text:
I thought that I had better start up my own journal of having, (or not), reconstructive surgery following massive weight loss instead of hijacking kazbo's!
So have gone through my posts both on bandingtogether.com and gastricsleevesupport.com to which I also belong (same username and profile photo lol!).
So here goes:
CATCH UP POSTS
Just discovered this site - and hopefully this gives those of us who have excess skin from weight loss as opposed to post-pregnancy (different Medicare items) hope:
I am going to see a plastic surgeon tomorrow (!) re my saggy, baggy, wrinkly tum and my arms - I'm not just talking "tuck shop" or "bat wings" or "ta ta's", I am talking the upper ie visible surface of them on the upper arm - BAD crinkles. (I seem to have lived the last 20+ years in 3/4 length sleeves *sigh* to hide my upper arms. ALWAYS had big arms )
Dr Sam Cunneen, West Perth.
I am also having a nurse consult at another practice next week - this is the practice that my bariatric/hernia surgeon is affiliated to, so I guess that if he is affiliated to them, and if they give me a GOOD discount, then I'm going to have it done while I still have some Medicare and top level Medibank rebate, 'cos when I move back to NZ (whenever that may be) - I would NEVER be able to afford it there.
On full Disability Pension now too, And I have already gone above the "Safety Net" for Medicare this year, so should get more back as rebates, hopefully.
Dr Hanh Ngeyen, Nedlands.
Will keep you posted...
01/10/2015 QuirkyQuaintrelle gastricsleeve.com
“Best of luck with your appointment Denzel! From what I can gather, the upcoming changes aren't going to effect patients with massive weight loss so fingers crossed I'll still qualify when it's my turn when my PHI kicks in next year. I'm greedy and want my tummy, thighs and bum all taken care of!
Make sure you let us know how you go - good luck!”
I didn't end up going today as I had a really upset tummy...but will re-schedule as he seems quite cheap.
Oh wow Kazbo!!! I am so excited for you!!!
I am looking at having a tummy tuck and arms lifted.
Later on a breast uplift and thighs lifted
Quotes, note neither of these include the Anaesthetist:
"Thanks for your website enquiry to Dr Sam Cunneen through WhatClinic.
Your arms and tummy are certainly something we can help you with.
We would need to see you at least twice for consultations prior to booking surgery for you, as there is a lot to consider with these procedures and especially given your medical history.
As a rough idea of costings for surgery you would be looking at around $6500 - 7500 for Dr Cunneen' surgery fee with anaesthetist and/or hospital fees on top of that."
I have been in contact with them querying that cost as it seemed remarkably cheap to me. I had an appt, but had to post-pone due to a ghastly tummy upset, so have reappointed.
Sculpt Surgery - really lovely, I went there and had a long consult (free) with the nurse consultant Theresa Chung. I felt totally comfortable with her and she went though everything in detail. "Attached is your quote as requested. If you do not wish to have the circumferential lipectomy (being cut around the back) then the surgeon fee is $12000 for the abdominoplasty and the arm lift."
OK, here is my latest research.
I rang Medibank to find out of the hospital costs are for Items 30177 and 30171 are covered - yes, for me (I have top-level cover and have well and truly met qualifying period) IF the surgeon fills out a "Specialist Exemption Form" otherwise the procedures are considered cosmetic, and therefore no hospital cover.
Here is the Medicare info:
Category 3 - THERAPEUTIC PROCEDURES 30171
Group T8 - SURGICAL OPERATIONS
Subgroup 1 - GENERAL
LIPECTOMY wedge excision of skin and fat, not being a service associated with items 45564, 45565 or 45530 and not being a service to which item 30165 applies, 2 OR MORE EXCISIONS (H)Multiple Services Rule
Fee: $691.75 Benefit: 75% = $518.85
See para T8.8 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES 30177
Group T8 - SURGICAL OPERATIONS
Subgroup 1 - GENERAL
LIPECTOMY radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service performed within 12 months after the end of a pregnancy and not being a service associated with a service to which item 45564, 45565 or 45530 appliesMultiple Services Rule
Fee: $985.70 Benefit: 75% = $739.30
(See para T8.8 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES T8.8
Lipectomy - (Items 30165 to 30177)
Multiple lipectomies, e.g., both buttocks and both thighs attract benefits under Item 30171 once only, i.e. the multiple operation rule does not apply. Medicare benefits are not payable in respect of liposuction, except in the circumstances outlined in Items 45584 and 45585.
Lipectomy items 30165 and 30177 may not be claimed for patients if performed within 12 months after the most recent pregnancy.
Lipectomy items 30165 to 30177 cannot be claimed in association with items 45564, 45565 or 45530. Where the abdomen requires closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565) or breast reconstruction (45530), item 45569 is to be claimed.
Related Items: 30165 30168 30171 30174 30177
Multiple Operation Rule The fees for two or more operations, listed in Group T8 (other than Subgroup 12 of that Group), performed on a patient on the one occasion (except as provided in paragraph T8.2.3) are calculated by the following rule:-
- 100% for the item with the greatest Schedule fee
plus 50% for the item with the next greatest Schedule fee
plus 25% for each other item.
(a) Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.
(b) Where two or more operations performed on the one occasion have Schedule fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.
(c) The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.
(d) For these purposes the term "operation" only refers to all items in Group T8 (other than Subgroup 12 of that Group).
This rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient if the medical practitioner who performed the operation did not also perform or assist at the other operation or any of the other operations, or administer the anaesthetic. In such cases the fees specified in the Schedule apply.
Where two medical practitioners operate independently and either performs more than one operation, the method of assessment outlined above would apply in respect of the services performed by each medical practitioner.
If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.
There are a number of items in the Schedule where the description indicates that the item applies only when rendered in association with another procedure. The Schedule fees for such items have therefore been determined on the basis that they would always be subject to the "multiple operation rule".
Where the need arises for the patient to be returned to the operating theatre on the same day as the original procedure for further surgery due to post-operative complications, which would not be considered as normal aftercare - see paragraph T8.2, such procedures would generally not be subject to the "multiple operation rule". Accounts should be endorsed to the effect that they are separate procedures so that a separate benefit may be paid.
Extended Medicare Safety Net Cap
The Extended Medicare Safety Net (EMSN) benefit cap for items subject to the multiple operations rule, where all items in that claim are subject to a cap are calculated from the abated (reduced) schedule fee.
For example, if an item has a Schedule fee of $100 and an EMSN benefit cap equal to 80 per cent of the schedule fee, the calculated EMSN benefit cap would be $80. However, if the schedule fee for the item is reduced by 50 per cent in accordance with the multiple operations rule provisions, and all items in that claim carry a cap, the calculated EMSN benefit cap for the item is $40 (50% of $100*80%).
Related Items: 13506 30084 31539 31542 31545 34527 34528 34530 35518 35614 36851 37217 37339 41884 48660 48663 48666 48669 48672 48675 48684 48691 48692 48693
I met with Dr Hanh Nguyen at Sculpt Surgery today, along with his nurse Theresa, who I had met at my last consultation - she is so lovely, and I feel relaxed with her.
I am a "good candidate" for the proposed procedures - circumfrential abdominoplasty and bilateral brachioplastys as I have little fat, but lots of skin!
She will be getting back to me with updated costs - she is going to talk to the surgeon and they are going to try to bring it down due to my financial status.
Then had my GP appt later, she doesn't want me to do anything until my weight loss has reversed and I start putting on some weight - she wants me back up to 45 kg (I had dropped to 42.5). Got some 'results' back from some recent 'tests' and have got a gut infection - no wonder I've had a problem with diarrhoea and loss of appetite lol!. She also wants me to re-visit the dietician, who I don't think will be able to offer me any advice than what I had discussed with her last time - ie ongoing weight loss and diarrhoea *sigh*.
15/10/15 jellybelly89 to me bandingtogether.com
“Have your surgeons confirmed if you're still eligible for Medicare Denzel? There is so much conflicting information on what the new criteria is, have they given you anything?”
15/10/2015 me to jellybelly89
No, I looked it up on the Medicare site - the surgeon gave me the item numbers.
Update: The nurse has just rung me with new, improved costs, having discussed it over with the surgeon and the anaesthetist.
She confirmed that they have received an email from Medicare re rebate for abdominoplasty and the changes aren't expected to take place until the middle of next year.
They have brought the cost for bilateral arm lift and circumferential abdominoplasty down to $13,000.00, and which I'll get a rebate of Fee: $691.75 Benefit: 75% = $518.85, so Medibank will pay approx. $172.00.
And there will be $1,000.00 gap for the anaesthetist.
Because I am having both bilateral arm lift and circumferential abdominoplasty it will be about a 7 hour op.
15/10/2015 leya22 to me bandingtogether.com
“I remember Theresa from my days at Hollywood too, she is super lovely. . . . I hope you go ahead with Sculpt, they are a really fantastic team!”
Oh wow leya22, thank you for the above feedback!
Theresa is super lovely, she is so easy to be with that she feels like an old friend!
Yes, I am going ahead with Sculpt, with Dr Nguyen operating, and Theresa being a support person. She even visits her clients in hospital post-op!
I'll be operated on at Hollywood. Hope that the staff there are better than the ones at Murdoch. - ferkin' scary there. We are looking at November 27th that gives me time to get some stuff organised in my personal life ie sale/no sale of my house and that then impacts on me moving/not moving back to NZ, get over my gut infection, and put on a couple of kgs - GP is quite concerned about that and doesn't want me to have surgery until I do).
15/10/2015 leya22 to me bandingtogether.com
“Hanh is a really great surgeon, his follow-up is fantastic, and as you mentioned Theresa will visit you on the ward post-op and change your dressing etc. they provide a really great service!!
I worked on John Carroll ward at Hollywood, which is where you will most likely stay, there has been a few staff changes since I left but quite a few that are the same and they are a really great team of nurses, I actually really miss working there!
I look forward to hearing of your progress with the surgery :-)”
16/10/2015 Me to QuirkyQuaintrelle gastricsleevesupport.com
Honey, you aren't greedy!
You'll be pleased to know that the changes in Medicare won't happen until the middle of next year - the nurse from where I have decided to go - "Sculpt Surgery" confirmed that.
I met with Dr Hanh Nguyen at Sculpt Surgery on Wednesday, along with his nurse Theresa, who I had met at my last consultation - she is so lovely, and I feel relaxed with her.
I am a "good candidate" for the proposed procedures - circumferential abdominoplasty and bilateral brachioplastys as I have little fat, but lots of skin!
She got back to me with updated costs - she talked to the surgeon and they are going to try to bring it down due to my financial status. I also had that consult bulk billed.
Then had my GP appt later, she doesn't want me to do anything until my weight loss has reversed and I start putting on some weight - she wants me back up to 45 kg (I had dropped to 42.5). Got some 'results' back from some recent 'tests' and have got a gut infection - no wonder I've had a problem with diarrhoea and loss of appetite lol!. She also wants me to re-visit the dietician, who I don't think will be able to offer me any advice than what I had discussed with her last time - ie ongoing weight loss and diarrhoea *sigh*.
I am delaying having it done until 27th Nov, gives me time to sort out things here IN CASE my house sells, or not, which then impacts on me moving back to NZ. + to get my gut back on track, and put on a couple of healthy kgs.
