High Fat, High Protein, Low Carb menu for one day

                        calories   total fat  saturated fat   carbs     protein    sodium    oz/grams    
3 large eggs      295        24g          6g                1.5 g       18g       210 mg       150g             


3 Bacon slices   126        10g            3g                0g           9g        246mg          24g               

3 sausages        652         51g          18g                3g         45g        2310mg      9oz/255g       

10 oz Lean        500        20g          10g                0g         80g         170mg         10 oz           

Total                1,573         105g       37g               4.5g     152g       2936mg                          


% calories                    60%fat   21%sat fat  1.1%carb 38.7% protein
                
fat  (105X9=945) divide by 1,573= 60%
carb (4.5X4=18) divide by 1,573 = 1.1%
protein (152X4=608) divide by 1,573 = 38.7%
Total cholesterol 1,060 mg

I have been on a diet similar to this since Jan. 2011.  My LDL-P has been excellent. 

Carbs do creep in during the day.  I have salad with Blue Cheese dressing.  I have coffee with cream.

I eat olives.  I drink approx. 12 oz wine/d often.  I eat munster cheese, swiss cheese.  I will have a bagel once or twice a week.  I use a lot of mayo in my tuna and cook my eggs with butter and put it on my steak sometimes.

I have stayed on this diet because I have not gained weight on it and I am not hungry. 

I have followed my advanced lipid profile, CAC and CIMT frequently and the results are excellent.

Since my return from my Southeast driving tour,  I have gone from 263 pounds back to 256 pounds.  That is the weight I started this diet on in Jan 2011.  On the car tour I was sedentary and I had more carbs than usual.  Mostly 3 pizzas. 


http://nutritiondata.self.com/facts/dairy-and-egg-products/111/2

http://nutritiondata.self.com/facts/pork-products/7676/2

nutritiondata.self.com/facts/sausages-and-luncheon-meats/1376/2 (I got most of the data off the package label from SAMS)

http://nutritiondata.self.com/facts/beef-products/3577/23

Post Hawaii Trip weigh-in

After 35 days in Hawaii and back on Testosterone in gel form,  I weighed 255 pounds.

Again I stayed on a low carb, high fat diet.  On Oct. 27 I weighed 254. 

I started the low carb, high protein, high fat diet in Jan. 2011.  I weighed 256 pounds at that time. 

It is now 23 months later.  I haven't lost weight but I have not gained weight despite approximately 250 days on cruise ships.  I usually just eat three times a day.  I don't get hungry.  I actually exercise less than my routine before 2011.  I do try to walk at least 20-40 minutes a day. I usually drink alcohol every day- avg 4 oz a day.

I continue to take my usual medications.
Lipitor 10 mg
OTC niacin 1,000 mg
Fish oil 4,000 mg
ASA 81 mg
Metformin 2,000 mg
Actos 45 mg
ACE inhibitor
Victoza injection

Lab after 37 days on Oceana Cruise

It continues to amaze me that my LDL-P  is excellent on a low carb, high protein, high fat diet.
I had wonderful food on the cruise.  I was never hungry.

LDL-P  733
LDL-C  86
Small LDL-P 349
Pattern A 21.0 nm
HDL-C 46
HDL-P  30.9
TG 35
TC 139
Non-HDL cholesterol 93
LP-IR score 22

Before we left for Europe, I weighed 261 pounds on Aug. 14, 2012.
During the 47 days in Europe, I went off IM testosterone as I thought this drug caused my weight gain.
On 10-5-2012 back in Topeka, I weighed 250 pounds.
I had lost 11 pounds while on my usual low carb diet. 

Gdansk, Poland 8-28-12

Riga, Latvia 8-26-12

Tallinn, Estonia 8-25-12

St. Petersberg, Russia 8-23-12

Helsinki, Finnland 8-22-12

Cheap Food in Stockholm

 At one stand I saw 2 hot dogs for 25 Krona ($3.40)
Can of soda is 20 Krona $2.90) but I did see 2 cans for 30 Krona ($4.30)

 A Gyro with Coke is $49 Krona ($7.00)

Hooray for Burger King.  We did not get to eat one of these $3.50 burgers.

