5 Steps to prevent Heart Disease

Monday, July 30, 2018

Surprising results of Low Carb High Ketone diet

To my surprise my very low carb very high protein with resulting high ketosis did not make a significant change. 
Despite the high ketosis I became very hungry at times. 

What is interesting with the Fit Bit data during the week of my very low carb diet is that I had an average calorie burn of 2,780 daily from exercise.
 The body composition report below says my resting metabolism to maintain my weight is 2660 calories with moderate activity 
3000 calories with heavy activity. 
 Both numbers are incorrect for me as I am in the category of the 


As having DM2, I take Invokana 300mg which urinates out 
300- 400 calories of glucose a day. 
So I was surprised when I drank wine only on 2 days and cut my calories to 2000 a day that my BIA was not better. 

The actual date of the above analysis is 7/30/18, done this morning as noted on top of paper when the weigh in was done at 8 AM

Wednesday, July 25, 2018

My 32 hour fast

On morning of fast after a low carb day (less than 25 g)
I rarely have a fasting glucose of 150.  I am not on insulin as I am on LCHF or Atkins (less than 50 g CHO/d) and on Invokana, Victoza, Metformin and recently Actos 10 mg a day.  Off insulin. Usually my ketone level is around 1.0

MIDNIGHT.  I never get to glucose 88 on LCHF 50 g CHO.  Not eating helps my glucose.  Famine would cure the obesity epidemic.  This is 23 hours into the fast.  I was hungry last night and ate a lettuce, celery, onion, pickle salad with red wine vinegar and a teaspoon of olive oil. Internet says eating 50 calories will not disturb fasting state? It didn't hurt my fast as demonstrated by my 32 hour fast numbers below.

32 hours into Fast.
Please note how glucose goes up with sleep due to liver putting glucose into blood stream.  Not due to eating during the night.
I have never had a ketone level this high.  I feel fine with it.  I wasn't starving this AM but I did enjoy my 3 eggs 3 slices of bacon Coffee with a little cream.

Saturday, July 21, 2018

What CAC score should be treated with Statins?

I applaud Cummings and Gerber for their advocacy of getting CAC's early as I did in my book The Tubby Theory from Topeka 2010.

However they never specify at what CAC score should statins, niacins or Zetia be started?

Published 2018

Above "But even a HIGH CAC score is NOT necessarily a problem- IF you take action on it."

Above "The only snag: you can't lower your CAC score with the orthodox approach of a low-fat diet and MEDICATION."

Above : "Greater than 400 means it's write-the-will time--or else address all ROOT CAUSES immediately so you can get to safety."  No mention of statins.

Above  "But the majority of the heart attacks occur in this middle risk category not the high risk." 

Friday, July 20, 2018

I tried to unravel the puzzle of HDL in 2010

Here is Chapter 14, The Truth About HDLc  from my 2010 book:

 The Tubby Theory from Topeka. link

Subsequently there has been AIM-HIGH and HPS-2

The misinterpretation of those two trials has resulted in the mistaken removal of Niacin from guidelines for which drugs to use.

HDLp or HDLc is not a treatment goal of any guidelines 2018

Triglyceride level non-fasting less than 100 will become part of the guidelines someday.

Here are several blogs on Niacin link

Poor evidence for TG/HDL ratio as supreme marker for ASHD

Ivor Cummings book Eat Rich Live Strong says that Triglyceride/HDLc ratio "reigns supreme" over and is vastly more predictive than the LDL value 

                                      Reference one: 340 cases

Reference two: 544 women

Reference  three: 220 males 154 females

Ivor has used only 1258 people in his evidence. 

 2010 Nov 13;376(9753):1670-81. doi: 10.1016/S0140-6736(10)61350-5. Epub 2010 Nov 8.

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials.


Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. 
There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would reduce risk by about 40-50%.


UK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council, and National Heart Foundation.

6 of the trials:

1-  Search Trial 2010


3- TNT trial 2005

4- A to Z trial 2004

5-- PROVE-IT Trial 2004

6- SSSS trial 1994 Statin vs. Control "Simvastatin produced highly significant reductions in the risk of death and morbidity in patients with CHD followed for a median of 5-4 years, relative to patients receiving standard care." 

Thursday, July 19, 2018

Insulin while fasting in nonDM2 and in DM2 not fasting.

A physician friend of mine answered a question I had asked.

Dear Brian,
Now to your insulin question: (long answer offered before reviewing your material)

 My insulin level was 3 after a 72 hour fast.  The question is How low can you go?
 As I said, Normal values, especially in America, are no longer my ideals!
    Protein in an intact stomach can raise the insulin levels.
Fasting, of course, is pretty much guaranteed to lower it.

