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MTF HRT and Belly Fat?

Started by richie, February 02, 2016, 12:25:18 PM

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Lady_Oracle

Quote from: richie on February 02, 2016, 12:25:18 PM
I'm a very small 18 year old that will be starting HRT in a few days. My current weight is 105 and I'm 5'5. My body can be best described as "skinny fat". I look very skinny but my body is just a small layer of fat with skin on top.

I still have a little bit of belly fat remaining from a recent weight loss but it's only noticeable when I sit down. If I maintain my current healthy diet and more active lifestyle (I walk up to 5 miles a day just from running errands/going to classes), will I be able to diminish the belly fat and have it go somewhere else while on HRT?

I know that people say old fat doesn't move upon starting HRT unless it's burned, but if the amount is minuscule like mine, what will happen?

I didn't read through the responses but just thought I'd give my 2cents since it sounds like we have similar body types. I'm 4 years hrt and that belly fat doesn't really go away (on its own) but it changes greatly. Being as thin as I'am (135lbs, 5'10) I dont have much of a belly at all and most of my fat has been redistributed however I still have a small pouch/pudge. From my belly to the mons pubis, the entire area changed dramatically, like it has a lot more padding than before. I haven't tried to get rid of it since its not really noticeable unless I binge eat or become bloated. So basically since your metabolism is burning so much so fast, you'll notice a quicker change in fat redistribution than most (within what your genetics allow) whenever you gain weight.
  •  

KayXo

Quote from: WendyA on February 09, 2016, 09:54:17 AM
The science is still out on whether long term low carb high fat diets will provide healthy outcomes.

BMJ 2013; 347

"An influential Swedish health organisation has recommended a diet that is low in carbohydrates but not low in fat for people who are overweight or obese or have diabetes.

The advice from the Swedish Council on Health and Technology Assessment is the result of a two year review of 16 000 scientific studies of diet.1 The recommendation contradicts the generally held belief that people should avoid foods that are rich in fat, especially those high in saturated fat.

The council, which advises the Swedish healthcare system, concluded that the scientific evidence did not support a low fat diet. Instead people should focus on reducing their intake of carbohydrates."

"The guideline advises that meat and fish rich in fat, along with nuts and olive oils, should form a large part of a healthy diet, while the consumption of pasta, potatoes, and white bread should be reduced."

Also, here is a "healthier" diet that was tested on a large sample over many years, AND

JAMA. 2006 Feb 8;295(6):655-66.

"Randomized controlled trial of 48,835 postmenopausal women aged 50 to 79 years, of diverse backgrounds and ethnicities, who participated in the Women's Health Initiative Dietary Modification Trial. Women were randomly assigned to an intervention (19,541 [40%]) or comparison group (29,294 [60%]) in a free-living setting. Study enrollment occurred between 1993 and 1998 in 40 US clinical centers; mean follow-up in this analysis was 8.1 years."

"Intensive behavior modification in group and individual sessions designed to reduce total fat intake to 20% of calories and increase intakes of vegetables/fruits to 5 servings/d and grains to at least 6 servings/d. "

"Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors"


I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
  •  

Lady_Oracle

As far as diets go, what worked for me was a high protein and carb diet with lots of snacks/small portions. I never really exercised, I just let my metabolism and diet do the work.

  •  

KayXo

Quote from: WendyA on February 09, 2016, 09:54:17 AM
My way of eating has never included calorie restriction, so it is a long term solution.

Low carb/high fat also doesn't include calorie restriction, just carb restriction (vs. fat restriction for vegan diet) and it is a long-term solution, intended to be followed for a lifetime.

QuoteThe reason I chose this diet is because it has been clinically proven over the last 30 years to halt and reverse heart disease.

One thing that struck me in the study is the lack of control group or rather a control group that was inadequate, significantly smaller in (sample) size, we also don't know if in terms of other demographics, lifestyle, habits, these two groups are similar or not. Perhaps those non-adherents differed in some respects that made them more prone to cardiovascular complications. A similar study needs to be replicated where both experimental and control groups are similar in all respects except in their diets. Also, it would be interesting to compare plant based, low fat vs. low carb high fat. Such a study was actually conducted and this was mentioned by me in the other thread "Blood Test Result Questions" despite you asserting that none of these studies included diets with 10% or less fat.

JAMA. 2007 Mar 7;297(9):969-77.

"In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss."

"The primary emphasis for the Ornish group was no more than 10% of energy from fat. Additional recommendations given for physical activity, nutritional supplements, and behavioral strategies were consistent with those presented in each diet book.8,9,18,19" The Ornish diet is a very low fat, vegetarian diet.

"Compared with women who were assigned to follow diets having higher carbohydrate content, women assigned to the diet with the lowest carbohydrate content had more weight loss and more favorable changes in related metabolic risk factors at 2 and 6 months. The finding of greater weight loss for the Atkins diet continued through 12 months, reaching statistical significance in comparison with the Zone diet."

"Many concerns have been expressed that low-carbohydrate weight-loss diets, high in total and saturated fat, will adversely affect blood lipid levels and cardiovascular risk.34- 36 These concerns have not been substantiated in recent weight-loss diet trials. The recent trials, like the current study, have consistently reported that triglycerides, HDL-C, blood pressure, and measures of insulin resistance either were not significantly different or were more favorable for the very-low-carbohydrate groups.12- 16"

The Atkins dieters in this study saw greater improvements in body fat %, HDL, triglycerides, in insulin lowering and blood pressure vs. the Ornish group. All these factors are important in determining cardiovascular risk.

Interestingly enough, adherents to the Ornish diet in the study couldn't eat 10% fat (perhaps unpalatable and too difficult) and ended up eating between 20-30% of fat. Atkins dieters increased carb content, as planned, after 2-3 months as part of the ongoing weight loss phase.

In another study I provided (Am J Epidemiol. 2012 Oct 1;176 Suppl 7:S44-54.), one can find a study where low fat/high carb (10% fat (3% saturated fat), 70% carbohydrate, 20% protein) was compared to a high fat, low carb diet (4% carbohydrate, 60% fat (20% saturated fat), 35% protein). Very Low carb resulted in greater weight loss (-3 kgs vs -2 kgs).

