MEDEXCLINIC medical weight loss program relieves many symptoms associated with obesity.

• Type 2 diabetes
• High blood pressure
• High cholesterol
• Coronary artery disease
• Chronic back pain

KETOGENIC Diet:
Ketogenic diet eliminates carbohydrates. For most effective weight loss, you will need to keep the total number of carbohydrate grams to fewer than 20 grams per day.

Always check the label and make sure that the carbohydrate count is

• 1 to 2 grams or less for meat and dairy products,
• 5 grams or less for vegetables.

All food may be cooked in a

• microwave oven
• baked
• boiled
• stir-fried
• sautéed
• roasted
• fried (with no flour, breading, or cornmeal)
• grilled

KETOGENIC DIET
CONSUME FOLLOWING FOODS:

Meat: Beef (preferably grass-fed & hormone-free), Goat, Lamb, Veal.
Check the label carbohydrate count should be about 1 gram per serving (and be organic if able and nitrate free).

Poultry: Chicken, turkey, duck, or other fowl.

Fish and Shellfish: Any fish, including tuna, salmon, catfish, bass, trout, tilapia, red snapper, pompano, shrimp, scallops, crab, and lobster (no farmed seafood, there are too many toxins in them).

Eggs: Whole eggs (Preferably Cage-free, vegetable-fed have higher omega-3 content)

• You do not have to avoid the fat that comes with the above foods.
• You do not have to limit quantities deliberately, but you should stop eating before you feel full.

DAILY FOOD ITEMS:
Salad Greens: 2 cups a day.
Includes arugula, bokchoy, cabbage (all varieties), chard, chives, endive, greens (all varieties, including beet, collards, mustard, and turnip), kale, lettuce (all varieties), parsley, spinach, radicchio, radishes, scallions, and watercress. (If it is a leaf, you may eat it.)

Vegetables: 1 cup (measured uncooked) a day.
Includes artichokes, asparagus, broccoli, Brussels sprouts, cauliflower, celery, cucumber, eggplant, green beans (string beans), jicama, leeks, mushrooms, okra, onions, pepper pumpkin, shallots, snow peas, sprouts (bean and alfalfa) sugar snap peas, summer squash, tomatoes, rhubarb, wax beans, zucchini.

Bouillon: 2 cups daily—as needed for sodium replenishment.
Clear broth (consommé) is strongly recommended, unless you are on a sodium-restricted diet for hypertension or heart failure.

LIMITED QUANTITIES FOODS ITEMS:
Cheese: up to 4 ounces a day. Includes hard, aged cheeses such as Swiss and Cheddar, as well as Brie, Camembert blue, mozzarella, Gruyere, cream cheese, goat cheeses.

Avoid processed cheeses, such as Velveeta.
Check the label; carbohydrate count should be less than 1 gram per serving.

Cream: up to 4 tablespoonfuls a day.
Includes heavy, light, or sour cream (not half and half).

Mayonnaise: up to 4 tablespoons a day. Duke’s and Hellmann’s are low-carb. Check the labels of other brands.

Olives (Black or Green): up to 6 a day.

Avocado: up to 1/2 of a fruit a day.

Lemon/Lime Juice: up to 4 teaspoonfuls a day.

Soy Sauces: up to 4 tablespoons a day. Kikkoman is a low carb brand. Check the labels of other brands.

Pickles, Dill or Sugar-Free: up to 2 a servings a day. Mt. Olive makes sugar-free pickles. Check the labels for carbohydrates and serving size.

Snacks:
NUTS: RAW & UNSLATED nuts and seeds are allowed.
upto 1 ounce a day are allowed (almonds, peanuts, walnuts, pine nuts, sunflower seeds, flax seed, pumpkin seeds, sesame seeds, pistachio (unsalted, not honey-glazed, Just plain nuts).


