Bariatric Surgery Alters Gene Expression -- WHAT?

IS THIS GOING TO CHANGE MY 23 & ME?!  

Food intolerances two years after gastric bypass (PS - No, really?)

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers - PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.  

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought?  Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients?  And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

I am using a lot of question marks lately.  I need to stop that.

Discuss.

Study blurb via Reuters -

(Reuters Health) - A common weight loss surgery is associated with long-term gastrointestinal problems and food intolerance, a recent study suggests.

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

Full - http://onlinelibrary.wiley.com/doi/10.1002/bjs.10419/full

 

 

Bariatric Embolization - new procedure?

Study - Weight-Loss Surgery Linked To Increased Suicide Risk

Another OBVIOUS. 

Reuters -

“These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them, and perhaps some screening in the second year and onwards,” Bhatti said. 

During the first three years after surgery, 111 patients received emergency care for self-inflicted injuries, or roughly 1 percent of people in the study. While small, the risk of these emergencies was 54 percent higher after surgery than it was before.

Study - JAMA

Importance  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

Objective  To compare the risk of self-harm behaviors before and after bariatric surgery.

Design, Setting, and Participants  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.

Main Outcomes and Measures  Self-harm emergencies 3 years before and after surgery.

Results  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P= .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

Conclusions and Relevance  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.

Link - http://archsurg.jamanetwork.com/article.aspx?articleid=2448916

Gastric bypass surgery lowers women's alcohol tolerance

Download 2015-08-gastric-bypass-surgery-lowers-women

A small study indicates that changes in how alcohol is metabolized after surgery can speed its delivery into the bloodstream, resulting in earlier and higher peaks in blood-alcohol levels. Studying women who had undergonegastric bypass surgery, the researchers found that those who had consumed the equivalent of two drinks in a short period of time had blood-alcohol contents similar to women who had consumed four drinks but had not had the operation.

The research is published Aug. 5 in the journal JAMA Surgery.

"The findings tell us we need to warn patients who have gastric bypass surgery that they will experience changes in the way their bodies metabolize alcohol," said first author M. Yanina Pepino, PhD, an assistant professor of medicine in the Division of Geriatrics and Nutritional Science. "Consuming alcohol after surgery could put patients at risk for potentially serious problems, even if they consume only moderate amounts of alcohol."

Although this study included only women, it is likely that men who have gastric bypass surgery experience similar changes in how their bodies metabolize alcohol.

The researchers studied alcohol's effects in 17 obese women. Eight of the women had undergone Roux-en-Y gastric bypass surgery—the most common bariatric surgical procedure worldwide—one to five years before the study began. The other nine participants had not yet had the operation.

As part of the study, the women spent two days, about one week apart, at Washington University's Clinical Research Center. On one visit, each woman randomly consumed either the equivalent of two alcoholic drinks or two nonalcoholic beverages during a 10-minute period. At the second visit, each was given the beverages not received during the first visit. At both visits, the researchers measured the women's blood-alcohol contents and used a survey to assess their feelings of drunkenness.

The women in the gastric bypass group had an average body mass index (BMI) of 30, which is considered obese, but it compared with an average BMI of 44 for the women who had not yet had the surgery. Among those who had not undergone surgery, blood-alcohol content peaked about 25 minutes after they finished consuming the alcohol and measured 0.60. In women who had the surgery, blood-alcohol content peaked at 5 minutes after drinking and reached 1.10, significantly above the legal driving limit of 0.80.

"These findings have important public safety and clinical implications," said senior investigator Samuel Klein, MD, the William H. Danforth Professor of Medicine and director of the Center for Human Nutrition. "After just two drinks, the blood-alcohol content in the surgery group exceeded the legal driving limit for 30 minutes, but the levels in the other group never reached the legal limit.

"The peak blood-alcohol content in the surgery group also met the criteria that the National Institute on Alcohol Abuse and Alcoholism uses to define an episode of binge drinking, which is a risk factor for developing alcohol problems."

Women who had undergone gastric bypass also reported feeling the effects of alcohol earlier and for longer periods of time than women who had not had the surgery.

The study is not the first to find that gastric bypass surgery can alter alcohol metabolism, but Pepino said it is significant because earlier studies had measured blood alcohol less vigorously and were less clear about the extent of the changes in alcohol metabolism.