In this study, low carb and low fat groups were only able to maintain very low carb (12%) and very low fat (12%) for 3 months while the group who ate moderate carb and fat maintained the same proportions throughout the study and lost the most weight (-3.7 kgs), but only at the conclusion of the study.

When carb content was the lowest in the low carb group and fat content the lowest in the low fat diet, at 3 months, low carb and low fat outperformed the other groups, low carb coming on top at -8 kgs, then low fat at -6.7 kgs, followed closely by the other diet (50% carb, 30% fat) at -6.3 kgs.

Low carb also did better on markers of triglycerides, Trig:HDL ratio, fasting insulin, blood pressure at 3 months, all important markers of cardiovascular risk. As expected, Vitamin B12 dropped in the low fat group.

QuoteIf my chance of heart disease can change from 40% eating the Standard American Diet to less than .6% eating a whole food plant based no oil diet, I'll choose the latter.

Quick conclusion for a study that is flawed in one important way.

The study lacks a control group eating the SAD, that is, half the group randomized to SAD, the other to the plant-based whole food, low fat. Then, truly, we would have been able to determine difference in risk. In this case, the non-adherents were not randomized but rather self-selected, and could have differed in many respects and were only 22, I think, compared to close to 200. 

One cannot jump to such quick conclusions based on a study with no real control group. I provided several studies where there WAS a control group.

QuoteAdd to that poorly constructed studies comparing low carb with "low" fat diets.

Why poorly constructed? Did you read the studies I mentioned in the other thread, in detail? Yes, those were not low fat diets in the sense that people did not eat 10% or less fat but the only study so far to have been able to study such a low fat diet was the study you provided with NO REAL CONTROL GROUP and the study mentioned by me, just above, where for 3 months, you could compare participants eating 12% carbs vs 12% fat and the VLC (very low carb) seems to have fared better in general, despite high amounts of fat (including saturated close to 20%) vs low amounts of fat in the other (only 5% saturated).

The other study provided by you that reviewed several studies seems to only include studies where associations are found (hence, the risk for confounding variables and the inability to conclude cause and effect), also processed and non processed meats are lumped in the same category as meat, you also have studies that only include one group that eat Very Low Fat and no control group and in those studies that do have a control group, that group is eating the SAD so it's not surprising that Very Low fat, eating less processed, more whole foods would be better.

The Prostate study also compared very low fat to SAD (no intervention, control group), not to low carb.

My point...so far, we only really have one study, after 3 months, comparing VERY low carb and VERY low fat and VERY LOW CARB does somewhat better.

QuoteAdditionally your take on vegetable oils is spot on they have virtually no nutritional value and add to inflammation,  this includes "heart healthy" olive oil.

I agree to a certain extent. Olive oil contains very small amounts of polyunsaturated and mostly monounsaturated fat, so even though omega6:omega3 is high, the total content of it in this oil is so low that I personally wouldn't worry. Same for animal fats and coconut oil.

QuoteThe science is still out on whether long term low carb high fat diets will provide healthy outcomes.

I provided one such study in the other thread.

Mol Cell Biochem. 2006 Jun;286(1-2):1-9.

"Various studies have convincingly shown the beneficial effect of ketogenic diet (in which the daily consumption of carbohydrate is less than 20 grams, regardless of fat, protein and caloric intake) in reducing weight in obese subjects. However, its long term effect on obese subjects with high total cholesterol (as compared to obese subjects with normal cholesterol level is lacking. It is believed that ketogenic diet may have adverse effect on the lipid profile. Therefore, in this study the effect of ketogenic diet in obese subjects with high cholesterol level above 6 mmol/L is compared to those with normocholesterolemia for a period of 56 weeks."

"The body weight and body mass index of both groups decreased significantly (P < 0.0001). The level of total cholesterol, LDL cholesterol, triglycerides and blood glucose level decreased significantly (P < 0.0001), whereas HDL cholesterol increased significantly (P < 0.0001) after the treatment in both groups."

"This study shows the beneficial effects of ketogenic diet following its long term administration in obese subjects with a high level of total cholesterol. Moreover, this study demonstrates that low carbohydrate diet is safe to use for a longer period of time in obese subjects with a high total cholesterol level and those with normocholesterolemia."

Also,

N Engl J Med 2008; 359:229-241

"We conducted the 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) to compare the effectiveness and safety of three nutritional protocols: a low-fat, restricted-calorie diet; a Mediterranean, restricted-calorie diet; and a low-carbohydrate, non–restricted-calorie diet."

"In this 2-year dietary-intervention study, we found that the Mediterranean and low-carbohydrate diets are effective alternatives to the low-fat diet for weight loss and appear to be just as safe as the low-fat diet. In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects, a result suggesting that these dietary strategies might be considered in clinical practice and that diets might be individualized according to personal preferences and metabolic needs. The similar caloric deficit achieved in all diet groups suggests that a low-carbohydrate, non–restricted-calorie diet may be optimal for those who will not follow a restricted-calorie dietary regimen. The increasing improvement in levels of some biomarkers over time up to the 24-month point, despite the achievement of maximum weight loss by 6 months, suggests that a diet with a healthful composition has benefits beyond weight reduction."

Also,

http://www.jbc.org/content/87/3/651.full.pdf

"Two normal men volunteered to live solely on meat for one
year, which gave us an unusual opportunity of studying the
effects of this diet. The term "meat," as used by us, included
both the lean and the fat portions of animals. The subjects
derived most of their calories from fat and the diet was quite
different from what one, who uses the term "meat" as including
chiefly lean muscle, would expect."

"It is well known that the Eskimos have lived on an almost exclusive
meat diet for generations. Certain explorers in the North
also have subsisted for long periods on meat.
Dr. Vilhjalmur
Stefansson in particular has demonstrated that it is feasible for
travelers in the arctic region to "live off the country," which
means living on meat alone. The experiences of Stefansson and
his companions have been given in his book "The Friendly Arctic"
(2). He spent over 11 years in arctic exploration, during 9 years
of which he lived almost exclusively on meat.
"

"Thomas (4), finding no elevation of blood pressure and
rarely any evidence of renal disease in the examination of 142 Eskimos,
concluded that a carneous diet under strenuous living conditions does not
produce renal or vascular disease."