I have had some good feedback from another forum I am on re who I am going with, and the hospital where I will be operated at.
"Hanh is a really great surgeon, his follow-up is fantastic, and as you mentioned Theresa will visit you on the ward post-op and change your dressing etc. they provide a really great service!!
I worked on John Carroll ward at Hollywood, which is where you will most likely stay, there has been a few staff changes since I left but quite a few that are the same and they are a really great team of nurses, I actually really miss working there!"
16/10/2015 me to leya22
Thank you so much for this leya22, great to hear positive and reassuring things (I'm a nurse as well, so know the difference between good care and poor care).
16/10/2015 4:29:02, kazbo said:
“Now I've made the decision, I'm starting think that it'll be a great opportunity to get a few other things done (like my double chin lipo'ed and lifted and the stubborn fat on my soccer ball hips lipo'ed).
I wonder how many people go through this "oh well seeing you are going to be working on me you may as well...[insert cosmetic items here]"
Later I would like a thigh lift and breast (what is left lol - I used to have biggies, not anymore!) lift. Don't want an enhancement there, I would be happy just to have small perky ones!
'Cos I am little, with little fat, they are able to do my arms and circumferential abdominoplasty all in one go. Some bigger folk, they can't do the circumferential abdominoplasty in one op.
Ohhhh, Sam Cunneen in West Perth is much cheaper, by about $6,500 . I'll keep my appt I had made with them for next Thurs.
Mind you, I could always save a heap of dosh and do a "do-it-yourself" tummy tuck lol!
I went to my 1st appt today with Sam Cunneen, was very impressed with him. Here I am having a 3D photo.
Following on from my recent barium swallow demonstrating "mild to moderate dysmobility" in my oesophagus along with "tertiary contractions" (causing severe oesophageal spasm and hold up at the junction between the oesophagus and the stomach) I had a "gastroscopy" this week.
Anyway, the results of the Gastroscopy (I had wondered why it was being done, considering I thought that we had a diagnosis via the barium swallow ) were - to me - a bit shocking.
The Gastroenterologist (Dr Peter Evans) came to see me before discharge and I think that he was even outstanded at the results, considering how non-complaining I am.
I saw the pics, which he was sending to Dr Stephen Watson - my original bariatric surgeon who referred me to him following the result of the barium swallow. And, being a non-Gastronterologist, they were ugly. Really ugly.
Anyhoo, results of FYI:
"Findings Oesophagus: There were broad and thin linear reflux ulcers extending 8 cm above the OG junction. The remainder of the oesophageal mucosa appeared normal. The SC/OG junction was located at 35 cm, above a 3 cm hiatus hernia; there was no Barrett's change.
Stomach: The stomach was tubular consistent with sleeve gastrectomy. The fundus, body and antrum were otherwise normal. Duodenum: The cap and the loop were normal. Conclusion: Severe ulcerative oesophagitis.
Coincidentally I had a double appt with my GP this am, and showed her the copy of the report.
She was somewhat gob-smacked as well!
She's commenced me on Pantaprazole 40 mg twice day for 2/51, then to drop back to one daily.
Weight yesterday fasting, naked 48.71 kg, BMI 20.6 (then I went to the loo twice after).
At GP today fully dressed including shoes, 48.5 kg
I am going to do my sister's raw garlic protocol to eliminate bad bacteria in my gut, and have started today (I already use probiotics, just need to increase prebiotics).
I am particularly hopeful by doing the raw garlic both pre- and post sleeving that it will have a significant beneficial effect (on my ME/CFS), particularly as sleeving affects the gut biota through induced changes in the gut microbial community via FXE signalling pathways.
for interest - changes in but biota following VSG
"VSG is known to increase circulation of bile acids. The bile acids bind to farsenoid-X receptor (FXR), a receptor in the nuclei of cells that regulates gene expression."
"The surgery also increased circulating bile acids and induced changes in the gut microbial community via FXR signaling pathways."
So that's how it works! *snigger*!
Today is Jan 1st 2015!
My surgery is booked for 2nd Feb 2015, gastric sleeve, Dr Stephen Watson at SJOG Murdoch.
I have told my Mum that I have more ovarian cysts that may need to come out...
Commitments for this month, January 2015:
Working Friday ams in a Pharmacy as a RN/RM doing "Baby" and "Healthwise" Clinics.
4th - Greyhound "Greet and Meet" at Kalamunda Markets
11th - brother and nephew's birthdays
14th - appointment with Dietician "Diet by D'Zyne" northern suburbs
15th - nieces birthday, second anniversary of my Dad's passing away
19th - EEG brain in preparation for seeing specialist Neurologist in March
22nd - Meet friend at SCGH for her appointment immunology
23rd - Appt with Dr Watson at Murdoch
27th - CPAP review and get connector for O2 for recovery post surgery.
I 'spose I should do my measurements and photos, my friend is - she is doing a HCG (using homeopathic HCG globuli from Germany) diet, starting today - good luck to her. 1. I don't reckon that she'll stick it out for the 21 days, and 2. Give you a bet that in 6 months she will weigh the same, 1 year - she will weigh more.
32 days until my surgery!!!
The countdown is on!
I like this!
It would cover all the incisions from the circumferential abdominoplasty, + also when I have the breast and thigh lift, would be suitable (Ot5herwise I'd want something supportive for the boobies):
ahttp://www.asos.com/au/Motel/Motel-Cinch-Swimsuit/Prod/pgeproduct.aspx?iid=5376714&WT.ac=rec_viewed&CTAref=Recently+Viewed I can't work out the sizing though, and as in no need for swim wear (my boys age 8 Op Shop board shorts +/- bikini top will have to suffice for now, I haven't been at the beach since Jan 2014 anyway )
So, in no hurry to purchase now. But it's the first pair of bathers that I have seen and liked for a long time!
"Very low carbohydrate diets in the management of diabetes revisited".
From Gary Fettke No Fructose
(The combination of Fructose, refined Carbohydrate and Polyunsaturated Oils create inflammation in every blood vessel and eve...ry organ of the body. A Low Carbohydrate and Healthy natural Fat diet (LCHF) can have an enormous benefit to your health. Dr Gary Fettke Orthopaedic Surgeon M.B.,B.S.(University NSW), F.R.A.C.S.(Orthopaedic Surgery), F.A.Orth.A Launceston, Tasmania, Australia www.NoFructose.com www.NutritionForLife.healthcare )
"How does diabetes affect you?
There are only 3 groups of people out there.
You either have diabetes, you are going to get diabetes or you are going to be caught up in the economic or personal costs of diabetes. Pretty simple - so it's worth paying attention to this topic.
Whatever we are recommending for those with diabetes is not working. My New Zealand colleagues have just put this paper together for the New Zealand Medical Journal. Brilliant.
For my patients, LCHF has given them their lives back!!!!
Low Carb in Diabetes management and treatment works better than the current low fat/ high carb recommendations that currently exist.
Eat what you want and chase it with medication is completely unsustainable.
"We’re just continuing to make the point that low carb eating is a very sensible way to go for people with diabetes. The outcomes are better."
"higher-carbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications."
Take the link to read the whole paper."
Humans can derive energy from carbohydrate, fat, or protein. The metabolism of carbohydrate requires by far the highest secretion of insulin. The central pathology of diabetes is the inability to maintain euglycaemia because of a deficiency in either the action or secretion of insulin. That is, because of either insulin resistance often accompanied by hyperinsulinaemia, or insulin deficiency caused by pancreatic beta cell failure. In individuals dependent on insulin and other hypoglycaemic medication, the difficulty of matching higher intakes of carbohydrates with the higher doses of medication required to maintain euglycaemia increases the risk of adverse events, including potentially fatal hypoglycaemic episodes. Thus, mechanistically it has always made sense to restrict carbohydrate (defined as sugar and starch, but not soluble and insoluble fibre) in the diets of people with diabetes. Randomised clinical trials have confirmed that this action based on first principles is effective. The continued recommendation of higher-carbohydrate, fat-restricted diets has been criticised by some scientists, practitioners and patients. Such protocols when compared with very low-carbohydrate diets provide inferior glycaemic control, and their introduction and subsequent increase in carbohydrate allowances has never been based on strong evidence. The trend towards higher-carbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications. Here we will introduce some of the evidence for very low-carbohydrate diets in diabetes management and discuss some of the common objections to their use.
Very Low Carbohydrate Diets for Diabetes (ADA 2018)
By Maria Muccioli Ph.D.
June 26th, 2018
A crowd overfilled the ballroom this Sunday afternoon at the ADA 78th Scientific Sessions to hear two presentations about very low carbohydrate diets (VLCD) for diabetes.
In the first presentation, Dr. Jeannie Tay from the University of Alabama at Birmingham summarized the current knowledge on VLCD for type 2 diabetes (T2D) patients and presented new clinical trial results. In the second presentation, Dr. Martin I. de Bock of Princess Margaret Hospital discussed the limited data on VLCD for children with type 1 diabetes (T1D), including the benefits, hypothetical concerns, and areas for additional follow-up.
Study Demonstrates Health Benefits for Patients with T2D
Dr. Tay began her presentation by summarizing the available data on very low carbohydrate diets (VLCD) for patients with T2D. She defined VLCD as that containing between 20-70 grams of carbohydrate per day.
She evaluated results from randomized controlled trials (RCTs) that followed patients for at least six months and highlighted that some data showed greater A1c improvements with the approach. The researcher noted that patients also experience an increase in HDL-C levels, a reduction in triglyceride levels, and improved insulin resistance.
Dr. Tay explained that while some studies showed an increase in LDL-C levels in patients following a VLCD, other studies did not find this. She addressed that LDL-C is becoming a controversial metric to assess cardiovascular disease risk and that context is important when discussing its relevance as a risk factor. Dr. Tay noted that it is generally believed that LDL-C increases may be a result of the higher saturated fat content of some VLCD.
Dr. Tay and colleagues set out to determine how a VLCD that is also low in saturated fat (LCLSF) compares against a high carbohydrate (HC) diet for the metabolic management of patients with T2D.
RCT of HC vs. LCLSF Diet for T2D
The researcher enrolled 115 adults with T2D and obesity with a mean A1c level of 7.3 +/- 1.1% and excluded patients with pre-existing renal conditions. The patients used a variety of methods to control their diabetes, including oral agents and/or insulin. They assigned the participants to either follow a HC diet (53% carbohydrate) or a LCLSF diet (14% carbohydrate, <10% saturated fat). Importantly, the diets were identical in calorie content.
All participants followed the same exercise program and their adherence to the diet was closely followed via food logs, regular meetings with a dietician, as well as urinalysis for ketones and urea/creatinine.
The researchers compared numerous parameters between the groups, including weight, body composition, A1c and markers for cardiovascular disease risk. Furthermore, they also used CGM technology to evaluate post-prandial blood glucose control and glycemic variability. The patients were followed for two years.
Main Study Outcomes
The drop-out rate (~50%) was not significantly different between the two groups, and the researchers confirmed that the remaining participants adhered to the prescribed diets.
While the data showed a comparable reduction in A1c (~1%), weight, and similar body composition, the participants in the LCLSF group:
Lowered their medication use by more than two-fold compared to the HC group
Experienced a greater than two-fold reduction in glycemic variability parameters compared to the HC group
Experienced a greater reduction in triglycerides than the HC group
