NLA guidelines fails to represent Low carbohydrate High Fat data.
Data that NLA Part 2 guidelines is missing link
Friday, September 25, 2015
I wish to correct a bias of NLA Part 2 guidelines
NLA guidelines fails to represent Low carbohydrate High Fat data.
Data that NLA Part 2 guidelines is missing link
Thursday, September 24, 2015
Head to Head Comparative Diet Study over 2 years Feb 2009
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
Sachs http://www.nejm.org/doi/full/10.1056/NEJMoa0804748We randomly assigned 811 overweight adults to one of four diets; the targeted percentages of energy derived from
fat, protein, and carbohydrates in the four diets were
20, 15, and 65%;
20, 25, and 55%;
40, 15, and 45%;
40, 25, and 35%.
The diets consisted of similar foods and met guidelines for cardiovascular health.
Conclusions
Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.
 |
This is composition of low fat average protein diet
 |
| This is composition of high fat high protein diet |
Wednesday, September 23, 2015
Cochrane review of saturated fat effect on cardiovascular risk 2015
Link at Cochrane 2015 article on saturated fat
AUTHORS' CONCLUSIONS:
The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake.
Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy, and replacement with carbohydrate appears less useful,
but effects of replacement with monounsaturated fat were unclear due to inclusion of only one small trial.
This effect did not appear to alter by study duration, sex or baseline level of cardiovascular risk. Lifestyle advice to all those at risk of cardiovascular disease and to lower risk population groups should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturated fats.
The ideal type of unsaturated fat is unclear.
Data that KEY COMPONENTS of MEDITERRANEAN DIET help weight loss
"The key components of Mediterranean diets are also beneficial for weight loss in obese patients [126] and for preventing long-term weight gain in non-obese populations [127]."
Mozaffarian
Mozaffarian
126: N Engl J Med. 2008 Jul 17;359(3):229-41. doi: 10.1056/NEJMoa0708681.
Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.Shai I1,
"Mediterranean and low-carbohydrate diets may be effective alternatives
to low-fat diets. The more favorable effects on lipids (with the
low-carbohydrate diet) and on glycemic control (with the Mediterranean
diet) suggest that personal preferences and metabolic considerations
might inform individualized tailoring of dietary interventions."
127:
127:
N Engl J Med. 2011 Jun 23;364(25):2392-404. doi: 10.1056/NEJMoa1014296.Mozaffarian D1,
Changes in diet and lifestyle and long-term weight gain in women and men.
PREDIMED diet from Spain is the Mediterranean diet that is evidence based
Do you lose weight on Mediterranean Diet? link
"A total of 7,447 persons in Spain were randomized to either
1- a Mediterranean diet with increased extra virgin olive oil,
2-a Mediterranean diet with increased nut intake, or
3-a control diet where the participants received low fat diet advice.
The high extra virgin olive oil group ingested an average of
3.6 tablespoons/day (51 grams/day equal to 459 calories/day)
of olive oil with 98% of it being extra virgin olive oil.
The high nut group ate 8.2% of their total daily calories in the form of nuts, including an additional approximately one ounce packet of nuts (15g of walnuts, 7.5 g of almonds, and 7.5g of hazelnuts) provided by the study coordinators. "
Tuesday, September 22, 2015
Mozaffarian: A Sensible Voice in Nutrition
In the summer of 2010 I heard Professor Mozaffarian speak for the first time at a National Lipidology Conference in Washington DC.
Professor Mozaffarian asked a room of about 200 lipidologists how many of them measured the amount saturated fat they ate in their diet?
Only one Lipid specialist raised their hand.
Professor Mozaffarian's lecture was an epiphany to me.
In 2008 I had devised a diet that used mostly frozen dinners to achieve the 7% saturated fat limit. I published it on page 130 in my book The Tubby Theory from Topeka.
I was very happy to read:
Professor Mozaffarian asked a room of about 200 lipidologists how many of them measured the amount saturated fat they ate in their diet?
Only one Lipid specialist raised their hand.
Professor Mozaffarian's lecture was an epiphany to me.
In 2008 I had devised a diet that used mostly frozen dinners to achieve the 7% saturated fat limit. I published it on page 130 in my book The Tubby Theory from Topeka.