"buffalo meat was the "staff of life" of the Central Plains' Indians. He cited also Head's
account of subsisting on the native diet of beef and water while crossing the
South American Pampas. All of these races are noted for their endurance
of exertion and hardships."

"Thomas (4) found no rickets or scurvy among the Greenland Eskimos,
but a large incidence of these diseases among the Labrador Eskimos who
live mostly on preserved food including dried potatoes, flour, canned foods,
and cereals. Stefansson (7) reported three patients with scurvy on his last
expedition, one of whom was our subject, Andersen. These cases were
caused by eating canned foods with only a small amount of cooked meat,
and were cured by eating raw meat."

"Lieb, in 1922 (8), carefully examined Stefansson and stated that he found no evidence of injury from the prolonged
and exclusive use of meat. He mentions the experience of two other men who lived mainly on meat for shorter periods."

Conclusion of the study:

"At the end of the year, the subjects were mentally alert,
physically active, and showed no specific physical changes in any
system of the body."

"In these trained subjects, the clinical observations and
laboratory studies gave no evidence that any ill effects had
occurred from the prolonged use of the exclusive meat diet."

Also,

The Masai in Africa also lived for millennia in a harsh environment, eating mostly meat, raw milk and blood.

These populations, the Inuits and Masai, had to be in excellent health and physical shape to survive their environments for such a long time and were observed by scientific people, doctors, dentists, and explorers as being so and not suffering from any of the chronic diseases seen in our Westernized populations.

The fact that a whole country (Sweden) would also endorse a low carb, high fat diet for their population strongly suggests its long-term safety especially given a review of thousands of studies.

I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
  •  

WendyA

Quote from: Lady_Oracle on February 09, 2016, 10:37:44 AM
I didn't read through the responses but just thought I'd give my 2cents since it sounds like we have similar body types. I'm 4 years hrt and that belly fat doesn't really go away (on its own) but it changes greatly. Being as thin as I'am (135lbs, 5'10) I dont have much of a belly at all and most of my fat has been redistributed however I still have a small pouch/pudge. From my belly to the mons pubis, the entire area changed dramatically, like it has a lot more padding than before. I haven't tried to get rid of it since its not really noticeable unless I binge eat or become bloated. So basically since your metabolism is burning so much so fast, you'll notice a quicker change in fat redistribution than most (within what your genetics allow) whenever you gain weight.

Excellent to have a first hand similar set of circumstances to compare to.  I always thought (don't recall why) that increased padding from the lower belly to the mons pubis area was a normal response taking E. 

Quote from: KayXo on February 09, 2016, 05:21:58 PM
Low carb/high fat also doesn't include calorie restriction, just carb restriction (vs. fat restriction for vegan diet) and it is a long-term solution, intended to be followed for a lifetime.

I never said otherwise.  The possibility exists that the diet you promote is fine long term.  I only know at this point the science is mixed. Frankly I could care less.  On the other hand the preponderance of scientific literature supporting the benefits of a whole food plant based diet needs no defense by me.

Quote from: KayXo on February 09, 2016, 05:21:58 PMA similar study needs to be replicated where both experimental and control groups are similar in all respects except in their diets.

Based on the science this would be an unethical study and never be approved.  There are plenty of other studies in which to compare the results. 

Quote from: KayXo on February 09, 2016, 05:21:58 PMAlso, it would be interesting to compare plant based, low fat vs. low carb high fat. Such a study was actually conducted and this was mentioned by me in the other thread "Blood Test Result Questions" despite you asserting that none of these studies included diets with 10% or less fat.

The study you quote had a goal of 10% fat but actually that group ranged from 20-30% fat. 

Quote from: KayXo on February 09, 2016, 05:21:58 PMIn another study I provided (Am J Epidemiol. 2012 Oct 1;176 Suppl 7:S44-54.)

This was a meta-analysis study where low fat was defined as <30% so I'm unsure what specific study you are referring to in reference to 10% fat.

Either way this has nothing to do with eating a whole food plant based diet.  I'm pretty sure we both agree that if you eat a crap diet simply controlling for the macro-nutrient ratios is going to result in still a crappy diet.

Quote from: KayXo on February 09, 2016, 05:21:58 PMQuick conclusion for a study that is flawed in one important way.

The study lacks a control group eating the SAD, that is, half the group randomized to SAD, the other to the plant-based whole food, low fat.   
...~~~...
One cannot jump to such quick conclusions based on a study with no real control group. I provided several studies where there WAS a control group.

2000 people in the U.S. each day have a heart attack.  1000 people in the U.S. each day die of coronary artery disease.  There are ample examples of various studies that can be thought of as controls to this study it is ridiculous to think otherwise.

I never said that reversal of heart disease, diabetes, obesity, prostate cancer, breast cancer, MS, rheumatoid arthritis, erectile dysfunction etc... could only happen with a whole food plant based no oil diet I simply said it has been clinically proven to positively effect those diseases.  Until any other diet has the same track record I'll stick with what works.

That said if my child was suffering from seizures I would be the first to suggest a ketogenic diet because it has a proven track record with seizures in children.

Quote from: KayXo on February 09, 2016, 05:21:58 PMMy point...so far, we only really have one study, after 3 months, comparing VERY low carb and VERY low fat and VERY LOW CARB does somewhat better.

The only study that I'm aware of that locked folks up and compared macro-nutrient ratios along the lines of what you describe was titled "Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity" and published in Cell Metabolism Volume 22, Issue 3, p427–436, 1 September 2015.

Even though it found that folks eating low fat lost more body fat than those eating low carb, I don't think this study proves anything.  I am not advocating a "very low fat diet per se, I think emphasizing macro-nutrient levels and not the food is a little backwards.  I am stating simply the benefits of eating a whole food plant based no oil diet. 

Again, I'm not saying that a ketogenic diet isn't healthy.  I am saying that I am more comfortable with the track record of the diet I choose to eat.

