5 Steps to prevent Heart Disease

Thursday, June 14, 2018

My challenge to proponents of LCHF

I am in nutritional ketosis and yet I do not lose weight because of being in the plateau.
My challenge to ketosis fans is show me the list of patients (10 would be a good start) on LCHF who have maintained their weight loss for 5-10 years
Tell me how to get down to 190 lbs without muscle loss and maintain it for 2 years.

Here's my story
My goal is to get to 190 pounds and waist 39 inches
to help my DM2 and insulin resistance.
I am trying to not lose muscle so I have
been eating 130 to 160 grams of protein a day.
Subsequently I usually eat 2,500 calorie a day.
My exercise is about an hour including walking 12-20 mins, stretching 5 mins and lifting weight 35 minutes.

I increased my Victoza to 3.0 mg to fight off increased hunger with increased exercise.
 I have not been hungry even though cutting down on popcorn and pistachio snacks.
Still eating Yogurt Lite and Lively 80 calories.
Yesterday I have 4 oz wine and a 3 oz Vodka martini.  The Bon Vivant Diet

I think the reason I don't gain weight on 2,500 calories despite having
the Sponge syndrome is that I take INVOKANA for DM2
and urinate 500 calories a day.

Nutritional ketosis is thought to decrease hunger. I believe this is well documented for VLCD (very low calorie diet) 800 calories/d for first 8 months

However once the weight is lost but not the number of fat cells, leptin makes it very difficult to not gain weight with ghrelin causing hunger.

The high protein also helps fight hunger and a good guide is 30 g protein for breakfast, lunch and dinner for a total of 90 grams.
I suggest (if you need it) a Premium Clear Protein Drink of 20 g of protein for morning and afternoon snack which is another 40 grams of protein.
That is a high protein diet (130 g) excellent for weight lifting to prevent muscle loss.
I try to lift weights everyday.
Upper body on even days and Lower body on odd days.
I am working my way up to 3 sets.
I do 25 repetitions with each weight. I use low weights to do this.  Cuts down on injury.  I try to experience a burn in the muscle on the last three reps.

I don't push it.  I don't even break out into a sweat.  I am 66 years old.  It's good enough.  You can't outrun your fork.

Thus for the Reduced Obese with Sponge syndrome:
1-LCHF (which usually allows ad libitum diet and eating 500 calories less with less hunger)
2- High Protein (will satiate better than carbohyrates)
3- Nutritional ketosis (serum greater than 0.5 usually decreases appetite)
4- Exercise (Can't outrun your fork)

the above 4 items will not prevent weight regain
after a large weight loss
 due to the fact that the number of fat cells remain
with very low leptin levels.

I attribute the maintenance of 210 pounds (after70 lb. weight loss) for me to 5 diet medications I take. Still despite drugs and Ketosis of 1.9 I don't lose weight on 2,500 calories.

My four electrode point bioelectrical impedance scale prints out this data above.

It calculates that my Basal Metabolic rate is 1751 calories.
This means if I eat only 1700 calories a day, I should lose weight because I can subtract all the calories from activity.  Walk 5 miles a day I burn 500 calories, right? Wrong, low leptin causes your exercise metabolism to slow down 52% when you lose 10% weight.  That means for every mile I walk I only burn 48 calories.

The print out above following all the rules of a calorie is a calorie states my moderate exercise (42 minutes?) allows me to eat 2626 calories a day without gaining weight.

I do eat around 2,500 calories a day.  I did get down to 199 pounds on less calories.

With Invokana we can say I take in 2,100 calories a day.  I do this because I am not hungry.  LCHF is ad libitum, correct.  I have gone from 199 to 212 pounds. By calculation I can eat 2632 calories a day without gaining weight, but I have gained weight thanks to the Sponge syndrome and drugs, ketosis, high protein have not prevented it.

The problem of maintaining weight loss has not been totally solved which is why I broke through my plateau for only at short time at 199 pounds.

With medications I am not hungry on 2,500 calories a day.

But to lose weight need to get my calorie intake to about 1,800 calorie a day.

I guess I could stop the daily wine and martini.  Nah.

What I will do is start Actos 15 mg a day to help my insulin resistance.

I expect to gain 10 pounds of water on the new pill.

It will be interesting to see if my BIA reflects only water gain.

Actos supposedly moves the central fat (unhealthy) to periphery (healthy)?

My scale does measure visceral fat so we will see.

