clearance. Caffeine competes for CYP1A2, driving theophylline toxicity (tachycardia, seizures). - Syntro Action: Maintains stable macronutrient ratios; limits methylxanthine/caffeine beverages. Rule 24 — Isoniazid (Anti-Tubercular Agent): - Interacting Agent: Pyridoxine (Vitamin B6), Dietary Tyramine & Histamine. - Mechanism: Isoniazid forms an inactive hydrazone complex with pyridoxal 5'-phosphate and inhibits pyridoxal kinase, driving severe peripheral sensory neuropathy; also inhibits diamine oxidase, risking histamine toxicity from spoiled fish. - Syntro Action: Recommends mandatory 25 - 50 mg/day pyridoxine supplementation; restricts high-tyramine/histamine foods. Rule 25 — Sulfonylureas (Glimepiride, Gliclazide, Glipizide): - Interacting Agent: Alcohol; Skipped meals. - Mechanism: Insulin secretagogues stimulate pancreatic beta-cell SUR1 receptors irrespective of circulating glucose. Ethanol suppresses hepatic gluconeogenesis, producing prolonged, irreversible hypoglycemia. - Syntro Action: Synchronizes exact carbohydrate intake timing with medication administration; strictly prohibits alcohol. Rule 26 — SGLT2 Inhibitors (Empagliflozin, Dapagliflozin, Canagliflozin): - Interacting Agent: Very-low-carbohydrate / Ketogenic diets; Inadequate hydration. - Mechanism: SGLT2 inhibition causes continuous urinary glucose excretion. Combining with severe carbohydrate restriction drives glucagon elevation, accelerated lipolysis, and severe Euglycemic Diabetic Ketoacidosis (euDKA) with near-normal blood glucose (< 200 mg/dL). - Syntro Action: Mandates a strict carbohydrate floor of >= 130g/day; enforces minimum 2.5 - 3.0 L/day hydration. Rule 27 — GLP-1 Receptor Agonists (Semaglutide, Tirzepatide, Liraglutide): - Interacting Agent: High-volume fibrous meals; High-fat meals. - Mechanism: Marked deceleration of gastric emptying (gastroparesis). High-fat or very high-volume meals precipitate severe nausea, vomiting, gastroesophageal reflux, and dehydration. - Syntro Action: Formulates small, nutrient-dense, high-protein meals (>= 25g protein per small plate); emphasizes chewing mechanics and liquid separation. Rule 28 — Allopurinol (Xanthine Oxidase Inhibitor): - Interacting Agent: Alcohol; Inadequate hydration. - Mechanism: Alcohol increases adenine nucleotide turnover and renal urate reabsorption; low fluid volume allows precipitation of xanthine or urate crystals in renal tubules. - Syntro Action: Enforces hydration floor >= 2.5 L/day; neutralizes dietary purine surges. Rule 29 — Colchicine (Antigout Tubulin Disruptor): - Interacting Agent: Grapefruit juice; CYP3A4 / P-gp inhibitors. - Mechanism: Significant CYP3A4 and P-gp inhibition increases colchicine systemic exposure, causing multiorgan failure, bone marrow aplasia, and myopathy. - Syntro Action: Absolute ban on grapefruit. Rule 30 — Antithyroid Drugs (Methimazole, Propylthiouracil): - Interacting Agent: High-iodine seaweed, kelp, iodized contrast dyes. - Mechanism: Massive exogenous iodine substrate load overrides antithyroid drug block (Wolff-Chaikoff escape / Jod-Basedow phenomenon), worsening thyrotoxicosis. - Syntro