I did have Swedish meatballs at the Sheraton hotel as part of their complimentary happy hour for club members.  A Swedish lunch went for $30 each and dinner for $50 each.  We stuck with the free breakfast and Happy Hour at the Sheraton and the above.

Ostermalms Saluhall, Stockholm

 Roasted chicken is 110 Krona/kg or $15.00 for a small chicken.

Kott means meat in Sweden.

 Beef fillet is $50/1.2 lb. 

I had a dish of beef bourguignon for 110 Krona.  It included fried potatoes.  Quite good for $7.70.

Vasa Warship from 1628, Stockholm

The photos don't do this exhibit justice.  To think not only was a ship from 1628 recovered but that it was the very elaborate and ornate Royal Flagship.

National Museum in Stockholm, Sweden

Marie Antoinette

Excellent collection.  Not overwhelming, only 3 floors.  80 SEC for seniors or a about $9 US.

Stockholm, Sweden

Sunny day in August in Stockholm.

LDL-P improved despite 10 lb. gain on 60% fat diet

I gained 10 pounds after this last road trip to NC, FL and LA.  I didn't change my diet.  I was more sedentary because of driving.  I think my weight gain was mostly due to starting testosterone 200 mg IM every two weeks on May 26.  I "believe" my muscles have more tone or more response to my moderate weight lifting.   I had read that testosterone may lower HDL-C.   My HDL-C stayed the same at 47.  However,  my HDL-P went down from 30.3 to 28.2.  The latest trend seems to follow HDL-P. 



IMPORTANT POINT :


After gaining 10 pounds on a low carb diet that is 60% fat my LDL-P decreased from 779 to 504.



LDL-C went up from 52 to 58.  NOTE the reverse discordance.

Non-HDL-C went down from 63 to 62.



My Hgb A1c went down from 8.4 to 7.4. 

I made no changes to Victoza, Actos or Glucophage.

I did decrease my lipitor to 10 mg and added Niacin (endur-acin) 1,000 mg a day.

I have chronic A. Fib so I take ASA 81 mg and 4,000 mg of SAM's triple strength fish oil

Today I am 5 pounds above my weight on June 1.  Again I attribute this to testosterone.

I continue to average 3 oz of ETOH a day.  Mostly wine with dinner.  



More lab:

TG 30  (was 54)

Total Cholesterol 109 (was 110)

Non-HDL-C 62 (was 63)

LDL size 21.1(was 20.8)

Small LDL-P 163 (was 386)

LP-Insulin resistance score:17 (was 44)

HDL size 9.7 (was 9.1)

Large HDL-P 5.7 (was 4.7)
Large VLDL-P less than 0.7(was 1.2)


FINAL POINT

Nutritionists would tell me Atkins was Lipid neutral (or better) in the A to Z Gardner trial or the Sachs NEJM Comparative Diet study because of weight loss.  My book documents that I maintained my weight in 2011 with 60% fat in my diet yet my LDL-P and Apo B was execellent.


I hit 263 pounds after this last road trip.  I weighed 261 pounds when I had this last lab test done.  I decreased my statin (atorvastatin purchased in India) from 20 to 10 mg by cutting the tab in half.  I started low dose Niacin (Endur-acin 1,000 mg).


I gained weight on 60% fat and yet my LDL-P improved.  This is just one case study.

National Lipid Association Meeting at Scottsdale, AZ

Great meeting!

 Gary Taube and Robert Lustig gave presentations.  This was a historic moment for the NLA. Not all calories are the same.  Sugar and CHO create more fat because of insulin.

HDL-C is more confusing than ever as devotees cling to it despite the new genetic evidence, the pharmaceutic dumping of it's HDL-C elevating drug and the old AIM HIGH information. 

