A group of nuns that represent the leadership of Catholic women’s religious orders from across the United States (the "amici curiae") filed a brief last week with the nation's Supreme Court in support of President Obama's Patient Protection and Affordable Care Act.
The sisters have a long record of service in the public health care sector, founding free clinics and hospitals for the underprivileged since the earliest days of the union. Their powerful words:
Amici have witnessed firsthand the national crisis that prompted Congress to pass the Affordable Health Care Act. We have seen the devastating impact of the lack of affordable health insurance and health care on women, children, and other vulnerable members of society.
We believe..... it is a moral imperative that all levels of government institute programs that ensure the poor receive health care (and that) Medicaid expansion under the Act is critical to the communities we serve.
Did You Know: Catholic Means "Universal"
Many of the Amici (Latin for "friends") have devoted their lives to providing care to those most in need, and it appears they are not alone in their devotion. Even the Holy See has called health care an “inalienable right,” and the
Jesus Agrees!
Dr. Jesus Ortiz agrees. The state of American health care drove him to create Orbicare (Latin for "care for the world"), an organization that helps the uninsured and under-insured (which numbers about 30% of the US population) get health care in Latin America and Europe, where health care costs tend to be much lower than the US, with equal quality and, often, superior service. As Dr. Ortiz notes,
"American health care is among the best in the world - why the high cost, and what can we do about it?" ~Dr. Jesus Ortiz, Founder, Orbicare
What We're Driving At: Is it Time To Outsource American Health Care?
Dr. Ortiz compiled some fascinating statistics (in this free downloadable brochure) about the sad state of the US health care system, including the shocking statistic that US ranks #1 in the world in cost of heath care, but much farther down the list - forget the top 3, not even the top 25 - in life expectancy and infant mortality.
For those neither young nor old that think this problem somehow does not affect them, General Motors says this is how much health care adds to the cost of each new car it sells:
a. more than $500
b. about $750
c. more than $1500
The American Society of Aesthetic and Plastic Surgeons reports that Since 1997, there has been a 155%+ increase in the total number of cosmetic procedures.
Even after the recession hit, Americans still made room in their budget for cosmetic self-improvement: Americans spent nearly $10.7 billion on cosmetic procedures in 2010. Of that total almost $6.6 billion was spent on surgical procedures.
From 2009-2010, there was almost a 9% increase in the total number of cosmetic surgical procedures, with over 1.6 million cosmetic surgical procedures this year.
Surgical procedures increased by more than 71%
Nonsurgical procedures increased by 228%
Mostly a girl thing.....
Women had almost 8.6 million cosmetic procedures, 92% of the total. The number of cosmetic procedures for women increased over 164% from 1997. The top five surgical procedures for women were:
Mostly- but not limited to - middle age
People age 35-50 had the most procedures – more than 4 million, accounting for 44% of the total number of cosmetic procedures.
ages 19-34 account for 20% of procedures
ages 51-64 account for 28%
ages 65 and account for 7%
ages 18 and younger account for 1.3%
...with 1 in 5 among ethnic groups
Racial and ethnic minorities, as of last year had approximately 19% of all cosmetic procedures:
Hispanics 8%
African-Americans 6%
Asians 5%
Traveling for Beauty On The Rise
The recession has had a notable impact on cosmetic surgery in one key aspect: Health Travel Guides reports the number of people traveling abroad to have their procedures shows a double digit increase over the past two years.
Director of International Patient Services Deborah Natsch reports that procedure popularity for so-called 'cosmetic travelers' mirrors the ASAPS report on procedure popularity, with breast enhancement procedures leading the way.
"Getting breast augmentation abroad means working with a board-certified cosmetic plastic surgeon who is a member of ASAPS, but the patient saves well over 50%, simply due the structure of the health care system," Ms. Natsch points out.
The US fee-for-services model has driven up the cost of medical care to the point that US ranks #1 on health care spending, but lower than #30 on infant mortality and life expectancy. It's no wonder that more and more Americans are choosing to circumvent a system that charges too much, particular for elective surgeries.
Natsch reports that the average cost of breast augmentation in a top-flight cosmetic surgery clinic in Cancun, for example, is about $4500, while breast lift runs about $4,250. Plus, there is the added advantage of recovering in a beautiful setting. The program prices include a dedicated Health Travel Guide (chat with one here) and even a logistics coordinator to book patient's travel.
"We have an 80% referral rate," said Natsch. "Our patients are delighted with their results, and many have additional procedures that would have been out of reach had they chosen to stay in the U.S. "
If you have been researching weight loss procedures, you can't afford to miss this free gastric plication webcast produced by Health Travel Technologies, part of the excellent Patient Education Series.
