Can we stop calling Oatmeal healthy?

What is best breakfast for people with Insulin resistance? 

This Ask Well article resulted in a flurry of tweets about fiber 
link above

I tried to find the evidence for fiber. 

The Handbook of Obesity did not offer much other than this:

Nutr Rev. 2001 May;59(5):129-39.
Dietary fiber and weight regulation.
Howarth NC1, Saltzman E, Roberts SB.

Abstract

The influence of dietary fiber on energy regulation remains controversial. 
This review summarizes published studies on the effects of dietary fiber on hunger, satiety, energy intake, and body composition in healthy individuals.
 Under conditions of fixed energy intake, the majority of studies indicate that an increase in either soluble or insoluble fiber intake increases postmeal satiety and decreases subsequent hunger. 
When energy intake is ad libitum, mean values for published studies indicate that consumption of an additional 14 g/day fiber for >2 days is associated with a 10% decrease in energy intake and body weight loss of 1.9 kg over 3.8 months. 
Furthermore, obese individuals may exhibit a greater suppression of energy intake and body weight loss (mean energy intake in all studies was reduced to 82% by higher fiber intake in overweight/obese people versus 94% in lean people; body weight loss was 2.4 kg versus 0.8 kg). 
These amounts are very similar to the mean changes in energy intake and body weight changes observed when dietary fat content is lowered from 38% to 24% of energy intake in controlled studies of non-obese and obese subjects. 
The observed changes in energy intake and body weight occur both when the fiber is from naturally high-fiber foods and when it is from a fiber supplement.
 In view of the fact that mean dietary fiber intake in the United States is currently only 15 g/day (i.e., approximately half the American Heart Association recommendation of 25-30 g/day), efforts to increase dietary fiber in individuals consuming <25 b="" day="" g="">may help to decrease the currently high national prevalence of obesity.

So much of the article is so wrong.  Go to More evidence for fiber


Internet View:
CHOLESTEROL REDUCTION HOAX by Konstantin Monastyrsky Link

Recent trial showing positive outcome for oatmeal for N= 14,000. However was control group on LCHF?
Oatmeal good for kids link

Preparing for a week of tenderloin steak

Preparing for a week of tenderloin steak 

The Atkins diet or the LCHF (low carbohydrate high fat) is often criticized because people can't sustain the restriction on carbohydrates.  All diets are restrictive but do they satisfy hunger?  These photos show one part of how I have stayed on a LCHF diet since 1/2011.
(Link to book documenting first year on LCHF while traveling)

Here is a typical 7.45 pound tenderloin fillet that I buy at Sam's every 7-10 days.
At $12.78 it seems expensive.  Is it more expensive than eating out?

Fillet cut up into 14 steaks.  Size varies from 4.5 oz to 11.5 oz.
$95. 21 divide by 14 = $6.80 for a steak dinner.  Impossible to find tenderloin steak for that price in a restaurant?

The weights of 14 different steaks above.

  6.5 oz steak

Largest steak from the tenderloin. 11.5 oz.
I had this steak last night.
(Calorie breakdown of my core LCHF diet link)

I heat up the grill at high flame for 5 minutes and then cook each side of steak for 5-6 minutes at medium heat.

I did not marinate this steak.  I do that if I have time.  I avoid steak sauce (Heinz 47) by using butter.  3 tbsp of butter is about right to add to a cooked steak.  Butter makes LCHF diet much less restrictive and more flavorful.  Problem with Vegan diet is you still can't eat cheesecake.

This bag has about 3 servings of salad.  Since I had a large steak last night, a cup was enough.  I will often return to leftover later at night if hungry.  Very quick and easy to mix up.

Simple satisfying affordable quick meal.

I look at wine as a replacement for dessert. 
Below is quote from Handbook of Obesity by Bray and Bouchard:
"Alcohol is not essential for body functioning and is thus not considered a nutrient.  In fact, it is rather occasionally perceived as a toxin.  It is then surprising to note that body metabolic processes, including energy partitioning, are oriented toward giving priority to clearing alcohol from the body.  
Alcohol drives its own oxidation,  and its thermic effect exceeds that of carbohydrate.
Alcohol clearance also benefits from energy partitioning since its oxidation has priority over fat oxidation... Suter showed... alcohol... resulted in an immediate daytime reduction in fat oxidation of about 45 g/day."
"some nutritionists.. consider alcohol consumption are equivalent to units of fat intake.
 p294 and p295 vol 1Handbook of Obesity 3rd edition 


I do eat some carbs.  I had a bagel with creme cheese yesterday before a early meeting.  I had cold cuts with mayo for lunch. No bread. Dinner is as I outlined above.
This morning my fasting glucose was 135 (good for me)  ketones 1.0 and my weight was 238.5 lbs.