The EPA vs. DHA was fascinating for this lipid geek.  I am not running out to buy EPA products. 

The June 2011 Journal of Clinical Lipidology had a comprehensive update on Fatty Acids in Cardiovascular Health and Disease.  Let me quote Walter C. Willett MD from Harvard on p. 218, "Fifteen years ago, this debate would have been considered impossible because it was believed that Saturated Fatty Acid intake was the primary determinant of high rates of Cardiovascular disease in Western countries.  However, in recent years, that question has been re-examined, or more accurately, seriously examined for the first time.  In truth, there was not very good epidemiological evidence for this relationship from the beginning."

WOW!  No real surprise because that is what he said in NYC in May 2011 NLA meeting and echos the talk Dr. Mafassarian gave at the NLA meeting in Washington D.C. in summer 2010.  Penny introduced Doctor Mafassian and made a comment similar to "Fifteen years ago, this debate would have been considered impossible"

On Sunday, on June 3, 2012, I went to listen to Penny Kris-Etherton talk at the NLA workshop. 

To my surprise she reported the AHA recommendations on diet without the above qualifications.

On page 5, in the booklet titled program materials she read from the two slides.  Saturated fat < 7% of total energy uptake.  Strong evidence.  The next slide stated that the "overall strength of the available supporting evidence (for SFA) is a Grade I which means it is good. 

My interest is shining a light on the conflicting information the NLA is presenting and request we examine these issues more closely.

I thought that Dr. Kris-Etherton's talk was one of the best nutrition talks I have ever heard. 

She presented several trials to back up the diet recommendations:
1- Portfolio Eating Plan to lower cholesterol
2- DASH trial
3- PREMIER
4- DIET COMPARISON TRIAL by Sachs et. al.
5-The Diabetes Prevention Program
6- Look Ahead trial
7- Comparative Effectiveness of Weight-Loss interventions in Clinical Medicine
8-The Weight Loss Maintenance Trial
9- A Two Year Randomized Trial of Obesity Treatment in Primary Care Practice.


I don't know why she left out the Lyon Diet Heart Trial as it is often cited as proof of a healthy Mediterranean diet?

My first question is whether there was weight loss in the Portfolio diet and the DASH diet.  If there was weight loss,  does that confound the results?  When, I point to the Diet Comparison trial as evidence that low carbohydrate diet was at least lipid neutral, Nutritionists will counter that is because there was weight loss.

In my book, The Tubby Traveler from Topeka, I went on a 60% fat (mostly animal fat) low carbohydrate diet and did not lose weight.  I decreased my exercise from the prior year and my advanced lipid panel at the end of the year was excellent.    I did this because I could not find this detailed lab documented results anyplace else.
  
The DASH trial may be re-examined after reading Gary Taubes NY TIMES article on SALT today.


The Look Ahead trial was presented at this meeting by Dr Echel.  He showed slides that by year 4,  much of the original weight loss was regained.  I remarked in the question period that this maintenance of weight loss is the issue and no diet has been able to document more than 5-10% weight maintenance after five years.  The reason is well known.  The Energy Gap (aka plateau, resettlement point).
I said that after a 40 pound weight loss their is an energy gap of 350 to 500 calorie energy gap.  This needs to be made up with less food or more exercise according to the NWCR, just to maintain the weight loss. At the Orlando Obesity Society Meeting, I was told that the 6,000 folks who maintained their weight loss more than five years ate about 7 calorie/lb/day and exercised the equivalent of 500 calories a day.    I said that five miles of walking a day does not burn off 500 calories a day because of the 42% reduction in exercise metabolism.   I said this is why low calorie diets fail.  The reduced obese develop the Sponge syndrome where calories get soaked up like a sponge due to several compensatory mechanisms to prevent starvation.  Dr. Echel said my energy statements were incorrect but did not go into detail. 


