5 Steps to prevent Heart Disease

Wednesday, January 3, 2018

Diet fed to WW Two prisoners of Japan


My interest has been in understanding why people fail to maintain their weight loss.
If you are one of the reduced obese take heart.  The guidelines are asking you to stay on a starvation diet for the rest of your life.  Here are two examples.

I went to the Kansas State Museum and found an interesting exhibit on a POW from Topeka.  Here is the diet he was fed during his internment in WW2:

1.25 cup of white rice= 300 calories.  3 meals a day=1200 calories.  Not sure how many calories I should give the 400 cc of soup? 200 to 400 calories/d?


National Weight Control Registry tips to maintain weight loss link
“A clue may be found when studying a ‘rare’ clinical subject: a reduced obese person who has succeeded in losing weight and maintaining the new body weight for more than a year.

The National Weight Control Registry documented the metabolic and behavioral cost of maintaining a reduced obese state of maintaining a reduced obese state for more than 5 years.”
Men 1225 kcal/d net after exercise
Women 918 kcal/d net after exercise p. 945
Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011

CLUE TWO:
Can You Eat 7 Calories/Pound a Day  for the rest of your life?


The Great Starvation diet trial by Ancel Keys link

Saturday, December 23, 2017

Monday, June 12, 2017

Friday, May 19, 2017

The campaign to sell PCSK9

Expensive PCSK9 inhibitors should be used to treat LDLc greater than 189 mg/dl before trying inexpensive low dose triple therapy treatment.

In my book, The Tubby Theory from Topeka, I documented my success with triple therapy for high LDLc for about 200 patients.

I advised starting with lowest dose of a generic statin.  I have updated my advice from using generic simvastatin (Zocor) to lipitor (Atorvastatin) and now generic rosuvastatin (Crestor).
Zetia is now generic but there is a 6 month window where the company is allowed to sell the generic for $1.00 less than brand Zetia.
Endur-acin is an over the counter niacin which has a proprietary matrix that causes very little flushing and side effects.  1,000 tablets can be purchased on line for $90.  I advise 2 tablets (1,000 mg) a day.

I am Diabetic type 2 and have gotten my LDLp down to 333 with this triple therapy.  That is the lowest number/value Liposcience lab will give for LDL particles measured with NMR.  I have lost 80 pounds since 2006 but I gained back 50 lbs despite intensive exercise after 5 years.  I then went on Atkins since 2011 with 60% fat and less exercise.  No false hope for diet and exercise.

I am very skeptical of the usual recommendation of diet and exercise as the  10 year long LOOK AHEAD trial resulted in a negative study to prevent cardiovascular events more that the control.

I take:
 Lipitor 10 mg/d
Endur-acin (Niacin) 1,000 mg a day.
Cost about $100 a year.
This gets me to the lowest LDLp possible while eating 60% fat and walking 1-2 miles a day at a 20 minute per mile pace.

I gave my patients a third drug if they could not get to goal.
 Zetia 10 mg (ezetimide).
Presently, ezetimide is sold as generic and hopefully with go down in price.
At high price start with one half tablet.
(Note: there are hyperabsorbers of cholesterol that have great benefit with this drug)

I am at the NLA meeting in Philadelphia.  Last night I went to a dinner sponsored by Amgen.  I have great regard for the panel that participated in the discussion of Optimizing Patient Outcomes in the Era of PCSK9 Inhibitor Therapeutics. 

Doctor Harold E. Bays presented 3 case studies to treat a high LDLc.  
The problem for me with his questions is low dose triple treatment was never offered as a choice in the answers. 
Niacin was rarely mentioned and when it was it was diminished. 
To Dr. Bays credit he did say he didn't think there was a wrong answer in the quiz but the audience had been guided by the speakers to vote 90% as PCSK9 inhibitor use as the correct answer.
This is a manipulation of the Fourier trail 2 year data as being more important than 50 years of positive outcomes with Niacin. 
Niacin has a better long term decreased mortality 6.2%(CDP increased from end of trial) result than any statin (3.2% from 4S decreased from end of trial. )
"We therefore conclude that treatment with simvastatin for up to 8 years in patients with CHD is safe and yields continued survival benefit."
"Statin treatment for 5 years was associated with a legacy benefit, with improved survival and a substantial reduction in cardiovascular disease outcomes over a 20-year period, supporting the wider adoption of primary prevention strategies"

4-No long term outcomes for PCSK9. Fourier trial was stopped early after 2 years because it reached a 15% reduction in events. 

Niacin low dose is extremely safe after decades of use. 
We have no idea what the effect of decades of PCSK9  will be. 

Please place triple therapy with Niacin on the list of choices for treatment. 


