Healthy Weight Management: General Nutrition Tips

Losing weight should not be seen as a goal in itself, but as a tool for a healthier life. It is a known fact that overweight people have higher cardiovascular risks and are more likely to have health problems such as type 2 diabetes and metabolic syndrome. In addition to improving our appearance while losing weight, being healthier in biological and physiological aspects is an important goal for us.

If you do not have enough information about weight control and healthy nutrition, it is very important to get help from a nutritionist. In addition, if you think you have an eating disorder and that this eating disorder has a psychological/psychiatric basis, you should definitely consider getting help from a psychologist or psychiatrist. If you have reservations about this or do not know how to proceed, please ask for help during your consultation with Dr. Ahmet Özyiğit.

General Nutrition Recommendations

There are three types of macronutrients (macromolecules) that are essential for human health. These are called carbohydrates, proteins and fats. Our body also needs each macromolecule. That's why restrictive diets such as ketogenic and dukan diets can have negative consequences on health in the long term. It is considered appropriate for an average adult to have the following daily nutrients¹:

Carbohydrate: 45-65%

Protein: 10-35%

Oil: 20-35%

When we think of carbohydrates, we usually think of foods like bread, pasta and rice, but vegetables, legumes and many other foods are rich in carbohydrates. The difference is that carbohydrate foods like sugar, bread, rice and pasta have a high glycemic index, while carbohydrate foods like vegetables and legumes have a lower glycemic index.

The glycemic index shows how quickly a food turns into sugar and mixes with the blood. Since foods with a high glycemic index will rapidly increase sugar and subsequently insulin levels, they will have negative effects on insulin resistance, reactive hypoglycemia and type 2 diabetes. It is recommended that people with insulin resistance, diabetes or reactive hypoglycemia consume foods with a lower glycemic index.²Consumption of foods with a high glycemic index, especially after prolonged fasting, can also lead to eating disorders as it causes imbalances in sugar and insulin levels in the body.

The healthy fats our body needs are mostly omega-3 and omega-6 fats. These fats, found in foods such as fish, olive oil, avocado and bananas, should be a part of our nutritional ritual. However, animal fats and margarines with high saturated fat content can be left out of our daily food consumption.

Our meals should definitely be protein and vegetable based. Simple carbohydrates (pasta, rice, bread) should only make up a small portion of our plate. Never start a meal with simple carbohydrates. Since the glycemic index of simple carbohydrates is very high, you will experience sudden sugar and insulin spikes. For example, if a person who has been hungry for a long time feels sleepy after consuming pasta, pizza, bread, rice, or something similar, or if they have a desire to eat sweets for a while, this could be a sign of a condition called reactive hypoglycemia. Reactive hypoglycemia is a condition caused by insulin secreted uncontrollably in the face of sudden increases in sugar. Such imbalances are the cause of diabetes and eating disorders in the future.

Semaglutide (Ozempic or Wegovy) Injection

Semaglutide injection is a drug called glucagon-like peptide, or GLP-1 analog. You may also know this drug by its trade name Ozempic or Wegovy.

Semaglutide injection, which has been frequently mentioned recently with its success in appetite control and weight loss, has gained serious demand because it is applied once a week and its side effect profile is quite innocent.

This medicine has certain basic effects. These are mainly^6,7,8:

• Appetite control and reduced interest in food and drinks
• The slowing down of the passage of food from the stomach to the intestines after eating, and therefore the feeling of fullness in the stomach lasting longer than normal.
• By balancing the dopamine level in the brain, some foods and drinks that our brain perceives as rewards do not give the same pleasure.

This last item is actually quite important because the biggest complaint of most of my patients is the desire to eat even when they are full and the pathological level of food consumption. The ability of this drug to regulate this pathological condition coming from the brain also prevents the situation of binge eating or binge drinking, also known as "binge eating disorder" or limitless eating or drinking.