The Sunday morning NLA workshop on nutrition counseling is still trying to teach us how to change the eating behavior of our patients.  The Internet is the new tool for interactive support to help our patients stay on the diet. 

I'm sorry, until I am shown how to overcome the energy gap,  behavioral therapy will make no difference. 

It doesn't get much more intense in terms of support than the Look Ahead trial.  13 years from now, it will be inevitable that the participants will weight more than when they started their diet because their metabolism will have slowed by 2% just because of the aging process. 

If leaving three bites of food on the plate or replacing low glycemic fruit for SFA and salmon for beef solved the problem,  there would be no obesity crisis. 

I suggest we do what Dr. Willett says is beginning to be done with the SFA science:

"However, in recent years, that question(SFA causing CVD) has been re-examined, or more accurately, seriously examined for the first time.  In truth, there was not very good epidemiological evidence for this relationship from the beginning."

I believe his statement may be applied to diet and obesity.

Scotttsdale NLA lab results June 2012

New Lab results from National Lipid Association meeting.  Fasting results.  Lab taken at same time from two different companies.  I have remained on low carb diet.  My weight remains at 251 pounds.  I exercise at moderate intensity about 1 hour a day.   My basal metabolism test showed I burn 1350 calories/day. 


Liposcience:
LDL-P               779
HDL-C                47
HDL-P                30.3
Small LDL-P    386
Large HDL-P      4.7
TG                      54
TC                     110
Non-HDL-C       56
LDL-C                52


VAP:
apo B                                   53
Apo A1                              137
Total Cholesterol (TC)       113
HDL-C                                 49
Triglycerides (TG)               65
Non-HDL-C                         64


The important numbers are:
 LDL-P      779
apo B           53

I take Lipitor 20 mg/d,  Lovaza 4,000 mg/d.
I had stopped endur-acin 1,000 mg/d in Jan. because I had a small gastric ulcer.  I stopped crestor because of cost.  I will now cut my lipitor to 10 mg/d and resume endur-acin 1,000 mg/d.  


I am a case study of one. 
There are no larger studies of low carb dieters with extensive advanced lipid testing and CAC and CIMT results. 






   

Obesity Crisis: The Hunger Games

THE HUNGER GAMES:
There are basically three diet options and they are all restrictive:

1- Low calorie diet- eat 500 cal/d less than what you normally eat and wait for the energy gap.

2-Vegan diet- eat till full just no meat and no cheese cake and no joy

3-Low carbohydrate diet- eat till full but no bread or pasta however meat, bacon, butter and mayonnaise are okay. And guess what? the high protein and fat reduces hunger.

The HUNGER GAME is which can you do for the rest of your life?

The question is not which is the healthiest because whichever diet allows you to maintain your weight loss for 10 years or more is the healthiest diet.

The National Weight Control Registry proudly shows its 7,000 people who have maintained their weight loss for more than 10 years. Guess what, they are on 7 calories/day/pound and exercise off 500 calories a day. Talk about the village of the damned. This sub-starvation puts one in the psyche of a concentration camp detainee.

The common knowledge that high fat diets are deadly has been found to be questionable.

There is a sea change in the science of diet and obesity. Lets try to find the truth.

Part Two of my best video. 5 steps to prevent heart disease.

https://www.youtube.com/watch?v=Lejo7C7shS8

Largest Plain Waterfalls in Europe 1969

The Rhine Falls on the Upper Rhine near Schaffihausen in Northern Switzerland.  

Exercise will not cure the Obesity epidemic

I watched the lady Judge on Fox TV this am. The two physicians on the health segment seem to think the USA obesity epidemic can be prevented by exercise. Remember the 50's when only kids exercised. Then President Kennedy told us to walk 50 miles in a day. I remember being testing in grammar school on how many sit ups and push ups I could do. We really don't know how to cure the obesity epidemic as we don't really know what caused it.