Quote from: KayXo on February 09, 2016, 05:21:58 PMThe fact that a whole country (Sweden) would also endorse a low carb, high fat diet for their population strongly suggests its long-term safety especially given a review of thousands of studies.

It will be interesting to see how they fare.  Until then you might be interested in the experiment Finland conducted starting in the 70s.

Keep tilting at those windmills. :)
  •  

KayXo

Quote from: WendyA on February 09, 2016, 08:10:40 PM
Excellent to have a first hand similar set of circumstances to compare to.  I always thought (don't recall why) that increased padding from the lower belly to the mons pubis area was a normal response taking E.

I personally like it. Body looks more womanly, especially when I wear dress or skirt.

QuoteI only know at this point the science is mixed.

If you truly dig deep in the scientific literature as I have (and read about cultures that have subsisted on this type of diet, including explorers), you will realize that the science is not mixed and that low carb is beneficial...this has been known for several decades, just not sufficiently publicized, wrongly demonized for reasons that can easily be dismissed.

Quotethe preponderance of scientific literature supporting the benefits of a whole food plant based diet needs no defense by me.

So far, I have only seen convincing evidence that it is superior to the SAD and I didn't even need to read the studies as this is no surprise...whole foods are obviously better and low glycemic foods better than processed, high sugar, empty calorie foods.

QuoteBased on the science this would be an unethical study and never be approved.

To have a group with a normal SAD diet and another one with whole plant based food? It's actually been done, also with low carb diets. That's what should have been done. To take another set of people with similar profiles, let them continue eating the same way and see what happens. Similar studies have been undertaken.

QuoteThis was a meta-analysis study where low fat was defined as <30% so I'm unsure what specific study you are referring to in reference to 10% fat.

Volume 20, Issue 8, October 2010, Pages 599–607
Long-term effects of a low carbohydrate, low fat or high unsaturated fat diet compared to a no-intervention control

QuoteUntil any other diet has the same track record I'll stick with what works.

Very low carb with high fat works too, and perhaps better as I elaborated on results after 3 months on very low carb (12%) vs.very low fat (12%) in the above mentioned study from Oct 2010.

I provided many studies on the beneficial effects of very low carb diet, I can gladly provide more. I also provided evidence from populations that have eaten this way for millennia. This diet's track record is very solid and good. You just need to understand the details of it, how to go about it. I think you just prefer your current diet, a personal choice. That's fine.

QuoteThat said if my child was suffering from seizures I would be the first to suggest a ketogenic diet because it has a proven track record with seizures in children.

And much more, including cardiovascular benefits. Read Gary Taubes's book, Good Calories, Bad Calories (plenty of studies/references, thick, thorough book). Peter Attia and Jeff Volek have extensive knowledge in this matter as well. 

QuoteI am saying that I am more comfortable with the track record of the diet I choose to eat.

Because you aren't yet familiar with the track record of very low carb diets. You haven't researched this thoroughly. Read the above book, read what those two other scientists have to say and what they published...that is a good beginning in the world of the science of low carb, barely publicized and known to the public, sadly. :(

QuoteUntil then you might be interested in the experiment Finland conducted starting in the 70s.

http://www.econtalk.org/archives/2011/11/taubes_on_fat_s.html

"There's a famous study in Finland where Finland changed their diet and heart disease rates came down in this one part of Finland. And ergo they got everyone eating lower fat diets; but they also were quitting smoking and also doing other things. Then if you look at that part of Finland you say: This proves that our intervention works. And then other research came along and said: Wait, you've got the same decreases in heart disease rates all over Finland, in places where you didn't do the intervention. Slightly awkward."

http://www.drbriffa.com/2010/01/21/heart-surgeon-waging-war-on-saturated-fat-seems-seriously-short-on-science-to-support-his-claims/

"The first thing to note about the North Karelia Project is that is was multiple intervention in nature. In addition to attempts to have people eat less saturated fat, it also aimed to reduce smoking and blood pressure."

"Shah Ebrahim and George Davey Smith point out that while the results of the North Karelia project have been held up as a 'success', the reality is that it's results were quite unimpressive."

"Such trends do not provide unambiguous support for the hypothesis that the intervention was effective."

"It is notable that one of the original North Karelia investigators subsequently wrote to the Lancet to express his own doubts regarding the 'success' of the project [3]. He expressed the opinion that he did not think it was possible to draw the positive conclusions that had been presented in the original paper."

"1. It is a multiple intervention in nature, and it's therefore impossible to draw conclusions about the effects of any specific intervention within it

2. The multiple interventions appeared to have little or no benefit anyway"

"My belief is that to hold this up as evidence for the benefits of eating a less saturated fat is scientifically untenable."

http://anthonycolpo.com/monica-oh-monica-where-art-thou/

"In Finland, CHD deaths were four times higher in Karelia than in Turku, even though similar diets were consumed in both regions."

I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
  •  

Melanie ♡

It took a long time, maybe 8-9 months.
  •  

WendyA

Quote from: KayXo on February 09, 2016, 09:19:42 PMTo have a group with a normal SAD diet and another one with whole plant based food? It's actually been done, also with low carb diets. That's what should have been done. To take another set of people with similar profiles, let them continue eating the same way and see what happens. Similar studies have been undertaken.

Too randomize folks that have already had a heart attack and have half eat the SAD would without a doubt be unethical.  There are already 1000s of studies documenting how folks who remain on a SAD diet after heart disease continue to get worse.  This doesn't need studying.

Quote from: KayXo on February 09, 2016, 09:19:42 PMThis diet's track record is very solid and good. You just need to understand the details of it, how to go about it. I think you just prefer your current diet, a personal choice. That's fine.

May be true, I'm sure you're last 2 sentences are correct.  Have you read either of The Blue Zone books by Dan Buettner?
  •  

Deborah

One other book in favor of lower carbs is The Big Book of Endurance Training by Dr. Philip Maffetone.  This one is focused on both health and performance.  It eliminates all processed carbs but allows regular food.  So it's not really low carb in the sense of a <20 per day diet.  The book is good because it discussed extensively what is going on inside the body in response to different food combinations.