After five days of morning carbs as it was included with the hotel, some NYC pizza I gained 5 lbs to 245 weight.  When I got off the plane from NYC I was 245 pounds.

I was 235 lbs. on July12 while on Qysemia before leaving on my 48 day vacation on July 14.

I ran out of Qysemia while on the cruise on Aug 11. On Aug 14 I re-started Victoza and ran out of that on Aug 29.

I resumed strict LCHF on Sept. 6.  I was never hungry, I lost 6 lbs.  in 5 days off Qysemia and Victoza. .  Of course most would say it was water loss.  I have also decreased my Actos from 45 to 30 mg since Sept. 6.  That might have helped water loss.

I write all this to point out weight loss is complicated.  Exercise and calories did not change much in the above days.
In NYC on Sept 4 my Fitbit said I walked 17,000 steps.  I weighted 3 more lbs. the next morning Sept 5.
 I do walk more when on a cruise as I try to walk around the deck after each meal and probably averaged 10,000 steps a day.  Of course I ate more calories.

As a diabetic, I believe LCHF diet is the best diet.  I have kept to it for almost 4 yrs 8 months.
I am never hungry.  I exercise less than when I ate fruit.

I did not lose much weight of LCHF.  I remained at around 258 lbs.

I finally lost some weight with Victoza but the real weight loss occurred when I add Invokana.
30 lb weight loss with Invokana


Some nutritionists claim Carbohydrates are "essential".  Not true.  Some fats and amino acids are essential as the body does not produce them.

Thus some nutritionists say 60% fat on a diet is unhealthy for you fat.

I have kept careful records to show regression of plaque on LCHF.
Evidence of good arteries with CAC & CIMT link

I have yet to see other diet gurus published similar data with CIMT.

How do people stay thin in a world of abundance? Part 2

Part one of this discussion is here Link

BBC video  Why Are Thin People Not Fat ?

2009 article from BBC news magazine

Index of video:

To see final results go to video point 42 minutes

Professor Fredrik Nystrom video point 2:20 
University of Unkoping


Ethan Sims video point 3:05
University of Vermont: "When the thin people got fat,  their metabolism increased 50%"
Rethinking Thin p 116 to 120

Dr. Philipp Scherer video point 7:48
U Texas SW Wins ADA Banting award


Rudolf Leibel video point 16:24 & 47 mins.
Columbia University: "Each person has a comfortable weight range that the body gravitates to."
Rethinking Thin p 125
Rethinking Thin. The New Science of Weight Loss- and the Myths and Realities of dieting by Gina Kolata 2007

Professor Jane Wardle video point 25 mins
University London Profile- Prof Psychology

Nikhil Dhurandhar  video point 34:28
Lecture on Obesity

Ania Kosicka

Carel le Roux

Fredrik Nystrom

Eric Ravussin

My personal experience using LCHF diet and diet medicine to deal with weight regain after hitting plateau

I lost 30 pounds on Invokana 

Then started Atkins Induction phase 20 g CARB/d. 
Lost another 10 pounds in a week. 

Strangely this week I also felt the initial effects of nausea, early satiety of Victoza again. 

1-6-11 #LCHF No wt. loss 258 lbs


1-12  #Victoza caused 5 lb wt. loss 

5-12 # Insulin gained to 265 lbs

3-14  Started Invokana, 
10-14 wt. down to 235 lbs on Invokana

6-23-15  weigh in at Obesity Clinic. 244 lbs
 I Started  Qsymia

# Atkins Induction 20 g CHO/d 10-20-14

NK 1.6 10-29-14, then
Victoza suddenly seems to have side effects again with Nausea, early satiety last 5 days. 224 lbs. on 12-2-14

 On LCHF diet I simply avoid carbs as best I can.

I came back from Hawaii on March 1, 2014 and weighed in at 265.  

This is the closest I got back to my highest weight of 280 in March 2006.

I attribute both high weights to Insulin.
  

On March 4, 2014, I started Invokana and stopped Insulin.

My glucose immediately improved going down below 150.

 I also lost weight without changing diet or exercise. I was 239.5 lbs
 before leaving for Europe on Aug. 17, 2014.

Last week on, Oct 8, 2014. I came back from a 30 day cruise and I lost two more pounds to be at a new recent low of 237.
I ate well, tried to limit carbs, and drank alcohol each night 
but I tried to walk 10,000 steps a day.