Action: Bans kelp supplements and high-iodine algae. Rule 31 — Proton Pump Inhibitors (Omeprazole, Pantoprazole, Rabeprazole): - Interacting Agent: Vitamin B12, Non-heme iron, Calcium carbonate, Magnesium. - Mechanism: Hypochlorhydria (gastric pH > 4.5) impedes pepsin cleavage of food-bound cobalamin, reduces ferric-to-ferrous iron reduction, and diminishes insoluble calcium salt ionization. - Syntro Action: Prioritizes calcium citrate (pH-independent absorption); flags regular B12 and magnesium checks. Rule 32 — Levodopa / Carbidopa (Dopamine Precursor for Parkinson's): - Interacting Agent: High-protein meals (Neutral Amino Acids). - Mechanism: Large neutral amino acids (LNAAs - leucine, isoleucine, valine, tyrosine, phenylalanine, tryptophan) compete directly with levodopa for transport across the intestinal brush border and the blood-brain barrier via the L-type amino acid transporter 1 (LAT1). - Syntro Action: Implements protein redistribution protocol: low protein throughout daytime hours; aggregates daily protein target into the evening meal. ================================================================================ SECTION 8: ICMR-NIN 2020 DIETARY REFERENCE INTAKES (INDIAN POPULATION NORMS) ================================================================================ 8.1 Reference Adults (Reference Man: 65 kg; Reference Woman: 55 kg): Metric Sedentary Man Moderate Man Sedentary Woman Moderate Woman ----------------------------------------------------------------------------------------------- Energy (kcal/day) 2,110 2,710 1,660 2,130 Protein (g/day) 54.0 54.0 46.0 46.0 Dietary Fiber (g/day floor) 30.0 30.0 25.0 25.0 Visible Fat (g/day) 25 30 20 25 Calcium (mg/day) 1,000 1,000 1,000 1,000 Magnesium (mg/day) 440 440 370 370 Iron (mg/day) 19 19 29 29 Zinc (mg/day) 17.0 17.0 13.2 13.2 Potassium (mg/day) 3,500 3,500 3,500 3,500 Sodium (mg/day ceiling) 2,000 2,000 2,000 2,000 Vitamin A (mcg RAE/day) 1,000 1,000 840 840 Vitamin C (mg/day) 80 80 65 65 Vitamin D (IU/day) 600 600 600 600 Vitamin B12 (mcg/day) 2.5 2.5 2.5 2.5 Folate (mcg/day) 300 300 220 220 8.2 Special Physiological States (ICMR-NIN 2020 Allowances): - Pregnant Female (2nd Trimester): +350 kcal/day; Protein +9.5 g/day; Iron 27 mg/day; Folate 570 mcg/day. - Pregnant Female (3rd Trimester): +350 kcal/day; Protein +22.0 g/day; Iron 27 mg/day; Folate 570 mcg/day. - Lactating Female (0-6 months): +600 kcal/day; Protein +16.9 g/day; Calcium 1,200 mg/day; Vitamin A 1,150 mcg RAE/day. ================================================================================ SECTION 9: REGIONAL FOOD COMPOSITION MATRIX (IFCT 2017 DATABASE - 50 FOODS) ================================================================================ All values listed per 100 grams raw edible portion: Food Name Region Kcal Prot(g) Carb(g) Fiber(g) Fat(g) Ca(mg) Fe(mg) K(mg) Na(mg) ---------------------------------------------------------------------------------------------------------- Brown Rice (Whole Grain) All 353 7.5 73.6 4.4 2.7 21 1.8 214 4.2 Polished White Rice (Raw) All 345 6.8 78.2 1.3 0.5 10 0.7 110 3.8 Whole Wheat Flour (Atta) North 320 10.6 64.2 11.2 1.7 34 3.9 340 3.1 Finger Millet (Ragi) South 328 7.3 72.0 11.5 1.3 344 3.9 408 11.0 Pearl Millet (Bajra) West 361 11.6 67.5 11.3 5.0 42 8.0 390 10.9 Sorghum (Jowar) West 349 10.4 72.6 10.2 1.9 25 4.1 363 7.2 Foxtail Millet (Kangni) South 331 12.3 60.9 8.0 4.3 31 2.8 250 4.6 Yellow Pigeon Pea (Tur Dal) All 335 22.3 57.6 15.0 1.5 73 4.3 1104 28.5 Split Red Lentil (Masoor Dal)All 343 25.1 59.0 10.8 0.7 56 7.5 850 14.2 Split Bengal Gram (Chana Dal)All 372 20.8 59.8 15.3 5.6 56 5.3 912 35.1 Green Gram Split (Moong Dal) All 348 24.5 59.9 8.2 1.2 75 3.9 843 12.0 Black Gram Split (Urad Dal) All 347 24.0 59.6 9.8 1.4 154 7.5 983 38.0 Chickpeas (Kabuli Chana) North 360 17.1 60.9 17.4 5.3 105 6.2 875 24.0 Kidney Beans (Rajma) North 346 22.9 60.6 15.2 1.3 140 5.1 1406 18.0 Soybean (Glycine max) All 432 36.5 20.9 13.8 19.9 240 10.4 1797 4.0 Paneer (Indian Cottage Cheese)All 265 18.3 3.1 0.0 20.8 480 0.2 90 22.0 Curd / Plain Yogurt (Dahi) All 60 3.5 4.7 0.0 3.1 120 0.1 140 45.0 Skimmed Milk (Liquid) All 35 3.4 5.0 0.0 0.2 125 0.1 155 50.0 Spinach (Palak) All 26 2.0 2.9 2.5 0.7 73 2.7 558 70.0 Fenugreek Leaves (Methi) North 49 4.4 6.0 4.9 0.9 395 1.9 500 67.0 Moringa Leaves (Drumstick) South 92 6.7 12.5 6.8 1.7 440 0.85 259 9.0 Mustard Greens (Sarson) North 30 2.7 4.0 3.2 0.6 160 1.6 380 25.0 Bitter Gourd (Karela) All 25 1.6 4.2 2.8 0.2 20 0.6 319 3.0 Okra / Ladyfinger (Bhindi) All 35 1.9 6.4 3.6 0.2 66 0.4 249 8.0 Bottle Gourd (Lauki) All 15 0.6 2.5 1.2 0.1 20 0.5 150 2.0 Ridge Gourd (Turai) All 17 0.5 3.3 1.6 0.1 18 0.4 140 3.0 Cauliflower (Gobhi) All 25 2.0 4.0 2.6 0.3 33 0.7 300 30.0 Cabbage (Bandh Gobhi) All 27 1.3 5.3 2.8 0.2 39 0.5 170 18.0 Green Bell Pepper (Capsicum) All 24 1.3 4.3 1.7 0.3 10 0.4 180 3.0 Tomato (Ripe Red) All 20 0.9 3.6 1.2 0.2 10 0.3 237 5.0 Cucumber (Kheera) All 15 0.7 2.6 0.9 0.1 14 0.3 147 2.0 Onion (Red) All 40 1.2 8.6 1.7 0.1 23 0.3 146 4.0 Garlic (Raw Cloves) All 145 6.3 29.8 2.1 0.5 181 1.7 401 17.0 Ginger (Fresh Rhizome) All 67 1.8 12.3 2.0 0.7 16 0.6 415 12.0 Almonds (Badam) All 579 21.2 21.6 12.5 49.9 264 3.7 733 1.0 Walnuts (Akhrot) All 654 15.2 13.7 6.7 65.2 98 2.9 441 2.0 Flaxseeds (Alsi) All 534 18.3 28.9 27.3 42.2 255 5.7 813 30.0 Chia Seeds All 486 16.5 42.1 34.4 30.7 631 7.7 407 16.0 Pumpkin Seeds All 559 30.2 10.7 6.0 49.1 46 8.8 809 7.0 Sunflower Seeds All 584 20.8 20.0 8.6 51.5 78 5.3 645 9.0 Cold-Pressed Mustard Oil North 884 0.0 0.0 0.0 100.0 0 0.0 0 0.0 Extra Virgin Olive Oil Global 884 0.0 0.0 0.0 100.0 0 0.0 0 0.0 Ghee (Clarified Butter) All 897 0.3 0.0 0.0 99.5 8 0.1 5 2.0 Sesame Oil (Til Oil) South 884 0.0 0.0 0.0 100.0 0 0.0 0 0.0 Chicken Breast (Skinless) All 165 31.0 0.0 0.0 3.6 15 1.0 256 65.0 Egg Whole (Boiled) All 155 12.6 1.1 0.0 10.6 50 1.8 126 124.0 Egg White (Liquid) All 52 10.9 0.7 0.0 0.2 7 0.1 163 166.0 Salmon (Wild Atlantic) Global 206 22.1 0.0 0.0 12.3 12 0.8 490 59.0 Mackerel (Bangda) West 205 18.6 0.0 0.0 13.9 15 1.2 314 90.0 Rohu Fish (Freshwater Carp) East 97 17.3 0.0 0.0 2.8 110 1.0 288 60.0 ================================================================================ SECTION 10: NUTRITION CARE PROCESS (NCP) & PES STATEMENT TAXONOMY ================================================================================ Syntro implements the Academy of Nutrition and Dietetics (AND) Nutrition Care Process: - Structure: Problem (P) related to Etiology (E) as evidenced by Signs/Symptoms (S). 