Both groups experienced comparable decreases in blood pressure, insulin use, insulin resistance, and c-reactive protein levels (a marker of inflammation).
The researchers also performed a very comprehensive evaluation of renal function and cognitive performance in the subjects following the low carbohydrate approach. The researchers found no difference between the HC and LCLSF groups in any of the measured outcomes, demonstrating its safety with regard to renal function and cognitive performance.
Also, the researchers did not observe a significant difference in the LDL-C levels between the groups. Notably, the HC group experienced a significant drop in HDL levels during the study, while the HDL levels remained unchanged in the LCLSF group.
Dr. Tay stated that a very low carbohydrate diet offers a considerable advantage over a high carbohydrate approach for patients with type 2 diabetes.
She noted that reducing medication use is not only cost-effective but can also safeguard from the considerable side effects of some second-line medications. She also explained that achieving less glycemic variability, which may be an independent risk factor for the development of diabetes-associated complications, is “of great clinical importance.”
“It is a good diet to have if you have diabetes, and the data support that,” she concluded.
Endocrinologist Discusses Considerations for Children with T1D
Dr. de Bock began his presentation by describing what he believes to be the current political climate in discussing very low carbohydrate (VLC) approaches for children with T1D. “[It is] thorny, polarizing, and controversial,” he remarked. The speaker went on to explain that while he is no way against VLC approaches for children, the main purpose of his presentation was to identify putative concerns and areas that require additional study.
“I am not a denier. One can get exceptional glycemic control on a very low carbohydrate diet,” he stated, also remarking that frequent blood glucose monitoring and dosing adjustments were key to achieving the results.
Dr. de Bock believes that it is also possible to get “good control” on a high carbohydrate diet. To support this, he presented very limited blood glucose records for one teenage patient who consumes more than 300 g of carbohydrate per day, and also showed some data on pediatric A1c levels. Notably, while the A1c levels were below the average for that age group with T1D, they were still above normal.
Dr. de Bock identified five areas that he believes to be of relevance regarding the potential concerns regarding children eating a VLCD: 1) growth; 2) long-term metabolic profile; 3) bones; 4) exercise and 5) psychosocial impact and conflict. As published data specific to VLCD in children with T1D is limited, the speaker presented some data from animal studies, case studies, and children with epilepsy who followed a ketogenic diet.
Dr. de Bock did not define the specific nutrient distribution of VLCD and the data that he presented on varied greatly in the carbohydrate content, from “ketogenic” to “30% carbohydrate” for one particular case.
Since data on the exact diet composition or on glycemic control for the case study subjects that experienced adverse outcomes was not presented, it was impossible to gauge whether these could be attributed to suboptimal glycemic control or the specific macronutrient distribution.
Dr. de Bock stated that the available data on pediatric growth on a low-carb diet is contradicting and requires further investigation. His main theoretical concern is that those on a VLCD may use less insulin, and insulin is very important for numerous physiological processes, including growth. However, he did not discuss the administration of insulin to account for protein consumption, which is an important consideration. Dr. de Bock also addressed the importance of identifying any nutritional deficiencies, in particular, iron.
Long-Term Metabolic Profile
Dr. de Bock presented some data about elevated LDL-C levels in individuals on a VLCD, although the study results were variable. He stated that for those individuals who experience an uptick in LDL-C, it is unclear whether the improved glycemic control mitigates the LDL-C increase. Notably, the LDL-C metric is a controversial one and needs to be considered in the context of triglycerides, HDL, and other metabolic parameters.
Dr. de Bock pointed to some studies on children with epilepsy who followed the ketogenic diet and exhibited low bone density. He noted that individuals with T1D are prone to low bone density, so it is an important parameter to follow. Dr. de Bock did not mention the relevance of optimizing glycemic control, as chronic hyperglycemia is a relevant factor in low bone density in patients with T1D.
The speaker stated that the exercise capacity of children following a VLCD appears to be variable. He noted that some individuals do not have any problems, while others may experience fatigue. He believes the data on the subject is “inconclusive.” Careful assessment of the specific nutrient distribution of the diet to ensure appropriate nutrient intake may be at the heart of the matter.
Psychosocial Impact and Conflict
The speaker focused heavily on the potential mental and emotional implications of following a “restrictive” diet. He suggested that children (unlike adults) do not yet have the “executive thought” to make a rational decision to eat a VLCD. As such, he believes that children on a VLCD may feel deprived or resentful.
“We are a society that celebrates with food,” de Bock pointed out, as a photograph of excited children gathered around a birthday cake appeared on his presentation slide. He stated that eating cake “may or may not result in a postprandial blood glucose excursion,” depending on the management, and did not discuss that low-carbohydrate dessert recipes are widely available.
He also attempted to draw parallels between the perfectionism and idealism associated with the pursuit of very tight glycemic control on a VLCD and how these qualities are common to individuals who are at an increased risk for developing eating disorders. However, while there is no evidence to support that children on a VLCD are specifically at an increased risk for anxiety and eating disorders, there is evidence to suggest that these issues are more common in people with type 1 diabetes, in general, suggesting that they are likely related to glycemic control.
Dr. de Bock did not address the tangible concerns of suboptimal blood glucose management in pediatric patients, or the potential psychological impacts of increased anxiety, depression, and resentment that may arise from frequently abnormal blood glucose levels and the associated physiological consequences.
Dr. de Bock does not deny that a VLCD for children with type 1 diabetes can help to achieve exceptional glycemic control, as recently demonstrated in a study showing normal average A1c levels in a large cohort of patients. The speaker remarked that the patients in that study had very low glycemic variability.
He believes that more research needs to be conducted to evaluate the relevance of the potential concerns that he outlined. Until then, he advises parents of children who follow a VLCD to work closely with their medical care providers to monitor growth, cardiac, nutritional, and mental/emotional parameters.
Undoubtedly, very low carbohydrate diets for the management of diabetes have been gaining popularity and acceptance in recent years. It is difficult to deny that they constitute an effective and important tool for optimizing glycemic control for both type 1 and type 2 diabetes patients.
This symposium received considerable attention at the meeting and in social media channels. As always, we welcome your comments on the topic and hope that this review has been useful in summarizing the key points and relevant considerations in the broader context of the discussion.
6 MONTH CHECK-IN !
Weight 70.4 kg
46.5 kg, loss 23.9 kg (+ 4 from New Years Eve = 27.9)
% body fat (in am) 42.5
23.6, loss 18.9 %
Individual thigh (each)
My house did not sell.
Mum (in NZ) had to put the unit that she had bought on my behalf (in Orewa) , on the market (obviously, due to financial reasons). https://www.barfoot.co.nz/533537 Mum, and my sister Pam) put a lot of effort into this place, and it had remodelled kitchen, bathroom, repainted, new carpets etc etc etc.
Yes, it looked wonderful.
Yes, the Orewa lifestyle would have been magnificent.
That unit sold. (Settlement was 11th/12th Jan this year, I don't know exact dates).
Current Medication: Before Breakfast:
2 paracetamol/2 Panadol Osteo (depending on what day I have ahead of me...) for... your choice...: ME/CFS, Fibromyalgia, Osteo arthritis hips etc ...I can't stand...feel horrendous, have muscle pain, and "post-exertional malaise" (believe me, that sends you straight to bed) lasting into the next couple of days...
50 mg Lyrica (Fibroymyalgia)
Duloxetine 60 mg (Fibromyalgia/ME/CFS - works wonderfully!) Put on this by my Rheumatologist, Dr Antonia Cole @ Hollywood Specialist Medical Centre, Nedlands. Bless her!!!
Moduretic 50/5 (Menieres Disease, to reduce the fluid in the inner ear)
+/- "Serc" (Menieres Disease - too ferkin' expensive), "Seniere" (also expensive) 16 mg Betahistine dihydrodrochloride as needed
+/- "Panadeine Forte" (prescribed. I haven't used, I believe that I have - thankfully - a pretty high pain tolerance)
+/- "Stemitil" (Prochlorperazine) 5mg (poxy Menieres Disease...)
Post Breakfast (which tends to be about 1030 am:)
1 general multi-vitamin/mineral
6000 mg Gingko Biloba (just recently, as I have given myself haemorrhagic gastritis in the past - this was pathology taken from a gastric endoscopy done September 2013, taking 2000 mg Gingko biloba on an empty stomach) - to increase the blood flow to my inner ears. This was recommended to me by my ENT - Paul Yuen - surgeon in relation to the Menieres Disease...). Benefit - now I am back on it, I have noticed...that my poxy memory has started to improve again. I managed to combine menopause + ME/CFS + Fibromyalgia 2014/2015 lol! And lost my job with DPaW! "Employer Initiated Retirement On The Grounds Of Ill-Health".)
"Nature's Way" "Joint Restore Triple Action" Glucosomine + Chondroitin + MSM, x 1, for Osteo arthritis hips, (+ mainly left hand - c/o Complex Regional Pain Syndrome/ Reflex Regional Sympathy).
+/- OTC Ibuprofen 200 mg + Codeine Phosphate 12.8 mg in view of prospected day ahead...
+/- OTC "Nagestic Forte" Curcumin 6.074 mg if I remember... If I know that I am going to have a REALLY physical day...
+/- Ventolin puffer (prescribed) when I remember, or when I am REALLY having problems...
+/- Becotide puffer (prescribed) when I remember, or when I am REALLY having problems...
+/- And...this is really slack on my behalf..."Flo CRS" Nasal Irrigation followed by (prescribed) "Nasonex" (prescribed) nasal spray...when I remember...when my nose is REALLY bugging me oe O can't breathe through my nose....at all...
"Meniett" machine $2,500.00 to try to relieve poxy Menieres symptoms... when I remember... ( Sleep study showed that "Mandibular Adjustment Splint" - $2,500.00 - become redundant...didn't control UARS/Sleep Apnoea...).
Throughout the day:
[*]+/- OTC Ibuprofen 200 mg + Codeine Phosphate 12.8 mg in view of prospected day ahead... [*]2 paracetamol/2 Panadol Osteo (depending on what day I have ahead of me...)
Night-time: 7.5 mg Mirtazapine (prescribed) - to sleep. The Duloxetine "revs" me up too much. And I don't. Sleep. + WAY TOO MANY sleep behaviour disorders! (Diagnosed on sleep study. STILL have Upper Airway Resistance Syndrome). I sleep "like a good baby" on this lol! 1 x Night-time part of multi-vitamin/mineral ("Nature's Own - Restore Multivitamin Day and Night Formula For Women"). So.
I am still here (24 Ward Cres, Kelmscott WA 6111).
And the unit in Orewa would never had been 'mine' . Mum (turning 85 this coming March!!!) and my sister, had put too much work into it. "Entitling" them to call it "Theirs" and ...dictating... what I could do, and what I couldn't do.
"Things happen for a reason".
My life is no longer "on hold", as it was from January 2015.
Spiritually, I got given, "The timing wasn't right".
I have "Moved On" in many ways.
I have "Taken The Leap Of Faith".
Gone on with 'plans'.
I had plastic reconstructive surgery with Mr Hanh Nguyen & team at Hollywood Hospital 4th December 2015 (arms, abdominoplasty, and "belt lipectomy"). "Sculpt Surgery".
I can not fault them (just only a couple of niggles with Hollywood, but nothing outstanding as at Murdoch SJOGH).
"Sculpt Surgery" - Theresa and Hanh - were fantastic.
And have adopted a boy foster Rescue Greyhound, Zumba, the day before Christmas (I hads fostered him for four months, so knew his personality).
Also, have gone back to fostering Rescue Greyhounds.
I am doing well, and very, very happy that I had had the Gastric Sleeve.
12 Month Measurements
BODY FAT %
Body Fat %
