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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