Monday, May 1, 2017

HOW MUCH PROTEIN TO PREVENT LOSS MUSCLE MASS DURING DIET

How much protein for each individual?
2.4 grams of protein for each kg of lean body weight.  
Difficult for people to figure lean body weight without bioelectrical impedance scale.
5-1-17:    Wt.              Fat%
              204 lbs          24.9%
               92.5 kgs       22.8 kg

Subtract 22.8 (total fat) from 92.5 (total body weight) = 69.7 (lean body weight)

Thus for me:
2.4 X 69.7= 167.28 grams of protein per day.

 Diet yesterday:     Protein       Calories     Carbohydrates      Fiber:

Breakfast
3 eggs fried in butter     18g             300                 0                           0
3 slices bacon                9g              165                 0                           0
Butter 1 TBSP                                  100
Lunch:
Atkins Beef                   16g             310                9g                            3g
Almonds  28 nuts           6g              170                6g                           3g
Atkins shake- vanilla      15g            160               2g                             1g
Tenderloin fillet 7oz        56 g            490               0                             0
Cauliflower 1 oz                0.5             14               1.1 g
Butter 1 TBSP                                   100
Pistachios  I bag              5g              120                8g                         2 g
Light/Lively yogurt           12g             80                  9g                         0
Martini Pear/Apple                            355                18g
Red wine 12 oz               0g            240                 6g

TOTALS                  Protein        Calories       Carbs                   Fiber
                                       137g          2504 cal            59g                       9g

FASTING GLUCOSE 126
SERUM KETONE LEVEL 1.7

Friday, March 24, 2017

Who has healthiest hearts in the World?

 Who has healthiest hearts in the world?
Very interesting but there is still some heart disease in the tribe. 25% in elderly.  Thus is this age, inflammation (age) or genetics with high cholesterol?
There are silver bullets for early atherosclerosis and the sooner it is treated with multiple drugs the less chance of a cardiac event.

One thing is clear, the lower the LDLc or LDLp or apoB the less cardiac events occur.
I think the drug company paid a billion dollars on PCSK9 trial.



1-NEJM 2017 PCSK9 drug Rx

"At 48 weeks in the evolocumab group, the LDL cholesterol level was
reduced to 
1-70 mg per deciliter (1.8 mmol per liter) or lower in 87% of the patients,
2-to 40 mg per deciliter (1.0 mmol per liter) or lower in 67% of the patients,
3-and to 25 mg per deciliter (0.65 mmol per liter) or lower in 42% of the patients,

as compared with 18%, 0.5%, and less than 0.1%, respectively, of the patients in the placebo group (P<0 .001="" all="" br="" comparisons="" evolocumab="" for="" of="" placebo="" vs.="">
 
<0 .001="" all="" br="" comparisons="" evolocumab="" for="" of="" placebo="" vs.="">2-Tracy has a LDLc of 17

"At a time when the target for low-density lipoprotein (LDL) cholesterol, more commonly called 'bad cholesterol', in Americans' blood is less than 100 milligrams per decilitre (a level many people fail to achieve), Tracy's level is just 14."

3-IMPROVE IT trial for Zetia

Conclusions

"1-When added to statin therapy, ezetimibe ( resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes.
2-Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit."



This chart above shows it took 7 years to get a good result with Zetia combo.
The Niacin  combo trial was stopped after 3 years AIM HIGH TRIAL.






This chart shows results of many trials lowering LDLc. The lower the result the better the outcome.

AIM HIGH trial stopped after only 3 years.  If AIM HIGH  was allowed to go on for 7 years as above IMPROVE trial did, I suspect AIM HIGH would have had similar good results .
LDLc went below 65 on combo Rx.



​This is Terry Jacobson's slide at the Master NLA program last year.
It is a shame this trial was stopped early due to side-effects that later turned out to be insignificant.


While reports of Egyptian mummies and Amazon tribe and elderly Japanese women are interesting they are not hard science.

Thursday, March 2, 2017

Rand Paul tries to get into secret meeting on Repealing ACA

This history shows why GOP not likely to Repeal and Replace Obamacare.   It was extremely difficult for Obama to pass it.


The incident today with Rand Paul in the basement of Congress not allowed in a secret meeting on ACA reminds me the secrets meetings reported in the link.  Watching how sausage is made is not for the squeamish.


20 page report on How Obama passed ACA. 
link above


‘After looking at this old transcript,  I don’t think GOP has much of a chance to Repeal or Reform Obamacare.
Repeal and Replace Obamacare is the most important issue facing the USA.   Unfortunately the Media discusses what they think will raise ratings as being the most sensational news.
As I read this transcript I was amazed how similar Obama"s and Trump’s effort
to make the

‘Sausage” of Obamacare.

I think Obama got his bill passed as the media did not focus on the secret 
 meetings, as they will with Trump.


I high lighed much of the transcript so readers can skim through the 20 pages quickly.