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Normal Insulin Dynamics

Once a patient has been tested

completely to see which category

he/she falls under using a full

metabolic profile, and fasting and

after glucose load test, Dr. Nawar

explains that those patients who fall

under the normal insulin dynamics

and have no issues in carbohydrate

metabolism are put on fat restricted

diets. “70 percent of obese patents

have insulin problem and they are

on a low carb, non-ketogenic diet.

30 percent of people have normal

insulin dynamics will respond well

to a low fat diet or fat restricted diet,”

she says.

Awareness is Key

Once you know what you have a

problem metabolizing and you

learn when you are on a diet with

nutrients you can consume without

any issues, the road to weight loss

is more about self-awareness and

understanding your food. “Once

you understand what you can eat

all the time versus some foods

you need to restrict, then you

learn there’s no food restriction

as in quantity so you don’t feel

hungry. There is no starving. So

you learn to eat wherever you are.

We teach patients there are certain

foods you can have all the time,

you can choose wherever you

are in a restaurant or anywhere

else for that matter…it’s very

practical. Then once the patient is

successful in the weight loss phase

from either the carb restrictive

diet or the fat restrictive diet,

you can re-introduce them but

cautiously,” she explains. “In fact,

obese patients are usually not

lacking in will power but more

a lack of education. When you

educate them they respond even

to the point of the equivalent of

undergoing bariatric surgery. We

have a high success rate with both

types of patients.”

The Role of Physical Activity

With obesity, Dr. Nawar points

out that there is always genetic

and epi-genetic factors and

unfortunately we can’t change the

genetic part. “That’s why if we have

a tendency to gain weight we will

always have it no matter what. We

have to learn to control and master

our food. We encourage our

patients in general to increase their

daily physical activity. However

you need to exercise around 77

hours to lose 1 kilogram of fat so

it does not really match. But yes

physical activity is very important

to be able to maintain the weight,”

she tells.

Carbohydrate

Restrictive Eating

According to Dr. Nawar,

following the macro

nutrient restriction diet,

people who are even insulin

resistant or who are at the

pre-diabetes stage or even

diabetic, will respond more

to carbohydrate restricted

diets which is a low carb

non-ketogenic diet. “What

this means is that we have a

minimum amount of carbs

that can be consumed on

a daily basis. Atkins on the

other hand, is a very low

carbohydrate ketogenic

diet. The body needs a

minimum amount of carbs

so what we give to these

types of patients who are

insulin resistant is a low

carb, non-ketogenic diet

which gives them between

130 to 150 grams of carbs

per day, which makes this

type of diet for weight

management practical and

sustainable. What we do is

very sustainable. That’s the

big difference in fact.”

13

May/June 2015