NOT ALLOWED ITEMS:
CARBOHYDRATES
On ketogenic diet, no sugars (simple carbohydrates) and no starches (complex carbohydrates) are eaten.
The only carbohydrates encouraged are the nutritionally dense, fiber-rich vegetables listed.
Sugars are simple carbohydrates.

Avoid these kinds of foods:

• white sugar
• brown sugar
• honey
• maple syrup
• molasses
• corn syrup
• beer (contains barley malt)
• milk (contains lactose)
• flavored yogurts
• fruit juice
• fruit

Starches are complex carbohydrates.
Avoid these kinds of foods:

• grains (even “whole” grains)
• rice
• cereals
• flour
• cornstarch
• breads
• pastas
• muffins
• bagels
• crackers
• “starchy” vegetables such as slow-cooked beans (pinto, lima, black beans)
• carrots
• parsnips
• corn
• peas
• potatoes
• French fries
• potato chips

FATS AND OILS
All fats and oils, even butter, are allowed.

Olive oil and peanut oil are especially healthy oils and are encouraged in cooking.
Avoid margarine and other hydrogenated oils that contain trans fats.

For salad dressings, the ideal dressing is a homemade oil-and-vinegar dressing, with lemon juice and spices as needed.
Blue-cheese, ranch, Caesar, and Italian are also acceptable if the label says 1 to 2 grams of carbohydrate per serving or less.

Avoid “lite” dressings, because these commonly have more carbohydrate.
Chopped eggs, and/or grated cheese may also be included in salads.

Fats, in general, are important to include, because they taste good and make you feel full. You are therefore permitted the fat or skin that is served with the meat or poultry that you eat, as long as there is no breading on the skin. Do not attempt to follow a low-fat diet!

SWEETENERS AND DESSERTS:
Dr. Nouman do not recommend any artificial sweeteners.
But If you feel the need to eat or drink something sweet, you should select: Splenda or Stevia.

BEVERAGES
Drink as much as you would like of the allowed beverages. The best beverage is water. Essence-flavored seltzers (zero carbs) and bottled spring and mineral waters are also good choices.

Caffeinated beverages:
Wean-off yourself with caffeinated beverages. Initially you may have difficulty getting off the coffee or tea, but it may not take even a week that you will not be dependent on these drinks. For the first week, switch to 1 cup a day Coffee or Tea (black, or with artificial sweetener),
Later switch to 1 cup of Green Tea (unsweetened).

ALCOHOL
At first, avoid alcohol consumption & eat healthfully on this diet.
But if 1 low carb drink will make you stay with this diet plan much more successfully then have it.

QUANTITIES
The diet works best if you eat whenever you are hungry; try not to eat more than what will satisfy you. Learn to listen to your body. A low-carbohydrate diet has a natural appetite-reduction effect to ease you into the consumption of smaller and smaller quantities comfortably. Therefore, do not eat everything on your plate just because it’s there. On the other hand, don’t go hungry! You are not counting calories. Enjoy losing weight comfortably, without hunger or cravings.

It is recommended that you start your day with a nutritious low-carbohydrate meal.

IMPORTANT TIPS AND REMINDERS
The following items are NOT on the diet: sugar, bread, cereal, flour-containing items, fruits, juices, honey, whole or skimmed water, milk, yogurt, canned soups, dairy substitutes, ketchup, sweet condiments and relishes.

Avoid these common mistakes: Beware of “fat-free” or “lite” or “slim” diet products, and foods containing “hidden” sugars and starches (such as coleslaw or sugar-free gums, drinks, cookies and cakes). Check the labels of liquid medications, cough syrups, cough drops, and or other over-the-counter medications that may contain sugar. Avoid products that are labeled “Great for Low-Carb Diets!”

Weight loss medications should never be used during pregnancy, and weight loss is not advised during pregnancy. Women who are thinking about becoming pregnant should avoid these drugs, as they may harm an unborn baby.