Post World Cruise Lab Results

I returned home from my 112 day world cruise yesterday.  I weighed in on my home scale at 251.5 pounds.  I attribute the weight loss to taking Victoza injections.  I also attribute the improvement in my Hgb A1c down to 8.1 to Victoza as well.  I tried to walk two hours a day on sea days.   I tried to stay on a low carbohydrate diet.  I drank at least one glass of wine a day.  I was never hungry.

The LDL particle number is the most important lipid metric to prevent heart attacks and strokes.
Berkley Heart Lab does an excellent apo B test.
My apo B before the cruise was 62.  After the cruise on May 2, 2012 my apo B was 47.

The routine lipid panel was also done on 5/2/12:
Total Cholesterol          109
HDL-C                           45
Tubby Factor                  64
LDL-C                            50
Triglycerides                  72

This data is not included in my book, The Tubby Traveler from Topeka as that manuscript is at the printers.


It is very important to focus on the fact that this excellent lipid profile is obtained while eating 60% fat. 

CONFOUNDING COVARIABLES:
I lost 5-7 pounds while on the cruise.
My Hgb A1c improved.

 I switched from Crestor 5 mg to Atorvastatin 20 mg to save money.
 I stopped Endur-acin because I found I had an asymptomatic peptic ulcer.
  I increased my exercise and continued my actos.
  Off the niacin my HDL-C fell, however I don't know what my HDL-P is.   But does it matter?


Dr. Dayspring has always taught that the main goal is the particle number.  We don't treat HDL-C or triglycerides.  The AIM HIGH TRAIL confirmed this.  Particle size is also not important.  I have included as many lipid results in my book because it is a case study.
For the average patient going on a low carbohydrate diet.  Get your CAC, CIMT and Tubby Factor (non-HDL cholesterol).  If you have plaque go on a statin.  If you can afford a baseline LDL-P or apo B, I strongly advise it to make certain you do not have discordance.  As you eat 60% fat in your low carbohydrate diet, please check your Tubby factor or LDL particle number every four months if you are on a statin.

Much of the Low carb promoters push that the LDL-C may go up but the particles are larger.  The HDL-C goes up and the Triglycerides go down.  I try to bridge this point of view to the lipidologist viewpoint that it is the LDL particle number that we have to keep our focus on.

Vegans point out that Ornish had regression of plaque.  Similar to the lipid neutral trials of Gardner and Sachs, the CONFOUNDING COVARIABLE of weight loss obfuscates the interpretation.

In any vegan diet that is low calorie, the total carbohydrates are also reduced.

I hope my case study brings some clarification or at least a reduced fear of going on a high fat diet if you follow your LDL particle number. 

In 2011 I did not gain or lose weight by the end of the year.
My Hgb A1c was worse as I went off actos for a few months.
My exercise was zero to 40 minutes a day.
I tried to minimize the CONFOUNDING COVARIABLES in 2011.
My lipid panel remained quite good during most of  the year and I have no increase in plaque on my serial CIMT.  My CAC increased a little but was done while I was in Atrial fibrillation and was still lower than my highest CAC of 20 before I got my LDL-P below 750.

Florida Gulf Beach at Fort Walton

We checked into the Four Points Sheraton here.  Our platinum membership gave us a great upgrade to a corner balcony on the beach front.  No oil on the beach.  The sand is beautiful while and soft.  

Madiera, Portugal

Cabo Girao

Cadiz, Spain

Barcelona, Spain

W hotel

Birthplace of Napolean

Ajaccio, Corsica

Birthplace of the Olympics

Brian on the starting line in the first Olympic stadium.

Judas trees in bloom.  Beautiful.

Erupting Volcano on Cruise

The volcano was heard erupting in the distance.  It became very active the night we left.
 

Piraeus, Greece

Tombstone saying farewell

Oldest Fort in Europe

Mycenae Fort in Greece.  There are two lions above the gate entrance.

Mangalore, India

 

Temple of a thousand columns

Colombo, Sri Lanka

We purchased a 7 carrot "Sapphire" and a 9 carrot "Ruby" for a total of $2100.