Great article on Bariatric surgery. My review on excerpts.

Great article on Bariatric surgery.  

My review on excerpts IN PURPLE

ONE

Good lead to the title of my book that I published last year. 

                                                                           

I guess the author never heard of :

The National Weigh Control Registry (NCWR) link

Very Low Calorie diets (VLCD) 800-1000 calories do counter hunger with ketosis in first 9-12 months. 

                      Remember that bariatric surgery does not affect the number of fat cells.  After 10 years 30% of bariatric patients regain their weight as the Sponge syndrome keeps their leptin low which causes decreased thermogenesis and increased hunger. 
                                                             
                                    TWO

THIS IS A GREAT ADVANCE. 

HOPEFULLY ALL STATES WILL EXPAND THEIR MEDICAID.

NOW THEY HAVE TO PAY FOR MULTIPLE DIET MEDICATIONS FIRST BEFORE SURGERY

MULTIPLE DIET MEDICATIONS.  LINK

THREE

The statement above is not accurate as it does not take into account the Waterfall Effect of all diet trials. 

FOUR

Again I think fails for many patients. Dr. Rosenbaum talks about 

'set point' here  link

FIVE

I think we have to  wait five years at least before we can say the bariatric surgery does actually do this.  The shrunken fat cells eventually win and cause weight regain.

No one addresses Sponge Theory  of mine.

SIX

The 3-9% re-operation rate for bypass and sleeve are major reasons to use  combination multiple diet medications first.

SEVEN

But how many gained their weight back?

It is a bias to not share the waterfall weight change of the whole group.

EIGHT

Exactly. 

"safe and effective" on average"

Not very encouraging for such an expensive operation that fails 30% of patients 

after 10 years they regain their weight with potential death.

NINE

TEN

ELEVEN

Very important 0.3% mortality risk

 and other potential harms. 

3 out of 1,000 patients will die.

TWELVE

EXACTLY. 

 MANY OF THE BARIATRIC TRIALS FLAWED.

I RARELY SEE 

INTENTION TO TREAT NUMBERS. 

 I HAVE TRIED TO WRITE AUTHORS FOR INFORMATION  AND THEY DON'T HAVE IT. 

THIRTEEN

My worry is that other than trials or large centers this long term follow up is not done

FOURTEEN 

FIFTEEN

This is his opinion.  

We now have multiple diet medications that can be taken at same time for life. 

Why risk being one of the three in 1,000 that die. 

SIXTEEN

GASTRIC LEAKS 5%

BARRETTS ESOPHAGUS 17%

SEVENTEEN

Suicide 

Drug and Alcohol disorders. 

EIGHTEEN

How many pts did I know had ASHD?

Here is all the data.
 Maybe you can count the exact numbers.  Looks like 50% had documented CVD?
I started the list here.

My thanks to Ivor and Tro for their leadership in getting me to try Intermittent Fasting.

I have done well just having coffee for breakfast and lunch since Nov 13, 2019

11-16-19 results.  CGM advised by Dr. Tro has made a big motivator to stay fasting.

I stared modified intermittent fasting Nov 9 

Blog to starting IF link 

Eat Rich Live Long p. 297

Initially I thought intermittent fasting was too restrictive for general public. 

I found I developed hyperphagia if I skipped a meal.

Now I realize it is easy to skip breakfast but I was taught never to skip breakfast. 

Despite Low Carb High Fat and nutritional ketosis I was having trouble getting below 210 lbs and staying there. 

I have an advantage. 

I take the diet medications Victoza and Belviq.

I also take Invokana and metformin. 

My problem is night eating. 

I realize with dark roast coffee I am not having too much trouble skipping breakfast and lunch. 

My steps this week ranged from 5,000 to 10,000 a day.

Martini night at The See No Evil bar in Topeka, KS

Martini night at The See No Evil bar in Topeka, KS

Oh wait that is every night. 

I  learned that a Sapphire Martini is different as it is more herbal.

