Number One Health Problem in U.S.

timbalionguy wrote:...books on the Atkins diet, and the fine books by the Eades....

Eades just posted on his blog that he eats fatty meats. Maybe you need the naturally saturated fats more than the fiber (if I remember correctly there is a fair amt of fiber in meat, maybe your portion size has been too small)? I eat 6-8 ozs of meat/poultry/fish at dinner, 4 oz at lunch sometimes with celery+cream cheese or a sm salad, b'fast is typically just 3 eggs and a small can of low sodium V8. I eat deviled eggs, cheese sticks, grd beef seasoned with cumin & chili powder for snacks and try to eat every 3-4 hrs. even if only a sm handful of nuts.

Eating out: steak of course, side dish: salad? no...asparagus? no...tomatoes? no...I assume that broccoli & cauliflower are out (if ya don't like, ya probably don't have the gene to sense the tasty part in crucifers and just taste the bitter). Well, if you can handle some carbs, try potato skins with cheese and bacon, just make sure not to eat much of the 'white" part, some places serve swt potatoes and 1/2 won't be too high in carbs, if you like swt potatoes. Finding places with large protein portions is always a challenge; I add cheese to everything.

You did this before and it worked, you can do it again but you have to plan ahead what you can eat (remember?). My buddies all know this because they understand my desire to lose wt. and this is the only way that works for me. There are only a few chain restaurants that are a challenge for me either because of irresistible temptation or few good low-carb choices. Sweets --keep reminding yourself why you are eating low carb. Popcorn -- I'm so tempted that I even avoid smelling it , when my craving is huge, I pop a small amt in refined organic coconut oil, add butter, take it someplace quiet and free of distractios and savor every single tiny morsel.

Remember to drink enough water and get enough sodium as these are real issues when initiating/re-initiating low, low carb eating.

Pick up a whole rabbit at market and eat it like an apple. Yeah, that'd freak out the other shoppers

Muse-Inc wrote:
Eades just posted on his blog that he eats fatty meats. Maybe you need the naturally saturated fats more than the fiber (if I remember correctly there is a fair amt of fiber in meat, maybe your portion size has been too small)? I eat 6-8 ozs of meat/poultry/fish at dinner, 4 oz at lunch sometimes with celery+cream cheese or a sm salad, b'fast is typically just 3 eggs and a small can of low sodium V8. I eat deviled eggs, cheese sticks, grd beef seasoned with cumin & chili powder for snacks and try to eat every 3-4 hrs. even if only a sm handful of nuts.

I know he has discussed the fatty meat thing in his book, and so did Atkins. Without the carbs, fatty meat is OK. The fats in red meat are primarily energy stores, and are not metabolized by the body when in ketosis (which I think both you and I easily achieve). Essential fatty acids are more important, and everyone needs those. Besides, it is the fat that lends meat most of its flavor.

Meat contains virtually no fiber. I can eat a really gristly piece of meat (gristle= tendons, ligaments, cartilidge, etc.) and see little if any of it in my feces. I do find that eating good-sized portions helps immensely. For breakfast, I typically eat a pound of sausage. I rarely do lunch, and often just have some beef jerky (watch the sugar in that stuff, though!). Dinner usually consists of a whole chicken or equivalent. I will get either a whole rotisserie chicken, or 8 pieces of a baked chicken preparation a local supermarket sells. Even with these prepared foods, i eat for less per day than many people. With the fiber supplement, I stay completely regular on this diet.

I will sometimes, get beefsteak instead of the chicken. Top sirloin, round steak, and when I can afford it, T-bone or New York Strip. Sometimes, I get a cheap cut like chuck steak. Sometimes bratwurst or Italian sausage. Good quality (no fillers) hot dogs are a treat as well. I also love lamb, goat and venison. I will eat virtually any red meat I can get my hands on.