10.1 Diagnostic Domains & PES Template Library: - Domain 1: Intake (NI) - NI-5.1 Excessive Fat Intake related to frequent restaurant meal consumption as evidenced by dietary history of 45% kcal from fat and serum LDL of 165 mg/dL. - NI-5.4 Inadequate Fiber Intake related to refined carbohydrate preference as evidenced by calculated dietary fiber intake of 11 g/day and chronic constipation. - NI-5.8.2 Excessive Carbohydrate Intake related to frequent intake of sugar-sweetened beverages as evidenced by calculated daily glycemic load of 142 and HbA1c of 8.2%. - NI-5.7.1 Inadequate Protein Intake related to restrictive dietary habits as evidenced by calculated protein intake of 0.55 g/kg/day and muscle loss. - Domain 2: Clinical (NC) - NC-2.2 Altered Nutrition-Related Laboratory Values related to insulin resistance and sedentary lifestyle as evidenced by fasting plasma glucose of 142 mg/dL, HbA1c of 7.4%, and elevated ALT. - NC-3.1 Underweight related to malabsorption secondary to untreated celiac disease as evidenced by BMI of 16.8 kg/m2 and villous atrophy on endoscopy. - NC-3.3 Overweight / Adult Adiposity related to chronic energy intake exceeding expenditure as evidenced by BMI of 31.4 kg/m2 and waist circumference of 102 cm. - Domain 3: Behavioral-Environmental (NB) - NB-1.5 Disordered Eating Pattern related to severe caloric restriction anxiety as evidenced by SCOFF screening questionnaire score >= 2 (triggers hard-gate clinical safety lock). - NB-1.7 Inappropriate Food-Drug Interaction Knowledge related to lack of pharmacological nutrition education as evidenced by daily concurrent intake of levothyroxine with high-dose calcium carbonate. ================================================================================ SECTION 11: CLINICAL SAFETY GUARDRAILS & HARD-GATE REFERRAL THRESHOLDS ================================================================================ 11.1 Hard-Gated Conditions (AI Generation Aborted / Referral Required): Syntro Health enforces deterministic safety checks before running LLM meal synthesis. If any of the following clinical flags are detected, meal plan generation is suspended and a structured Medical Referral Notice is delivered: - 1. End-Stage Renal Disease on Dialysis without Nephrologist Authorization. - 2. Eating Disorder Signal: Any positive indication on the SCOFF questionnaire (score >= 2), BMI < 16.0 kg/m2, or stated history of anorexia nervosa / bulimia nervosa. - 3. Acute Diabetic Ketoacidosis (DKA) / Hyperosmolar Hyperglycemic State (HHS) symptoms: Blood glucose > 400 mg/dL or presence of ketones with altered sensorium. - 4. Advanced Hepatic Encephalopathy (West Haven Criteria Grade >= II). - 5. Active Malignant Hypercalcemia (> 12.0 mg/dL). - 6. Severe Congestive Heart Failure (NYHA Class IV) with unmonitored fluid