1st January 2016
2nd February 2016
"WHAT CAN WE REALLY LEARN 40 YEARS ON FROM THE MINNESOTA CORONARY EXPERIMENT?"
"What a massive week in nutrition science! It was revealed that part of the results from the biggest study ever done to test the diet-heart hypothesis were hidden away and never published. Until now, published in the BMJ by a sort of data archaeologist Christopher Ramsden from the National Institute of Health.
The diet-heart hypothesis says that saturated fat raises cholesterol and thus causes heart disease.
This might not seem like an important question to you, but widespread acceptance of this idea has shaped the way we look and how we eat more than anything else in the history of health and medicine.
It’s still the cornerstone of conventional wisdom and dietary guidelines in virtually every country. It’s still the reason the conventional experts can’t take the biologically obvious leap to embracing low carb healthy fat diets for important treatments like weight loss and diabetes.
So, 40+ years on. Here it is in all its glory, published in the BMJ no less. What did they find?
“Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.”
That’s right, there was no support for their hypothesis in a randomised trial of more than 9500. Replacing saturated fat with Omega 6 fat did reduce cholesterol, but as we’d predict had no effect on heart disease. The one effect they did see was that older subjects who lowered their cholesterol had higher overall mortality.
Yes, cholesterol lowering in older adults caused more death. This is an effect already seen in some population studies.
So what should we take from all this?
It’s hard to say.
It’s hard because we will never know the exact motivations of Ancel Keys the co-principal investigator and infamous diet-heart hypothesis. The guy who shouted down sugar and had the world believe it was butter that was killing us via clogged arteries. If we knew why he decided not to publish these results, and why he waited 16 years to publish the only report on this experiment that did come out during his lifetime, it would be interesting.
If it turned out that the data just didn’t suit his view of the world, then that would be bordering on scientific fraud.
If he just got too busy because of his career success, and ran out of time in the end. Well…is that even plausible for the biggest diet experiment ever conducted? Its hard to imagine Keys being short of resources to help publish a study this important, especially for the time it was published.
How should it change our minds? Well, that depends on who you are really. I’ve never seen the evidence that says that eating saturated fat, in the context of whole food causes harm including more death or even heart disease. The “saturated fat raises LDL cholesterol, and LDL cholesterol is associated with more heart disease in some groups” argument isn’t a cause and effect argument. It’s just a hypothesis.
So I’m perfectly happy to look at this for what it is. Ancel Keys probably behaved unethically, the full extent of which is hard to say. There was never any evidence to demonise saturated fat to the extent that it should become public health enemy number one.
Will convention change?
There is now mounting evidence to advise people to eat less sugar and starch, especially if you are insulin resistant. This is creeping into policy.
But the status quo around fat? Why won’t this change, even with these new (but old) studies being revealed. Even with the evidence of publication bias like this?
I think we all see the word through our own dissonance.
Conventional experts will find problems with Key’s study. I’ve already seen many of these in the rapid response section of the BMJ (we have one there too). Such things as trial length, lack of knowing what they actually ate, low numbers in the autopsy results and so on. These are all issues to be sure, but not such that they’d somehow magically change the outcome to suit the diet-heart hypothesis. All of the diet-heart trials suffer from some of these issues, and usually from others as well (like telling the subjects cutting saturated fat to eat less refined food and more whole food, which at least didn’t happen here, making it a purer test of the hypothesis)
I’d add an issue – they replaced saturated fat with corn oil in high doses (about 19% of calories). Does anyone in modern nutrition science think this is a good idea? Yet they had to do this to lower cholesterol enough to make a difference, in terms of the diet-heart hypothesis.
Predictably, the experts have told us there is no reason to change current dietary advice which is low fat, and saturated fat is to be substituted by polyunsaturated fat.
Why? They cite the results of the meta-analyses of prospective cohorts (following large numbers of people living freely in the population with no actual experiment done). We agree that adding some essential polyunsaturated fats may be a good idea up to the point you get what you need (probably well under 10% of energy). But these studies don’t show that replacing saturated fat is the cause of any benefit, because you see the same small equal benefit of substituting in polyunsaturated fat for carbs.
These cohort studies give us the hypothesis that adding polyunsaturated fats in smallish amounts regardless of what they substitute might have some benefit. The experiments need to be done to find this out for certain.
They cite the Hooper Cochrane review of all the actual diet experiments where saturated fat lowering was part of the diet intervention. In this review there is no effect of these interventions on anything much at all, except one small effect of the interventions on combined coronary events.
OK, so digging deeper what is this effect? This small effect and how it was worked out is critical for the perpetuation of the modern diet-heart hypothesis and mainstream nutrition rejecting low carb eating.
You’ll be surprised about this little effect. When all experiments are added together we see that for the “Reduce saturated fat (treatment)” there were 21 791 people, of which 1774 (or 8.14%) had some sort of cardiovascular event over the study period (52 months). In the “usual diet (control)” there were 31509 people, or which 2603 (or 8.26%) had some sort of cardiovascular event over the same period.
To more directly compare what might happen here we can extrapolate. If we extrapolated and pretend we randomised 20 000 people – 10 000 to a reduced fat diet and 10 000 people their usual diet then we would expect to see 826 CVD events for the usual diet and a reduction to 814 for the reduced saturated fat. That’s a difference in 12 CVD events in 10 000 people over just about 4.5 years, because of eating less saturated fat (compared to doing nothing). And these 12 CVD events that make up the difference do not include either heart attacks or deaths; they include events like angina instead.
That’s a change in absolute risk of 0.12%.
Underwhelmed? Hell yes. So am I, especially because the trials that did show some positive effect like the Oslo diet heart study weren’t just about substituting out saturated fat. They were about more exercise, more vegetables, less processed food, eating fewer calories and often more. In fact, the statistical adjustment the authors make means that these smaller, multifaceted studies end up being given extra weighting because of the chance the bigger studies overwhelm the results.
In the end, it’s hard to see a path, other than a new generation coming through, for the diet-heart hypothesis to go away. It’s hard to see conventional wisdom changing anytime soon.
Remember – in all these studies, there has never been a diet-heart trial of replacing carbohydrate with polyunsaturated and/or monounsaturated fat. There hasn’t even been one that was a test of reducing sugar. All the government funding for long term trials to test the effect of diet on heart health over the years has gone to one team with one idea – to try to lower cholesterol by replacing saturated fat in the diet and see what happens.
Butter or corn oil?
I said before that we all end up with our own dissonance. I’m not naïve enough to think I am excluded from this. I obviously have a bias for low carb healthy fat eating and may see the world that way. That’s why it’s critical for you to take a little time to see the world of nutrition science for what it is and make up your own mind."
Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors
A FAT LOAD OF GOOD: WHY IT'S TIME TO BRING FULL FAT BACK
April 13, 2016
Start your day with toast, hold the butter but add margarine if you like. Have it with an egg-white omelette because the yolk is bad and a strong coffee with a splash of fat-free milk and maybe a calorie-free sweetener.
Splenda perhaps – apparently, according to Splenda, "people with diabetes can enjoy up to 4 packets of SPLENDA® No Calorie Sweetener or up to 8 teaspoons of SPLENDA® No Calorie Sweetener, Granulated, because it is considered a 'free food'."
Ten or 15 years ago, this messed-up meal might have been considered a healthy breakfast.
In recent years however, we have learnt that fat is nothing to be afraid of; fat, unlike the message sounded out since the 1950s, does not make us fat. Fake food like margarine and calorie-free sweeteners on the other hand ... well, that's another story.
Another food myth that has been busted is that full-fat dairy and other animal fats – including bacon and egg yolks – lead to heart disease.
In fact, new research has found that those who consume full-fat dairy tend to weigh less and have a reduced risk of diabetes.
Research published in the American Journal of Nutrition analysed the data of 18,438 women in the Women's Health Study, and found that those who consumed the most high-fat dairy products were about 10 per cent less likely to be overweight.
A separate meta-analysis of more than 3000 people over 15 years found that consumers of full-fat dairy had a 46 per cent lower risk of diabetes.
"There is no prospective human evidence that people who eat low-fat dairy do better than people who eat whole-fat dairy," lead researcher Dr Darian Mozaffarian, of Tufts University, told Time.
It makes sense that the fat from full-fat dairy is more satiating, so people are less likely to overeat and the fat is not being swapped for sugar or carbohydrates, but why the association with diabetes?
"They did find that saturated fatty acids in dairy are strongly associated with reducing risk (of diabetes)," explains cardiologist and adviser to the UK's National Obesity Forum, Dr Aseem Malhotra, who was not involved in the study. "When you remove fat you remove the fatty acids."
In a separate paper tellingly titled Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983, researchers concluded that recommendations to reduce fat intake to lessen the risk of heart disease were misguided.
"The present review concludes that dietary advice not merely needs review; it should not have been introduced," concluded the researchers from the University of West Scotland.
It is an issue close to Malhotra's heart.
"The science is quite clear," says Malhotra. "There are two major factors why the low-fat message is perpetuating itself – that fat will increase the risk of heart disease and that fat makes you fat.
"The latest data on saturated fat – over several decades – has revealed that it doesn't increase heart disease and, if it comes from dairy, it is protective against diabetes and heart disease."
He adds fat has the lowest impact on insulin resistance and says that insulin resistance is the greater risk factor in cardiovascular disease. "Good fats – extra virgin olive oil, nuts, butter, coconut oil – are anti-inflammatory and reduce the risk of a heart attack," Malhotra says.
So why is it that the Australian Dietary Guidelines and many doctors and dietitians still advise consuming reduced fat dairy?
"We're unwilling to admit that we were wrong, but science evolves," Malhotra says. "I started off giving that advice [low-fat]. For me, knowing what I know, it would be unethical to give that advice now.
"There is an urgent need to overhaul the dietary guidelines – the guidelines lag behind the science."
As they stand, he says they're a "direct cause" of the obesity epidemic.
Dr Joanna McMillan says we "have to be careful" not to attack the guidelines with every new study.
"Is the dairy making the difference or is it what they're eating instead?" she asks. "What about if you have a diet with plenty of fat from extra virgin olive oil, nuts, seeds, oily fish, avocado and so on, but choose to have skim milk to reduce the kilojoules from your several coffees? Or just because you like it (as I do!)?"
There is also the fact that not all fat is equal of course. "At the end of the day saturated fat from a piece of cheese is not the same as saturated fat from a party pie," McMillan says, adding: "The message overall is to stop buying low fat when it is replaced by refined carbs (not just sugar) – in fact eat more real food that is not manipulated by manufacturing to meet some nutrient criteria."
