WHAT IS THE DIFFERENCE BETWEEN YOUR NUTRITION ADVICE AND THE ATKINS DIET?
We teach what modern nutrition tells us our bodies need. Let’s compare the two instructions based on the food groups and calories intake for weight loss:
|ATKINS||unlimited||less than 20 grams||unlimited||unlimited|
|US||minimum 4 palm sizes meat||10 – 15 total tsp carbs/sugar||less than 30%||ladies: 1200 men: 1500|
Atkins teaches that you can eat all the protein and fat you desire.
We teach that a minimum of 4 palm sizes of protein every day is needed for Sunnyvale and San Jose patients.
This is based on the science of DAILY MINIMUM REQUIRED PROTEIN, which is ½ gm of protein per pound ideal body weight. For example, if the goal weight is 140 pounds, then you need minimum 70 grams protein per day. If your goal weight is 200 pounds, you need minimum 100 grams protein per day
WHAT IS A GRAM OF PROTEIN?
For women, the average palm size and thickness in a piece of meat is about 20 grams. For men, the average palm size of meat is about 30 grams. We teach most Sunnyvale and San Jose patients need a MINIMUM 4 PALMS OF PROTEIN DAILY for weight loss. That is a palm size serving of chicken, beef, pork, fish, eggs and meat, cup of cottage cheese, or good quality protein bar or shake.
Atkins’ teachings put you in a condition called ketosis. We think the science on this is acceptable and not harmful to the body. However, unless you stay in ketosis the rest of your life, you will not have learned to manage your carbs outside of ketosis. This means that you are likely to gain the weight back quickly because 50 – 75% of overweight patients in Sunnyvale and San Jose have a metabolism problem called insulin resistance (IR). If you do not learn to manage your carbs, IR returns and you quickly regain the weight. Also, this diet is too low in fibers.
We teach that you need 50 – 75 grams of carbs (or 10 – 15 total tsp Sugar/carbs). This is the lowest amount of carbs most people can eat to prevent ketosis. This allows us to learn to manage our carbs.
Atkins teaches that you can eat all the fat you desire.
We teach that less than 30% fat is acceptable. This is achieved by controlling the total calorie count. Which sounds correct to you?
WHY ARE WE TAKING IN SO MUCH CHROMIUM AND WHAT DOES IT DO FOR US?
Chromium is a naturally occurring mineral that is necessary for the body to metabolize the carbohydrates we consume. It is necessary for insulin to work correctly so we have the lowest insulin levels in our bloodstream possible. As we age, we ingest more and more white carbs and we intake less chromium. Studies have shown that many overweight people are low in chromium. This may contribute to insulin resistance and block weight loss. (See FAQ: What is insulin resistance?) Many feel that chromium may help somewhat with sugar cravings.
We use a form of Chromium called chromium polynicotinate. Chromium is bonded to the vitamin Niacin forming what is called Glucose Tolerance Factor.
Chromium picholinate is a popular form of chromium bound to picinolinic acid. In this form, the picinolinic acid must be broken away from chromium and bound to Niacin in the body. Therefore, we prescribe the form already bonded to the niacin.
We prescribe at least 200 micrograms to everyone and 400 micrograms to those who are insulin resistant. The multivitamin you take may have 200 micrograms also. That is acceptable. Up to 1000 micrograms are considered safe. We have not seen any evidence or research that taking more than 400 micrograms is helpful.
If you have any questions or if your primary MD has any questions, we are happy to answer or help in any manner possible.
WHAT IS A PROTEIN SPARING MODIFIED FAST?
Simply explained, PSMF is an aggressive effective way to lose a lot of weight quickly. This is a very low calorie diet in the range of 400 – 800 calories with primarily protein taken in to help protect lean body tissue. It is absolutely essential for any patient on this weight loss plan to be followed closely (weekly) by a specialist. It can be dangerous if not done correctly. We think of this program as being the last step before having the $30,000 dollar stomach bypass surgery. This bypass surgery has a serious complication rate of 3% and about one in 200 die from the surgery. The PSMF is much safer than the surgery and can give close to the same results.
Think of dietary changes for weight loss in different levels. Each has advantages and disadvantages.
