First page of new book, The Bon Vivant Diet

  To treat the Chronic Disease of Obesity

2-25-16

Most obesity is a chronic disease. 

 Diet and Exercise alone usually fail to maintain weight loss long term.

Even 30% Bariatric surgery patients gain back their weight after 10 years.

Only a small group in the National Weight Control Registry have maintained their weight long term and half of them did it completely on their own. Unfortunately their diet is similar to Ancef Keys diet in The Great Starvation Experiment.  

This is why there are only 10,000 people in this registry out of the millions who have gone on diets.

The largest, longest and best diet trial called Look Ahead failed to maintain the 10% weight loss of most of their patients and was a negative study compared to the control group.

I have good news.  There are four new FDA approved diet medications that may be taken for life.

This book will show that similar to Hypertension and Diabetes, there is no cure for Obesity.  These chronic diseases need lifelong treatment with diet medications.

I went on a FAST to prevent hunger as I ran out of Qsymia

I ran out of Qsymia yesterday while in Hawaii.
I decided it was a good time to test the appetite suppression of nutritional ketosis.

Previously I  gained weight while in nutrtional ketosis
and exercising one hour a day with weight lifting.

Then I decreased exercise to 20 mins walk per day and Qsymia
while staying on the same Atkins or Low Carb High Diet.
I lost 20 lbs as I was not as hungry and ate less.

Yesterday I held my:
Metformin 2,000 mg
Invokana 300 mg
But I continued my Victoza 1.2 mg.

I was surprised that I did not get crazy hungry as I had in previous decades.
I was probably well prepared as I started out the fast in a state of my usual ketosis at 1.3
I was hungry at times and slight nausea as I drank coffee.
 A little dizzy and difficulty in mental focusing around 5 PM.
 I didn't go for my usual 40 minute walk.

I started my FAST in my usual state of NK on LCHF
7:30 AM     Glu:   142   ketones 1.3  weight 222 lbs. 

Noon:         Glu:  134

5:00 PM     Glu:  111    ketones 2.3

9:30 PM     Glu    94    ketones 3.5

11:30 PM   Glu    99    ketones  3.1

6:30 AM    Glu   110    ketones  3.9  weight 219 lbs


Breakfast at 7 AM 3 eggs 3 slices bacon Cooked in butter Coffee w half and half
Snack- 2 handfuls of almonds

Lab Post Prandial done at 11:00 AM on a High Protein High Fat Low carb breakfast
Glucose 143 from 110 AM fasting
Ketones 3.0 from 3.9 AM fasting.


For me, its clear when I don't take my morning Invokana 300 mg and
Meformin 2,000 mg my glucose will get elevated with protein and fat alone
while in ketosis.
I did increase my Victoza to 1.8 mg this AM as I ran out of Qsymia. 


 My wife (who is also type 2 DM but does not follow LCHF)  fasted with me.

Her glucose was 94 yesterday afternoon and 124 this AM.
 Her ketones 0.3 after 34 hour fast.
 She didn't take her metformin either.

It was a fun experiment with my wife as a sort of control.
There are many physiologic teaching lessons in this experiment. 
Since I believe in the Bon Vivant diet so I don't intend on fasting again ;)

Summary of Low carb gurus misses the main point of science

Corby Cummer article and my response in purple


" As Dietz points out and as Ludwig’s diet (not to mention behavioral psychology) is premised on, once something becomes routine you crave it less—including food that was once forbidden"

This is not true as demonstrated for Dietz type diet in the LOOK AHEAD trial 

The closest diet to Ludwigs is found in
 2 year Shai trial ad libitum low carb high fat diet 

On page 14 of his book Always Hungry
 Dr Ludwig writes;
"In full disclosure, this diet-like all other diets-hasn't been fully proven."
Dr. Ludwig claims "improving the quality of what we eat will program fat cells to store fewer calories, in effect reducing the "body weight set point".
My theory The Sponge Syndrome claims that the billions of white fat cells that the obese have never go away even with massive weight loss. 
 These cells are like a sponge that will regain fat with any type of diet that is not low calorie for the reduced obese.  
LCHF helps because the satiety does allow lower calorie diet but ultimately multiple diet medicine will be needed over the long term for the disease of chronic obesity.  
I believe the fat cell cannot be retrained. 
 We have to trick the brain that it is not starving with diet medications and reduce food intake that way. 
 Reduce calories with satiety and no hunger with diet medications. 
 I am sure Dr. Ludwig's diet works for a few years but as the graph shows there is a waterfall effect of results that gets worse over time. 
I suddenly realized I was on 5 diet medications

These 3 methods help weight loss with reduced calories by decreasing hunger

"Weight loss medications and surgery change the physiology of body weight regulation and are the best chance for long-term success.