Indeed Yale's Dr David Katz has argued that the low-fat advice, based largely on the controversial findings from a 1950s study by scientist Ancel Keys and echoed by Preventive Medicine Research Institute founder Dr Dean Ornish, has been warped by the food industry.
"When [Ancel Keys] advised that we should eat less fat, the advice meant eat more spinach," Katz tells Jeff Wilser in his new book The Good News About What's Bad For You. "The food industry said, we can't make a lot of money selling spinach, but we can invent Snackwell Low-Fat Cookies."
"I wouldn't disagree with that," says Malhotra, who eats up to 15 eggs a week and has bacon a couple of times a week. "If you're avoiding fat and eating more vegetables, there's not a problem with that."
His problem is whether fat is being replaced by sugar or refined carbohydrates, and that people still fear fat. McMillan agrees this needs to change.
"I think we will see a revisal of the dairy guidelines in future Australian Dietary Guidelines and that would be a welcome move," she says.
"Eating fat is as likely to make you fat as eating greens is to make you green," Malhotra says. "It's time to bring fat back."
How much fat is OK?
"Force yourself to eat anything in excess and you will probably do harm," Malhotra says. "Eat until you're full. Try to avoid snacking and eat real food."
Read more: http://www.theage.com.au/lifestyle/diet-and-fitness/a-fat-load-of-good-why-its-time-to-bring-full-fat-back-20160412-go4gyc.html#ixzz46Ew9HfiK
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Me - female, 153.5 cm tall (short!), turning 55 next month (how did that happen??).
Sleeved 02.02.2015 by Dr Stephen Watson at SJOG Murdoch Perth, weighed 82.5 kg at my heaviest in 2002 - BMI 35, weighed 74 kg at pre-op appt - BMI 31.4 , and weighed ??70.4 kg BMI 30 immediately pre-op. Lightest I got down to was 41.3 kg, BMI 17.5 in 2015 (I had a gut infection).
I had plastic reconstructive surgery - 1/2 bodylift and arm lift at the end of 2015. My blog is on bandingtogether.com, same username.
Not working, heaps of medical problems not obesity related, on Disability Pension. Health-wise, I do best on a gluten-free, low FODMAP, LCHF diet.
Recent heaviest weight was 22.03.2018 54.88 kg, BMI 23.29. My only consolation is that when I last weighed this, in May 2015, I had more body fat (I have scales which also measure hydration and body fat %). Dietitian's long-term goal for me was 50-53 kg, so I am over my goal weight. My original goal eight was 50 kg. I desperately want to get back to 46 kg, BMI 19.5 - my happy weight.
Following another Campylobacter gut infection last year, i ceased some prescribed medication as I simply could not face taking it. Then inadvertently went through seven months of hideousness with Cymbalta Withdrawal Syndrome, had no energy, was hideously fatigued, no appetite control, and ate and ate and ate. I am now back on Cymbalta for Fibromyalgia/ME/CFIDS nerve and soft tissue pain. For me, a bonus of Cymbalta is one of it's known side effects - diminished appetite! Yay!
Negatives for me are: Still feeling very fatigued and drained with post-exertional malaise (ME/CFS), feel great in the mornings until after I walk the hounds and then it's downhill from there. As far as my "energy/wellness/health budget" go, I either spend it on walking the dogs, or other activities such as housework. Walking the dogs wins out ....
Positives/strategies for me are:
Involvement in a group of like-minded supportive folk, i.e. this forum!
I continue to follow a LCHF diet, and have made the effort over the last couple of days to chew more and to take a break between mouthfuls.
I have found doing the 20, 20, 20 does slow my eating down, and therefore I fill up/reach satiety faster! I am not doing any other activity while I am eating, and quite frankly, it is quite boring, so I don't stretch the time period out more.
I continue to use small crockery and cutlery.
I have been back and looked at the guidelines given to me by my dietitian post-op. I had consulted her at every stage - pre-op, and then at every progression post-op, and have found a very basic guide for a plan for getting in protein when on full diet.
I continue to walk briskly minimum 3.4 km daily with two houndies.
I have identified areas that I personally for me need to work on, these are in italics.
Slow down your eating pace. If you have a gastric band, you may need to wait up to 90 seconds between each swallow.
Chew well and clear the mouth between small forkfuls (spoonfuls). There’s no need to rush when the meal is small.
Skip energy-laden drinks, such as sugar-drinks (soft drinks, cordials, energy drinks) and drinks containing alcohol (beer, wine, spirits, cider, liqueurs).
Choose nutrient rich foods including protein rich foods. Protein is nature’s natural appetite suppressant.
Stick with a smaller serving size that is just enough to take your hunger away without either making you feel over-full or leaving you hungry soon after - a fine balance that takes time to to discover. Serve more and you’ll attempt to eat more - human nature at work! Serve too little and you will slip into a less helpful grazing and snacking pattern.
Learn to recognise the differences between true tummy hunger and head hunger. Head hunger is driven by social occasion, desire, emotions, or mood. Respond to head hunger with something other than food.
Stop grazing and random snacking. Between meal eating and drinking is easy to forget and accounts for stalled weight loss and weight regain in many. http://www.foodtalk.com.au/contents/en-us/d136_The_Pouch_Reset_Test_Diet__does_it_really_work_.html
I am now in the first stages of meal planning and looking at recipes.
I've gone through some of my resources here at home, and had a good browse through "Curb the carb. The safer way to diet. The healthy low-carbohydrate weight loss programme" by Amanda Cross. It's not bariatric, but has good recipes with macros and meal planning. Also goes through three stages of weight loss - fast, slower, maintenance. A lot of the recipes are 1-2 serves for folk who haven't had weight loss surgery, so it's easy enough to split the meal up into servings appropriate for me and know what the macros are for each serve.
I am going to source a LCHF dietitian in Perth - and see them under a Chronic Disease Management Plan. I am really confused about how much my daily protein should be, there is a lot of conflicting info, and also whether or not I should have snacks *sigh*.
It's my 2nd Surgiversary!
I am 26.8 kg down from when I had my pre-op appts, 34.88 kg down from my all-time heaviest (I have lost a good sized Greyhound )
From my heaviest my BMI was 35, pre op 31.04, currently 20.2, no measurement of body fat% at my heaviest, pre-op 42.5%, currently24.9% I have had plastic reconstructive surgery - abdominoplasty, belt lipectomy and brachioplastys.
I had a couple of unwell months with diarrhoea and weakness, and had dropped down to 41.82 kg, body fat 18.6% a couple of weeks ago. My GP was starting to get concerned when I got down to 45 kg, which was the level at which Jo Anne Dembo had said that she didn't want me under, and to contact her if I did.
I have to say that I am very disappointed with Jo Anne Dembo. I last saw her in July (I had a total of seven visits to her, five under a Chronic Disease Management Plan) and we discussed the problems with my diarrhoea (she just advised me to increase my fibre and to have smooth peanut butter. We also discussed strategies for me to maintain my weight without losing more, to which she advised me to increase my intake of "healthy" fats such as avocado. I contacted the day after that appt as I have done a huge amount of reading on diets etc, and all my reading indicated that maintaining a low-carb higher fat diet would actually just lead to more weight loss...didn't hear back on that one. I have cut out sugar and other sugar substitutes, and refined carbohydrates (I have been a big proponent of low carb for years, obviously had a big problem with portion control and occasional carb-fests to get me obese lol!). Interesting reading: http://whatthefatbook.com/top-tip-tuesday-20th-oct-profiling-nic-gill-for-wtf-sports-performance/
Anyway, my weight loss continued along with the diarrhoea. I kept advising her by email, and heard nothing from her. I went to my GP last month, did a stool test and grew Campylobacter, for which I was put on antibiotics as my GP did not want me to lose any more weight. The antibiotics worked well, and I have put on a bit of healthy weight, my nausea has gone and food intake has increased. She also wanted me to go back to Jo Anne Dembo, I didn't go as I really didn't think that Jo Anne could offer me anything new, and we had already discussed the issues back in July.
So this is where I am:
Body Fat %
I am very happy with that. I am a mini-me, and have resorted to wearing boys shorts/jeans, ages 8-10.
I've had two consults at Sculpt Surgery for abdominoplasty and bilateral arm lift. They were really lovely there, but came in lots more expensive than who I have decided to go with, Sam Cunneen.
I am booked at Bethesda Nov 17th. And if all goes well, will be looking at having bilateral thigh and breast lifts.
Calculating a patient’s waist-to-height ratio is the most accurate and efficient way of identifying whether or not they are at risk of obesity, a new study shows.
The research, published in PLOS One, examined the whole-body fat percentage and visceral adipose tissue mass of a group of 81 men and women.
The British authors discovered that 36.5% more adults would be classified as obese using whole-body fat data (one in two participants) rather than BMI (around one in seven participants, or 13.5%).
To conduct their study, they gathered accurate whole-body and abdominal fat data using a total body dual energy X-ray absorptiometry (DXA) scanner — a highly accurate way of measuring body composition and fat content.
They then calculated five predictors of whole-body fat and visceral adipose tissue that could be easily replicated in a GP’s office, and compared the results with those of the DXA scan to determine which simple predictor of obesity was the most accurate.
The five predictors tested were: BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and waist-to-height ratio0.5 (WHtR0.5).
Lead researcher Dr Michelle Swainson, senior lecturer in exercise physiology at Leeds Beckett University, says although there are benefits to the conventional BMI method, there is concern that it is a misleading measurement.
“This is most definitely the case when people have a 'normal’ BMI but high abdominal fat that is often dismissed,” Dr Swainson says.
The results from the study show the best predictor of whole-body fat percentage and visceral adipose tissue in both men and women is WHtR.
This simple method of waist circumference divided by height measurement is not a new obesity classification but, despite evidence supporting its use, it is still not routinely measured in clinical settings, the authors note.
Cut-points for predicting whole body obesity were 0.53 in men and 0.54 in women. The cut-point for predicting abdominal obesity was 0.59 in both sexes
I have emailed the info to Dr Watson (Perth)
(I've just declicked BBCode Mode Icon and that let me paste!)
Nothing like having a large Greyhound to hide behind! He looks little next to me
I've just walked 1km back from the shops, having done a circuitous route via the park to get there (had to buy dog bones for the houndies - Spud Shed In Kelmscott do nice ones).
This was carrying 18 kg and walking two Greyhounds.
Pre-coffee this am I checked my BP (using correct technique) and it was a pleasing 113/69.
A massive improvement from earlier this year when I was still working 2/7 and had inadequately treated sleep apnoea, BP then went up to 163/83. I had to have a 24 hour BP monitor applied.
Now I am feeling much better than a couple of months ago with a ME/CFS relapse, my appetite has diminished, and I find it easier to go low carb.
My blood tests done recently were excellent:
Cholesterol: 4.5 (<5.5)
Triglyceride: 0.6 (<1.8)
HDL Chol: 2.4 (1.1 - 3.5)
Risk Ratio 1.9 (<3.5)
LDL Chol: 1.8 (<3.5)
S-Insulin 9 (<20)
Glucose 5.4 (3.5-5.4) - I would like to get that down.
So I guess, that's not bad for a 51 year old with chronic medical problems and who society looks down on and judges as 'fat' (along with all the connotations of that!).
At this rate I could pass the pack hike test for fire-fighters! (done it before and passed).
I didn't go for it this year as I knew that I wouldn't pass the medical due to the chronic medical problems.
Anyway, I am no longer working there, so now just working casually in my original career.