That's why a different vermouth might be used. 

See My favorite vermouth link

See my Bon Vivant diet link

Autumn in Topeka 2019

November 9, 2019
After a freeze and some wind most of the leaves fell off. 

October 30, 2019

My New Bon Vivant diet with modified Intermittent Fasting

My attempt at Intermittent Fasting

Fasting glucose (finger stick) 124
CGM 116
Ketones 4.0

BREAKFAST
One egg cooked in butter 7-9 AM
100 calories 0.5 g CHO 8 g Fat 6 g protein


Diet Pepsi
Snapple diet Tea
CGM 131 at 10:40 AM
Poweraide with Premium Clear Protein drink
90 calories 20 g protein

CGM 116 at 12:15 PM
LUNCH
Caffeinated coffee w one dark chocolate
1 square 60 calories 14 g CHO 3 g fiber 15 g fat Protein 2 g

Gym workout
presently I walk treadmill 20 minutes and stretch for back
PROTEIN20
60 calories 15 g protein

CGM 129 at 3:50 PM
 3.5 oz large salad 
160 calories 14g CHO 3.0 g Fiber 1.50 g saturated fat.
here then:
CGM 142 at 4:33 PM

DINNER

8 OZ BEEF FILLET 
560 calories 62 g protein

Butter 2 pats
200 calories 

CGM 170 7:43 PM


After Dinner Gin Martini
135 calories 20g ETOH 0 CHO
4 garlic stuffed large olives
40 calories 4 g CHO 1 g Fat

8 oz red wine

160 calories 22 g ETOH 4 g CHO
360 calories 4 oz cheese

CGM 171 at 8:22 PM 

Total calories:

100

 90

  60 

  60

160

560

200

160 

  40

360

total: 1630 calories 

Please note:

Basal Metabolic Rate : 1761 calories 

Moderate activity (5,000 to 8,000 steps):

2,642 Calories 

I have a daily deficit of 1,000 calories a day

Why don't I lose weight.

Answer:

I am a reduced obese with the Sponge Syndrome

Validation of Sponge Syndrome link

I have been down to 208 lbs but next day I can jump up to 213 lbs. 
I will cut down to one block of chocolate now. 
I will just have one egg instead of one yogurt. 
Less carbs more calories. 
I have been 200 lbs but it is very difficult for me to stay there due to the Sponge syndrome. 

My goal is 200 lbs which means I will jump  back and forth to 205 lbs if I am lucky or very consistent. 
While watching TV at night I am not so hungry as bored with some cravings. 

I will eat popcorn, almonds, or pistachios as a snack. 

I have cut down on my snacking due to using a
 Continuous Glucose Monitor (CGM).
It is a helpful motivator to turn away from snacks.  

My true help with appetite is:
Victoza 3.0 mg injection
Belviq 20 mg day
Metformin 500 mg a day.
Caffeine 
My true help with my Diabetes Mellitus type 2:
Invokana 300 mg 
Lost 30 l lbs on Invokana without change of diet or exercise link

Recent BIA's

Products I use with nutrition information



Propel water below



 20 gram protein drink with Poweraide Zero to bridge lunch 




15 gram protein drink which I take during my workout at gym
















I compare 3 vermouths for my Classic Gin Martini link

Insulin references in The Hungry Brain. by Stephen J. Guyenet

I have Stephan J. Guyenet's book, The Hungry Brain.

I missed his references to the central action of Insulin on the brain.

In his tweet below he writes, "The effect of insulin seems to be smaller and less consistent though."

I guess he is comparing it to low levels of leptin action on the brain?
My article on the paradoxical effects of insulin link

Excerpts:
1-Although many factors affect fat cells, the hormone insulin exerts dominant anabolic control. (peripherally)

2- Catabolic state of uncontrolled diabetes despite elevated blood glucose

I have tried to figure insulin and leptin effect in lean, obese and reduced obese. Article from Aug 2017

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583684/