People who will benefit from this treatment can be grouped as follows:

– People with eating disorders and an unhealthy relationship with food

– People with large portions and above-normal food intake

– People with insulin resistance

– People who consume too much alcohol and develop health problems due to it

Recently, the Food and Drug Administration (FDA) of the United States has approved the use of this drug for people over the age of 12. In other words, it is appropriate to treat children with weight and eating problems before they become even bigger. Before starting treatment, certain tests should be performed and treatment should be applied accordingly. Applying this treatment on your own without consulting a physician and passing certain tests may have negative results. After all, it is a drug that will be used and the dosage and duration of use should be designed specifically for the person.

Before starting Semaglutide injections, some medical tests are necessary to ensure that the treatment is safe and effective. Semaglutide is a medication used primarily for managing sugar balance and weight loss. It affects blood sugar levels and affects metabolic functions.

Why Should I Get Tested Before I Start?

1- Assessment of Baseline Health Status: It is important to evaluate the function of the liver and kidneys at the beginning. Every drug is metabolized either by the liver or the kidneys. Therefore, it is important to look at the general health of these organs when starting any drug.

2- Identifying Other Health Problems: Especially for patients with thyroid disorders, the main source of the weight problem may be inadequate thyroid function. Therefore, before starting treatment, it is important to determine if there is another problem underlying the weight problem. If there is an increase in pancreatic enzymes, it is important to investigate this and not to use drugs that may affect the pancreas.

3- Comparison of Before and After Treatment: Since it is generally expected that there will be an improvement in health parameters, it is important to perform tests to be able to compare before and after.

Common Tests Before Starting Semaglutide

1. Blood Glucose Tests (FPG, Homa-IR and HbA1c): It is done to evaluate current blood sugar levels and long-term blood sugar control. In addition, the person's insulin resistance is evaluated.

2. Kidney Function Tests (Creatinine and BUN)Semaglutide injection may affect kidney function, these tests evaluate the baseline of kidney health.

3. Liver Function Tests (ALT, AST, GGT, Bilirubin): It is important to make sure that the liver can metabolize the drug effectively.

4. Thyroid Function Test (TSH, fT4): Semaglutide may not be suitable for people with thyroid cancer or certain thyroid diseases. At the same time, it is more meaningful for people with thyroid disorders to first correct their thyroid disorder.

5. Pancreatic EnzymesSemaglutide can affect the pancreas, so these enzymes are checked to rule out existing pancreatic problems.

6. Lipid Profile: It is done to assess cholesterol levels because managing metabolic health can require a holistic approach, especially for weight loss.

If abnormalities are observed in these tests, further examinations (such as thyroid USG, whole abdomen USG) may be requested.

What is the Success Rate with Semaglutide Injection?

Semaglutide (Ozempic or Wegovy) is far superior to the previously released drug liraglutide (Saxenda). The weight loss achieved with liraglutide is on average %8.3 of the initial body weight, while⁹, Semaglutide ile kilo kaybı başlangıç kilosuna göre vücut ağırlığının %15’inin üzerindedir¹⁰.

Liraglutide kullanan kişilerin %54’ünde anlamlı bir kilo kaybı görülmüştür¹¹. Semaglutide kullanan kişilerde kilo verme başarısı %86 olarak ölçülmüştür¹². That is, 86 out of every 100 people who use semaglutide manage to lose weight. On the other hand, 14 out of 100 people who receive treatment do not benefit from this treatment. One of the main reasons for this may be chronic inflammation or inflammation.

People who are not successful in losing weight or suppressing their appetite with Semaglutide injection are likely to have chronic inflammation, or even chronic inflammation that disrupts metabolic activity, i.e. metainflammation.

Metaflamason: Inflammation that Becomes Chronic and Disrupts Metabolic Regulation

Long-lasting chronic inflammation in the body is an important underlying factor in metabolic diseases and is a type of chronic, low-grade, unresolved inflammation seen especially in obesity and age-related pathologies. This metabolically orchestrated state is closely related to basic vital functions such as the regulation, diversity and quantity of energy and nutrients, and the management of macromolecular synthesis and degradation processes. These systems, which are vital for a healthy organism, play critical roles especially in the physiology and pathology of chronic metabolic diseases.¹³.