After a week of following LCHF more carefully at home, I am down to 233.5.

On Oct 20, I started Induction phase again of Atkins
 which means I tried to eat less than 20 g CHO.

 I also stopped alcohol.  On Oct. 27
 I am down to 229 pounds.

I had my lab taken this morning. My lab data here

Update 11-1-14

Interesting development as of 10-30-14.  My Victoza is decreasing my appetite with some nausea and a tired feeling similar to when I first started the injections in Jan. 2011.  Has the improved ratio of my body fat to lean muscle improved to the point that the hormone is more effective or my central adipose tissue is producing less hormones to induce insulin resistance? My weight is down to 224 pounds. I am in the land of temptation NOLA.

Update 11-19-14

Intermittent epigastric pain.  3/10 lasting a minute or two.  

Update 4-8-15 

I have been traveling for the last 3 months.
 I circumnavigated the world.  46 of the travel days was on Oceania cruise.
The good news is I am at 233 lbs.
I was 231 lbs when I left Florida on Dec 30.

I follow Atkins or LCHF in general.
 I am not hungry.
 I probably walk more than I do at Kansas.
 My high intensity interval training is walking the stairs on the ship.
 No weight lifting and I ran out of testosterone 2 months ago.
 I continued Victoza, Invokana, metaformin, Actos,  and atorvastatin 10mg faithfully.

My LDLc was: 71, 
non-HDLc 85, 
Triglycerides 68, 
HDLc 68.  
I am awaiting Hgb A1c and Liposcience profile for advanced lipid testing.  see Metrics on 60% fat link.

My last month was in Hawaii.  Maui always presents the greatest challenge to my LCHF diet and exercise. 

I had frequent pasta on the cruise but I mitigated those carbs with walking almost after every meal and walking stairs.   I did drink a lot of alcohol.  I am after all trying to be a Bon Vivant.  

I have been having some epigastric pain since Nov.  It started after a large steak.  I had a EGD or gastroscope in Dec.  Despite 12 hours fasting I still had food in my stomach.  I believe my gastroparesis is more from Victoza than diabetes.  

I felt better in Jan while taking tetracycline for Malaria prevention.  I have diverticulitis and perhaps this antibiotic made the pain better? 

However after a very large spicy meal in Sydney I had what I thought was diverticulitis in my left lower quadrant. It was very different from the epigastric pain and was better after 3 days of resuming tetracycline.  

I had a normal ultrasound of abdomen in Dec. and my amylase and liver function blood tests are normal.   When I peaked my alcohol consumption while on the premium drink package for 16 days from Sydney to Auckland on Oceania I had no abdominal pain. I had at least 10 drinks a day.

UPDATE July 16, 2015

Despite stopping Victoza, I continued to have vague epigastric discomfort intermittently.  No nausea, not related to ETOH.  I had a contrast CT scan of abdomen/pelvis which showed diverticulosis and small hiatal hernia. 

On June 24, 2015 I started the lowest dose of Qysmia. I was 241 pounds.  The only change in my diet and exercise was to decrease my ETOH to 4oz week.  After 3 weeks I lost 6 pounds. 

I am on the next higher dose of Qysmia and have started a Trans-Canadian train trip followed by a 29 day Land of the Midnight Sun cruise.  The Saga of Topeka Tubby continues. 

 UPDATE 9-6-15

I just returned from a 28 day cruise on Holland America.  It was part of a 54 day vacation.  
When I left for Canada on July 14 I weighed 235.5 lbs.  
On August 11 I ran out of Qsymia.  I resumed Victoza on August 14 to replace the Qsymia and ran out of it on Aug 29.
I weighed 240 lbs  first day back in the states on Sept. 1 in NYC.  
I ate a lot of carbs in NYC.  I weighed 245 lbs back in Kansas today 9-6-15.
I hope that now I can resume my LCHF diet that I will rapidly get back to 240 lbs. 
Most interesting is that the mild abdominal pain came back on Victoza.  This is the only diet medicine that has abdominal pain as a side effect?

I am 63 years old.  I lost 80 after going on 1500 calorie diet and one hour exercise a day in 2007.  I gained 50 lbs back despite 2 hours of exercise a day.  I did not want to go back to a sub-starvation lifestyle.  LCHF since 1-11 has allowed me to enjoy my life without further weight gain.  Invokana and Victoza have helped me lose another 30 pounds recently.  

My goal is to get off Actos.  I decreased my dose today (9-6-15) from 45mg to 30 mg. 