Sapere Aude
Love is not obedience, conformity, or submission. It is a counterfeit love that is contingent upon authority, punishment, or reward. True love is respect and admiration, compassion and kindness, freely given by a healthy, unafraid human being....  - Dan Barker

U.S. Army Retired
  •  

KayXo

Quote from: WendyA on February 10, 2016, 08:13:39 AM
Too randomize folks that have already had a heart attack

Correction: 44 of the 198 people had had a myocardial infarction or a heart attack. All 198 people were diagnosed as having cardiovascular disease. But I still agree with you that it would be unethical. I should have taken this into consideration. My error.

QuoteThere are already 1000s of studies documenting how folks who remain on a SAD diet after heart disease continue to get worse.  This doesn't need studying.

But say it had been done, it would have allowed to determine with more certainty if it was the diet that helped keep them healthy or if even had they not followed the diet, the same results would have been observed.

QuoteHave you read either of The Blue Zone books by Dan Buettner?

No.
I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
  •  

mnrjpf99

Wow! you are tiny. Lol I am 5' 6" and used to weigh around 115 or so for a long time. I now weigh 135. I am super tiny boned. I wear from a 0 to a 4 pants depending on the brand.

I just started HRT 3 weeks ago and am keeping an eye on things as far as weight goes and stuff.
There is a HUGE difference between acceptance and just being tolerated. Being who you really are and being accepted is awesome, but merely being tolerated for who you are, would be more hell than it's worth. No matter what. Never change who you are for ANYONE because they are not worth it...
  •  

Steph34

Quote from: KayXo on February 08, 2016, 10:55:38 AM
That doesn't make much sense to me. I suspect it has more to with first insulin increasing due to excess carbs, body fat stores increasing as a result, in body fat, increased conversion of T to E (due to aromatization) so less T, more E induces increases in SHBG which binds T more strongly so even less T.
The excess carb/insulin theory has been thoroughly debunked, in the article I sent you several months ago. Aromatization does not make sense because it is a minor influence on T levels in men, whose SHBG forms primarily in response to the presence of T. Also, SHBG only reduces free and not total T levels; I was referring to total T here.

QuoteIt doesn't mean you don't have insulin resistance that you aren't producing too high levels of insulin for too long a period time which keep the body from burning fat and instead promote body fat storage.
People with insulin resistance tend to have high or borderline high blood sugar. My fasting glucose level tends to be borderline low, like near 70. That is strongly indicative of normal insulin function.

QuoteIf one is chronically stressed, cortisol can also be chronically be high and increase abdominal fat over time.
There seems to be no solution for chronic stress; it is part of who I am, unfortunately.

QuoteProgesterone can help relieve stress due to conversion to a neurosteroid called allopregnanolone which has anxiolytic and anti-depressant properties. But, it seems, in some women, it can also increase fat around the abdomen.
Progesterone does seem to make it worse, but I have this problem even when I do not take P. Also, estradiol valerate injections (which I no longer use) increased my abdominal fat dramatically within the first 48 hours post-injection. I thought female hormones were supposed to help with fat redistribution, not give me a potbelly!

QuoteEating less carbs is not a FAD diet. LOL.
Like all fads, low-carb diets need to reinvent themselves every few years to remain socially relevant. (Atkins, South Beach, Zone, and now Paleo, the list goes on.) Eating a healthy, varied diet, with a nice mix of complex carbs and good fats, never goes out of style, but it is much harder to sell to a desperate overweight population seeking a quick fix to substitute for the clinically proven mantra "eat less, exercise more." A varied diet is the only way (besides supplementation) to prevent nutrient deficiencies.

QuoteYou continue eating this way your whole life. I am one of them and I know plenty of ppl like myself who've lived for years, decades eating like this.
Dr. Atkins himself was one of them. He was overweight and had a heart attack due to his diet, because, like you, he believed that saturated fats were healthy and that a person does not need to count calories as long as one avoids the carbs.

QuoteGoes in the toilet. You become nauseous from eating too much fat and will throw it up...or goes right through you. Fat is not like carbs where you can easily overindulge. Fat, on its own, is VERY satiating and there is only so much you can eat. That is the beauty of it. Hunger drops and you aren't constantly munching away.
I need to eat at least 300g of carbs daily to prevent dizziness. If I try to replace any of those carbs with fat or protein, I suffer from hypoglycemia and that makes me eat more junk before my next scheduled meal time. Carbs are essential for me in order to prevent hypoglycemia and resultant cravings for high-glycemic foods. I have gastroparesis so the fat does not go right through me. Anti-emetics stop it from going the other way. Slower transit times in the digestive tract lead to greater absorption and weight gain from excess fat. Also, my father is a stomach doctor and he knows that the body is very efficient at absorbing calories; the fat will not just go "in the toilet." I should know because on Fridays, I eat as much fat as I want - no limits - and the result is increased caloric intake and resultant abdominal fat gain.

QuoteI should also know from years of eating fat...try eating butter with fatty meat in excess, it's impossible and if you do, well, see what happens...LOL!
I think I would throw up on purpose... total gross-out, ewww! In addition to animal "foods" being totally disgusting and slimy, animal agriculture leads to Holocaust-like treatment of farm animals and terrible pollution.

It is also a major factor in heart disease, which is often linked to abdominal fat. The evidence is so convincing that the American Heart Association refuses to grant its seal of approval to full-fat animal products, and even the meat industry's intensive lobbying, together with meat industry-funded pseudoscience, has been unable to change the medical profession's consensus that saturated fats should be limited. Eating a few grams of animal fats per day may not kill you (though it would kill innocent sentient beings), but the notion that is is 'impossible' to over-consume is absurd; the stomach expands over time in response to increases in food intake enabling more to be consumed. If you just go from 2000 to 6000 calories overnight, you might throw up, but the body learns how to process it. My abdominal fat problem is due to excess CALORIE intake - both fats and carbs.