ADIPEX OR PHENTERMINE
Phentermine is a stimulant that is similar to an amphetamine. Phentermine is an appetite suppressant that affects the central nervous system.

Phentermine is used together with diet and exercise to treat obesity (overweight) in people with risk factors such as high blood pressure, high cholesterol, or diabetes.

Do not use phentermine if you are pregnant or breast-feeding a baby.

You should not take phentermine if you have a history of heart disease, severe or uncontrolled high blood pressure, overactive thyroid, glaucoma, if you are in an agitated state, or if you have a history of drug or alcohol abuse.

Do not use phentermine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

HOW TO TAKE ADIPEX OR PHENTERMINE

Considerations for people taking phentermine include the following:

• Phentermine comes in tablet and capsule form. It is usually taken by mouth once daily, although some people may need to take it twice a day.
• Your dose should be taken either before breakfast or one to two hours after breakfast.
• This medication should be combined with an appropriate diet. It is not meant to be used without dieting.
• Do not take phentermine more often or at higher doses than prescribed, as this can lead to addiction or dependence.
• For the medication to work properly, it must be taken as prescribed.
• If you are unsure about anything related to your phentermine dosage, please talk to your doctor or pharmacist.

What should I discuss with my healthcare provider before taking Adipex-P (phentermine)?
Do not use phentermine if you have taken an MAO inhibitor in the past 14 days.
A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

You should not take phentermine if you are allergic to it, or if you have:

• a history of heart disease (coronary artery disease, heart rhythm problems, congestive heart failure, pulmonary hypertension);
• severe or uncontrolled high blood pressure;
• overactive thyroid;
• glaucoma;
• if you are pregnant or breast-feeding;
• if you are in an agitated state;
• if you have a history of drug or alcohol abuse; or
• if you are allergic to other diet pills, amphetamines, stimulants, or cold medications.
• Taking phentermine together with other diet medications such as fenfluramine (Phen-Fen) or dexfenfluramine (Redux) can cause a rare fatal lung disorder called pulmonary hypertension.
• Do not take phentermine with any other diet medications without your doctor’s advice.

To make sure you phentermine is safe for you, tell your doctor if you have:

• high blood pressure;
• diabetes;
• kidney disease; or
• thyroid disorder.
• Weight loss during pregnancy can harm an unborn baby, even if you are overweight. Do not use phentermine if you are pregnant.
• Phentermine can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking phentermine.
• Do not give this medication to a child younger than 16 years old.
• Phentermine may be habit forming.
• Never share phentermine with another person, especially someone with a history of drug abuse or addiction.
• Keep the medication in a place where others cannot get to it.

Phentermine-Topiramate (Qsymia)
In July 2012, the FDA approved the drug combination phentermine and topiramate, sold as Qsymia (pronounced kyoo-sim-EE-uh) to treat obesity in adults. Qsymia combines two FDA-approved drugs:

• Phentermine, a medicine approved to suppress appetite.
• Topiramate, a medicine approved to control seizures. It may also be used to prevent migraine headaches. It is in an extended-release form in Qsymia.

The doses used in Qsymia are much lower than the usual doses of Phentermine and Topiramate when prescribed separately.

Side effects. Common side effects include tingling of hands and feet, dizziness, taste alterations (particularly with carbonated beverages), trouble sleeping, constipation, and dry mouth. Serious but rare side effects include allergic reactions (such as rash, hives, difficulty breathing), thoughts of suicide, memory problems, mood problems (such as anxiety, depression, panic attacks), and changes to your vision. Rare side effects associated with topiramate include kidney stones and acute glaucoma. Qsymia must not be used during pregnancy because it may cause harm to the baby. People with an overactive thyroid gland, glaucoma, or who have recently taken certain antidepressant drugs known as MAOIs should not use Qsymia, although the drug was studied in patients taking SSRI and other antidepressants without adverse events.