Most aggressive to least aggressive – top to bottom
|Stomach bypass surgery||Effective, essentially cures type II diabetes, massive weight loss||$30,000, 1 in 200 die from surgery, can still regain weight, other problems|
|Protein sparing modified fast (600-800 calories). Several nutrition plans available||Effective, rapid weight loss – 30 or more pounds first month possible||MD close follow-up, very tight nutrition control, frequent lab testing, EKG|
|Low calorie diet||Safer with less close follow-up, long term success good, a realistic goal is 10% weight loss in 2-4||Slower weight loss, may plateau at lower weight|
|Balanced Deficit (eg: decreasing your present intake 300-400 calories)||Very safe, medical involvement not required. Should have tried this before beginning a medical weight loss program.||Very slow weight loss|
We are pleased to announce that we now offer the PSMF to qualifying patients. Ask us if you have any questions.
Also, we offer high-protein low-sugar shakes and bars to patients on low calorie diets or to any person needing excellent nutrition in a quick manner to help their dietary intake. Ask the staff if you would like an explanation or a taste test.
WHY DO YOU ADVISE DAILY WEIGH-INS DURING WEIGHT MAINTENANCE?
Everything we teach is firmly based in science and the experiences of thousands of weight loss patients. Obesity is a disease and checking your weights during weight maintenance is just like a diabetic checking his blood sugar daily. A person in maintenance needs to catch a weight gain before they feel it in their clothes. The National Health Care Weight Registry, which tracks thousands of patients who have lost over thirty pounds, found that among those that maintained the weight, daily check-ins was part of their routine.
However, during the weight-loss phase, science hasn’t taught us the answer. We don’t know if it is better to weigh or not weigh. We discuss that with each patient individually during the weight-loss phase of their program.
WHY DO YOU INSIST WE HAVE A PRIMARY MD AND CONTINUE OUR ANNUAL EXAMS? CAN’T YOU BE MY PRIMARY MD?
We strongly believe in preventive medicine. That is why we specialize in weight treatment and the diseases related to weight problems. Dr. Sani is trained and qualified to perform complete primary care. However, Bariatric (weight loss medicine) is a specialty. Most primary care doctors do not emphasize weight management to the degree that Dr. Sani does. Rather than treat high blood pressure, diabetes, and depression, we directly treat the primary cause of many of these health problems: body weight and excess body fat. Dr. Sani also treats these associated conditions. By treating the weight problem, we hope to prevent these other conditions other than just address them.
However, we cannot forget many other conditions must be screened for, monitored, and treated when indicated. For example, one could have a healthy weight and a healthy heart but develop a breast cancer that is not detected or prostate cancer that is missed. Therefore, please keep up your annual exams with your primary MD.
Also, your primary MD typically is part of a group practice and provides after-hour emergency call service. Health & Beauty Physicians is a solo practice and cannot be available 24hr / 7 days. Whenever possible, we provide after-hour coverage and phone call returns with 24 hours but you must have your primary MD for emergencies.
HOW ARE YOUR PROGRAM MEDICATIONS DIFFERENT FROM PHEN-FEN?
Phen-fen uses a combination of two medicines: Phentermine and Pondimin (fenfluramine). Also, a derivative of fenfluramine called Redux (dexfenfluramine) is sometimes used.
Current studies show the following:
Patients who took fenfleuramine or dexfenfluramine have a 5.4% risk of developing heart valve abnormalities. Obese patients have a 4.8% risk of having the heart valve abnormalities whether they took the medicines or not.
We now know the problem was caused by the fenfluramine medicines overstimulating serotonin receptors (specifically the 5 HTP 2B) on the heart valves, which caused thickening of the valves.
Phentermine, Tenuate, Phendimetrazine, Avandia, Actos, Glucophage, Zenical, Meridia, and the other medicines we may use do not work in the serotonin system. Therefore, there is no risk to develop the same problem that fenfluramines caused.
Sometimes patients are started on or are already take a class of medicines called SSRI’s or selective serotonin re-uptake inhibitors. These are antidepressants such as Prozac, Celexa, and others. Current studies suggest these medicines do not affect the serotonin receptors on the heart valves. Dr. Sani, along with other physicians, have published their findings in a medical journal that demonstrate any risk of phentermine class medicines and SSRI meds are extremely low.
