5 Steps to prevent Heart Disease

Friday, August 26, 2016

Letter to National Academy

Project Title: Review of the Process to Update the Dietary Guidelines for Americans

I recently reviewed the UP TO DATE chapter on Low Carbohydrate diet.

 I was surprised to see Meta-analysis data misrepresented.

Dr. Bonnie Brehm's 2 year head to head trial and Shai's 2 year head to head trials showed LCHF diet had better weight loss results than low fat diet. 
These long term trials are very important .

I am certified by the American Board of Obesity Medicine.
 I am shocked to see the latest text(2016) of Nutrition Concepts and Controversies state on p 136:
"several times this minimum (130 grams CHO/d) is recommended to maintain health and glycogen stores."

Insulin resistance is a major consideration in treating obesity and metabolic syndrome.
 It should always be a footnote in these discussions just as
LDL particle number or apoB or non-HDL cholesterol level must replace the old LDLc data because of the discordance that occurs between particle data and calculated LDLc.

Please choose  Obesity clinicians and Lipidologists who understand the new science of obesity.

See reviews
 by Frank Greenway and May 2015 and
Christopher N Ochner Feb 2015

Thursday, August 25, 2016

What Docs read about low carbohydrate diets

I paid $500 to get the latest information on medical science.  
This is what I got for my money on Low Carbohydrate Diets. 
Obesity in adults: Dietary therapy
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jul 2016. | 
   This topic last updated: Jun 15, 2016.

Low-carbohydrate diets —  

Proponents of low-carbohydrate diets have argued that the increasing obesity epidemic may be in part due to low-fat, high-carbohydrate diets. 
But this may be dependent upon the type of carbohydrates that are eaten, such as energy dense snacks and sugar or high fructose containing beverages.
The carbohydrate content of the diet is an important determinant of short-term (less than two weeks) weight loss.

Low- (60 to 130 grams of carbohydrates) and

very-low-carbohydrate diets (0 to less than 60 grams) <60 grams="" span=""> have been popular for many years [20].

Restriction of carbohydrates leads to glycogen mobilization

 and, if carbohydrate intake is less than 50 g/day, ketosis will develop.

 Rapid weight loss occurs, primarily due to
1- glycogen breakdown and
2-fluid loss
rather than fat loss.

Low- and very-low-carbohydrate diets are more effective for short-term weight loss than low-fat diets,
 although probably not for long-term weight loss. 

A meta-analysis of five trials found that the difference in weight loss at six months, favoring the low-carbohydrate over low-fat diet,
was not sustained at 12 months [27]. (See 'Choice of diet' below.)

I looked up this (27)reference and found this chart:

 Then I looked up the original Brehm trial which went out to 2 years:

 I then went to a more recent head to head 2 year Shai Trial:

 I must say I don't think I am getting my $500 worth of UP TO DATE material.

Back to UP TO DATE article:

Low-carbohydrate diets may have some other beneficial effects with regard to
1- risk of developing type 2 diabetes mellitus,
2- coronary heart disease, and
3-some cancers,
particularly if attention is paid to the type as well as the quantity of carbohydrate.

A low-carbohydrate diet can be implemented in two ways,
 either by
1-reducing the total amount of carbohydrate or by
2- consuming foods with a lower glycemic index or glycemic load (table 3).

Glycemic index and load are reviewed separately.
 (See "Dietary carbohydrates", section on 'Glycemic index'.)

If a low-carbohydrate diet is chosen,
healthy choices for fat (mono- and polyunsaturated fats) and protein (fish, nuts, legumes, and poultry) should be encouraged because of the association between saturated fat intake and risk of coronary heart disease.

During 26 years of follow-up of women in the Nurses' Health Study and

20 yrs of follow-up of men in the Health Professionals’ Follow-up Study,

low carbohydrate diets in the highest versus lowest decile for vegetable proteins and fat
were associated with
1- lower all-cause mortality  and
2-cardiovascular mortality  [28].

 In contrast, low-carbohydrate diets in the highest versus lowest decile for animal protein and fat were associated with
1- higher all-cause and
2-cardiovascular  mortality.
(See "Dietary fat" and "Overview of primary prevention of coronary heart disease and stroke", section on 'Healthy diet'.)