I was very happy to read:
He wrote:
"Foods rich in refined starches and sugars—not fats—seem to be the primary culprits for weight gain and, in turn, risk of type 2 diabetes. To blame dietary fats, or even all calories, is incorrect. Although any calorie is energetically equivalent for short-term weight loss,
a food's long-term obesogenicity is modified by its complex effects on:
1- satiety,
2-glucose–insulin responses,
3-hepatic fat synthesis,
4-adipocyte function,
5-brain craving,
6-the microbiome, and even
7-metabolic expenditure.
Some foods improve these physiological compensatory mechanisms toward long-term energy balance, whereas others have neutral or even adverse effects."
To my chagrin, NLA, announced Part 2 of it's lifestyle advice Sept. 2015.
New guidelines advised less than 7 per cent saturated fat, less than 200 mg Cholesterol and 5% weight loss to prevent cardiac events.
The contrast of PSCK9 being introduced as a new therapy to lower LDLc with this old saw of low fat diet was stunning.
Please read Saturated Fats: Its Complicated
Mozaraffarian on Mediterranian diet. link
Mozaraffarian on Mediterranian diet. link
"The Spanish PREDIMED trial demonstrated a reduction in the risk of cardiovascular events by approximately 30% when participants were advised to follow a Mediterranean diet, supplemented with either nuts or extra-virgin olive oil [15]. Notably, extra-virgin olive oil largely replaced regular (non-virgin) olive oil, suggesting that the benefits of olive oil may be more closely related to bioactive compounds in extra-virgin oils [124] rather than to monounsaturated fats per se.
Mediterranean diets also improve glycemic control [125] and reduce the incidence of type 2 diabetes [31].
The key components of Mediterranean diets are also beneficial for weight loss in obese patients [126] and for preventing long-term weight gain in non-obese populations [127].
Thus, rather than focusing on reductions in total calories or portion sizes, or on increasing or decreasing isolated nutrients, an emphasis on overall diet quality according to types of foods consumed has the strongest evidence-base for reducing adiposity and preventing diabetes and cardiovascular diseases.
One close relative is the Dietary Approaches to Stop Hypertension (DASH) diet, which shares many of the same characteristics.
Notably, while the original DASH diet was lower in fat and higher in carbohydrate,
controlled clinical trials demonstrate that a higher-fat DASH diet, rich in healthful vegetable oils and nuts, produces even larger cardiometabolic benefits than the original low-fat DASH diet [128,129]."
,
Sunday, September 20, 2015
Can Exercise Maintain Weight Loss: Controversy at NLA Pittsburgh
Maintain Weight Loss with Exercise Controversy
Can you maintain weight loss with exercise?
(Fast answer go to:
these two minute videos by Freedhoff and Weil: excellent)
This question came up at the NLA meeting at Pittsburgh on Sept. 20, 2015.
There were 3 experts present to answer the question.
Eric Westman MD
Diplomate of the American Board of Obesity Medicine
President of the American Society of Bariatric Physicians
Answered: No.
Harold Bays MD
Board Certified in Endocrinology and Internal Medicine
Diplomate of the American Board of Clinical Lipidology
Diplomate of the American Board of Obesity Medicine
Answered: Yes
Daniel H. Bessesen MD
Professor, Endocrinology, Metabolism and Diabetes
University of Colorado
Answered: Yes
I am
Brian S Edwards MD
Board Certified Internal Medicine and Geriatrics
Board Certified Infectious Disease
Diplomate of the American Board of Clinical Lipidology
Board eligible to be a Diplomate in Obesity Medicine
Last April I took a course at Columbia College of Physicians and Surgeons to prepare for the Boards in Obesity.
The slide below presented by Richard Weil from the conference tries to answer this question.
It’s interesting to me that Dr Bays and Dr. Bessesen qualified their answered with saying you can’t lose weight with exercise but you can maintain weight loss with exercise.
The slide below tells you exactly how much exercise to lose weight and how much exercise to maintain weight loss.
Richard Weil questions the validity of these numbers if the number of calories taken in is not reported.
I asked Dr. Bays about this afterwards and he said of course, but he still felt you could maintain weight loss with exercise. I pointed out only 5-15% of people maintain weight loss after five to ten years.
I exercised 2.5 hours a day for 5 years after a 80 pound weight loss. I slowly gained 1.5 pounds a month for a total regain of 50 pounds.
In Jan 2011 I went on LCHF diet and stopped regaining weight. I reduced my exercise to 20 to 40 minutes a day. Dr. Westman said the exercise prescription correlates with the amount of carbohydrate you eat. I ate quite a bit of fruit during those five years of slow weight gain.