If you have any questions or if your primary MD has any questions, we are happy to answer or help you in any manner possible.
WHAT IS INSULIN RESISTANCE AND WHY IS THAT IMPORTANT?
To explain Insulin Resistance (IR) on quickly is difficult. In short, it is the chemical abnormality of pre-diabetes with normal blood sugars. Current estimates show that over 50% of Americans have IR.
Insulin is a very important hormone for our body. Its primary function is to regulate the sugar in our bloodstream at a constant level. Each adult has about 5 quarts of blood. The entire amount of sugar normally dissolved in our bloodstream is ½ to 1 teaspoon of sugar in all 5 quarts of blood. That is important. THE NORMAL SUGAR IN OUR BLOOD IS ½ TO ONE TEASPOON IN FIVE QUARTS OF BLOOD.
We teach our patients how to calculate the teaspoons of sugar in every food serving we eat or drink.
Example: If you eat two plates of spaghetti, two cups pasta on each plate, you absorb 48 teaspoons of sugar into your blood. A 12 ounce soda is 7.5 teaspoons of sugar. Within 2 hours, the sugar in our blood should be back to ½ to 1 teaspoon. Insulin is the main hormone that moves the sugar out of blood into the cells of the body. Extra sugar in the cells is turned to a form of fat called triglycerides. Triglycerides are released back into the blood and then collected in the fat cells.
As we gain weight, the cells don’t want any more sugar and fat so they become RESISTANT to more sugar coming into the cell. Insulin is less effective. The body compensates for this by putting higher levels of insulin into the blood. INSULIN RESISTANCE IS HIGH INSULIN LEVELS IN THE BLOODSTREAM. If insulin resistance progresses to the point that blood sugar is not controlled, then we have developed type II diabetes.
Why is this important? Insulin in normal levels is a great hormone. In high levels, insulin results in weight gain, blocking weight loss, increased hunger, sugar cravings, and several other negative consequences to our health such as fatigue, headaches, premature heart disease and more.
How does a doctor diagnose IR? Information from your history, physical, and from blood testing provides the vital clues. Sometimes specific testing for blood insulin levels may be needed.
WHAT ARE THE ESSENTIAL FATTY ACIDS (EFA)?
Essential is a medical term meaning the human body cannot make it; therefore we must consume it in our diet. We have three types of essential nutrients: water, nine amino acids found in proteins, and two fatty acids called the Omega 3 and Omega 6 fatty acids.
The fatty acids are the building blocks of every cell wall in our body. These are important in every function and chemical reaction, including metabolism, immunity (fighting infection), skin health, heart health, controlling cholesterol, mood swings, and most importantly for us, weight control. The average American diet is low in Omega 3 EFA.
Studies of rates of heart disease suggest a direct correlation between low EFA consumption and high insulin levels resulting in heart disease, and obesity.
Omega 3 Consumption
|Eskimos||7,000 – 10,000 mg/day|
|1 Tbsp cod liver oil||2,500 mg/day|
|AHA guidelines||250 mg/day|
|Current US average intake||125 mg/day|
The less we control our insulin, the more EFA we need. The usual American diet is so high is carbohydrates (sugars) that the current levels of EFA intake are not enough.
To improve your EFA, take:
Omega 3 (Linolenic acid, EPA, DHA) sources:
- Fats and oils (canola, soybean, Flax seed, wheat germ)
- Nuts and seeds
- Fish and shellfish, fish oils
Remember, heating oils removes the benefits
Omega 6 (Linolic acid) sources:
- Vegetable oils corn and sunflower seed oils
Fish oil capsules supply our EFA needs. We suggest 2000 – 3000 mgs of fish oil capsules daily. There may be a problem with some fish oil capsules. Fish around the world are contaminated. Studies are underway, but at this time it appears very safe to take over-the-counter fish oil supplements. We will follow the studies and if it becomes apparent that pharmaceutical grade EFA’s are recommended, we will begin to provide them through our office and recommend the more expensive form. We do provide the pharmaceutical grade through the office because they have less of a “fish burp” side effect. However, if that is intolerable for you and then over-the-counter fish oil capsules will do just fine.