UPDATE 5-12-18

Still on Low Carbohydrate High Fat diet. 
Usually run 205 to 211 lbs. 

Trying to gain muscle mass with little weight gain. 
 Try to eat 150 grams of protein a day.  
Try to lift weights everyday alternating 
upper body on even days and 
lower body on odd days. 
 I try to do 25 repetitions with lowest weight or till my muscle burns on last 3 reps.  
I try to get up to 3 sets but with breaks in the routine I have not been able to get to that many sets.  After two weeks I get to two sets.  

Saropenia at 66 years old is what I am trying to avoid.  
Unfortunately with large weight loss is also large muscle loss.  
I only learned about high protein with high repetition resistance training last year. 

Older men lose much of their muscle mass in their legs.  Fortunately for me I do better with lower body exercises can do more sets sooner. 

My goal is to decrease my visceral fat from 15 to 9 while not losing muscle mass. (my body composition scale at home can read this for me)

In simpler terms, I want my waist to go from 41" to 39".

If I am not on strict LCHF diet, my fasting glucose will go up to 180.  I am happy with  150 and a Hgb A1c of 6.5.

Insulin always makes me gain a lot of weight.  

I went off Actos and my FG shot up to 300.  
I did lose 5-10 lbs. 

I went on Invokana and Victoza.  I had already been on metformin. 

LCHF has not caused weight loss despite being in serum nutritional ketosis.  

Diet medications caused weight loss and definitely not exercise.
 Yoni Freedman taught me you can't outrun your fork and Eric Westman echoed that at a meeting. 
Obesity specialist clinic know this.  Guidelines don't know it yet. 

I am happy on Low Carb High Fat as I am never hungry and my diet medications, now Belviq, keeps the hunger at bay despite low leptin due to being reduced obese with billions of fat cells the never go away. 

205-210 lbs is a good weight.  I just want to see if I can improve my insulin resistance with loss of visceral fat and not muscle loss. 

UPDATE 9-5-18
I was on a seven day cruise out of Paris to Normandy.  Very nice. Great drink package and met good Australian drinking buddies. Good time. I keep on LCHF on cruise with occasional bite of ice cream. 
I stopped lifting weights on this trip and since the trip.  I have been disappointed with trying to get more muscle with  less fat. I ate 200 gram protein a day and got up to two sets of 25 reps.  Increased weight as it got easier so that I would feel the burn in the last few repetitions. At 66 yo I am on testosterone 100mg/d yet it is an effort and while I did look better, my weight went up as I was on low dose Actos to improve my FBS.  No real difference in FBS, around 150.
I will still lift weights and walk 20 minutes a day for health. However in accordance with my Bon Vivant diet I will not push the protein (at least 110 g/d) high fat and try not to eat any carbs.  I am not hungry on meds. 
This last week I had diverticulitis.  I took flagyl and bactrim.  Flagyl causes an antabuse reaction so I have not drank any alcohol for last 8 days. 

DATE           Weight    Glucose   Ketones

6-30-2018           209.6            164               0.6

9-5- 2018             211.4            170              1.3

THE SPONGE SYNDROME LINK 

How do people in NWCR maintain weight loss.

How do people maintain weight loss according to National Weight Control Registry?

This group of extraordinary people did the following

1- weigh themselves every day

and then if 3-5 pounds heavier, they had a plan what to do about it immediately

2-they tended to have little variety in their food

3-they splurged less on food on holidays.

4-they ate 1,385 calories/day but the facilitator said they are under reporting

5-they ate 4.87 meals a day

6-they linked behaviors to something more than just losing weight.

For example they use walking as their social time.  They linked good behaviors to something they want to do.

7-they often had a life changing event such as divorce or new job.

8- they walk about five miles a day or exercise equivalent

“A clue may be found when studying a ‘rare’ clinical subject: a reduced obese person who has succeeded in losing weight and maintaining the new body weight for more than a year.

The National Weight Control Registry documented the metabolic and behavioral cost of maintaining a reduced obese state of maintaining a reduced obese state for more than 5 years.”

Men 1225 kcal/d net after exercise

Women 918 kcal/d net after exercise p. 945

Dubnov-Raz & Berry
Medical Clinics of North America Sept. 2011

CLUE TWO:

Can You Eat 7 Calories/Pound a Day

And Walk 5 Miles Every Day of Your Life to Maintain Your Weight?

“Treatment of Obesity obviously must lead to a negative energy balance, preferably through reducing food intake and increasing energy expenditure. Even though this strategy sounds simple in theory (according to the first law of thermodynamics), decades of advocating weight loss have failed to stop the obesity epidemic” (Dubnov-Raz and Berry, Medical Clinics of North America [September 2011], p. 940).