I don't care at all for eggs. Fish is OK. Most poultry is good, especially chicken. I don't often do fresh pork, although some things like roasted pork loin are very good. Lots of pork sausage. Bacon and ham are both favorites, although I have to eat both in moderation. Good dry-rubbed pork ribs are great, too. (And we have a rib festival here!)

When you are saying ground beef snacks, and the spices you mention am I assuming this is raw? When I eat raw beef, it is typically things like round steak or other lean cuts. No seasoning whatsoever. The way God intended meat to be enjoyed

Muse-Inc wrote:Eating out: steak of course, side dish: salad? no...asparagus? no...tomatoes? no...I assume that broccoli & cauliflower are out (if ya don't like, ya probably don't have the gene to sense the tasty part in crucifers and just taste the bitter). Well, if you can handle some carbs, try potato skins with cheese and bacon, just make sure not to eat much of the 'white" part, some places serve swt potatoes and 1/2 won't be too high in carbs, if you like swt potatoes. Finding places with large protein portions is always a challenge; I add cheese to everything.

I don't enjoy any of that, even the potato skins. You may be right; I might be missing a gene that allows some of these veggies to actually be tasty. I don't care much for cheese by itself, but do enjoy mild to moderate cheese in combination with other foods. I an not nuts at all about nuts.

Muse-Inc wrote:You did this before and it worked, you can do it again but you have to plan ahead what you can eat (remember?). My buddies all know this because they understand my desire to lose wt. and this is the only way that works for me. There are only a few chain restaurants that are a challenge for me either because of irresistible temptation or few good low-carb choices. Sweets --keep reminding yourself why you are eating low carb. Popcorn -- I'm so tempted that I even avoid smelling it , when my craving is huge, I pop a small amt in refined organic coconut oil, add butter, take it someplace quiet and free of distractios and savor every single tiny morsel.

I wish my friends were more understanding! A few are, as they have done this themselves. Sweets aren't a problem once I am solidly in ketosis, although I do drink a fair amount of diet soda. Popcorn.... very hard to resist. So, I have missed more than a few good movies due to avoiding the temptation. One trick I do to keep the disruption down is to see 2 or 3 movies in a night, and binge just once on the popcorn.

Muse-Inc wrote:Remember to drink enough water and get enough sodium as these are real issues when initiating/re-initiating low, low carb eating.

I do drink a lot of water anyway, as I take allopurinol for gout. One of the very few maintenance drugs I probably won't be able to completely stop using. I get plenty of sodium. Calcium is very important though, as all the protein in your blood tends to draw out calcium. (Some need a little potassium as well, but meat is appropriately high in potassium.) I can't crunch bones like the cats, so I take 2 grams of calcium a day, in 2 doses. This is a 'calcium/magnesium/zinc' preparation. High dose calcium should always be taken with these other minerals, and most high dose calcium supplements are made this way.

Vitamin C is also very important, as meat contains little vitamin C unless 'still warm from being alive'. Man is one of only a handful of mammals that cannot synthesize vitamin C. I take 1 gram of vitamin C a day, in two doses. I also take a good multivitamin, and often extra vitamin E and B complex.

Muse-Inc wrote:Pick up a whole rabbit at market and eat it like an apple. Yeah, that'd freak out the other shoppers

A local store sells a pork leg preparation that is essentially the lower leg with the hoof still attached. (I think it is a Hispanic ethnic thing, as the name on the package is in Spanish.) I have thought of roasting one of these, and then eating it like an apple on the streets of certain college campuses that frown of flesh-eating!

There are many fine books on the issue of fats and carbs. In addition to Atkins and Eades, I've read Carlson's "Genodicide", Taubes' "Good Calories, Bad Calories", somebody or other's "Live Without Bread", Berstein's diabetes solution, and Kendrick's "The Great Cholesterol Con". Here's a link to a presentation by Taubes. His audience is medical students who don't show much interest except for one person.
http://www.dhslides.org/mgr/mgr060509f/f.htm
Another subject of the carbs and fat debate is Tom Naughton's movie, Fat Head. It's funny, entertaining, and very educational. Here's a link to an interview with him: http://livinlavidalowcarb.com/blog/?p=3551 If you follow this link, you will be able to find a source of many interviews over the topic of getting rid of the sugars.

