5 Steps to prevent Heart Disease

Tuesday, February 26, 2019

Critique of Kevin Hall's article on weight loss maintenance

My full detailed critique  link here

Short review below of Kevin Hall's article link

Maintenance of lost weight and long-term management of obesity
Kevin D. Hall, Ph.D.1 and Scott Kahan, M.D., MPH2,3
I agree except for bullet three.  Best long term trial (10 YEARS)failed. Gary Foster on LOOK AHEAD trial link

Again LOOK AHEAD failed to achieve it's Primary outcome on cardiac goals. 

I don't argue there are many benefits to weight loss.  I question if the benefit remains if you gain much of the back in 5 to 10 years

Finally Kevin gets to what I think is the solution

"5-For patients with BMI greater than 30 kg/m2
(or 27–30 kg/m2
with obesity-related comorbid conditions),
obesity pharmacotherapy
leads to as much as 15% weight loss
in responders,
with weight loss being maintained
in several studies for several years 9092."

Monday, February 25, 2019

Faroe Islands: Halfway between Norway and Iceland

Capital of the Faroe Islands

Temperatures average above freezing throughout the year
 because of the Gulf Stream.

I have been to Faroe Islands two times.  These photos are from the last visit in 2015 on a cruise.

"DNA analyses have revealed that Y chromosomes, tracing male descent, are 87% Scandinavian.[49] The studies show that mitochondrial DNA, tracing female descent, is 84% Celtic."

"Genome research in the Faroe Islands

Some hereditary conditions are more common in the Faroe Islands than elsewhere.
 This is due to the country’s remote location and the fact that most Faroese people are the descendants of relatively few original settlers. 
Gene testing has confirmed that the Faroese population can be considered a genetically isolated population, which is very interesting in the context of genetics research.
All Faroese people are registered in the so-called Genealogy Registry, which is a family tree of the Faroese people dating all the way back to the 17thcentury." 

 seat of a part of the Faroese government
I walked all over this area. It was very interesting

Other than Vatican City this may be smallest national capital in the world. 

Sunday, February 24, 2019

Lerwick, Shetland Islands

  I visited the Shetland Islands in August 2015 on a cruise.  I became interested again after watching the TV series Shetland series 4 link called Hinterlands.

"Modern Shetlanders have almost identical proportions of Scandinavian matrilineal and patrilineal genetic ancestry, suggesting that the islands were settled by both men and women in equal measure."  Also true for Orkney Islands. 

I find the Viking genetics in United Kingdom to be very interesting.  

Interestingly, much of the TV series is not taken in Shetland.  The characters do have a Scottish accent.  

I don't remember much of my visit there.  I have studied my photos to see what I remember.  I remember the ponies and the historical site called Jarlshof. 

Photos of Lerwick, Shetland, Scotland

Jarlshof historic remnants link

Atkin's success stories from Dr Eric Westman

Kudos to Dr Eric Westman for publishing 3 patients who have maintained more weight loss for more than five years in his book below

My list of 15 who have maintained weight loss with LCHF

Now I can add 3 from Dr. Westman's list

1- Janet Freedman
Age 64  Loss 25 pounds  (157 to 132) 5 ft 3 inches

2- Jay Wortman
Age 59  Loss 25 pounds (185 to 160) 5 ft 9 inches
 On Atkins maintained weight loss for 7 years 

3- Jennifer Kingsley
 Age 39 Loss 113 pounds (230 to 117)  5 ft 4 inches

4- Jennifer Munoz
Age 33  Loss  39 pounds (198 to 159) 5 ft 3 inches

5- Jessie Hummel
Age 65  Loss 34 pounds ((228 to 194) 6 ft.
On Atkin maintained for 3 years

6- Julian Snead 
Age 30  Loss 107 pounds (306 to 199) 6 ft 1 inch
On Atkins maintained  50 pound weight loss for 2 years and then went on to lose more weight restarting Induction phase

7- Loralyn Hamilton 
Age 45  Loss 35 pounds (165 to 130) 5 ft 6 inches
On Atkins Maintenance for 14 years

8- Rebecca Latham
Age 54 Loss 10 pounds (150 to 140) 5 ft 3 inches

9- Sara Carter 
Age 46  Loss 100 pounds (235 to 135) 5 ft. 9 inches
On Atkins Maintenance for 8 years

10-  Traci Marshall
Age 42 Loss 95 pounds (267 to 172) 5 ft. 6 inches

Thursday, February 21, 2019

Pictorial journey of my struggle with Chronic Obesity

Feb. 17, 2006   283 lbs.  Waist 52 inches

I went on 1800 calorie diet and then 1500 cal as per the 3 hour diet by J. Cruise.