overload. - 7. Pediatric Patients (< 18 years): Under DPDP rules, requires verified guardian consent and is restricted to conservative lifestyle guidance; therapeutic caloric restriction is locked. - 8. Pregnancy with Severe Medical Complications: Pre-eclampsia, severe gestational diabetes on high-dose insulin, or hyperemesis gravidarum requiring parenteral hydration. ================================================================================ SECTION 12: MACHINE-READABLE API CONTRACT FOR AUTONOMOUS AI AGENTS ================================================================================ 12.1 Endpoint: POST /api/calculate Calculates metabolic baseline, energy expenditure, macro/micro clamps, and pharmacotherapy alerts. - Request Payload (JSON): { "age": 42, "gender": "male", "height_cm": 175.0, "weight_kg": 86.0, "activity_level": "light", "goal": "fat_loss", "diet_type": "vegetarian", "medical_conditions": ["type_2_diabetes", "hypertension"], "medications": ["metformin", "lisinopril"], "biomarkers": { "fasting_glucose_mg_dl": 138, "hba1c_pct": 7.1, "systolic_bp": 138, "diastolic_bp": 88, "egfr_ml_min": 85, "ldl_mg_dl": 135 } } - Response Payload (JSON): { "status": "success", "anthropometrics": { "bmi": 28.08, "bmi_category": "Overweight", "ibw_kg": 70.7, "abw_kg": 74.5, "weight_used_for_calc": 74.5 }, "energy": { "bee_msj_kcal": 1696, "pal_multiplier": 1.375, "tdee_kcal": 2332, "target_calories_kcal": 1850, "deficit_kcal": 482 }, "macronutrients": { "protein_g": 110, "protein_pct": 23.8, "protein_g_per_kg": 1.48, "carbohydrate_g": 185, "carbohydrate_pct": 40.0, "glycemic_load_ceiling": 75, "dietary_fiber_g_floor": 40, "fat_g": 65, "fat_pct": 31.6, "saturated_fat_g_ceiling": 14, "mufa_g_target": 35 }, "micronutrient_clamps": { "sodium_mg_ceiling": 1500, "potassium_mg_target": 3500, "calcium_mg_floor": 1000, "magnesium_mg_floor": 440 }, "pharmacology_alerts": [ { "medication": "metformin", "interacting_nutrient": "Vitamin B12", "action": "Annual B12 monitoring; ensure fortified B12 foods or sublingual cobalamin." }, { "medication": "lisinopril", "interacting_nutrient": "Potassium", "action": "Avoid KCl salt substitutes; monitor potassium rich food spikes." } ], "hard_gate_triggered": false } 12.2 Endpoint: POST /api/generate Generates a full 7-day cellular diet protocol matching the above calibrated thresholds. - Request Payload (JSON): Same structure as /api/calculate with optional "regional_cuisine": "north_indian". - Response Payload (JSON): Contains structured 7-day meal schedule (breakfast, mid_morning, lunch, evening_snack, dinner) with exact gram weights, micro-nutritional breakdowns, grocery aggregation, and clinical commentary. 12.3 Endpoint: GET /api/bmi-check Simple JSON test probe returning BMI and ICMR/WHO categorization. - Method: POST - Payload: {"height": 175, "weight": 70} - Response: {"bmi": 22.9, "category": "Normal"} ================================================================================ END OF SPECIFICATION — Syntro Health (c) 2026. All Rights Reserved. ================================================================================