WHAT CAN I DO TO PROTECT MY WEIGHT LOSS OVER THE HOLIDAYS?
The answer to this question is the question itself. Our goal over the holiday doesn’t have to be to lose weight but to MAINTAIN OUR WEIGHT LOSS AND PROTECT OUR NEW GOOD HABITS!
Enjoy the holidays! Those of us with obesity deserve to enjoy the season as much as someone without obesity. But we must balance enjoyment with protecting the progress we have accomplished.
Think about past holidays. What was your downfall? What was the toughest part? Let’s create a plan to address the biggest challenge to you. For example, some problems faced may include:
NOT CONTINUING EXERCISE
TOO MAY CAKES AND PIES
EXCESSIVE LIQUID BEVERAGES (ALCOHOL, EGGNOG, AND OTHERS)
- NO EXERCISE
Use the 6-P PLAN: Prior Planning Prevents Pitifully Poor Performance. Schedule your exercise time more carefully and stick with it. In fact, many people who get extra time off during the holidays actually improve their exercise during this time period.
- CAKES, PIES, AND OTHER DESSERTS
This was my own personal weakness. Initially, I tried denying myself any desserts. This didn’t work for me. Instead I made the following realization: EATING THE WHOLE PIE DOES NOT MAKE THE FIRST PIECE TASTE ANY BETTER!! By thinking this at every meal, I did not totally deny myself desserts but controlled my dessert intake. Remember to follow sugar teaspoon guidelines.
- PORTION CONTROL
This was a really tough one for me and for many of my patients. The medicines we prescribe will help with this. Eat slowly and enjoy the food, savor the flavor, and enjoy the holiday tradition. However, this year, you can start a new tradition: the day following the holiday, you can be proud for taking control of your disease.
4. ALCOHOL AND BEVERAGE CONTROL
This is an additional stress. For me personally, I created the following plan. My not-so-secret plan is simply WATER. I alternate each serving of alcohol with a glass of water. I would even take my empty beer can to the faucet and fill it up with water to keep the liquids flowing and “save the calories”.
|Food||Serving Size||Calories||Carb (g)||Sugar (tsp)||Fat (g)|
|Turkey 4oz. light meat w/o skin||4 oz.||178||0||0||3.7|
|Turkey 4oz. light meat w/ skin||4 oz.||223||0||0||9.4|
|Turkey 4oz. dark meat w/o skin||4 oz.||212||0||0||8.2|
|Turkey 4oz. dark meat w/ skin||4 oz.||251||0||0||13.1|
|Bread stuffing||1/2 Cup||178||22||4.5||9|
|Mashed potatoes||1/2 Cup||111||15||3||4.5|
|Turkey gravy||1/2 Cup||60||7||1.5||3|
|Candied sweet potatoes||1/2 Cup||134||27||5.5||3|
|Cranberry sauce||1/4 Cup||105||27||5.5||0|
|Pumpkin pie||1/8 9″ pie||316||41||8||14|
|Pecan pie||1/8 9″ pie||339||48||9.5||17|
I AM NOT TAKING MY APPETITE SUPPRESSANTS EVERY DAY. IS THIS SOME SORT OF PUNISHMENT FOR NOT CONTINUING MY WEIGHT LOSS?
No. This is not a punishment in any way. We always try to find the lowest dose of medicines and the lowest number of office visits to control the disease.
We spread out the medications from daily medicine to an intermittent dosing schedule in a few different situations.
- You have reached your goal and we are weaning you totally off the medicines.
- You have reached your goal and we are weaning you into a maintenance program.
- You have not reached you goal but your weight loss has reached a plateau.
In this situation, intermittent dosing will often resume you weight loss. If your weight loss does not resume, then we feel we can maintain your loss at the present level. If necessary, we will hit it hard again several months later. In the interim, your office visits will be every few months rather than every month.
We do this for two reasons. First, although the medicines are used by many physicians in long term use, they are actually FDA approved for short term use. Using them long term is considered “OFF LABEL”. Many medicines are used in this manner. We feel patients need to be aware of this usage of the medicine.
Second, as discussed in our patient classes, these medicines have the infrequent potential for becoming psychologically dependent. As long as a patient is making steady progress, daily usage is appropriate. When this progress slows or stops, weaning the dosage is indicated.