Wednesday, August 24, 2016

130 grams Carbohydrate/day still advised

The above is from a 2016 Nutrition textbook

Dr. Ludwig has a different viewpoint in Always Hungry 
seen below:

Thursday, August 18, 2016

Using Bioelectric Impedance Scale in Reduced obese

Bioelectrical Impedance analysis

"BIA is considered reasonably accurate for measuring groups, or for tracking body composition in an individual over a period of time,
but is not considered sufficiently accurate for recording of single measurements of individuals."

"Two-electrode foot-to-foot measurement is less accurate than 4-electrode (feet, hands) and eight-electrode measurement."

 I  am on 5 diet medications!

I am not losing weight.

However, I lost 40 lbs since I started Invokana and stopped Insulin and Actos.

Now the challenge is to maintain weight lose in the reduced obese state as demonstrated in THE BIGGEST LOSER by Gina Kolata

 Yesterday when I went to my Obesity Clinic at Stormont, the Nurse Practitioner who takes care of me was please with my body composition results.
Compare 5-16-16 when I weighed in at my lowest at 217.3 lbs to
8-17-16 at 222.5 lbs.

Without the benefit of Bioelectric Impedance Scale, one might say the five diet medications are failing.

However, in the last two months I began a high protein (2.4 mg/kg lean body weight) and circuit weight lifting of 25 repetitions to preserve muscle mass.( How to preserve muscle while losing weight)

My muscle mass increased by 1.8 lbs.
My body fat decreased by1.1%.
My fat free mass increased by 1.2%
My body water increased by 1.6%

I did this with an AD LIBITUM ADKINS DIET.   I am never hungry and I drink 2-4 oz ETOH almost everyday.

This is the Bon Vivant diet

The guidelines advise the National Weight Control Registry aspects of success.

1- weigh themselves every day
and then if 3-5 pounds heavier, they had a plan what to do about it immediately
2-they tended to have little variety in their food
3-they splurged less on food on holidays.
4-they ate 1,385 calories/day but the facilitator said they are under reporting
5-they ate 4.87 meals a day
6-they linked behaviors to something more than just losing weight.
For example they use walking as their social time.  They linked good behaviors to something they want to do.
7-they often had a life changing event such as divorce or new job.
8- they walk about five miles a day or exercise equivalent

It's also reported in Medical Clinics of North America Sept 2011 V 95 #5
on page 945:

Now compare the NWCR program to The Great Starvation Experiment done by Ancel Keys at the end of World War 2.

He put about 32 men on 24 weeks of a "starvation diet" that they had a very difficult time staying on.
It was about 1550 calories a day and they walked one hour a day.

The reduced obese are told to do this do the rest of their life.

Very few can do this for the rest of their life due to the low Leptin in the billions of shrunken fats cells that never go away.  I call this the
 Sponge Syndrome

Monday, August 15, 2016

At a Saxenda presentation I found the rules of use were CRAZy

I went to a Saxenda presentation last night and to my amazement I learned I am supposed to increase the dose every week without fail till the maximum dose.
If the patient cannot tolerate the maximum dose I have to give up on the drug. 
I can't go back to the lower dose that may have had an effective weight loss of 5%.
However if the patient tolerates the high dose and loses weight, I can cut Saxenda down to a lower dose if I wish.

Thursday, August 11, 2016

10 year data on Bariatric surgery Feb 2016

52 cases over 10 years


"A mean maximum percent excess weight loss of 71±25% (percent total weight loss: 28±15%) was reached at a median of 12 (range 12-120) months after SG.

 At 10 years, a mean percent excess weight loss of 53±25% was achieved by 32 patients, corresponding to a percent total weight loss of 26.3±13.4%.

Nineteen of the 53 patients (36%) were converted to Roux-en-Y gastric bypass (n = 18) or duodenal switch (n = 1) due to
1- significant weight regain (n = 11), 
2-reflux (n = 6), or
3-acute revision (n = 2)
at a median of 36 months.

Two patients died at 3 and 101 months postoperatively, unrelated to SG.

A total of 31 patients (59%) suffered from weight regain
of 10 kg or more,
among them 24 patients (45%) with 15 kg or more,
16 patients (30%) with 20 kg or more,
 and 7 patients (13%) with 25 kg or more weight regain from nadir.

 Mean BAROS  (Bariatric Analysis and Reporting Outcome System) score was 2.4±2.2 at 10 years follow-up, classifying SG as "fairly efficient."

I have two questions.
1-How many patients gained all their weight back after 10 years?  

2-Was diet medication considered in the treatment of the regain? 

The best way to maintain weight loss

NHLBI "Guideline"
 suggests adding diet medicine to maintain weight loss.

My Blogs on using Diet Medications