Jason Fung, MD is a Nephrologist in Toronto, Canada.
 I have been following his blog weekly for about 4 years -
 He is especially interested in insulin, DM2 and fasting.
 He was treating DM2 (800 patients) last year initially
with extended fasting (10 to 14 day only water and vitamins),
especially if the patient is over weight.
(His treatment may be different this year.)
   He is very critical of current medical treatment of diabetes (DM2)
(a nutritional disease with a total body hyperinsulinemic state
that should not be treated with insulin injections, in pursuit of "normal BLOOD sugars")

I preordered his  
 The Complete Guide to Fasting:
Heal Your Body Through Intermittent, Alternate-Day, and Extended  (2016)

and  following  the protocols in this book,
I have successfully completed some "extended fasts"
(5 - 72 hour fasts,  4 - 120 hour fasts and 1 - 240 hour fast.)

 It becomes easy to maintain an only water fast after the first day or two.
Strength, mental clarity and energy levels are fine
(watching for hypovolemia, of course)
   My weight comes down dramatically,
and this new found power to control my weight
has worsened the "Emotional Eating" component of my weight problem -
I am now cheating more because I can lose it later.

My comment in purple: Bob I am worried about the nitrogen balance with fasting.

and most recently  The Diabetes Code (2018)    

My question about your Uric Acid is from another book I liked,
older (2012) but also by an independent thinking MD.

 I take 500  mg Vit C (Costco chewable) daily in two doses
   and I am lowering my uric acid (per Dr. Johnson's suggestions)
with Allopurinol 300 QD (partly for hyperuricemia of fasting,
and partly because of the protein quantities I eat)
      Both of these recommendations are from
 The Fat Switch  (2012) by Richard J Johnson, MD      

I occasionally get pain in the proximal phalange of the great toe,
and the Allopurinol seems to help, though my uric acid has never been above 7.


We have many things to talk about,
I would especially like your comments on the four books
and the blog mentioned above, most especially the 2018 book.



Dear Bob,
Thanks for the information.
My friend Ivor Cummings has a book Eat Rich Live Long Feb 2018
which I have read and reviewed on Amazon.com.  

Thus I am somewhat familiar with fasting.

I did fast for 30 hours once.  I was surprised it was not very difficult.  
My FBS was better and my nutritional ketosis went higher.
 I wish I had gotten an Insulin level.

I think it is clear that early insulin resistance
does have increased insulin levels
(even with fasting glucose of 95?)
Ivor in his book above suggests that we can start LCHF or Atkins
on people EARLY on to prevent the IR from getting worse.
I agree with Ivor.
No guideline advises checking insulin levels on a routine basis.  
Thus I never did it on my patients unfortunately.

I think my insulin level is normal now because I have had DM2 since 1998.  
When I took insulin in the early years
I did have to take very high doses of insulin to control my glucose to normal levels.
 I no longer take insulin as it caused me to gain 20 pounds
and found Invokana to substitute for insulin
with subsequent 30 lbs weight loss.

My insulin is now low because I think enough of my pancreatic Beta cells have died.  

I still have insulin resistance thus
the normal insulin level of 6 or 8
doesn't control my fasting glucose which is usually around 150.

To address the IR I have decided to go back on ACTOS 15 mg.
 My waist is still 41 inches. In the last 2 years I have been down to 199.
 My waist did decrease a little but not less than 40 inches.

I could try fasting more but I find that too difficult
as a lifelong practice at my age.  

I could stop drinking and watch my protein intake more carefully.
 i.e. less than100 grams a day.

However that would be no fun, and I worry about developing sarcopenia.

Thus I am trying ACTOS and >150 g protein/day and
weight lifting 5-6 days a week
alternating upper and lower body doing 25  repetitions to feel a burn in the last 3 reps.
The goal is to do 3 sets. I am up to 3 sets on legs but only one set upper body.

As I have taken ACTOS with high protein and weight program
my Bioelectrical impedance scale results have been:

                wt fat%          water% muscle lbs Fat Free Mass   Visceral Fat

5-3-18        210.3       26.5%         54.4%     39.7                                               15

Started ACTOS 15 mg 6-20-18

Resumed Testosterone 100 mg once a week IM 7-30-18

7-17-18      218.5       26.8%          54.1%        41.1                73.1%           17
7-19-18      217.2       26.5%          54.4%                                                           

ACTOS causes water weight gain.
 Reason for the concern in people with congestive heart failure.
I was on ACTOS 45 mg years ago.
 Dr. Eric Westman suggested I stop it.
 I did and I quickly lost 10 lbs
but my FBG went up to 300 despite being on LCHF.

I have not noticed a change in my FBG presently:

Fasting Glucose 145
Ketones 1.5