domain: medical


text:
Peaks and valleys
Purpose - This paper aims to study how the trajectory of fundamental values affects price discovery in an experimental asset market. Design/methodology/approach - An experiment is conducted with two treatments, in which the time path of fundamentals differs between treatments. In the peak treatment, fundamentals first rise and then fall, while in the valley treatment fundamentals first fall and then recover. The experiment allows market prices to be compared to fundamental values. Findings - Both peak and valley treatments experience bubbles when traders are inexperienced. However, price discovery is more rapid and complete in the peak than in the valley treatment. In the peak treatment, prices track the value, the direction of the trend, and changes in trend, more closely than in the valley treatment. Originality/value - This paper documents the first experimental results regarding pricing behavior in markets with non-monotonic fundamentals. It creates an environment (the valley treatment) in which convergence to close to fundamentals does not occur even with repetition of the market under identical conditions. The results demonstrate that the likelihood that an asset market tracks fundamentals depends on the time path of fundamentals.
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Volume (Year): 37 (2010)
Issue (Month): 2 (May)
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domain: finance


text:
You Can Achieve Hormone Balance Naturally!
Understanding more about your body and the changes you are experiencing as you enter perimenopause and menopause is vitally important to your success on the path to natural hormone balance.
Here are articles, books and videos on natural hormone balance to help you gain the knowledge you need for hormone balance including the effects of low hormone levels, low progesterone, low estrogen, excess estrogen, the benefits of natural progesterone, hormone balance for men, PMS and much more!
More Information and Related Products:
Insulin and Your Health
Insulin Levels Are Key to Your Health
The importance of insulin and your health, what happens when your body can't utilize insulin, insulin resistance and what you can do to restore your utilization of insulin.
35 Menopause Challenges
Balanced Progesterone Leads to Better Overall Health
Balanced Progesterone Levels Leads to Better Overall Health
Essential to hormone balance, progesterone is the foundation for many body hormones vital to good health.
Hormone Balance Books
Health Source Books Index
Excess Estrogen Symptoms
Prostate Health FAQ's
Men's Hormone Balance
All About Hormone Imbalance
Hormone Balance Made Simple Book Excerpt
Hormone Balance Videos Featuring Dr. John Lee Index
Get Off Synthetic Hormones
How to Wean Yourself Off of Synthetic Hormones Article
2002 Women's Health Study overcame the idea that synthetic HRT drugs were good for age-related diseases; droves of women began to stop taking them.
I Had Extreme PMS
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Menopause FAQ's Exercise
Most Asked Questions About Menopause and Exercise Article
Exercise's importance during menopause + natural products that may help you deal with menopause symptoms stopping you from being motivated to work out!
Menopause FAQ's Fatique
Most Asked Questions About Menopause and Fatigue Article
Menopause fatigue and simple ways to address fatigue with exercise, natural progesterone, phytoestrogens, and more.
Menopause FAQ's Hot Flashes
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Hot flashes during perimenopause and menopause and simple ways to address hot flashes with bio-identical hormone balance using natural progesterone and phytoestrogens.
Menopause FAQ's Insomnia
Most Asked Questions About Menopause and Insomnia Article
Hormone imbalance may cause your insomnia - natural herbs and natural hormones such as progesterone could help you catch some ZZZZ's.
Menopause FAQ's Lifestyle Changes
Most Asked Questions About Menopause and Lifestyle Article
Going through menopause may mean you need to change your lifestyle, how you eat, sleep and exercise!
Menopause FAQ's Part 1
Most Asked Questions About Menopause and Menopause (Part 1) Article
FSH & LH levels and what they mean to you, the symptoms of menopause and the stages of menopause.
Menopause FAQ's Part 2
Most Asked Questions About Menopause and Menopause (Part 2) Article
Your body during menopause, if you can still get pregnant, & why progesterone creams are more effective than pills.
Menopause FAQ's Part 3
Most Asked Questions About Menopause and Menopause (Part 3) Article
Your sleep patterns during menopause, your sex life, & if you need to take different vitamins during this stage of your life.
Menopause FAQ's Mood Swings
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Mood swings and simple ways to address them with bio-identical hormone balance using natural progesterone and phytoestrogens.
Menopause FAQ's Weight Gain
Most Asked Questions About Menopause and Weight Gain Article
Menopause and hormone imbalance may mean weight gain and why it all seems to end up around your middle!
Perimenopause FAQ's (Part 1)
Most Asked Questions About Pre-Menopause (Part 1) Article
What is really normal during perimenopause, perimenopause symptoms and why perimenopause may start before you expect it.
Perimenopause FAQ's (Part 2)
Most Asked Questions About Pre-Menopause (Part 2) Article
When you move from perimenopause into menopause, irregular periods and how natural hormones such as progesterone can help.
Natural Hormone Balance
Hormone Balance Knowledge Center - Articles - Books - Videos
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Progesterone & Pregnancy
Progesterone and Pregnancy Article
There is some evidence that the decreased progesterone production in women who eventually miscarry is not a cause of the miscarriage, but a result of a pregnancy that - for reasons we don't always understand - didn't "take.".
Skin Care Knowledge Center Index
Symptoms of Low Estrogen
Symptoms of Low Progesterone
The Benefits of Phytoestrogens
Bio-Identical Hormones Affect Menopause and Perimenopause
Night Sweats Cause
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Easy Menopause and Perimenopause
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Being informed about natural hormone therapy such as natural progesterone, diet, exercise and attitude and following this simple plan makes all the difference in the world.

