Against the grain: Obese patients should eat a diet low in carbohydrates
In treating obesity, physicians often make two major mistakes, said Adam S. Nally, DO, in an OMED presentation today. They choose the wrong diet for their patients, and they focus more on exercise as an engine of weight loss.
Dr. Nally noted that he once employed these methods in his practice, too.
“I had one lady come into my office,” said Dr. Nally, an AOA board-certified family physician who practices in Surprise, Ariz. “She said, ‘Dr. Nally, I’ve been seeing you for eight years, and every year you give me a new pill.’
“And that’s about [what I was doing]. Every year, [patients] came in, and they got a new pill from me because their blood pressure went up, their cholesterol went up and they were gaining weight. I was telling them to eat a low-fat diet and exercise, and they were doing it, and they were still getting fat.”
To understand how he could help his patients lose weight, Dr. Nally studied bariatric medicine. He said he learned that instead of focusing on exercise and calories, physicians need to identify what’s causing patients to gain weight, which is often insulin resistance, and help them choose less insulinogenic foods that will make weight loss easier.
Most of the cases of obesity Dr. Nally sees are caused by insulin resistance, he said. The high-carbohydrate, high-sugar diet common in the U.S. contributes to obesity because insulin directs fat to be stored and carbohydrates to be used as the body’s main fuel source. Over time, as fat cells become larger, they produce hormones that drive insulin resistance, he said.
“For those of you who say, ‘Dr. Nally, I like my doughnuts. I ate a doughnut, and then I went and ran for 30 minutes,’ what you have to realize is that you probably only burned 100 calories of the 220 calories that you got from that donut,” Dr. Nally said. “And that the rest of that glucose is converted through the mitochondria into triclyceride, and it went right into the fat cells because you produced insulin from that doughnut.”
Insulin resistance is reversible with a low-carbohydrate diet, Dr. Nally said. Eventually, fat cells can stop producing inappropriate hormones.
Dr. Nally follows a low-carbohydrate diet and counsels his obese patients to do the same. They’ve had success eating fewer grains, breads and sugar-rich foods, and some patients have even reversed their diabetes.
Terri A. Nickel, DO, said Dr. Nally’s presentation confirmed what she’s seen in her patients in her Wichita, Kan., practice.
“My patients on low-carb diets have been more successful than those trying to restrict fats,” she says. “Because if you restrict the fats too much, your body will make you eat more in order to get the fat that it needs to function on a daily basis. What I usually tell patients to do is to balance their carbs and their protein. It’s not that they can’t have carbs, but they have to have an equal amount of protein.”