"The women who had the surgery only received the equivalent of two drinks, but it was as if they had consumed twice that amount," she said. "Consuming alcohol after surgery the way one did before the operation could put patients at risk for potentially serious consequences, even when they drink only moderate amounts of alcohol."

More information: Pepino MY, Okunade AL, Eagon JC, Bartholow BD, Bucholz K, Klein S. Effect of Roux-ex-Y gastric bypass surgery: converting 2 alcoholic drinks to 4. JAMA Surgery, published online Aug. 5, 2015. DOI: 10.1001/jamasurg.2015.1884 

Related articles

FDA approves non-surgical temporary balloon device to treat obesity -

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

'Anyone with a functioning brain' makes sure they look good in a bikini

Long-term followup of type of bariatric surgery finds regain of weight, decrease in diabetes remission

While undergoing laparoscopic sleeve gastrectomy induced weight loss and improvements in obesity-related disorders, long-term followup shows significant weight regain and a decrease in remission rates of diabetes and, to a lesser extent, other obesity-related disorders over time, according to a study published online by JAMA Surgery.

Obesity was recognized as a global epidemic by the World Health Organization 15 years ago and rates of obesity have since been increasing. Obesity is currently considered a severe health hazard and a risk factor fordiabetes mellitus, hypertension, abnormal lipid levels, heart failure, and other related disorders. Bariatric procedures are reportedly the most effective strategy to induce weight loss compared with nonsurgical interventions. Laparoscopic sleeve gastrectomy (LSG) is a common and efficient bariatric procedure with increasing popularity in the Western world during the last few years, but data on its long-term effect on obesity-related disorders are scarce, according to background information in the article.

Andrei Keidar, M.D., of Beilinson Hospital, Petah Tikva, Israel, and colleagues collected data on all patients undergoing LSGs performed by the same team at a university hospital between April 2006 and February 2013, including demographic details, weight followup, blood test results, and information on medications and comorbidities.

A total of 443 LSGs were performed. Complete data were available for 54 percent of patients at the 1-year follow-up, for 49 percent of patients at the 3-year follow-up, and for 70 percent of patients at the 5-year follow-up. The percentage of excess weight loss was 77 percent, 70 percent, and 56 percent, at years 1, 3 and 5, respectively; complete remission of diabetes was maintained in 51 percent, 38 percent, and 20 percent, respectively, and remission of hypertension was maintained in 46 percent, 48 percent, and 46 percent, respectively.

The decrease of low-density lipoprotein cholesterol level was significant only at years 1 and 3. The changes in total cholesterol level (preoperatively and at 1, 3, and 5 years) did not reach statistical significance.

"The longer follow-up data revealed weight regain and a decrease in remission rates for type 2 diabetes mellitusand other obesity-related comorbidities. These data should be taken into consideration in the decision-making process for the most appropriate operation for a given obese patient," the authors write.

More information: JAMA Surgery. Published online August 5, 2015. DOI: 10.1001/jamasurg.2015.2202 

Related articles

FDA approves non-surgical temporary balloon device to treat obesity -

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

'Anyone with a functioning brain' makes sure they look good in a bikini

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

Something I feel like we already knew?  Sigh.  Please read.

PR from The Obesity Society -

Alcohol Sensitizes Brain Response to Food Aromas and Increases Food Intake in Women, Research Shows

First study of its kind ties hypothalamus, in addition to the gut, to the aperitif phenomenon

SILVER SPRING, MD – The first study of its kind measuring the brain's role in mediating caloric intake following alcohol consumption among women shows that alcohol exposure sensitizes the brain's response to food aromas and increases caloric intake. The research, led by William J. A. Eiler II, PhD, of the Indiana University School of Medicine's Departments of Medicine and Neurology, adds to the current body of knowledge that alcohol increases food intake, also known as the "aperitif effect," but shows this increased intake does not rely entirely on the oral ingestion of alcohol and its absorption through the gut. The study is published in the July issue of the journal Obesity published by The Obesity Society (TOS).

"The brain, absent contributions from the gut, can play a vital role in regulating food intake. Our study found that alcohol exposure can both increase the brain's sensitivity to external food cues, like aromas, and result in greater food consumption," said Dr. Eiler. "Many alcoholic beverages already include empty calories, and when you combine those calories with the aperitif effect, it can lead to energy imbalance and possibly weight gain."