domain: health


text:
Pardon my ignorance, but here goes... I am becoming interested in powders because they are so cost effective... Mainly Test. Is this something a person with no background in chemistry can do? And if so, are there any good guides you know of?
Basskiller made it very clear... While I have a couple reliable sources for constituded items, I have never purchased powders and I am finding very little information as to reliable sources of powder... I very much understand source checking is not allowed, and why, so please understand that I am not asking for specific sources. Can anyone direct me anywhere to ascertain the reliability and/or quality of powder providers? Has anyone had experience with cheaperpharma.com?
It's incredibly easy. Easier than baking a cake.
If you're doing home-personal use...mix powder, oil, and solvents in a beaker. Heat it close to the melting point of the hormone, mix until dissolved.
run it through a .2 filter (syringe filter works fine but is slow), into a sealed sterile vial.
^^^ you don't need to heat a hormone to it's melting point to get it into solution. I've done Test E, Test Ace, Mast Prop, Tren Ace, Testolone Ace, Bold Cyp, and NPP, all of them made it into solution at just 120 F. A lot of steroids have melting points in the upper 200's even 300's. There's just no need to heat the brew that high IMO.
Ba/BB are solvents so there is really no need to even heat it. Your putting it through a filter for sterility. All that the heat will do is speed up the time it takes to make the solute, and make it slightly easier to push through the filter.
Really all you need to do is take your time and be very clean. basskillers calc is pretty good too, especially for small batches.
Everything I say is for entertainment purposes only and not to be taken seriously.

domain: chemistry


text:
Connecting state and local government leaders
Business executives told attendees at the National Governors Association meeting in Washington, D.C. that a simplified permitting process would encourage the private sector to engage on infrastructure projects.
WASHINGTON - Streamlining the permitting process is a key step states can take to encourage the private sector to back infrastructure projects, business executives told the nation’s governors.
“The fastest way to do it is to require there be a single approval process or a single permitting process so you can’t get lost across multiple agencies,” said Doug Peterson, president and CEO S&P Global.
Peterson was among the executives who addressed state leaders gathered at the National Governors Association winter meeting in Washington D.C. on Saturday.
The question of how to pay for major, and often expensive, infrastructure projects has increasingly become an area of concern for governors as federal government investment has dwindled. States are increasingly turning to public-private partnerships as a way to finance large-scale projects.
States and local governments spent about $342 billion on infrastructure projects in 2017, accounting for about three-quarters of all infrastructure spending in the United States, according to the Brookings Institution. The amount of money the federal government spends on infrastructure declined from $101 billion to $98 billion between 2007 and 2017.
Dominion Energy, a Virginia-based power and energy company, has committed to spending $26 billion in private investments over the next five years, with a focus on emerging technologies. But to do that, the company needs legislative and regulatory cooperation in place that can make it easier to partner up, said Diane Leopold, Dominion’s vice president told lawmakers.
“Nobody is looking for any kind of rubber stamp. But a clear, consistent, timely process is essential,” she said. “If we are going to invest $26 billion, to be able to do that and finance it, it is critical there is that clear process to be able to go through.”
Environmental groups have raised questions about recent efforts at the federal level to streamline permitting, particularly through the Environmental Protection Agency, saying they could leave communities vulnerable to pollution. State leaders have also chafed at Trump administration moves to cut them out of some permitting decisions, such as an order signed by President Trump in April that could reduce states power to block pipelines.
Maryland Gov. Larry Hogan, NGA’s chairman, has focused on infrastructure as a top priority this year. In recent years, governors and state leaders have come to Washington to push the Trump administration and Congress to invest in infrastructure. But Democrats and Republicans haven’t agreed on what that should look like and are unlikely to come to any consensus in an election year.
New York state has $275 billion in upcoming infrastructure projects, ranging from a new LaGuardia Airport to backing from rural broadband expansion, said New York Gov. Andrew Cuomo as he addressed governor’s at the NGA meeting.
These projects are “essential for economic survival,” Cuomo said. “If the federal government will not step up and fund them then the state must.”
Building and maintaining a transportation network infrastructure plays an important role in growing economic development, business executives told state lawmakers. When Amazon is looking to expand its facilities, infrastructure and accessibility are two factors executives evaluate when making decisions about where to locate, said Sarah Rhoads, the vice president Amazon Global Air.
Delegating one agency in the state to have knowledge of all assets and infrastructure projects in the pipeline would also be helpful for companies interested in financing projects, Peterson said. Engaging a company on a series of infrastructure projects could lead to savings over piecemeal completion.
As an example, Peterson cited the 2014 decision by the Pennsylvania Department of Transportation to engage in a public-private partnership to repair and maintain the state’s 558 bridges.
“They could have never done that if they didn’t have the inventory of assets,” Peterson said.
Andrea Noble is a staff correspondent with Route Fifty.

domain: economics


text:
There are a total of 257 collectibles (40 Artifacts, 71 Logs, 73 Weapon Parts, 61 Circuits, 12 Blueprints) in Dead Space 3. The video guide below will show you all their locations. Blueprints are needed to develop new weapons. Weapon parts and Circuits can be used to upgrade and customize existing weapons.
Your collectible progress will be saved each time you reach a new checkpoint. If you die or restart the last checkpoint you will have to collect some items again. You can keep track of your progress in the chapter select menu.