- You do not lose weight from the beginning.
If you do not have an adequate response (weight loss) we must try some other way to help get your obesity under control. However, rather than quickly stopping the medicines, we wean them so the hunger returns less quickly.
At any time if you are not sure why the medicines are changed or not changed, please ask the doctor or the staff.
I REACHED MY GOAL, NOW WHAT HAPPENS?
First, congratulations! You receive satisfaction, self esteem, and self-confidence for all of your hard work. Second, you will receive the congratulations of your family, friends, all of our clinic staff, and from your private doctor. Third, you have obtained the physical health, mental health, and social benefits of weight loss.
Stage 1 was losing weight
Stage 2 is transition
That involves a weaning program. A typical weaning program may begin by taking the medicine two days, then skipping a day. Return to the clinic in six weeks. Then the medicine is taken one day on one day off. Return to the clinic in two months. Then the medicine is taken every third day or two times a week. The pills then last for three months. We have an accelerated transition available if there is a reason to get of the medicines in a hurry (e.g. pregnancy planning).
Stage 3 is weight maintenance
Dr. Sani and the staff work with each patient to develop an individual maintenance program. It always includes continuing good nutrition, exercise, and physical activity. It often includes medications. All patients are encouraged to wean the medications down. When medications are used long term, they are to be used at the lowest dosage or intermittently rather than daily.
All patients are given a CAP plan.
C = Control: Your disease is in check.
A = Action: Your disease is backsliding. Try to control it with action.
P = PANIC. You are having a fat attack like an asthma patient has an asthma attack. Call the office for an appointment to resume the weight loss program, including medications.
|Beginning weight 200 pounds and lost to 154. this persons CAP plan would be:C: less than 159A: if scale hits 160, some extra focus on the disease is needed
P: if the scale hits 168, the person is having a fat attack, call the office for help.
Our goal therefore is to never let this person hit the 170’s again. If he/she doesn’t reach 170 they can never hit 180, 190, or 200.
I TRIED SO HARD TO DO SO WELL, WHY DID I STILL GAIN WEIGHT OR NOT LOSE?
Asthma is a disease. People who suffer from asthma will tell you that despite all they try, when an inversion hits the valley, their lungs tend to be worse. They must get extra treatment for their disease. They may get mad at their disease but they don’t get mad at themselves.
Allergies are a biochemical disease. Persons who suffer from allergies will tell you that when trees and flowers bloom, their allergies get worse. They must get extra treatment for their disease. They may get mad at their disease but they don’t get mad at themselves.
Overweight and obesity is a disease. Persons who suffer from obesity will tell you despite all they try to do when certain stressors hit, they “lose control” and their old habits return and their disease gets worse. Both good and bad events can stress our disease. Holidays, birthday parties, family outings, families moving together, vacations, all are good stressors. They are good. They are fun. But they are still stressing our disease. There are bad stressors also: injuries, family losses, money problems, others. They all can stress our disease, allowing us to lose focus and slip into old habits of poor nutrition and lack of exercise.
Sometimes there are biochemical causes of not losing weight. Insulin can block weight loss. In patients with Insulin Resistance (see FAQ Insulin Resistance), sometimes even a slight increase in carbohydrate intake can raise insulin levels enough to block weight loss. Changes in thyroid levels can slow or block continuing weight loss. The doctor may need to do follow-up blood testing.
Sometimes we hit a “comfort zone”. We lose enough weight, we look and feel better. We lose our focus on excellent nutrition and portion control. The doctor and staff will work with you to try and find any of the possible causes for not losing more weight. But sometimes weight loss patients hit a plateau that cannot be explained or corrected.
OBESITY PATIENTS NEED TREATMENT WHEN THEIR DISEASE FLARES UP. Unfortunately, the treatment of obesity doesn’t involve just taking pills. It needs both medication and personal involvement. Let’s not get mad at ourselves, let’s get mad at our disease. Let’s rededicate ourselves to doing the things we must do to control the relapse of our disease.
WHY DID MY WEIGHT LOSS SLOW?
This is a very good question and we all must understand the answer to avoid disappointed. There are several reasons why after losing weight, especially if the first two months showed very good weight loss, the amount of weight loss slows down.