Researchers conducted the study in 35 non-vegetarian, non-smoking women at a healthy weight. To test the direct effects of alcohol on the brain, researchers circumvented the digestive system by exposing each participant to intravenously administered alcohol at one study visit and then to a placebo (saline) on another study visit, prior to eating. Participants were observed, and brain responses to food and non-food aromas were measured using blood oxygenation level dependent (BOLD) response via fMRI scans. After imaging, participants were offered a lunch choice between pasta with Italian meat sauce and beef and noodles. 

When participants received intravenous alcohol, they ate more food at lunch, on average, compared to when they were given the placebo. However, there were individual differences, with one-third of participants eating less after alcohol exposure when compared to the placebo exposure. In addition to changes in consumption, the area of the brain responsible for certain metabolic processes, thehypothalamus, also responded more to food odors, compared to non-food odors, after alcohol infusion vs. saline. The researchers concluded that the hypothalamus may therefore play a role in mediating the impact of alcohol exposure on our sensitivity to food cues, contributing to the aperitif phenomenon.

 "This research helps us to further understand the neural pathways involved in the relationship between food consumption and alcohol," said Martin Binks, PhD, FTOS, TOS Secretary Treasurer and Associate Professor of Nutrition Sciences at Texas Tech University. "Often, the relationship between alcohol on eating is oversimplified; this study unveils a potentially more complex process in need of further study."

Study authors agree and call for further research into the mechanism by which the hypothalamus affects food reward.

"Today, nearly two-thirds of adults in the U.S. consume alcohol, with wine consumption rising, which reinforces the need to better understand how alcohol can contribute to overeating," continued Dr. Binks.

Read the full article in Obesity here.

Related articles

'Anyone with a functioning brain' makes sure they look good in a bikini

Gastric Pacemaker in use in Boston

Blogging as a business as blogging.

New Treadmill Stress Test Spits Out Your Risk Of Dying

New Treadmill Stress Test Spits Out Your Risk Of Dying.  Hooray. 

 

If there were any means to get my ass back to the gym and motivated it is reading things like THIS  and pushing through back pain and tearing up my stupid excuses.  BLAH BLAH BLAH BETH, I DON'T CARE THAT YOU CAN'T DRIVE YOU WILL WALK TO THE GYM AND DO IT ...

The FIT Treadmill Score is calculated using the patient’s age, gender, fitness level measured by METs, and peak heart rate reached during exercise. Researchers found these four factors to be the greatest predictors of mortality risk. After the research team accounted for other important variables, such as diabetes and family history of premature deaths, they determined fitness level to be the single most important predictor of death and survival.

“The notion that being in good physical shape portends lower death risk is by no means new, but we wanted to quantify that risk precisely by age, gender, and fitness level, and do so with an elegantly simple equation that requires no additional fancy testing beyond the standard stress test,” said Dr. Haitham Ahmed, a cardiology fellow at the Johns Hopkins University School of Medicine.

FIT Treadmill Scores ranged from negative 200 to positive 200 — participants over 0 had a lower mortality risk while participants under 0 has a higher mortality risk. Participants with a score between negative 100 and 0 had an 11 percent risk for dying in the next 10 years compared to three percent among participants with a scare between 0 and positive 100. Participants with a score lower than negative 100 had a 38 percent mortality risk compared to two percent among those who scored positive 100 or higher.

The study abstract - 

Objective

To determine which routinely collected exercise test variables most strongly correlate with survival and to derive a fitness risk score that can be used to predict 10-year survival.

Patients and Methods

This was a retrospective cohort study of 58,020 adults aged 18 to 96 years who were free of established heart disease and were referred for an exercise stress test from January 1, 1991, through May 31, 2009. Demographic, clinical, exercise, and mortality data were collected on all patients as part of the Henry Ford ExercIse Testing (FIT) Project. Cox proportional hazards models were used to identify exercise test variables most predictive of survival. A “FIT Treadmill Score” was then derived from the β coefficients of the model with the highest survival discrimination.