Final Answer: Watch these 2 short videos if you have not done so already link
In all fairness to Dr Bays and Dr Bessesen I will quote the Handbook of Obesity:
pg. 282: "Is Exercise associated with reduction in body weight and total adiposity in a dose-response manner?"
"A total of 39 studies met the inclusion criteria...On average, studies with longer duration reported smaller weight loss for a given EE, whereas shorter duration reported greater weight loss."
"Not surprisingly, the exercise-induced changes in fat mass revealed a similar pattern to that observed for weight loss."
"It is also possible that adherence to dietary intake instructions was more readily adhered to in short-term as opposed to long-term trials."
pg. 290: "Clearly, there is a need for additional well-controlled trials that consider the independent effects of exercise on obesity reduction."
"However, although exercise alone is associated with reduction in total and abdominal fat in a dose-responsive manner, gaps in knowledge persist."
"Nevertheless, the dose-response relationship observed in the short-term studies indicates that to reduce bodyweight by about 0.25kg/week, the required EE (energy expenditure) approximates 2700 kcal/week.
Our observations suggest that EE of this magnitude will require exercising for about 50 minutes, five times a week at 70% VO2max (83% of maximum heart rate).
It is important to reinforce the observation that these calculations are derived from short-term studies alone. "
"It is evident that in long term trials, despite the similarity in the EEs prescribed, that the corresponding reduction in both total and abdominal obesities is substantially less."
"demonstration that the adoption of exercise alone as a treatment strategy for obesity reduction can be sustained long term remains a challenge."
However, I believe the above paragraph is discussing losing weight with exercise which Dr Brays and Dr Bessesen did not believe in.
I don't think the above addresses exercise maintaining weight loss.
Can you maintain weight loss with exercise?
(Fast answer go to:
these two minute videos by Freedhoff and Weil: excellent)
This question came up at the NLA meeting at Pittsburgh on Sept. 20, 2015.
There were 3 experts present to answer the question.
Eric Westman MD
Diplomate of the American Board of Obesity Medicine
President of the American Society of Bariatric Physicians
Answered: No.
Harold Bays MD
Board Certified in Endocrinology and Internal Medicine
Diplomate of the American Board of Clinical Lipidology
Diplomate of the American Board of Obesity Medicine
Answered: Yes
Daniel H. Bessesen MD
Professor, Endocrinology, Metabolism and Diabetes
University of Colorado
Answered: Yes
I am
Brian S Edwards MD
Board Certified Internal Medicine and Geriatrics
Board Certified Infectious Disease
Diplomate of the American Board of Clinical Lipidology
Board eligible to be a Diplomate in Obesity Medicine
Last April I took a course at Columbia College of Physicians and Surgeons to prepare for the Boards in Obesity.
The slide below presented by Richard Weil from the conference tries to answer this question.
It’s interesting to me that Dr Bays and Dr. Bessesen qualified their answered with saying you can’t lose weight with exercise but you can maintain weight loss with exercise.
The slide below tells you exactly how much exercise to lose weight and how much exercise to maintain weight loss.
Richard Weil questions the validity of these numbers if the number of calories taken in is not reported.
I asked Dr. Bays about this afterwards and he said of course, but he still felt you could maintain weight loss with exercise. I pointed out only 5-15% of people maintain weight loss after five to ten years.
I exercised 2.5 hours a day for 5 years after a 80 pound weight loss. I slowly gained 1.5 pounds a month for a total regain of 50 pounds.
In Jan 2011 I went on LCHF diet and stopped regaining weight. I reduced my exercise to 20 to 40 minutes a day. Dr. Westman said the exercise prescription correlates with the amount of carbohydrate you eat. I ate quite a bit of fruit during those five years of slow weight gain.
Final Answer: Watch these 2 short videos if you have not done so already link
In all fairness to Dr Bays and Dr Bessesen I will quote the Handbook of Obesity:
pg. 282: "Is Exercise associated with reduction in body weight and total adiposity in a dose-response manner?"
"A total of 39 studies met the inclusion criteria...On average, studies with longer duration reported smaller weight loss for a given EE, whereas shorter duration reported greater weight loss."
"Not surprisingly, the exercise-induced changes in fat mass revealed a similar pattern to that observed for weight loss."