11-28-2006 Plateaued at 204 lbs

Marriage 6-30-2007  weight 200 lbs 

After 9 months of traditional low calorie diet (from Feb 2006 to July 2007) I reached my plateau.

I maintained my weight loss (80 lbs)
from 11/2006 till 12/2007 (13 months)
with 1500 calorie diet and 2 hour day exercise

In Dec 2007 I found it impossible to get below 200 pounds with 1500 calorie diet and 2 hours exercise a day.  

I ate more calories in form of low glycemic fruit and more exercise to gain muscle. It did not work out very well.  Despite 2.5 hours of exercise a day I gained 1.5 lbs each month.

Dec. 2010 weight 250 lbs
Unfortunately I didn't have a 4 electrode Bioelectrical Impedance Scale to measure fat mass and muscle mass.

Jan. 2011 started Low carbohydrate High fat or Atkins diet
I wrote about my year of traveling while cruising and maintaining my LCHF diet Free to read at The Tubby Traveler from Topeka. 2012  link
Weight 256 lbs Jan 2011

Below are labs done over weight loss period
My Hgb A1C went down from 6.8 to 5.7 due to Actos and weight loss

Labs below from period when I started LCHF or Atkins
Notice how initially my LDLp went up from 651 to 1245 
However it went back down to 765 two months later

I never really lost weight on LCHF but I did maintain my weight with it despite many cruises.

I finally lost 30 lbs on LCHF when I started Invokana (link) and stopped Insulin>

3-14  Started , 
10-27-14 wt. down to 229 lbs on Invokana

Presently I am down to 210 pounds after a 34 day cruise and 3 weeks in Hawaii.  

I have maintained my weight loss with LCHF, Belviq, Victoza 3.0 mg (Saxenda dose) and Invokana without being hungry. 

Sunday, February 17, 2019

Critique of Peter Attia's email on ketosis. 2-17-19

My comments in purple

Email from Peter Attia 2-17-19 (I have edited with highlights and list)

I read an interesting article authored by my friend Dom D’Agostino
and his colleagues on the anti-catabolic effects of ketone bodies in skeletal muscle.

Does anti-catabolic equal anabolic ?

Some definitions from wiki:
"Catabolic Reactions. Catabolic reactions (also called “catabolism”) 
break down larger, more complex molecules into smaller molecules 
and release energy in the process. 
The smaller end products of a catabolic reaction may be released as waste or they may be fed into other reactions".  wiki
"Anabolism is the process by which the body utilizes the energy
 released by catabolism to synthesize complex molecules. 
These complex molecules are then utilized to form cellular structures 
that are formed from small and simple precursors 
that act as building blocks." wiki

They note that we’ve already known about anti-catabolic effects of ketones
including attenuation of
2 hepatic glucose output, and
3-adipose tissue lipolysis.

Web results

Definition from wiki

Lipolysis /lɪˈpɒlɪsɪs/ is the breakdown of lipids and involves hydrolysis of triglycerides into glycerol and free fatty acids. Predominantly occurring in adipose tissue, lipolysis is used to mobilize stored energy during fasting or exercise.

This statement by Peter is really confusing to me.  Obviously I must not understand what he means by "ATTENUATION".  
I thought ketosis on LCHF was from adipose tissue lipolysis?

The authors point to a recent study showing that
anti-catabolic effects of B-hydroxybutyrate (BHB)
were demonstrated in human skeletal muscle
under inflammatory insult
(in this case, provided by lipopolysaccharide, or LPS for short),
supporting the hypothesis that BHB can exert anti-catabolic effects
in inflammation-driven muscle atrophy.

I also remember reading years ago from the work of Steve Phinney and Jeff Volek
that the primary driver of muscle protein synthesis (MPS)
is the availability of essential amino acids (especially leucine)
and that in the keto-adapted state, blood levels of leucine increase.
Here, the keto-adapted state, which includes elevated levels of BHB, spares protein and preserves lean tissue. (For more on this, check out Phinney and Volek’s book,
The Art and Science of Low Carbohydrate Performance.)