Another excellent book is 'The Metabolic Typing Diet', forget who the author is. It shows that there is a continuium of body types, from extreme 'protein types' (of which i closely fit the mold), and at the other end, extreme carb types. Each has a die right for them, and the lucky folks in the middle can choose things from both ends. The protein types need to eat a lot of heavy protein (red meat, organ meats, etc.), tend to have an energy problem, and need to avoid as much carbs as they can. They also tend to have strong apetites (to drive them to hunt, and perhaps gorge when fresh 'kill' is available?) Carbohydrate types need to eat light proteins (fish, eggs, maybe chicken, etc.), eat a lot of complex carbs, and they tend to be able to easily skip meals, etc. They usually don't have an energy problem, and often have a thin build. Everyone should avoid refined sugars, alcohol, and really high glycemic index carbs. Great book!

rooster wrote:I had sleep apnea undiagnosed for decades. When I graduated from college (age 22) I was a very fit BMI 21.

Sometime in my mid-twenties I developed sleep apnea. Then my weight increased to BMI 25 by age 40 (Most people thought I was still skinny but surprise, 25 is actually overweight).

Now with CPAP, I have the energy to exercise strenuously and regularly and my BMI is again a very fit 21 (age 60). But I still have severe OSA and my CPAP pressure needs have not been reduced. Very nicely though, type 2 diabetes has disappeared. Even on days I have high carb intake, my bg levels remain normal.

Interesting post. I'm hoping that treating my recently-diagnosed OSA aggressively will give me the energy to exercise the way I did years ago (tennis, cycling, rowing) and bring my weight down some, as well as improving all around well-being. My BMI has been around 25-26 for years, not so high that I thought about OSA as an explanation for my various symptoms, which is a pity of course. I would still be undiagnosed it if weren't for the suggestion of a GI doc that I would have ignored if it were possible to do so and keep flying light planes legally. I thought I was a false positive for OSA after a bout of sedative-induced snoring/hypoxia in the hospital.

As someone else has said, the at-home overnight recording oximeter test is something that every doctor should order on the slimmest of evidence. Why not? Such a test for SA would have reasonable sensitivity (TP/(TP + FN))*, with some false negatives certainly but worsening of symptoms would then raise the stakes to a full evaluation. Positive Predictive Value (TP/(TP+FP)) would be high since the false positive rate would probably be low. The oximeter test for SA would have high specificity (TN/(TN+FP)) for the same reason. If I'd had this test done in the past 5-10 years I strongly suspect I'd have been positive, and truly so of course. I wonder if it's a fear of false negatives that keeps some docs from recommending it?

* TP = true positive
TN = true negative
FP= false positive
FN = false negative

Pneumonym wrote: ........ I wonder if it's a fear of false negatives that keeps some docs from recommending it?

.......

Pneu,

No, it was mass ignorance of SDB. Fortunately docs are now starting to learn about SDB.

Portable home PSG equipment is improving, becoming less expensive, and is beginning to be put to more use. It includes oximetry. To me, it is the way to go.

Oximetry alone will give too many false negatives.

The sleep labs are fighting home PSGs ( http://www.sleepreviewmag.com/issues/ar ... -04_09.asp ), but the ball is beginning to roll and they will be forced to change. The sooner the better.

Regards,

No doubt you're right that a portable PS device would be the way to go, other things being equal. But given the cost/inconvenience of the present diagnostic procedure (which I actually quite enjoyed though, I must say - a normal night's so-called sleep for me), oximetry should have a bigger place right now I would think. Yes, a negative result would not definitively rule it out, but then again a positive result would fully justify aggressive follow-up action. I'm clearly not an expert but surely those who experience substantial falls in O2 as I have been doing are at highest risk for cardiac issues and stroke, not to mention a bunch of other ills that we don't known much about yet ..... Any method that significantly increases discovery rate is a good thing, esp. in our large uninsured population. If I can soldier on in blissful ignorance of my condition for so long, it strikes me that many others are doing so as well. It took me about 2 seconds of looking at those O2 satn and REM curves for the first time for all the smoke to be blown clear away ..... (an O2 line alone would have been plenty good enough for me, pretty scary to be honest).