CLUE THREE:

In the Obesity Issue of Medical Clinics of North American Sept. 2011 on p 945, Dubnov-Raz & Berry write

“Both men and women(in the NWCR):

1- consumed a low-fat diet (24%) and

2-exercised to use 470 to 360 calories kcal/d, respectively.

The net energy balance was 918 kcal/d for women and 1225 kcal/for men.

These reduced obese subjects ate an average of five meals a day and conducted a very regimented existence.”



Update11-4-15 from TOS meeting in LA.  
Two slides below presented at lecture by Dr. Kushner. 

Twitter Good eats around the world

 Brian Scott Edwards ‏@brianedwardsmd   Manhattan, NY
Price 12" BMT #Subway sandwich $6.80.  Sharing it w my wife, Ginger, priceless! 

Brian Scott Edwards ‏@brianedwardsmd  27m27 minutes ago Manhattan, NY
@brianedwardsmd

#BigApple cheaper #Subway than in #Bergen #Norway 6" sandwich costs $4.20 (35 krone) 

The Topeka Tubby Theory of Obesity

1-Chronic Obesity is due to dysfunction of Leptin and Insulin

Insulin peripherally is anabolic. It promotes constructive metabolism. Insulin will store fat in adipose and glycogen in muscle and liver.

Insulin centrally is catabolic. (like Leptin) Insulin breaks down molecules to release energy.. 

Low Leptin increases food intake and suppresses energy expenditure. (Youdim p6).

"Leptin is an important signal for starvation." 

High Leptin reduces food intake by inhibiting NPY/AgRP neurons and stimulating the alpha-MSH neurons. (Except in the OBESE who become Leptin “resistant". Only LEAN individuals appear to be regulating body weight.) 

Centrally, Leptin and Insulin share same feeding inhibitory and thermogenic pathways.

Here is rest of theory link

10 reasons why people remain thin

Part two of this discussion is found on 2009 BBC video link

10 Reasons Why People stay thin  

1- CCK

2- GLP-1

3- Oxyntomodulin

4- PYY

5- Amylin

6- Adiponectin

7- Pancreatic polypeptide PP

8- Serotonin

9- Insulin

10- Leptin


These are distal signals to the brain that regulate food intake and negative energy balance.  They reduce food intake and increase energy expenditure.

This system works very well in people who remain thin throughout their life.  I suspect these folks lack the 100+ genes that predispose folks to obesity.  FTO gene influences enhancers and repressors

People who have FTO genes and family history of insulin resistance easily overcome the 10 signals above because of abundance of food and dysregulation of dopamine homeostasis and hypodopaminergic reward deficiency syndrome. (Wang et al)

A major mistake in nutrition was to steer people away from fat intake in favor of more carbohydrate intake.  Pasta was even said to be a health food.

Another error that continues are guidelines telling folks to have a minimum of 175 grams of carbohydrates.

There are essential amino acids and fats that the body cannot make and must get from nutrition.

There are backups in the body to maintain glucose levels in absence of carbohydrate intake.

Gluconeogenesis makes glucose in the liver and kidneys from lactate and amino acids and keeps the fasting morning glucose at a normal level.

Free Fatty acids may be used as energy in heart and liver.

Ketones may be used as energy in the brain.

I raised my kids on skim milk have been taught fat was bad for arteries.

Now I believe that an egg is the perfect food as it contains all the essential amino acids that we need.

Nutritionists need to push protein for satiety and fat for taste.  Avoid carbohydrates to avoid insulin resistance developing.

Fruit is not a magical anti-oxidant treatment for long life.  It is God’s sugar.

Low glycemic carbohydrates with fiber are pushed as health foods.

If you are chronically constipated you may find high fiber food to be healthy.

If you have hypertension you may find yourself to be salt sensitive.

If you are prone to obesity you definitely want to avoid carbohydrates.

Despite the 10 signals listed above to keep you thin, abundant carbohydrates in genetically predisposed obese will lead to insulin resistance and central obesity with leptin resistance or elevated leptin threshold.

For the naturally thin, when offered a whole pizza pie they will happily eat only one slice.  The 10 signals work for them.

A new theory of Obesity

Obese individuals are Leptin resistant and often insulin resistant. 
Thus Leptin and Insulin acts differently in the obese state. 
They also act differently in the reduced obese state which is why people cannot maintain their weight loss despite low calorie diet and exercise. 

Get the details at the Sponge Theory of Obesity

link above