Metaflammation is a new term that describes the disorders caused by long-term chronic inflammation in critical metabolic organs. This situation causes problems such as chronic inflammation, dyslipidemia, and insulin resistance, laying the groundwork for obesity and age-related pathologies such as diabetes, fatty liver, cardiovascular and respiratory problems, and cancer.¹⁴.

Management and understanding of metainflammation is an important goal of modern medicine because it is considered a key factor in a wide range of metabolic diseases. Dietary and lifestyle changes, anti-inflammatory therapies, and drugs aimed at metabolic regulation are among the potential strategies for managing this process.

Metaflammation causes your body to develop insulin resistance and be unable to use glucose effectively. This causes blood sugar to rise and insulin levels to increase, acting as an obstacle to weight loss. Additionally, increased metaflammation leads to fat cells growing larger and larger, which can make weight loss efforts more difficult. In short, metaflammation is a problem that can both cause weight gain and hinder weight loss.

If we look at the relationship between obesity and metaflammation, inflammation in the fat tissue (or inflammation, as it is also called) makes the existing fat tissue dysfunctional. Although fat tissue is a phenomenon that is seen as undesirable or bad, the ideal amount of fat tissue plays very important roles in many activities in our body. Loss of fat tissue function not only contributes to insulin resistance, but also affects the secretion of adipokines, which play a role in metabolic regulation. Adipokines are cytokines secreted by adipose tissue. Adipokines are cytokines that have both good and bad effects. Secretion in certain amounts is a condition that protects the heart, protects against insulin resistance and metabolic problems, and plays a role in the immune system. On the other hand, excessive amounts of secretions, or situations where dysfunctional fat tissue cannot secrete effectively, bring about metabolic imbalances and resistance to weight loss. At this point, even semaglutide or other GLP1 analogs fall short, and we find a significant barrier to weight loss in individuals.

Lifestyle changes known to help reduce metaflammation include a healthy and anti-inflammatory diet, exercise and sports, as well as food supplements that help reduce chronic inflammation in the body.

Managing chronic inflammation is vital to overall health and can help prevent many diseases associated with aging, such as heart disease, diabetes and cancer. Certain supplements can help manage chronic inflammation due to their anti-inflammatory properties and may be beneficial when used in conjunction with a healthy lifestyle. Here are supplements with evidence supporting anti-inflammatory effects:

1. Omega-3 Fatty Acids: Balık yağı, krill yağı ve yosun yağı gibi kaynaklarda bulunan omega-3 yağ asitleri (EPA ve DHA), bilinen anti-inflamatuar özelliklere sahiptir. İltihapla ilişkili maddelerin (örneğin inflamatuar eikozanoidler ve sitokinler) üretimini azaltabilir ve kronik iltihaplanmanın azalmasına katkı sağlayabilirler. Omega 3 yağ asitleri özellikle ileri yaşlarda kardiyovasküler risklerin azaltılmasında da ciddi boyutta rol oynarlar. Omega-3 yağ asitlerinin istenilen düzeyde olan kişilerin, omega-3 yağ asitleri düşük olan kişilere oranla kardiyovasküler sebeplerden ve kanser’den dolayı ölüm riskinin %13 daha düşük olduğu kapsamlı bilimsel çalışmalar ile ortaya konmuştur¹⁵.

2. Curcumin (Turmeric): Curcumin, the active component of turmeric, has powerful anti-inflammatory and antioxidant properties. However, curcumin is poorly absorbed from the intestine, so it is recommended to take it together with piperine, which is often found in black pepper, to increase absorption. Some curcumin preparations have a stronger absorption because they contain piperine. If curcumin supplements are to be used, preparations prepared with piperine should be preferred. There are scientific studies showing that it contributes to weight loss, especially in chronic conditions due to metaflammation.¹⁶.