"It is also possible that adherence to dietary intake instructions was more readily adhered to in short-term as opposed to long-term trials."
pg. 290: "Clearly, there is a need for additional well-controlled trials that consider the independent effects of exercise on obesity reduction."
"However, although exercise alone is associated with reduction in total and abdominal fat in a dose-responsive manner, gaps in knowledge persist."
"Nevertheless, the dose-response relationship observed in the short-term studies indicates that to reduce bodyweight by about 0.25kg/week, the required EE (energy expenditure) approximates 2700 kcal/week.
Our observations suggest that EE of this magnitude will require exercising for about 50 minutes, five times a week at 70% VO2max (83% of maximum heart rate).
It is important to reinforce the observation that these calculations are derived from short-term studies alone. "
"It is evident that in long term trials, despite the similarity in the EEs prescribed, that the corresponding reduction in both total and abdominal obesities is substantially less."
"demonstration that the adoption of exercise alone as a treatment strategy for obesity reduction can be sustained long term remains a challenge."
However, I believe the above paragraph is discussing losing weight with exercise which Dr Brays and Dr Bessesen did not believe in.
I don't think the above addresses exercise maintaining weight loss.
Saturday, September 19, 2015
New guidelines from NLA on diet made me very sad
#NLAPittsburgh
In quotes from NLA part 2 guidelines:
"Diet low in sat FA; trans FA & cholesterol: 5 to 10%
Loss of 5% of body weight: 3 to 5%
2 g /day PS or 7.5 g/day viscous fiber: 4 to 10%
Total: 12 to 25%
Combining any 2 of the interventions recommended would be expected to reduce LDL-C by 6 to 19%.
The portfolio diet approach, which combines PS, viscous fibers, soy, and almonds has been shown to reduce LDL-C by ~30% with controlled feeding, but the reduction was less(~15%) when subjects were free-living."
Very impractical
The Portfolio diet? That is not a weight reduction diet.
Look Ahead trial had negative CV outcome.
10 year graph of Look Ahead link
Only 3% delta weight loss after 4 yrs. Best study. Negative CVE outcome. How does NLA think it will achieve 5% weight loss with positive CV event outcome?
In April 2015, I attended a Obesity Board Review at Columbia University. This was a trial they presented that NLA missed.
Link to 3 minute video
In quotes from NLA part 2 guidelines:
"Diet low in sat FA; trans FA & cholesterol: 5 to 10%
Loss of 5% of body weight: 3 to 5%
2 g /day PS or 7.5 g/day viscous fiber: 4 to 10%
Total: 12 to 25%
Combining any 2 of the interventions recommended would be expected to reduce LDL-C by 6 to 19%.
The portfolio diet approach, which combines PS, viscous fibers, soy, and almonds has been shown to reduce LDL-C by ~30% with controlled feeding, but the reduction was less(~15%) when subjects were free-living."
Very impractical
The Portfolio diet? That is not a weight reduction diet.
Look Ahead trial had negative CV outcome.
10 year graph of Look Ahead link
Only 3% delta weight loss after 4 yrs. Best study. Negative CVE outcome. How does NLA think it will achieve 5% weight loss with positive CV event outcome?
In April 2015, I attended a Obesity Board Review at Columbia University. This was a trial they presented that NLA missed.
Link to 3 minute video
Thursday, September 17, 2015
Update on Tubby Theory - Add Zetia to list of proven drugs and lower LDLc is better
The Tubby Theory advises goal LDLp <750 nbsp="" p="">
IMPROVE-IT showed that lower LDLc is better.
Dr. Dayspring disagrees with using Niacin before Zetia as a second drug. I quoted an article on March 26,2014 by Dr. Dayspring where he defended Niacin in 2 of the outcome trials before, but now he reverses himself.
Here is an exchange I had on twitter with him.
Brian Scott Edwards
Need trial low dose combo vs. high dose statin in high risk naive drug group before we can be certain which is best
Did I misquote? http://meandgin.blogspot.com/2013/01/dr-daysprings-analysis-of-recent-niacin.html … @mdavidsonmd @nstone @lipiddoc @SethJBaumMD @PauliOhukainen @drpablocorral
- @brianedwardsmd I one arm does not reach LDLp goal then add zetia to that arm.
- @brianedwardsmd Goal is to avoid side effects while reaching LDLp goal.