Results

The median age of the 58,020 participants was 53 years (interquartile range, 45-62 years), and 28,201 (49%) were female. Over a median of 10 years (interquartile range, 8-14 years), 6456 patients (11%) died. After age and sex, peak metabolic equivalents of task and percentage of maximum predicted heart rate achieved were most highly predictive of survival (P<.001). Subsequent addition of baseline blood pressure and heart rate, change in vital signs, double product, and risk factor data did not further improve survival discrimination. The FIT Treadmill Score, calculated as [percentage of maximum predicted heart rate + 12(metabolic equivalents of task) – 4(age) + 43 if female], ranged from âˆ’200 to 200 across the cohort, was near normally distributed, and was found to be highly predictive of 10-year survival (Harrell C statistic, 0.811).

Conclusion

The FIT Treadmill Score is easily attainable from any standard exercise test and translates basic treadmill performance measures into a fitness-related mortality risk score. The FIT Treadmill Score should be validated in external populations.

 Now do it. 

But.  But.  But.

Related articles

Treadmill Stress Test Can Predict The Likelihood Of You Dying Within The Next Decade

Bariatric surgery may improve pregnancy outcomes - mostly

FAAAAAHTS or Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery

Gastrointestinal colonization with methanogens increases difficulty of losing weight after bariatric surgery.

This is totally my gut.

 

I feel like we knew this - have you lived with a gastric bypass or duodenal switch patient for a period of time?  I'm just saying, those of us with altered bariatric intestines  LIVE with "MARSH ASS."   Welcome to the world of pre-biotics, probiotics, fart-smell-better products and I kid you not, LINED UNDERWEAR.  

 

Hey, I never said I was a professional.  Read the studies.

 

What is a methanogen?  Wisegeek says --

"Methanogens are a type of microorganism that produces methane as a byproduct of metabolismin conditions of very low oxygen. They are often present in bogs, swamps, and other wetlands, where the methane they produce is known as "marsh gas." Methanogens also exist in the guts of some animals, including cows and humans, where they contribute to the methane content of flatulence. Though they were once classified as Archaebacteria, methanogens are now classified as Archaea, distinct from Bacteria.

Some types of methanogen, including those of the Methanopyrus genus, are extremophiles, organisms that thrive in conditions most living things could not survive in, such as hot springs, hydrothermal vents, hot desert soil, and deep subterranean environments. Others, such as those of the Methanocaldococcus genus, are mesophiles, meaning they thrive best in moderate temperatures.  Methanobrevibacter smithii is the prominent methanogen in the human gut, where it helps digest polysaccharides, or complex sugars."

Gut bacteria may decrease weight loss from bariatric surgery March 6, 2015

 

Source: Cedars-Sinai Medical Center

The benefits of weight loss surgery, along with a treatment plan that includes exercise and dietary changes, are well documented. In addition to a significant decrease in body mass, many patients find their risk factors for heart disease are drastically lowered and blood sugar regulation is improved for those with Type 2 diabetes.

Some patients, however, do not experience the optimal weight loss from bariatric surgery. The presence of a specific methane gas-producing organism in the gastrointestinal tract may account for a decrease in optimal weight loss, according to new research by Ruchi Mathur, MD, director of the Diabetes Outpatient Treatment and Education Center at Cedars-Sinai.

"We looked at 156 obese adults who either had Roux-en-Y bypass surgery or received a gastric sleeve. Four months after surgery we gave them a breath test, which provides a way of measuring gases produced by microbes in the gut," said Mathur. "We found that those whose breath test revealed higher concentrations of both methane and hydrogen were the ones who had the lowest percentage of weight loss and lowest reduction in BMI (body mass index) when compared to others in the study."

The methane-producing microorganism methanobrevibacter smithii is the biggest maker of methane in the gut, says Mathur, and may be the culprit thwarting significant weight loss in bariatric patient. Mathur and her colleagues are conducting further studies to explore the role this organism plays in human metabolism.

While that research continues, bariatric patients may still have options to improve weight loss after surgery.

"Identifying individuals with this pattern of intestinal gas production may allow for interventions through diet. In the future there may be therapeutic drugs that can improve a patient's post-surgical course and help them achieve optimal weight loss," said Mathur.

The study, "Intestinal Methane Production is Associated with Decreased Weight Loss Following Bariatric Surgery" was done in collaboration with the Mayo Clinic. The paper is being presented by Mathur Thursday, March 5, at the 97th annual meeting of the Endocrine Society in San Diego.