An increased understanding of the physiology of weight loss and regain will underpin the development of future strategies to support overweight and obese individuals in their efforts to achieve and maintain weight loss." Greenway article below

"Current biologically based interventions comprise:

1- anti-obesity drugs,

2-bariatric surgery and,

3- the most recent development, intermittent intra-abdominal vagal nerve blockade" Ochner article below. 

1- Nutritional Ketosis  (Bullet Proof Reference)
(The Ketogenic diet for health)



 2- Diet Medications (4 new diet medications)

"habituation to rewarding neural dopamine signalling develops with the chronic overconsumption of palatable foods, leading to a perceived reward deficit and compensatory increases in consumption.4"  Ochner article below

3- Bariatric Surgery 

Only banding surgery is solely a restrictive mechanistic procedure and is being done much less often. 

 If you look on internet this is how it answers the question.  It is an old viewpoint.

I learned a different answer when I took the American Board of Obesity Medicine Exam 12-15

 Gastric bypass causes increase in GLP-1 which decreases hunger by ileal brake. 

 Gastric Sleeve causes decrease in Ghrelin 

"Further, gastric bypass corrects obesity-induced changes in appetite-related hormone profiles11 and neural responsivity,12 which might explain why bariatric surgery is the only available treatment to show long-term effectiveness." 

Christopher N Ochner, Adam G Tsai, Robert F Kushner, Thomas A Wadden

Published Online: 11 February 2015 article in link below.

 Latest Science on Obesity summed up  at this link

Topeka Tubby diet philosophy in 4 sentences

First lesson: 

You can’t outrun your fork.

Controversy over Exercise can maintain weight loss  link

Second lesson: 

Best bang for health is 20 minutes walk/d

Book by Gretchen Reynolds NYT reporter   link

Third lesson: 

Weight loss 6-9 months.

 Any diet you want. 

Graphs showing that diet, surgery and pills fail at plateau link

Fourth lesson: 

 Weight loss maintenance for life with new diet medications. 

The four new diet medications link

How to lose weight and gain muscle

Article on how to gain muscle with more protein

"Both groups went on a low calorie diet, one with higher levels of protein than the other.

The higher-protein group experienced muscle gains -- about 2.5 pounds -- despite consuming insufficient energy, while the lower protein group did not add muscle.

The lower-protein group at least had the consolation of not losing muscle, which is a predictable outcome of cutting calories and not working out, say researchers.

"Exercise, particularly lifting weights, provides a signal for muscle to be retained even when you're in a big calorie deficit," says Phillips.

Researchers were intrigued because the high-protein group also lost more body fat."

I Gained muscle on Atkins while in nutritional ketosis  link

I documented this with a bioelectrical impedance scale.

Before Bariatric Surgery consider Diet medications

Please study the slides below.  

Patients may think surgery is easier than pills.

Patients may not know pills can now be taken for the rest of their life.

Patients may not know that when one pill wears off he can add another one to the present one he is taking.

Most importantly,
 as he regains weight after surgery 
a good program will start him on diet medicine.

 Surgeon Denis Hami slides from Wash DC OMA meeting

Surgeon Denis Hami slide from Wash DC OMA meeting

All weight loss results in a reduced obese state which ultimately causes a physiological state that causes the body to regain weight.  Surgery has best early result but many people have recidivism with surgery and will need to add multiple diet medications to maintain most weight loss.  Some day in the future we will hopefully see a graph proving this.

 

This 10 year data from SOS made me a believer in Bariatric surgery.  The next waterfall slide reminded me of the truth for many people in these studies. 

The Waterfall effect of results in diet trials.  
Note the 5-9% weight gain after 6 years after gastric bypass surgery.