3. Astralagus (Chinese Green Tea) Extract: Green tea contains polyphenols such as epigallocatechin gallate (EGCG) and has anti-inflammatory and antioxidant effects. On the other hand, Chinese tea, specifically known as Astralagus, causes increased telomerase activity, as well as anti-inflammatory and antioxidant effects. This feature, revealed by scientific studies, contributes to extending human life by causing telomere length in chromosomes to lengthen or decrease the rate of shortening.¹⁷.

4. Resveratrol and PterosylbeneFound in grapes, berries, and peanuts, resveratrol has been studied for its anti-inflammatory and antioxidant properties and may protect against chronic diseases. Pterosylbene is a stilbenoid chemically related to resveratrol. According to studies, it can be said that its absorption and activity in the body is higher than resveratrol. The antioxidant activity of pterosylbene has been extensively studied and has been shown to play a role in anti-carcinogenesis, modulation of neurological disorders, healing of vascular diseases and treatment of diabetes.¹⁸.

5. Vitamin D: Adequate levels of vitamin D are important for immune function and may help reduce the risk of chronic inflammatory diseases. It is known that the risk of chronic inflammation is much higher in people with vitamin D deficiency. For this reason, vitamin D supplementation in people with low vitamin D levels may help reduce chronic inflammation.

6. Alpha-Lipoic Acid: This antioxidant plays a role in cellular energy metabolism and has been observed to have anti-inflammatory effects, particularly in reducing inflammation associated with insulin resistance, heart disease, and other conditions.¹⁹.

It is important to approach the use of supplements with caution, as some supplements may interact with some medications and may not be suitable for everyone. Taking all supplements at the same time may also have undesirable consequences, because although antioxidants and supplements with anti-inflammatory properties are a method to restore our metabolic health, the presence of some oxidants in our body is also important for the active and proper functioning of the immune system. While repairing oxidative damage, it is very important not to cause reductive damage. Therefore, arranging a special treatment for you in line with your health complaint is the best method for your health. Doctors who specialize in anti-aging should always be consulted before starting a new supplement, especially to manage chronic conditions.

Lifestyle changes such as a healthy diet, regular exercise, adequate sleep and stress management are always elements that should be added to your life along with such supplements. Supplements alone are not enough to make you a healthy individual and are not a substitute for living a healthy life. Elements such as exercise and nutrition are always indispensable parts of a healthy life.

In addition, stress management, sleep hygiene and intestinal health are also important elements for weight loss.

Stress management If activities such as breathing exercises, meditation or yoga are not suitable for you or are not enough to reduce your stress level, Ashwagandha Supplements such as these can be very useful for stress management with their natural and additional health benefits.

Optimization of intestinal health, is very important for reducing bloating, preventing constipation and strengthening the gut-brain relationship in general. In order to maintain intestinal health, it is necessary to prepare an optimal environment where beneficial bacterial flora can live. This environment should be an environment where packaged foods and sugar consumption is very low, and plenty of vegetables and fibrous foods are consumed. In addition, periodic prebiotic and probiotic support is also very important. Prebiotics are foods that provide an ideal environment for the colonization of beneficial bacteria in the intestines. For example, foods such as whole grains, bananas, green vegetables, onions, garlic and artichokes are prebiotic foods. Probiotics, on the other hand, are supplements that add beneficial bacteria to the intestinal flora. In other words, they contain these bacteria. For example, yogurt, kefir or supplements sold in pharmacies are probiotic supplements. We can improve our intestinal flora with probiotic supplements and ensure the sustainability of this environment with prebiotics.

Optimization of sleep qualityIn general, waking up feeling rested and functioning at a better level is something everyone wants. However, both stress and medical conditions such as sleep apnea can cause a decrease in sleep quality.

What are the possible side effects?

Semaglutide injection may cause some common and rare side effects. These side effects are usually more noticeable during the first weeks of dosing and may decrease as your body gets used to the medicine.

1. Common Side Effects

Bu yan etkiler semaglutide kullananların %10’unda veya daha fazlasında görülebilir.

Nausea: This is one of the most common side effects and usually subsides once treatment is started.