- I love Zetia as 3rd drug. Economics for society calls for cheapest, safest treatment. http://meandgin.blogspot.com/2015/02/niacin-does-however-favorably-alter.html …
Tuesday, September 15, 2015
CAC vs. CIMT in predicting risk for stroke and heart attack
CAC vs. CIMT link from Jan 2015
CONCLUSIONS:
In adults without CVD,
CAC presence improves prediction of CVD and CHD more than carotid plaque presence or high IMT.
CAC and carotid ultrasound parameters performed similarly for stroke/transient ischemic attack event prediction.
2009 article
The principal finding of this study is that a substantial percentage of patients who have no clinically apparent atherosclerosis and a CACS of zero in fact have atherosclerotic disease, as determined by ultrasonography of the carotid arteries. Mayo Clin Proc. 2009 March; 84(3): 229–233
What if CAC zero, no risk? link
CONCLUSIONS:
In adults without CVD,
CAC presence improves prediction of CVD and CHD more than carotid plaque presence or high IMT.
CAC and carotid ultrasound parameters performed similarly for stroke/transient ischemic attack event prediction.
2009 article
The principal finding of this study is that a substantial percentage of patients who have no clinically apparent atherosclerosis and a CACS of zero in fact have atherosclerotic disease, as determined by ultrasonography of the carotid arteries. Mayo Clin Proc. 2009 March; 84(3): 229–233
What if CAC zero, no risk? link
Tubby Traveler data after 53 days vacation
I lost a pound between obesity clinic visits (64 days)
with 53 days vacation of which 28 days were on a cruise.
You can't outrun your fork:
April 5 to Sept 15, 2015 1,500,000 steps on Fitbit
Over 164 days that is 9,146 steps a day.
My data over the years
I ran out of Qsymia 7.5mg on Aug 11.
I re-started Qysemia 7.5 mg on Sept. 15
I tried to fill the gap while on the cruise with Victoza 1.8 mg from Aug 19 to Aug 29.
Of interest is that when I went off LCHF diet for 5 days in NYC because the Hotel gave us a free continental breakfast which consisted of only carbs I went up to 248 lbs despite a good deal of walking.
Aug 31: 8,000 steps
Sept 1: 6,200 steps
Sept 2: 6,300 steps
Sept 3: 9,900 steps
Sept 4: 17,900 steps
Back in Kansas I weighed 245 lb on Sept 5.
I decreased Actos from 45 mg to 30 mg on Sept 6
I have been off Prozac since Aug 20.
These are drugs that cause weight gain.
I have been off Qysemia and Victoza.
Yet with LCHF diet alone I went from 248 lb to 237 lbs.
Sept 5 8,700 steps
Sept 6 5,000 steps
Sept 7 5,300 steps
Sept 8 7,500 steps
Sept 9 6,900 steps
Sept 10 7,700 steps
Sept 11 7,400 steps
Sept 12 4,900 steps
Sept 13 8,500 steps
Sept 14 10,400 steps
I re-started Qysemia 7.5 mg on Sept. 15
with 53 days vacation of which 28 days were on a cruise.
You can't outrun your fork:
April 5 to Sept 15, 2015 1,500,000 steps on Fitbit
Over 164 days that is 9,146 steps a day.
My data over the years
I ran out of Qsymia 7.5mg on Aug 11.
I re-started Qysemia 7.5 mg on Sept. 15
I tried to fill the gap while on the cruise with Victoza 1.8 mg from Aug 19 to Aug 29.
Of interest is that when I went off LCHF diet for 5 days in NYC because the Hotel gave us a free continental breakfast which consisted of only carbs I went up to 248 lbs despite a good deal of walking.
Aug 31: 8,000 steps
Sept 1: 6,200 steps
Sept 2: 6,300 steps
Sept 3: 9,900 steps
Sept 4: 17,900 steps
Back in Kansas I weighed 245 lb on Sept 5.
I decreased Actos from 45 mg to 30 mg on Sept 6
I have been off Prozac since Aug 20.
These are drugs that cause weight gain.
I have been off Qysemia and Victoza.
Yet with LCHF diet alone I went from 248 lb to 237 lbs.
Sept 5 8,700 steps
Sept 6 5,000 steps
Sept 7 5,300 steps
Sept 8 7,500 steps
Sept 9 6,900 steps
Sept 10 7,700 steps
Sept 11 7,400 steps
Sept 12 4,900 steps
Sept 13 8,500 steps
Sept 14 10,400 steps
I re-started Qysemia 7.5 mg on Sept. 15
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