Wednesday, June 13, 2018

Tuesday, June 12, 2018

Critique of Ivor's IMPROVE-IT article

Ivor makes a common mistake in asking for decrease in mortality results.  If Zetia was tested with placebo as a control, there would have been a significant drop in mortality.  IMPROVE-IT was started at baseline LDLc at 94.  The control arm was a statin which is already known to decrease mortality.

Ivor writes:
"But not a single life saved.
Not even 1 out of 18,000 very sick people in a seven year timespan.
How utterly.......underwhelming."

Ivor makes a common mistake in asking
for decrease in mortality results.
 If Zetia was tested with placebo as a control,
there would have been a significant drop in mortality.  
IMPROVE-IT was started at baseline LDLc at 94.
The control arm was a statin
which is already known to decrease mortality.

4S trial Simvastatin vs Placebo with LDLc 188 link
Primary Outcome
All-cause mortality
11.5% vs. 8.2% (RR 0.70; 95% CI 0.58-0.85; P=0.0003; NNT 30)

For IMPROVE-TRAIL to get improved mortality from baseline LDLc 94
is not likely and does not disqualify  Zetia

The important point is that adding Zetia to a statin the LDLc was lower than a statin alone.  It took 7 years to tease out a statistically significant difference but it occurred.

To see my detailed review of Ivor's article go to my

 review  link easy to read

Monday, June 11, 2018

Breaking through plateau?


1-Low carbohydrate high fat diet with very high protein (150g/d)
2-Maintain ketosis greater than 0.5
3-High repetition (25) low weights 4 sets a week. 
4-Increase Victoza to decrease hunger of increased exercise
5-Add Actos to decrease insulin resistance

 I started Atkins in Jan 2011, I didn't lose weight
but I did maintain my weight despite ad libitum diet.

I lost and maintained my weight with diet medications link.

Does ketosis decrease hunger?  link

The Science of Ketosis and LCHF  link

I have been in a plateau region between 200 and 210 lbs.
 depending on travel and exercise.
I gain weight with exercise and high protein and
 nutritional ketosis greater than 0.5.

At 66 years old I am concerned about sarcopenia.
I want to get to 190 pounds and a waist less than 40 inches to help my DM2 insulin resistance.

Unfortunately as with most large amounts of weight loss there is a large amount of muscle loss.

I have started a program of 150 grams of protein a day (LCHF)
and weight lifting program.
I use mostly machines to avoid injury.
Upper body on even days, Lower body on odd days.
My goal is 25 repetitions 3 sets.
I am at two sets with lower body and one set with upper body.

Recently I was on 2,500 to 3,000 calories.
I try not to be hungry.

I was 204.3 lbs on 4-23-18
4 point bioelectrical impedance analysis (BIA)
Visceral (bad) fat : 14
H2O% : 55.8
Muscle: 38.4 pounds
FAT %:  25.1

Serum ketones: 0.8
Serum glucose 153

I am presently 210.2 pounds on 6-19-18
Visceral fat: 15
H20% 53.5
Muscle: 39.5 pounds
FAT %: 27.4

Ketones serum: 1.6
Glucose: 145

The BIA muscle measurement is probably not very accurate.

It's still early in my program.
Lets see if I can get to 3 sets of 25 reps with 150 g protein.

The diet medication with my additional 50 pound weight loss
 has probably done more than Atkins (LCHF) :
Visceral fat 20 on 11-16-15 at 235.1 pounds
Visceral fat 14 on 4-23-18 at  204.3   pounds

I started the weight lifting program on 5-21-18.
Then I increased Victoza from
diabetic dose of 1.8 mg to 3.0 mg (the diet medicine dose) on 5-23-18
 I wanted to curb the increased hunger from increased exercise.
I always walk around 5,000 to 10,000 steps a day to avoid being sedentary.

Tomorrow 6-12-18, I will add Actos to the long list of my medicine.
I will probably gain 10 pounds of water.
I hope it will improve my insulin resistance more than LCHF diet has.

Wednesday, June 6, 2018

How many people take statins

CNN Anderson Cooper report 2018 link

Easier edited version at Should you take statins 2018 link

'Over one in five Americans between the ages of 40 and 75 already take a statin to prevent an initial heart attack or stroke, the American study from 2017 estimated."

"The ACC/AHA recommendation in particular would more than double it."

From 23 and Me.  This is an interesting graph but what does it mean?  Much depends on the ages of the people who do 23 and me.  Asians don't tolerate statins very well which may explain the low number.

Tuesday, June 5, 2018