Pneumonym wrote:No doubt you're right that a portable PS device would be the way to go, other things being equal. But given the cost/inconvenience of the present diagnostic procedure (which I actually quite enjoyed though, I must say - a normal night's so-called sleep for me), oximetry should have a bigger place right now I would think. .....

Oximetry will diagnose oxygen desaturations. It doesn't tell the doctor what caused them.

The portable PSG will diagnose obstructive sleep apnea and central sleep apnea.

Desats diagnosed with oximetry alone are sent for an expensive sleep lab PSG and then a followup titration.

Apnea cases diagnosed with a portable PSG are sent straight for a titration, saving one night of a sleep study. Big cost savings if done properly.

All true, but you are not addressing the realities of SA diagnosis at the moment, especially the fact that large numbers of people presently experiencing significant (and dangerous) desaturations will not be diagnosed before serious damage is done.

I am not questioning the value of PS evaluation, portable or otherwise, I simply argue for much greater implementation of a reliable, accurate, convenient and inexpensive technology that provides important medical information. Of course not all oximetry test positives will be diagnosed with SA but a high proportion of symptomatic individuals will be, and those that aren't will likely benefit from the finding after further work-up to determine cause. And if you are experiencing marked desats, you had better get moving with full follow-up testing, that would be the whole point (bit of a no-brainer).

How long will we have to wait for truly mass implementation of portal PS devices? Let's hope it won't be long but the trend isn't so favorable, we shall have to see. In the mean time, very bad things are happening out there nightly to people who don't have a clue ....

Pneumonym wrote: ...... In the mean time, very bad things are happening out there nightly to people who don't have a clue ....

We are agreed on that point.

There are also many who have a strong suspicion or even a confirmed diagnosis but prefer denial. Compliance rate is, what, 50%?

Rather sad.

Pneumonym wrote: ........ In the mean time, very bad things are happening out there nightly to people who don't have a clue ....

I think Mack Jones coined the saying, "Healthy awake, deathly ill asleep".

Pneu, I like your attitude. Spread the word.

In the first three years after I was diagnosed and first learned what OSA is, I sent 25 people to sleep docs and then quit counting. 23 of the 25 now use CPAP. One is in denial even after being given a hard copy of her study. One had an AHI of 10 and was told by the sleep doc to sleep exclusively on her sides instead of using CPAP. I pray that is working for her.

My favorite story is about the guy who was misdiagnosed with pneumonia and given a powerful antibiotic. After talking to him, I told him to call a sleep doc. He got a PSG, a diagnosis of severe OSA, and CPAP equipment. He never had pneumonia. He still occasionally thanks me for "saving his life". Now we are working on getting him a data-capable machine, card reader and software. He is unemployed and insurance-less.

Regards,

That is a fascinating and rather beautiful post, thank you for it. I am hardly the one to proselytize just at the moment (precisely 8 days on the blower), but I can see it happening sooner rather than later. I'm already telling family and friends what's been happening lately. The still somewhat shocking thing is that your post doesn't surprise me in the least, now that I'm a bit less naive than I was a week ago. Heck, I am a fine, 100% A1 example of someone previously in denial, or at least willfully ignorant if you see the distinction. Symptoms like those should simply not be ignored.

What did me in was my sharing the misconception that OSA correlates strongly with obesity or near-obesity (I'm 185 and 6ft 0in). Had I know about morning headaches and sweats I'd have been straight off to the sleep doc - that was no way to live. I put my exhaustion down to other things, mostly psychological.