So...I was wondering about all of this in the context of
fasting compared to chronic caloric restriction
and their effects on muscle loss/preservation.
Do higher BHB levels in water-only fasting prevent muscle loss
greater than hypocaloric (i.e., CR) states without high ketone (i.e., BHB/AcAc) levels?

I thought Phinney and Volek were concerned about nitrogen balance with fasting?

Also, it’s been observed that resistance training prevents most,
if not all in some cases, the muscle loss that comes with CR.
You may recall in one of my AMA’swhen I discussed my quarterly 7-day water-only fasts,
I’m amazed at the lack of muscle loss, provided I lift weights daily.
In fact, with many cycles of such fasts, I see the same results over and over,
suggesting that preservation of leucine alone is sufficient to maintain muscle mass.

Yes but how much weight did you lose.
7 days does not equal months of 10-30% weight loss.
That is where the difficulty lies. My BIA below demonstrates this with a 42 lb weight loss.

- Peter

On LCHF since 2011 I presume I have sufficient leucine intake.  I frequently lifted weights during this period but I always lose muscle with significant weight loss.  I don't know how Peter checks his fat percentage.  I use a 4 electrode bioelectrical impedance scale. 
From 6-23-15 to 3-23-17 I lost 42 lbs. 
Muscle mass 46.1 lbs to 38.1 lbs
Fat mass 75.2 lbs to 49.5 lbs

Chart of BIA readings link for calculating protein intake

Friday, February 15, 2019

How bioelectrical impedance scale can help guide diet and exercise

Here are before and after BIA reports reflecting time interval from Dec 5, 2018 when I left for my cruise and Feb 15, 2019 when I leveled out after my trip.

BIA below is before cruise.

I gained 7.5 lbs of fat while in ketosis and maintaining weight on cruise.

12-4-18   3.6 ketones
2-18-18  3.3 ketones 6 days on cruise
2-9-19   1.1 ketones first day back in Kansas

My Atkins diet prevented significant weight gain but apparently not by fat burning metabolism as I was in ketosis. 

Thursday, February 14, 2019

How to use diet medications to maintain weight loss

6-23-15 was the first weigh in at Stormont Vail Obesity Clinic.  I started  Qsymia

On 2-13-19 
weight 214.3 lbs
Total body fat 29.1%
Total Body Water 51.8%
BMI 29.7

After 3 yrs and 2 months on diet medications I achieved body fat and water goal. 
The obesity nurse was off mark for the goal of BMI 25. 

Even when I hit this low weight of 199 my BMI was 27.5
Notice the drop in muscle mass: 46.1 lbs to 37.4 lbs

I just came back from a 34 day Oceania cruise circumnavigating Australia and then 3 weeks in Hawaii.
I am satisfied with 214.3 lbs. 
I would like to get back to 200 lbs. as I was on 5-23-17.  I have been off Belviq for the last 3 weeks and I have not done any weight lifting.  
I will start Belviq again and increase Victoza to Saxenda dose of 3.0 mg. 

Wednesday, February 13, 2019

Inexpensive Triple Rx rather than expensive PCSK9 my clinical experience 11 cases

Dr Seth Baum is excited at reduction of price of PCSK9
Topeka Triple Rx costs around $30 a month or higher at some places. 
Enduracin 500 mg 1,000 tabs around $100 (less than $10 a month)
Zetia generic (Ezetimibe) $28 for 90 tabs (less than $10 a month) 
Atorvastatin is $25 at Hyvee for 90 days (less than $10 a month)
Why not try the cheaper safe therapy that can reach similar goals as my 11 cases studies from 2010 demonstrate?
Published in book 2010 
The Tubby Theory from Topeka. 

11 cases on triple therapy of 
statin, enduracin and zetia. 

       LDLc  nonHDLc  LDLp
#1    56         85            1145
#2    57         89            1197
#3    50         63             958
#4    47         61            1098
#5    79         96            1017
#6    56         63             958
#7    69         81            1107
#8    53         61            1055
#9    45         55              970
#10   40        53             1091
#11   121     140            1269

Only two patients greater than LDLc 70

Which was my target at the time(less than 70)

Five achieved less than 60 LDLc

Three achieved less than 50 LDLc. 

Please try this Topeka Triple Therapy before going to expensive PCSK9 IV Rx. 

Cases 1,2,3

Cases 4,5,6

Cases 7,8,9

Cases 10, 11