domain: game


text:
Many trillions of dollars are proposed to be spent in dubious “green new deals” around the world. In an “Open Letter to World Leaders,” the Climate Intelligence Foundation says this proposed spending should instead be spent on health care, especially virus prevention, protection and cures.
The Climate Intelligence Foundation (CLINTEL), provides a reason up front. It says: “Your Excellencies, compared to COVID-19, climate change is a non-problem! It is based on immature computer models, and it looks into the distant future. In the current health emergency, however, your attention to the peoples’ needs is today! Please, don’t continue pushing your zero carbon emission ambition in a time that the world is dealing with a deadly global crisis. Yes, there is an emergency, but it is NOT climate.”
CLINTEL addresses its letter specifically to the leaders of the UN and EU, saying “People need an inspiring narrative that promises them a hopeful future. Today, for instance, it is totally inappropriate that the billion-dollar Green New Deal focused on climate is still on the agenda of leaders such as Mr. Antonio Guterres of the UN and Mr. Frans Timmermans of the EU.”
The reason is clear – there is no manmade climate and weather crisis.
The Europan Union could make a difference in the fight against COVID-19 almost immediately, extending over the next 7 years. To do this, it could reprogram €100 billion ($110 billion) of European Green Deal money. They have a Just Transition Mechanism that aims to “help mobilise at least €100 billion over the period 2021-2027,” through “financial support and technical assistance to help people, businesses and regions that are most affected by the move toward the green economy.” CLINTEL suggests replacing the Mechanism’s “green economy” with “corona crisis.”
Having already committed the Union to a compulsory transition to a “green economy,” the EU knows it will force tens of millions of its people into unemployment. The so-called “green economy,” would make the EU uncompetitive and more poor than it is today.
CLINTEL says the proposed spending of a trillion euros in the European Green Plan (EGP) is a foolish attempt to control the global climate. They know that China, India and other emerging economies are in the process of building hundreds of new coal and gas-fired power plants, hundreds of new airports, thousands of fossil fuel-based factories, and millions of internal combustion vehicles.
A far wiser decision would be to put money into improving health care for their people, with priority going into virus protection. The current news coming from Italy, France, Spain, Germany, Britain and other EU countries related to coronavirus is dire. Those AU leaders who are awake and seeing the effect this is having on their people know it is true.
In the United States, President Trump signed the $2.2 trillion emergency relief bill, Coronavirus Aid, Relief and Economic Security (CARES) Act. It is the largest relief package in US history. The Act provides money to help hospitals and state and local governments, assist with critical medical needs, and provide relief for small businesses and furloughed workers. An earlier bill was purposely delayed by Democrats who had inserted a massive amount of pork into it. Those provisions were all eliminated in the final bill sent to the President’s desk.
According to CLINTEL, a European Green Deal would cost many trillions of dollars, as would the US Green New Deal endorsed by Democrat presidential candidates, to address conjectural future risks. Presidential candidate Bernie Sanders says his version of the Green New Deal would cost “just” $11 trillion, but other estimates estimate the cost to be as high as $93 trillion!)
Some of money allocated should go to upgrading the health care system, testing people and getting COVID patients respirators and medicines that work, conducting clinical trials to evaluate anecdotal evidence about various treatments, and saving lives! Other spending is to assist families whose breadwinners have been laid off by the lockdowns and quarantines, and businesses that have been closed down.
In the USA, around 15 million workers are unemployed in the restaurant industry alone, plus millions more in restaurant support industries. If the business lockdown continues for an additional month or more, some 75% of independently owned restaurants will never reopen, business insiders say. Moreover, across the USA, it is minorities who are most seriously harmed by the shutdown, since they dominate the worst-affected sectors.
The rest of the money should simply not be spent, especially since it’s mostly more government debt. Spending it would further damage the economy and future taxpayers, in Europe and the United States.
CLINTEL calls the green new deals “foolish.”
The United Nations is obsessed with its faux manmade-climate-crisis. It continues to pressure all nations to adopt expensive zero-carbon-dioxide plans, preferably by this November, before the Glasgow climate summit.
CLINTEL says the UN’s obsession with climate underscores how wrongheaded and intransigent the UN has been for decades. The current virus problem must be urgently addressed instead, along with preparation for the inevitable subsequent viruses.
The economic crisis due to the shutdown engineered to stop the coronavirus pandemic will hit all countries, including those with relatively small virus outbreaks at the moment or in the future. With proper prevention and response systems in place, there is no reason these economic disasters should escalate. But those systems will not be in place in impoverished nations – largely because UN, EU, climate and other eco-imperialist activists for decades have prevented those countries from building fossil fuel, nuclear and even hydroelectric generating plants, forcing them instead to be content with minimal, unreliable, habitat-destroying wind and solar power.
CLINTEL has strong advice for world leaders. “To revive the global economy, don’t further increase government debts. Instead, apply the money intended for your costly Green New Deal to the present needs of people and society. Call it the COVID-19 RECOVERY PLAN. Be aware that, in today’s crisis, the conjectural policy of CO2 reduction is highly counterproductive!”
Here is the letter’s eloquent summary statement: “The world is moving to an open global economy of ten billion people. Top priority must be given to significant investments in a global health system that makes any pandemic less catastrophic. Considering COVID-19, climate alarmists and climate critics should admit that global warming is a non-problem. Therefore, stop fighting, step over your own shadow and work together against the deadly virus. In this tough battle we need each other!”
What CLINTEL Says
Imagine what would happen if abundant, reliable, affordable electricity from fossil, nuclear and hydroelectric were replaced by expensive, limited, intermittent, weather-dependent wind and solar power. The impacts on our coronavirus response, healthcare, living standards and life spans would be horrific.
Without reliable, on-demand energy sufficient to power modern, industrialized society – which neither wind nor solar power can provide at current levels of technology – hospitals could not maintain sterile conditions. Food and vaccines could not be grown, developed, preserved or transported. Protective equipment to safeguard front-line health care workers from COVID-19, and respirators for critically-ill patients, could not be delivered where they’re needed, let alone manufactured in the first place.
We would not even have clean water or reliable sanitation systems. We would not have jobs, industries, decent living standards, or anything approaching a vibrant, functioning, job and tax-generating economy.
That’s the situation African and other impoverished nations found themselves with Ebola – and will find themselves if (when) COVID-19 reaches them. It is where a GED or GND would take the United States.
President Trump is absolutely right. We need to fight the coronavirus and keep it from spreading. But we also need to begin soon to balance the virus threat against threats created by our response to the virus: deaths from COVID-19 itself (which could be overstated) versus deaths due to mass unemployment and recession because of the shutdowns: from stress, depression, despair, strokes, heart attacks, suicides and murder-suicides … amid bankruptcies, loss of life savings, and destruction of years’ of work and sacrifice.
And yet there are some who applaud the corona-economic recession for driving down fossil fuel use and CO2 emissions – or want more wind and solar mandates and subsidies built into any corona response plans.
Our health and economic emergency is real and immediate. The manmade climate emergency is years or decades away – if it even exists outside the realm of computer models that generate worst-case scenarios but cannot even forecast average global temperatures accurately … and pseudo-scientific studies that blame every observed (and imagined) temperature shift, climate fluctuation and extreme weather event on fossil fuels.
Fight the virus, not carbon.
Story by Paul Driessen and David Wojick
Paul Driessen is senior policy analyst for the Committee For A Constructive Tomorrow (www.CFACT.org) and author of books and articles on energy, environment, climate and human rights issues. David Wojick is an independent analyst specializing in science, logic and human rights in public policy, and author of numerous articles on these topics.

domain: politics


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The conference has taken place at the Audiori de la Facultat de Comunicació Blanquerna and it has been divided around 3 speeches. The moderator, Josep M. Carbonell, who is the Communication Blanquerna University dean, has introduced the first one. He has started with evidence that, in his opinion, should not be forgotten as time goes by: we are at the XIX Jornades Blanquerna, as old as the Faculty itself. He has also added that their origin comes from an alumni iniciative.
Wilfried Lemke, Special Adviser to the UN Secretary General on Sports for Development, has been the second one to speak for about 20 minutes. He has been clear and concise. He has remarked the fact that his objectives emerge from discussing the problems of sports, focused on “the grass for development and peace”. “The objective is not for athletes to jump higher or run faster. We all, as citizens, have a special responsibility. The leading clubs have also their responsibility.” And has added: “We want to connect the leading clubs to the UN system in a very concrete project”.
And the UN Project for Sports is organised through 5 millennium development goals. He has made a summary of the 5 most important ones out of 8. 1. Eradicate extreme poverty and hunger. 2. Gender equality on the sports field. 3. Promotion of people with disability through sport. 4. Conflict resolution and Peace building. 5. Young leadership programmes. And the point is that not the most of people know it.
Another issue he has remarked is that for the media sight, good news are not news. He has been totally in desagreement to this fact and has cemented the importance of future journalism professionals to open the world and let everyone know about beautiful stories. “Our duty is also to raise media attention for UN objectives”. He has also commented that society must focus on kids, we ought to oppose to “the winner takes it all”, we had better give them cooperation, peace, dialogue and tolerance values to make them model people for the future they are going to lead. He has encouraged everyone to “do not hesitate to transfer the straight line of media and the line normal things tend to go through. There are lots of positive stories, there are lots of big emotions as, for example, a blind runner in Kenya.”
He has finished: “Trust me, you will feel much better, I can tell you because I am very old”.

domain: news


Shape of YoU - Dj Nicks The CrazY BeaT
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In today’s fast-paced world, agreements and contracts play a crucial role in various aspects of our lives. From business deals to personal arrangements, understanding the terms and conditions stated in these documents is essential. Let’s delve into a few key agreements and contracts that you should be aware of:
1) Time Payment Agreement
A Time Payment Agreement is a financial arrangement between two parties where the payment is made over a specified period of time. This type of agreement allows individuals or businesses to conveniently manage their financial obligations.
2) KPMG Contractor Jobs
For individuals seeking employment opportunities, KPMG contractor jobs offer a promising option. KPMG, a renowned professional services firm, often hires contractors to work on specific projects or provide specialized services.
3) Purpose of a Software License Agreement
Have you ever wondered what is the purpose of a software license agreement? This legal document outlines the terms and conditions for using software. It helps protect the rights of both the software developer and the end-user.
4) Agreement Magarpatta
Agreement Magarpatta refers to an agreement associated with the Magarpatta City, a well-known township in India. This agreement outlines the rights, responsibilities, and regulations applicable to the residents and developers of the Magarpatta City.
5) Leave and License Agreement Needs to Be Registered
In many jurisdictions, a leave and license agreement needs to be registered to be considered legally valid. This agreement is commonly used for renting or leasing properties and establishes the rights and obligations of both the tenant and the landlord.
6) Third Parties Agreement Vertaling
When dealing with international contracts, understanding the terms used is crucial. “Vertaling” is the Dutch word for “translation.” Thus, third parties agreement vertaling refers to the translation of a contract involving multiple parties.
7) Paying Phone Contract in Advance
Wondering if you can pay your phone contract in advance? The answer depends on the terms and conditions set by your service provider. Some providers may allow early payment, while others may not offer such an option.
8) Subject-Verb Agreement Grammar Rules
The subject-verb agreement grammar rules are fundamental principles that govern the agreement between a subject and its corresponding verb in a sentence. Proper subject-verb agreement ensures grammatical accuracy and clarity in communication.
9) Shogun 2 Breaking Trade Agreement
In the popular video game “Shogun 2,” breaking a trade agreement can have significant consequences. Players must carefully consider the potential repercussions before making such a decision, as it may impact diplomatic relations and alliances within the game.
10) LLP Members Agreement Template
When establishing a Limited Liability Partnership (LLP), utilizing an LLP members agreement template can simplify the process. This template outlines the rights and obligations of the LLP members, ensuring a clear understanding of their roles and responsibilities.
These agreements and contracts are just a glimpse into the vast world of legal documents. Whether you’re a business professional, a gamer, or an individual seeking financial stability, knowledge of these agreements can prove invaluable.
Remember, agreements and contracts are designed to protect the interests of all parties involved. Familiarize yourself with their terms and conditions to ensure a smooth and fair interaction in various aspects of your life.

domain: law


text:
Council chiefs in part of Lancashire have become the first to register a ‘vote of no confidence’ in a decision by Police and Crime Commissioner to appoint former police authority members to senior positions.
A group of four Conservative councillors on Wyre Council tabled a notice of motion at a full council meeting last week, calling on Clive Grunshaw to reverse his decision to appoint a deputy commissioner and four assistant commissioners at a cost of £100,000 and instead plough the cash into frontline policing.
The notice said that the members “deplored” the decision and accused Mr Grunshaw of “cronyism”.
And it was carried by a majority of councillors at the meeting.
Coun Don MacNaughton, who tabled the notice, said: “That is the position of Wyre Borough Council now, it has been voted by the majority of councillors.
“We can’t enforce that on Clive Grunshaw but we are allowed to register our displeasure. A notice of motion is the most formal way of going about these things.”
Asked whether the decision represented a vote of no confidence in Mr Grunshaw’s decision to make the appointments, he added: “You can say that. The notice of motion condemned the decision by Clive Grunshaw to take £100,000 out of the police budget and spend it on his cronies.”
Ron Greenhough, Julie Newsham and Patsy Ormrod also signed the motion, which said all the positions went to old colleagues on the police authority and none of them were advertised.
Conservative members of the council voted for the motion and Labour members voted against it.
A spokesman for the commissioner has consistently pointed out that Mr Grunshaw has followed correct procedure under the law and is completely entitled to make the appointments.
A spokesman for the office of the commissioner said: “We can confirm that the correct procedure has been followed in relation to the recent appointment of the Deputy Police and Crime Commissioner, in accordance with the Police Reform and Social Responsibility Act.”