QuoteI can personally attest to all this as I eat bacon, sausage, eggs, full fat yogurt, REAL butter, coconut oil, fatty meats and my HDL has increased, my triglycerides dropped, HDL/Cholesterol ratio perfect and blood pressure around 120/80.
High cholesterol is mostly genetic, it seems. You can eat like that and have normal cholesterol because you lack the genetic predisposition to high cholesterol. My mother's relatives ate like that and had a cholesterol level of 300+. I stick with healthy, unsaturated fats like olive and sunflower and my cholesterol has never been over 170; Total/HDL ratios good as well. Meanwhile, my mother eats lots of meat, cheese, and butter and has to take strong statins to control her cholesterol. The cardiovascular advantage of Mediterranean people also disappears when they move to the USA because they eat more fatty meat.

I really do not care to argue anymore about diet. The take-home message here is that abdominal fat is a complex problem with no easy solution. "Eat less, exercise more, and give the hormones 2-5 years to redistribute fat cells" may not be what people want to hear, but the truth can be quite bitter sometimes. :(
Accepted i was transgender December 2008
Started HRT Summer 2014
Name Change Winter 2017
Never underestimate the power of estradiol or the people who have it.
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KayXo

#32
Quote from: Steph34 on February 16, 2016, 10:50:00 AM
The excess carb/insulin theory has been thoroughly debunked

Lipids. 2009 Apr;44(4):297-309.

"We recently proposed that the biological markers improved by carbohydrate restriction were precisely those that define the metabolic syndrome (MetS), and that the common thread was regulation of insulin as a control element. We specifically tested the idea with a 12-week study comparing two hypocaloric diets (approximately 1,500 kcal): a carbohydrate-restricted diet (CRD) (%carbohydrate:fat:protein = 12:59:28) and a low-fat diet (LFD) (56:24:20) in 40 subjects with atherogenic dyslipidemia. Both interventions led to improvements in several metabolic markers, but subjects following the CRD had consistently reduced glucose (-12%) and insulin (-50%) concentrations, insulin sensitivity (-55%), weight loss (-10%), decreased adiposity (-14%), and more favorable triacylglycerol (TAG) (-51%), HDL-C (13%) and total cholesterol/HDL-C ratio (-14%) responses. In addition to these markers for MetS, the CRD subjects showed more favorable responses to alternative indicators of cardiovascular risk: postprandial lipemia (-47%), the Apo B/Apo A-1 ratio (-16%), and LDL particle distribution. Despite a threefold higher intake of dietary saturated fat during the CRD, saturated fatty acids in TAG and cholesteryl ester were significantly decreased, as was palmitoleic acid (16:1n-7), an endogenous marker of lipogenesis, compared to subjects consuming the LFD."

Nutr Res. 2013 Nov;33(11):905-12.

"We hypothesized that a CRD (<50 g carbohydrate/d) for 6 weeks would improve lipid profiles and insulin sensitivity, reduce blood pressure, decrease cellular adhesion and inflammatory biomarkers, and augment VEF (flow-mediated dilation and forearm blood flow) in statin users."

"Daily nutrient intakes at baseline (46/36/17% carb/fat/pro) and averaged across the intervention (11/58/28% carb/fat/pro) demonstrated dietary compliance, with carbohydrate intake at baseline nearly 5-fold greater than during the intervention (P < .001). Compared to baseline, both systolic and diastolic blood pressure decreased after 3 and 6 weeks (P < .01). Peak forearm blood flow, but not flow-mediated dilation, increased at week 6 compared to baseline and week 3 (P ≤ .03). Serum triglyceride, insulin, soluble E-Selectin and intracellular adhesion molecule-1 decreased (P < .01) from baseline at week 3, and this effect was maintained at week 6."

Mol Cell Biochem. 2007 Aug;302(1-2):249-56.

"The body weight, body mass index, the level of blood glucose, total cholesterol, LDL-cholesterol, triglycerides, and urea showed a significant decrease from week 1 to week 56 (P < 0.0001), whereas the level of HDL-cholesterol increased significantly (P < 0.0001). Interestingly these changes were more significant in subjects with high blood glucose level as compared to those with normal blood glucose level."

"This study shows the beneficial effects of ketogenic diet in obese diabetic subjects following its long-term administration."

QuoteAromatization does not make sense because it is a minor influence on T levels in men

In men who gain weight and become more and more obese, there is increased conversion of T to E as aromatase is abundantly found in adipose tissue. More T to E=less T overall

Quotewhose SHBG forms primarily in response to the presence of T.

SHBG is produced in response to E (in portal vein, from intestines to liver, where E stimulates SHBG), not in response to T. This is why transwomen's levels of SHBG increase, this is why SHBG increases during pregnancy, this is why SHBG drops in transmen. More E = more SHBG, regardless of genetic sex. Ample studies confirm this and many TS women in this forum can attest to this, including myself. My SHBG is very high.

QuotePeople with insulin resistance tend to have high or borderline high blood sugar. My fasting glucose level tends to be borderline low, like near 70. That is strongly indicative of normal insulin function.

People who are insulin resistant have high blood sugar because cells are resistant to insulin, hence sugar remains in blood and becomes elevated. Your levels may be in the normal range but that doesn't necessarily imply that insulin levels are low. A person will produce higher and higher levels of insulin in response to cells becoming less and less sensitive to insulin, keep their blood sugar normal but eventually, no matter how high your insulin is, your cells suddenly stop responding and this is when the real problems begin. You don't want to wait until you get there, trust me! High insulin levels, in the presence of normal blood glucose are often times the precursor to diabetes and insulin resistance. I would test my insulin levels to be sure. You may have high insulin and yet normal blood glucose. Blood glucose only is high when insulin resistance occurs. Don't wait until then!

QuoteThere seems to be no solution for chronic stress; it is part of who I am, unfortunately.

You can take time off, relax, do things that you enjoy. Do yoga, exercise. Take medications for that. Progesterone is also calming due to the sedative effects of its metabolite, allopregnanolone. Finasteride/dutasteride can have the opposite effect due to inhibition of allopregnanolone formation.

QuoteProgesterone does seem to make it worse

Strange. :( It's supposed to make it better. It does for me. I take it with food to increase effect, I also don't take finasteride/dutasteride.