 

Honey Boo Boo Weight Intervention

Nutritional Deficiencies and seizure activity

Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times - 

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

Related articles

Honey Boo Boo Weight Intervention

Nutritional Deficiencies and seizure activity

Trader Joe's Greens, Beans and Grains Review

Fexaramine Tricks Mice Into Losing Weight Without Food?!

Lose weight without worrying about food? Imagine this?!

Via Popular Science "Safe and effective weight loss doesn't yet come in a pill, but maybe one day it will. A new study has found a chemical that keeps mice from gaining weight through overeating. The drug also seemed to protect lab mice from some of the harmful effects of obesity: When researchers measured the mice's blood, they found reduced levels of insulin, cholesterol, and other molecules, compared to obese mice who didn't get the drug."

'Imaginary meal' tricks the body into losing weight - Salk Institute - News Release.

“This pill is like an imaginary meal,” says Ronald Evans, director of Salk’s Gene Expression Laboratoryand senior author of the new paper, published January 5, 2014 in Nature Medicine. “It sends out the same signals that normally happen when you eat a lot of food, so the body starts clearing out space to store it. But there are no calories and no change in appetite.”

In the United States, more than a third of adults are obese and 29.1 million people have diabetes, according to the Centers for Disease Control and Prevention. Both obesity and diabetes lead to an increase in health spending, a greater risk of health complications and a shorter lifespan.

 

Study - http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.3760.html

Exercise improves insulin sensitivity after gastric bypass

Clinical trial demonstrates additive effect of exercise following gastric bypass.   

So. do. it.  I know, I know, easier said than done. 

Over 75 million adults in the US are obese. These individuals are predisposed to health complications, including diabetes, heart disease, and cancer. Gastric bypass surgery results in dramatic weight loss and can improve diabetes symptoms in obese patients. A new study in the Journal of Clinical Investigation reveals that exercise following bypass surgery provides additional benefit for obese patients. Bret Goodpaster and colleagues at the University of Pittsburgh conducted a study on individuals that had recently undergone gastric bypass surgery. One group followed a moderate exercise protocol for 6 months, while the control group underwent a health education program. Individuals in both groups exhibited dramatic weight loss and reduced fat mass. However, individuals in the exercise group had improved insulin sensitivity and cardiovascular fitness. The results of this study support the inclusion of an exercise program following gastric bypass surgery.

Read the article released earlier this week in JCI: http://buff.ly/1wlKroB

Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery

Patients With Psychiatric Illness Require Close Watch After Bariatric Surgery

A study conducted in Brazil and presented at a poster session at the 2014 annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders looked at six cases in which patients committed suicide or attempted suicide after bariatric surgery. The study did not specify the form of weight loss surgery that each patient underwent.

Health is Not Measured in Pounds

Bariatric Surgery Linked To Increased TASTE Sensitivity - Does Taste Perception CHANGE After Bariatric Surgery?

I think mine is broken. I go for SALTY every time.

I hereby define this study in the flesh.  Everything tastes too, everything to me.

-MM

Via Science Daily from ASMBS -

People with obesity may have an unexpected ally after weight-loss surgery: their tongues. New research from the Stanford University School of Medicine finds patients who reported a decrease in taste intensity after bariatric surgery had significantly higher excess weight loss after three months than those whose taste intensity became higher.

Findings from the new study, "Does Taste Perception Change After Bariatric Surgery?", were presented here at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2014, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. ObesityWeek 2014 is hosted by the ASMBS and The Obesity Society (TOS).

In the study, the majority (87%) of patients reported a change in taste after bariatric surgery, with 42 percent reporting they ate less because food didn't taste as good. However, those who said their taste intensity decreased, lost 20 percent more weight over three months, than those whose taste intensified.

"In our clinical experience, many patients report alterations in their perception of taste after bariatric surgery. However, little evidence exists as to how and why these changes affect weight loss after surgery," said study author John M. Morton MD, Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. "It appears it's not just the flavor that influences weight loss, it's the intensity of the flavor. Patients with diminished taste intensity lost the most weight. A potential application to these findings may include teaching taste appreciation in hopes of increasing weight loss."