First: If you have lost many pounds by sticking with a very strict diet, the difference from your new weight to your present calorie count is less than the difference between your old weight and your present calorie count. In other words, a 150-pound person just can’t lose as fast and as much as a 250-pound person.
Second: There is a theory that a “set point” exists in our brain that attempts to protect our present weight to some degree. In other words, if our weight is 240 pounds at our present calorie intake and energy metabolism level, if we are working to change our weight, our body will somewhat work against us when we move very far away from our present weight. Many bariatricians (weight loss doctors) feel that one of the advantages of the medicines we prescribe is that it allows this “set point” for our weight to be switched to a lower level. This is not yet been proven scientifically, but studies presented at national conferences strongly support this theory.
Third: As we lose weight, initially our weight loss is approximately 75% fat and 25% lean body tissue. As we exercise and increase our protein intake, we build muscle to replace the lost lean body mass. Therefore, our weight loss changes to primarily fat and we actually may be building our muscle mass. We may lose six pounds of fat and gain three pounds muscle resulting in only a three pound loss on the scale.
There are more reasons but the point is this: don’t be upset with 4 – 6 pounds weight loss in the fourth month after losing ten to twenty or more pounds in the first two months.
WHAT IS GLUCOPHAGE?
Drug Name: Glucophage (Metformin) 500mg, 850 mg (glue-co-fage) Glucophage XR
This medicine is used in the treatment of diabetes, Polycystic Ovarian Syndrome and in the treatment of Insulin Resistance.
Some medicines or medical conditions may interact with this medicine. Inform all doctors or pharmacists of all prescription and over the counter medicines you are taking. Contact our office or your doctor if you have any questions or concerns about using this medicine. Read the patient product information on the back of this sheet for cautions and possible side effects of this medicine.
Take the medicines as directed by Dr. Sani with meals. If you miss a dose, take with your next meal but do not double up the dose.
Using Glucophage (Metformin) to treat Insulin Resistance ( IR)
|Stage||Blood Sugar Level||Fasting Insulin Level||Non-Fasting Insulin Level|
Insulin resistance can prevent weight loss. Glucophage belongs to a group of medicines know as INSULIN SENSITIZERS which help insulin work better so we have lower levels of insulin. This may help patients attempting to lose weight be successful. Studies are under way to show that even if a person doesn’t lose weight, the medicine may help delay the onset of diabetes by years. Use of this medicine in weight loss is considered “off label”. This means the meds were not initially approved by the FDA for this indication. This is a common way for doctors to use many medicines.
Despite helping with the insulin level, the patient must continue to focus on good nutrition. Like other medicines used by weight loss doctors, Glucophage is not a ticket to eat whatever you want or how much you want.
Side effects such as nausea and or diarrhea are fairly common and usually stop within a couple days. If side effects continue for more than one week, stop the medicine and call the office. There is another form of the medicine called Glucophage XR that has lower side effects.
The doctor will follow blood testing to make sure kidney and liver functions continue normal. Typically, this class of medicines do not cause low blood sugar reaction.
Extremely rarely, this medicine can cause a serious condition called Lactic Acidosis. Please read any warning labels prior to usage.
MUST I WEAN SLOWLY OFF MEDICATIONS?
It depends on the medications prescribed. The main group of appetite suppressants may cause fatigue and rebound hunger if the meds are stopped quickly.
Normally, we wean the medications very slowly over a 6-month period. This is the phase known as Transition.
Step 1. Take meds two days and skip a day or skip every Monday and Thursday.
Return to the clinic in 5 weeks.
Step 2. Take meds one day and skip the next.
Return to the clinic in two months.
Step 3. Take the meds one day and skip the next two.
Return to the clinic in three months.
Sometimes, there may be reasons why you can wean off medications at a faster rate. For example, if you are trying to get pregnant, you should wean off the meds quicker.
The following is an example of an accelerated wean starting with 28 pills.
T = take that day S = skip that day
|Week 1 – 2||T T S T T S T T S T T S(take two days, skip a day)|
|Week 3 – 4||T S T S T S T S T S T S(take one day, skip a day)|
|Week 5 +||T S S T S S T S S T S S(Take one day, skip two days and continue until out of pills)|