QuoteAlso, estradiol valerate injections (which I no longer use) increased my abdominal fat dramatically within the first 48 hours post-injection. I thought female hormones were supposed to help with fat redistribution, not give me a potbelly!

Only 48 hours and you are already jumping to conclusions. It was most probably water retention, which can be countered by progesterone due to its antimineralocorticoid effects.

QuoteLike all fads, low-carb diets need to reinvent themselves every few years

Low carb diet is a way of life, not a fad diet, as I explained before. One needs to understand the intricacies of the diet, to eat enough fat, not stray away from saturated fats. Take enough salt, etc.

QuoteA varied diet is the only way (besides supplementation) to prevent nutrient deficiencies.

http://www.jbc.org/content/87/3/651.full.pdf

"Two normal men volunteered to live solely on meat for one
year, which gave us an unusual opportunity of studying the
effects of this diet. The term "meat," as used by us, included
both the lean and the fat portions of animals. The subjects
derived most of their calories from fat and the diet was quite
different from what one, who uses the term "meat" as including
chiefly lean muscle, would expect."

"It is well known that the Eskimos have lived on an almost exclusive
meat diet for generations. Certain explorers in the North
also have subsisted for long periods on meat. Dr. Vilhjalmur
Stefansson in particular has demonstrated that it is feasible for
travelers in the arctic region to "live off the country," which
means living on meat alone. The experiences of Stefansson and
his companions have been given in his book "The Friendly Arctic"
(2). He spent over 11 years in arctic exploration, during 9 years
of which he lived almost exclusively on meat."

"Thomas (4), finding no elevation of blood pressure and
rarely any evidence of renal disease in the examination of 142 Eskimos,
concluded that a carneous diet under strenuous living conditions does not
produce renal or vascular disease."

"buffalo meat was the "staff of life" of the Central Plains' Indians. He cited also Head's
account of subsisting on the native diet of beef and water while crossing the
South American Pampas. All of these races are noted for their endurance
of exertion and hardships."

"Thomas (4) found no rickets or scurvy among the Greenland Eskimos,
but a large incidence of these diseases among the Labrador Eskimos who
live mostly on preserved food including dried potatoes, flour, canned foods,
and cereals. Stefansson (7) reported three patients with scurvy on his last
expedition, one of whom was our subject, Andersen. These cases were
caused by eating canned foods with only a small amount of cooked meat,
and were cured by eating raw meat."

"Lieb, in 1922 ( 8 ), carefully examined Stefansson and stated that he found no evidence of injury from the prolonged
and exclusive use of meat. He mentions the experience of two other men who lived mainly on meat for shorter periods."

Conclusion of the study:

"At the end of the year, the subjects were mentally alert,
physically active, and showed no specific physical changes in any
system of the body."

"In these trained subjects, the clinical observations and
laboratory studies gave no evidence that any ill effects had
occurred from the prolonged use of the exclusive meat diet."

"Vitamin deficiencies did not appear."

QuoteDr. Atkins himself was one of them. He was overweight and had a heart attack due to his diet

Not quite.

https://en.wikipedia.org/wiki/Robert_Atkins_(nutritionist)#Death

"Atkins suffered cardiac arrest in April 2002, leading many of his critics to point to this episode as proof of the inherent dangers in the consumption of high levels of saturated fat associated with the Atkins diet. In numerous interviews, however, Atkins stated that his cardiac arrest was not the result of poor diet, but was rather caused by a chronic infection.[9] Atkins' personal physician and cardiologist, Dr. Patrick Fratellone, confirmed this assertion, saying, "We have been treating this condition, cardiomyopathy, for almost two years. Clearly, [Atkins'] own nutritional protocols have left him, at the age of 71, with an extraordinarily healthy cardiovascular system".

"Dr. Patrick Fratellone treated Dr. Atkins from 1999 until 2002, and also worked with the doctor at the Atkins Center. He says Atkins suffered from cardiomyopathy, a chronic heart weakness. But this condition, he says, was caused by a virus—not his diet: "I was his attending cardiologist at that time. And I made the statement... When we did his angiogram, I mean, the doctor who performed it, said it's pristine for someone that eats his kind of diet... Pristine, meaning these are very clean arteries. I didn't want people to think that his diet caused his heart muscle – it was definitely a documented viral infection."[14]

"Critics often misinterpreted this incident as a heart attack instead of an episode of cardiac arrest caused by his condition and often use the two interchangeably when citing the incident however the two are distinct problems. The American Heart Association clearly defines and shows the distinction between the two."

"A medical report issued by the New York medical examiner's office a year after his death showed that Atkins had a history of heart attack, congestive heart failure and hypertension. It also noted that he weighed 258 pounds (117 kilograms) at death, but Dr. Atkins weighed 195 pounds (88 kilograms) the day after he entered the hospital following his fall; he gained 63 pounds (29 kilograms) from fluid retention during the nine days he was in a coma before he died.[18][20]"

He was just under 6 feet tall so 195 lbs is not overweight.

Also, one does not always follow one's own advices anyways. So, even if what you had said was true, it didn't necessarily mean he followed his own diet. Many doctors smoke, eat unhealthy and yet advise the contrary to their patients. One needs to prove, as well, that heart attack would have been CAUSED by his diet and not by something else (i.e. stress). You quickly jump to conclusions before taking the time to read between the lines and dig deeper.

Quotelike you, he believed that saturated fats were healthy

Not a belief. Corroborated by science.

Am J Clin Nutr. 2010 Mar;91(3):535-46.

"A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD."

Ann Intern Med. 2014 Mar 18;160(6):398-406.

"Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats."

Adv Nutr. 2013 May 1;4(3):294-302.

"This review calls for a rational reevaluation of existing dietary recommendations that focus on minimizing dietary SFAs, for which mechanisms for adverse health effects are lacking."

Quotea person does not need to count calories as long as one avoids the carbs.

JAMA. 2007 Mar 7;297(9):969-77.

"In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets"

QuoteI need to eat at least 300g of carbs daily to prevent dizziness.

This is because you lose water and salt when you start restricting carbs. You need to increase water and salt consumption as you do when on Spiro. Bouillons/broths help. :)

Quoteon Fridays, I eat as much fat as I want - no limits - and the result is increased caloric intake and resultant abdominal fat gain.