Before surgery, patients with severe obesity had lower total taste scores than a control group of individuals with no obesity. The 88 patients in the study were on average, 49-years-old, had an average age of 49.2 years, more than half were female with an average preoperative body mass index (BMI) of 45.3. Prior to surgery, the patients and controls completed a baseline validated taste test that quantified their ability to identify the primary taste, using paper strips with varying concentrations of each taste solution, presented in random order. The tests were then performed again at 3-, 6- and 12-months after surgery.

"The study provides excellent new insight on taste change after bariatric surgery," said Jaime Ponce, MD, medical director for Hamilton Medical Center Bariatric Surgery program and ASMBS immediate past-president. "More research is needed to see how we can adjust for taste perception to increase weight loss."

Study - American Society for Metabolic & Bariatric Surgery (ASMBS). (2014, November 4). For some, losing weight after bariaric surgery may be a matter of taste.ScienceDaily. Retrieved November 5, 2014 from www.sciencedaily.com/releases/2014/11/141104083132.htm

Chocolate for MEMORY LOSS!?

I might be doing something ... right by my daily doses of unsweetened cocoa!  

I have serious memory issues if you did not notice, on account of the epilepsy, and I assume that someday I'm going to be in a home for the memory impaired.  So every time I see a study like this -- I go OOOOH!  LOOOK!  THIS!  I don't take them very seriously, but I read them ALL.  Firstly, it was sponsored in part by a chocolate candy-maker.  And, yeah.  

But check it.

The brain area outlined in yellow is the hippocampus; the dentate gyrus is shown in green and the entorhinal cortex in purple. Previous work, including by the laboratory of senior author Scott A. Small, M.D., had shown that changes in a specific part of the brain's hippocampus -- the dentate gyrus -- are associated with normal age-related memory decline in humans and other mammals. The dentate gyrus is distinct from the entorhinal cortex, the hippocampal region affected in early-stage Alzheimer's disease. Credit: Lab of Scott A. Small, M.D.

Via New York Times -

In a small study in the journal Nature Neuroscience, healthy people, ages 50 to 69, who drank a mixture high in antioxidants called cocoa flavanols for three months performed better on a memory test than people who drank a low-flavanol mixture.

On average, the improvement of high-flavanol drinkers meant they performed like people two to three decades younger on the study’s memory task, said Dr. Scott A. Small, a neurologist at Columbia University Medical Center and the study’s senior author. They performed about 25 percent better than the low-flavanol group.

“An exciting result,” said Craig Stark, a neurobiologist at the University of California, Irvine, who was not involved in the research. “It’s an initial study, and I sort of view this as the opening salvo.”

He added, “And look, it’s chocolate. Who’s going to complain about chocolate?”

The findings support recent research linking flavanols, especiallyepicatechin, to improved blood circulation, heart health and memory in mice, snails and humans. But experts said the new study, although involving only 37 participants and partly funded by Mars Inc., the chocolate company, goes further and was a well-controlled, randomized trial led by experienced researchers.

Besides improvements on the memory test — a pattern recognition test involving the kind of skill used in remembering where you parked the car or recalling the face of someone you just met — researchers found increased function in an area of the brain’s hippocampus called the dentate gyrus, which has been linked to this type of memory.

“Boy, this is really interesting to see it in three months,” said Dr. Steven DeKosky, a neurologist and visiting professor at the University of Pittsburgh. “They got this really remarkable increase in a place in the brain that we know is related to age-related memory change.”

There was no increased activity in another hippocampal region, theentorhinal cortex, which is impaired early in Alzheimer’s disease. That reinforces the idea that age-related memory decline is different and suggests that flavanols might not help Alzheimer’s, even though they might delay normal memory loss.

But unless you are stocking up for Halloween, do not rush to buy Milky Way or Snickers bars. To consume the high-flavanol group’s daily dose of epicatechin, 138 milligrams, would take eating at least 300 grams of dark chocolate a day — about seven average-sized bars. Or possibly about 100 grams of baking chocolate or unsweetened cocoa powder, but concentrations vary widely depending on the processing. Milk chocolate has most epicatechin processed out of it.

“You would have to eat a large amount of chocolate,” along with its fat and calories, said Hagen Schroeter, director of fundamental health and nutrition research for Mars, which funds many flavanol studies and approached Dr. Small for this one. (“I nearly threw them out,” said Dr. Small, who added that he later concluded that the company employed serious scientists who would not bias the research.) Mars financed about half the study; other funders were the National Institutes of Health and two research foundations.