Lorcaserin (Belviq)
Belviq (pronounced BEL-VEEK) or lorcaserin hydrochloride, works by affecting chemicals in your brain activating a serotonin receptor in the brain, which may help a person eat less and feel full after eating smaller amounts of food, according to the FDA.

Side effects. Common side effects of Belviq include headaches, dizziness, feeling tired, nausea, dry mouth, cough, and constipation. A rare but serious side effect is serotonin syndrome (high fever, muscle rigidity, and confusion), which can occur if the drug is taken along with SSRI antidepressants or MAOI medications. Belviq, as with all weight-loss agents, should not be taken if you are pregnant or planning to become pregnant.

Orlistat (Xenical and Alli)
The drug orlistat, sold under the brand name Xenical (pronounced ZEN-i-cal), has been available since 1999.
The over-the-counter version of orlistat is sold under the brand name Alli. The two drugs contain different amounts of orlistat. Xenical contains 120 mg, while Alli contains 60 mg.

Orlistat will stop about one-third of the fat from the food you eat from being digested. It does so by blocking the enzyme lipase, which breaks down fat. When fat is not broken down, the body cannot absorb it, so fewer calories are taken in. After 1 or 2 years of taking orlistat, patients may lose about 5 to 7 pounds.

Side effects. Common side effects of orlistat include stomach pain, gas, diarrhea, and leakage of oily stool. These side effects are generally mild and temporary, but may be worse when you eat high-fat foods. You should eat a low-fat diet (less than 30 percent of calories from fat) before starting to take this drug. Because orlistat prevents some vitamins from being absorbed, you should take a multivitamin while using orlistat.

Rare cases of severe liver injury have been reported. Stop using the drug and see your health care provider immediately if you develop symptoms of liver problems. These symptoms may include dark urine, itching, light-colored stools, loss of appetite, or yellow eyes or skin. Orlistat should not be taken with cyclosporine.

Other Appetite Suppressants
The other FDA approveddrugs promote weight loss by increasing one or more brain chemicals that affect appetite. You may feel less hungry or feel full sooner when taking these drugs. There are several appetite suppressants may be used to promote weight loss in adults. They include:

• Benzphetamine (Didrex)
• Diethylpropion
• Phendimetrazine (Bontril PDM, Bontril Slow Release)

Side effects: Common side effects of appetite suppressants include dry mouth, difficulty sleeping, dizziness, headache, feeling nervous, feeling restless, upset stomach, and diarrhea or constipation. Severe side effects may include chest pain, fainting, fast heartbeat, shortness of breath, confusion, and swelling in your ankles or feet. People with heart disease, high blood pressure, an overactive thyroid gland, or glaucoma should not use these drugs. These medications are controlled substances because of their potential for abuse.
The chart shows the commonly used prescription weight-loss drugs, how they work and their side effects.

Drug	Mechanism of action	Possible side effects
Phentermine (Adipex, Suprenza)	Decreases appetite, increases feeling of fullness	Increased blood pressure and heart rate, nervousness, insomnia, dry mouth, constipation
Phentermine and extended-release topiramate (Qsymia)	Decreases appetite, increases feeling of fullness	Increased heart rate, birth defects, tingling of hands and feet, dry mouth, constipation, anxiety
Lorcaserin (Belviq)	Decreases appetite, increases feeling of fullness	Increased heart rate, headache, dizziness, nausea
Orlistat (Xenical)	Blocks absorption of fat	Intestinal cramps, gas, diarrhea, oily spotting
Benzphetamine (Didrex)	Decreases appetite, increases feeling of fullness	Increased blood pressure and heart rate, nervousness, insomnia, dry mouth, constipation
Diethylpropion (Tenuate)	Decreases appetite, increases feeling of fullness	Increased blood pressure and heart rate, nervousness, insomnia, dry mouth, constipation
Phendimetrazine (Bontril)	Decreases appetite, increases feeling of fullness	Increased blood pressure and heart rate, nervousness, insomnia, dry mouth, constipation