You can't gain fat so quickly. LOL. Were you exclusively eating protein and fat, and no carbs? Try that, fatty meat and butter and see how much you can eat...The problem is we can overeat fat WHEN combined with carbs. THAT is the problem.

QuoteI think I would throw up on purpose... total gross-out, ewww! In addition to animal "foods" being totally disgusting and slimy

You seem to be already biased, have a moral prejudice. This is not about emotions but about setting facts straight. We need to remain objective and disconnect from our emotions. You sure have the right not to like animal foods, to each their own but animal foods are no less healthy because you find them disgusting. ;)

Quoteanimal agriculture leads to Holocaust-like treatment of farm animals and terrible pollution.

Do you use a car? How many things do you do that contribute to pollution, and to a greater extent than animal farming/raising?

One can buy directly from farms who raise their animals ethically, give them proper outdoor access and freedom/space, raise them on organic grounds, do not give them hormones or antibiotics. It's not always that much more expensive.

Or one can eat low carb/high fat without including animal foods. It IS possible and doable.

QuoteIt is also a major factor in heart disease, which is often linked to abdominal fat. The evidence is so convincing

I'm afraid you haven't really taken the time to read either the studies I provided or the science in general. This seems not to be the case.

Quotethe American Heart Association refuses to grant its seal of approval to full-fat animal products

and yet diabetes has risen in the last few decades despite people trying to eat lower fat and following recommendations while in Sweden...

BMJ 2013; 347

"An influential Swedish health organisation has recommended a diet that is low in carbohydrates but not low in fat for people who are overweight or obese or have diabetes.

The advice from the Swedish Council on Health and Technology Assessment is the result of a two year review of 16 000 scientific studies of diet.1 The recommendation contradicts the generally held belief that people should avoid foods that are rich in fat, especially those high in saturated fat.

The council, which advises the Swedish healthcare system, concluded that the scientific evidence did not support a low fat diet. Instead people should focus on reducing their intake of carbohydrates."

Just wait...in time, things will also change, here in America. It's a question of time, letting the older generations pass, and the newer generations come about very different conclusions. There is a lot of corruption. You absolutely need to read Gary Taubes's book. He is not tied to any organization, he is a scientific journalist and provides ample evidence in book.

Quotethe medical profession's consensus that saturated fats should be limited

Things are slowly, but surely changing. Doctors are influenced by pharmaceutical companies, have ties, scientists as well. Many are taught one thing at school and keep on repeating the same thing, over and over again, without reading the latest evidence or the bulk of evidence which is weak in favor of cutting saturated fats. Epidemiological studies, by the way, cannot show cause and effect, there are confounding variables.

QuoteIf you just go from 2000 to 6000 calories overnight, you might throw up, but the body learns how to process it. My abdominal fat problem is due to excess CALORIE intake - both fats and carbs.

Until you haven't taken the time to read opposing evidence in detail, we can't discuss further. I have personally listened to both sides of the argument, read tons of research. It is important to remain objective and scientific about this whole thing. 

QuoteHigh cholesterol is mostly genetic, it seems. You can eat like that and have normal cholesterol because you lack the genetic predisposition to high cholesterol.

If you read the latest studies and evidence, you would know that cholesterol is but a small part of the whole set of things that matter when it comes to cardiovascular health. For instance, cholesterol:HDL ratio, so if both increase but ratio remains good, there is no problem despite high cholesterol levels. Same thing with LDL, and size of LDL particles.

Did you know that low carb, high fat raises HDL, lowers triglycerides, improves blood pressure, reduces body weight and improve glucose tolerance for some, all these being markers for metabolic syndrome? LDL particle also becomes larger, less atherogenic, Apo B drops, etc.

QuoteI stick with healthy, unsaturated fats like olive and sunflower

Sunflower oil contains high Omega-6 relative to Omega-3, which can lead to excess inflammation in the body.

QuoteMeanwhile, my mother eats lots of meat, cheese, and butter and has to take strong statins to control her cholesterol.

It has been discovered that statins don't necessarily reduce cardiovascular risk due to lowering cholesterol but rather due to some other mechanisms on platelets and artery dilation, I believe. It's been shown there is an association between very low cholesterol levels and increased mortality although this is just an association. So, things are not as simple as you think.

High cholesterol on its own doesn't say much. One needs to look at other factors. I explained this above. I hope the doctors did this as well with her.

Statins have been shown to help those with previous heart attack or stroke but not so much in those with no previous occurrences. The link is especially weak in women.

QuoteThe cardiovascular advantage of Mediterranean people also disappears when they move to the USA because they eat more fatty meat.

Because that's the only change they make when they move to the US!?

QuoteI really do not care to argue anymore about diet.

Should you change your mind and decide to pursue this argument, please PM me. We can exchange ideas for as long as you want. :)

QuoteThe take-home message here is that abdominal fat is a complex problem with no easy solution. "Eat less, exercise more, and give the hormones 2-5 years to redistribute fat cells" may not be what people want to hear, but the truth can be quite bitter sometimes. :(

You first say the problem is complex and then go on to state that those three things, patience, eating less and exercising more is the solution, a fairly simple approach.

People eat less, exercise more but get more frustrated, hungry, etc. Obesity has increased in America, despite this advice and millions following this recommendation. It just doesn't work that way. One needs to dig deep into the science, understand hormonal intricacies, how hormones affect fat storage, appetite, etc.

You know the best way to get ready to someone's invitation to a copious dinner and be sure you'll be hungry enough to eat everything there? Eat little and exercise a lot that day. Come dinner, you'll be HUNGRY, trust me you!

I am not a medical doctor, nor a scientist - opinions expressed by me on the subject of HRT are merely based on my own review of some of the scientific literature over the last decade or so, on anecdotal evidence from women in various discussion forums that I have come across, and my personal experience

On HRT since early 2004
Post-op since late 2005
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GeekGirl

You may consider an exercise regimen with large amounts of cardio or a physical strength/mental discipline approach like yoga. Hot yoga, in particular, will burn away excess fat rather quickly.
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