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Therapeutic Carbohydrate restriction

Therapeutic Carbohydrate restriction

Therapeutic Carbohydrate restriction

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Therapeutic carbohydrate restriction refers to any dietary intervention that uses less than 130 grams of dietary carbohydrate per day. This is the “minimum” level recommended by the U.S. DietaryReference Intake (Institute of Medicine, 2005). However, there are different levels of carbohydrate restriction. 

  • Very low-carbohydrate ketogenic diets — or keto diets — are ones that recommend no more than 20 grams of net dietary carbohydrate per day.  Most patients find these diets very satiating. We do not recommend that patients restrict their calories or count calories, but simply eat to satiety.
  • Moderate low-carbohydrate diets recommend 20 to 50 grams of dietary carbohydrate per day(Saslow et al., 2017). This level of carbohydrate restriction may or may not result in nutritional ketosis. However, most individuals will still lose weight and improve metabolic markers at this level of carbohydrate intake (Saslow et al., 2017). As with very low-carbohydrate ketogenic diets, deliberate calorie restriction is not typically recommended on a moderate low-carb diet.
  • Liberal low-carbohydrate diets typically recommend 50-100 grams of dietary carbohydrate per day. This carbohydrate level is higher than most low-carb diets, but lower than 130 grams set by the U.S. Daily Recommended Intake (DRI). At this level, calorie restriction may or may not beused along with limiting dietary carbs.
    This liberal level of carbohydrate restriction may not result in nutritional ketosis or weight
    loss for some people. However, studies have shown that even mild carbohydrate restriction can improve certain metabolic markers like blood sugar, high density lipoprotein cholesterol (HDL- C) and triglycerides (Esposito et al. 2009, Krauss, Blanche, Rawlings, Fernstrom, & Williams. 2006; Lasker, Evans, & Layman, 2008; Sasakabe, Haimoto, Umegaki, & Wakai, 2011).

CONTRAVE® (NALTREXONE AND BUPROPION)

Therapeutic Carbohydrate restriction

Therapeutic Carbohydrate restriction

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CONTRAVE® combines low dose naltrexone, a medication commonly used to manage alcohol and opiod dependency, and Bupropion, an atypical antidepressant that is also prescribed for smoking cessation  These medicines work on two separate areas of the brain that are involved in controlling eating (hunger and cravings). CONTRIVE® is delivered in the form of an oral tablet; at the maximum recommended dose of 2 tablets twice daily.  In Canada it is approved for use (alongside a reduced calorie diet and increased physical activity) in adult patient with 

  • A  body mass index (MVI) of 30kg/M2 or higher or 
  • A  BMI of 27 KG/M2 or above with the presence of at least one weight-related condition such as Hypertension, Type 2 Diabetes or Dyslipidemia.  

SAXENDA® (LIRAGLUTIDE)

SAXENDA® (LIRAGLUTIDE)

SAXENDA® (LIRAGLUTIDE)

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GLP-1 (or glucagon-like peptide-1) is a hormone that is found naturally in your body that has effects on appetite and food intake. Saxenda® is a GLP-1 therapy that is similar to the natural GLP-1 found in your body. Saxenda® is thought to help patients lose weight by decreasing appetite and the amount you eat. Studies with Saxenda® have also shown that it may also improve other health factors beyond weight, including waist circumference, blood sugar, blood pressure and cholesterol levels. Saxenda® comes in a prefilled pen that you can use to self-inject.In Canada, Saxenda® is indicated along with a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of:

  • 30 kg/m2 or greater, or
  • 27 kg/m2 or greater in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes or dyslipidemia) and who have failed a previous weight management intervention.

XENICAL® (ORLISTAT)

SAXENDA® (LIRAGLUTIDE)

SAXENDA® (LIRAGLUTIDE)

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In order for fats from foods you eat to be absorbed into the body, they need to be broken down by enzymes called lipases. When Xenical® is taken with meals, it prevents these enzymes from working and causes a decrease in the amount of fat your body absorbs from your food. When you absorb less fat, you take in fewer calories, leading to weight loss. Xenical® does not decrease or change your appetite. Studies with Xenical® have also shown that it may also improve other health factors beyond weight, including waist circumference, blood sugar, blood pressure and cholesterol levels. Xenical® is administered as a capsule during or just following each main meal.

Bariatric Surgery

Weight loss surgery changes the way your digestive system works by closing off parts of the stomach. Making the stomach smaller means that you feel full after eating a small amount of food. Operations that reduce stomach size are known as restrictive operations because they restrict the amount of food the stomach can hold. Some operations combine restriction with a partial bypass of the small intestine (the intestines are where food and nutrients are absorbed into the body). By creating a detour around part of the intestine, less food is absorbed. Operations that use this mechanism to enhance weight loss are called malabsorptive operations. There are a number of different restrictive and malabsorptive operations being done. Here at Capital Health, we are doing a restrictive procedure called the “sleeve gastrectomy”, also called the gastric sleeve resection. Other types of weight loss surgeries are not done here. These include the laparoscopic adjustable gastric band procedure (LAGB) (stomach band, a restrictive operation), the Roux-en Y gastric bypass, the biliopancreatic diversion (a malabsorptive operation), and the duodenal switch (a malabsorptive operation). Information on these procedures can be found at: http://win.niddk.nih.gov/publications/gastric.h

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Halifax Obesity Network

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Halifax Obesity Network

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vertical-sleeve-gastrectomy (1) (pdf)

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