“Candy bars don’t even have a lot of chocolate in them,” Dr. Schroeter said. And “most chocolate uses a process called dutching and alkalization. That’s like poison for flavanol.”

Mars already sells a supplement, CocoaVia, which it says promotes healthy circulation, including for the heart and brain. It contains 20 to 25 milligrams of epicatechin per packet of powder or capsule serving, Dr. Schroeter said; 30 packets cost $34.95. Epicatechin is also in foods like tea and apples, although may be less absorbable.

The Columbia study had important limitations. For example, the only daily dietary requirements were either 900 milligrams of flavanols with 138 milligrams of epicatechin or 10 milligrams of flavanols with less than two milligrams of epicatechin, so participants could have eaten other things that played a role.

And while researchers also had half of the healthy but sedentary participants in each group exercise four days a week, surprisingly, the exercise had no effects on memory or brain effects.

Dr. Small, whose research previously found that exercise helped hippocampal function in younger people, suggested maybe more vigorous exercise is needed to affect older brains.

“It’s a very clever, interesting study, but there are some caveats,” said Dr. Kenneth S. Kosik, a neuroscientist at the University of California, Santa Barbara. “People are going to say, ‘It looks like I can have a lot of candy bars and not exercise.’ So it needs replication on a much larger scale.”

More extensive research is planned. As for why flavanols would help memory, one theory is that they improve brain blood flow; another, favored by Dr. Small, is that they cause dendrites, message-receiving branches of neurons, to grow.

“Everybody’s cautious about antioxidants, but this is a horse of a different color, a really elegant study,” Dr. DeKosky said.

The study -

http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.3850.html

 

 

Video - YOUR CHAIR IS KILLING YOU. Get up! Non-exercise Activity Thermogenesis - the N.E.A.T. Energy of Life

HERE is one of my favorite speakers at the #YWM2014 event. HANDS, BUTT down.

• Get up! Non-exercise Activity Thermogenesis - the N.E.A.T. Energy of Life

• Streamed live on Sep 27, 2014

  Everything that we do throughout the day uses up our metabolic energy. Dr. Levine explains all the components of your daily energy expense, or N.E.A.T., and the science of how you can make this energy loss part of your strategy to improve health.

 

Last Week Tonight with John Oliver: Dr. Oz and Nutritional Supplements (HBO)

This this this this this this this this this.

I love this.

I love you John Oliver.  Watch.  WATCH!

"Dr. Oz is just a symptom of the problem."  Yep.  And yet YOU keep BUYING THE SHIT.

How thoughts fool your stomach

 NPR - How Your Thoughts Fool Your Stomach 

The Effectiveness and Risks of Bariatric Surgery - March 2014

Study - 

The Effectiveness and Risks of Bariatric Surgery

Importance  The prevalence of obesity and outcomes of bariatric surgery are well established. However, analyses of the surgery impact have not been updated and comprehensively investigated since 2003.

Objective  To examine the effectiveness and risks of bariatric surgery using up-to-date, comprehensive data and appropriate meta-analytic techniques.

Results  A total of 164 studies were included (37 randomized clinical trials and 127 observational studies). Analyses included 161 756 patients with a mean age of 44.56 years and body mass index of 45.62. We conducted random-effects and fixed-effect meta-analyses and meta-regression.

In randomized clinical trials, the mortality rate within 30 days was 0.08% (95% CI, 0.01%-0.24%); the mortality rate after 30 days was 0.31% (95% CI, 0.01%-0.75%). Body mass index loss at 5 years postsurgery was 12 to 17. T

he complication rate was 17% (95% CI, 11%-23%), and the reoperation rate was 7% (95% CI, 3%-12%).

Gastric bypass was more effective in weight loss but associated with more complications.

Adjustable gastric banding had lower mortality and complication rates; yet, the reoperation rate was higher and weight loss was less substantial than gastric bypass.

Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass.

Conclusions and Relevance  Bariatric surgery provides substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients, although risks of complication, reoperation, and death exist. Death rates were lower than those reported in previous meta-analyses.

The Effectiveness and Risks of Bariatric Surgery