Table 1.

Common Reasons for Elevated Phe Levels

	Common reasons for elevated phe levels
Exchanges	Persistent excess intake of natural protein (“over exchanging”) Poor parental comprehension/adherence surrounding counting protein exchanges, older children/teenagers exerting resistance to the diet particularly outside of the home and at social events
Synthetic protein	Not taking some or all of the prescribed quota of synthetic protein resulting in catabolism Can be due to transition from one product to another, a negative association with synthetic protein, behavioral reaction to an environmental stimulus
Low protein foods	Insufficient intake of low protein foods resulting in calorie insufficiency and catabolism Can be due to difficulties with cooking low‐protein alternatives, fatigue of current products, negative comments from family members/friends regarding low‐protein diet

Above data extracted from patient's individual medical chart, dietetic notes, and phenylalanine‐level sheets.