Vomiting: May occur especially at high doses or in the early stages of treatment.

Diarrhea: Another common side effect; it is usually mild and temporary.

ConstipationSemaglutide can affect bowel movements and may cause constipation in some users.

Stomach acheSide effects such as nausea, vomiting or constipation may occur.

These side effects can usually be observed in the first weeks and then gradually disappear. In order to avoid constipation problems, it is very important to include high-fiber foods in our diet and to drink plenty of water.

2. Less Common Side Effects

Bu yan etkiler, %1 ila %10 arasında bir sıklıkla görülebilir.

Loss of appetite: In some people, the decrease in appetite may be greater than normal. In this case, it may be necessary to reduce the dose of the drug or reduce the frequency of injections.

Indigestion (Dyspepsia): Heartburn, gas and discomfort may occur. In such cases, depending on the severity of the side effect experienced, a short-term stomach protective supplement or adjustment of food intake may be necessary, or in very severe cases, it may be necessary to stop the injection.

HeadacheHeadache: Some people may experience headaches associated with the use of Semaglutide. This usually occurs 1-2 days after the injection.

Fatigue and Weakness: Some users may feel sluggish or lack energy. The main reason for this may be loss of appetite and lack of necessary vitamins and minerals. Therefore, it is important to establish the right balance of proteins and vegetables.

3. Rare Side Effects

These side effects may occur at a lower frequency than with %1.

Gallbladder Problems: Problems such as gallstones and gallbladder inflammation can be seen, although rare. The reason for this is usually not a direct side effect of the drug, but rather related to rapid weight loss.

Pancreatitis (Inflammation of the Pancreas): It is a rare but serious side effect; there may be a very rare possibility of pancreatitis developing in semaglutide users. Although there are serious scientific publications that do not support such a relationship, this possibility is still taken into consideration.

Thyroid ProblemsAn association with thyroid C-cell tumors has been observed in clinical studies, particularly at high doses, but this risk has not been confirmed in humans.

Kidney ProblemsSemaglutide may affect kidney function, especially when accompanied by severe nausea or vomiting, which may cause dehydration. It is important to establish a correct fluid balance and to consult your physician in cases of excessive fluid loss.

4. Very Rare Side Effects

These side effects occur at a frequency less than %0.1.

Allergic ReactionsSerious allergic reactions such as skin rash, itching or difficulty breathing are very rare.

Retinopathy (Visual Disorders): It is especially seen more in diabetic patients; it may occur with symptoms such as bleeding in the eye or loss of vision. It is not known whether this condition is related to this ejection, but the fact that it can be seen in type 2 diabetic patients while using this drug increases this possibility. However, the fact that this disorder is also seen in type 2 diabetic patients who do not use this drug weakens the possibility of it being a side effect of this drug.

Suggestions to Reduce Possible Side Effects:

Dosage Adjustment: Starting the dose slowly and increasing the dose gradually reduces the severity of side effects. Therefore, Dr. Ahmet Özyiğit's protocols proceed in a way that does not include rapid dose increases.

Drink Plenty of Water: It is especially important for side effects such as nausea and vomiting; the body's fluid balance is maintained.

Use with FoodSome people may find that taking the injection with or after food reduces nausea.

Although side effects are usually mild or moderate in severity, it is important to seek medical attention if you experience any serious side effects or discomfort.

References

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10. Garvey, W.T., Batterham, R.L., Bhatta, M. et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med 28, 2083–2091 (2022). https://doi.org/10.1038/s41591-022-02026-

11. Davies, M. J. et al. (2015) 'Efficacy of liraglutide for weight loss among patients with type 2 diabetes', JAMA, 314(7), p. 687. doi:10.1001/jama.2015.9676. 

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16. Unhapipatpong, C. et al. (2023) 'The effect of curcumin supplementation on weight loss and anthropometric indices: An umbrella review and updated meta-analyses of randomized controlled trials', The American Journal of Clinical Nutrition, 117(5), pp. 1005–1016. doi:10.1016/j.ajcnut.2023.03.006. 

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