Gastric Plication is the latest in a series of bariatric innovations (including the gastric pacemaker and metabolic surgery) and features some great benefits for patients:
- minimally invasive: the procedure is laparoscopic
- device free - no band to refill or adjust or remove
- no resection - no loss of stomach tissue
- greater weight loss than LAP-BAND
All of this adds up to lower risk of complication. Weight loss results have been consistently comparable to the much more invasive RNY Gastric Bypass, or Vertical Sleeve Gastrectomy. The procedure requires only an overnight hospital stay, and unlike LAP-BAND, which requires a healing period before the first fill (after which optimal weight loss begins), weight loss begins sooner, and happens at a faster rate.
The About Gastric Plication webcast was developed in cooperation with the obesity surgical team of Hospital Angeles, led by Dr. Juan Lopez-Corvala, the world's leading gastroenterologist surgeon performing the gastric plication.
This past Wednesday Hostess - that purveyor of Twinkies, Wonder Bread and Ho-Hos - filed for Chapter 11 bankruptcy protection. The company said it is struggling to stay competitive under the weight of debt and soaring labor force expenses - primarily referring to legacy pension and medical benefit obligations and restrictive collective bargaining agreements governing its 19,000 strong, predominantly union workforce.
A Sweet American Giant On Its Knees
The ingredients for a bankruptcy can be complex, but, it seems, no more so than the ingredients of the Twinkie itself. The description we hear in advertising - golden sponge cake, creamy filling - is rather vague and, it turns out, not very reflective of the very interesting (and somewhat alarming) ingredients of the snack cake.
Fun Facts About Twinkies
Vitamins. Who knew Twinkies have vitamins?! Where the vitamins come from, however, is another story: Food writer Steve Ettlinger, author of the book “Twinkie, Deconstructed, explains in an interview with NY Times health blogger Tara Parker-Hope that the vitamins in Twinkie are made from petroleum and fermented in enormous industrial plants mostly in China, part of what Ettlinger calls "the Twinkie Industrial Complex".
Rocks. No animals are harmed in the making of a twinkie, but rocks are put to work. Five rocks are required in the making of a Twinkie, including salt,.gypsum, trona, limestone and phosphorus ore.
Polysorbate 60 Ettlinger was unable to get Twinkie factory employees to give away the secret of the cream filling, but he suspects it is partially hydrogenated vegetable oil, polysorbate 60, and possibly cellulose gum.
Eternal Life. Twinkies will change consistency as they age, but apparently never become (more) inedible. The food writer interviewed in the NY Times has a Twinkie from 2005 in his office, with nary a speck of mold, which might explain the "good through 1/11/25" that was ink-jetted onto the cellophane wrapper of a Banana Flip - quite similar to a Twinkie except for the flavor - that I once purchased as part of a Halloween costume.
The year was 1992, and it actually took me awhile to understand that the '25' in the date line referred to 2025. I've moved twice since then, but the Banana Flip, still stored in a box somewhere, is still (according to them) just as edible a the day I bought it. I should add that the last time I saw it - sometime in 2002 - it looked the same, although the creme filling looked a trifle less creamy.
Doctor Criticizes Snack Cakes, Loses Job
While nothing in the Twinkie seems to resemble food as we know it, and sugar and fat are well-understood contributors to the American obesity rate - Tuesday the CDC reported that more than 78 million adults and almost 13 million children aged 2-19 are obese- a Florida doctor was removed from his job running a local health department after posting signs critical of junk food and doughnuts.
Associate professor of medicine at the University of Chicago Dr. Elbert Huang said in an interview with MSNBC news that current obesity rates guarantee that we will see dramatic increases down the road in diabetes and in costs linked with that disease. That's because Type 2 diabetes, strongly linked to obesity, becomes more prevalent as people age.
Twinkies are eternally nostalgic, (nearly) eternally fresh as that word is understood in processed food land, but neither obesity nor diabetes need to be lifelong burdens. Check out the articles below for an in-depth look at the factors contributing to obesity and diabetes, and how to control them.
Every two seconds someone in America needs blood, but only one in three Americans donates. That's a discrepancy that gets even wider in the winter, when blood is typically in short supply due to illness, holiday travel land and winter weather conditions.
Since 1970, FEMA has recognized January as National Blood Donor Month - a time to remind Americans that even when blood donations are down, the need for blood isn't: our society needs nearly 40,000 units of red blood every single day, and most blood centers are unable to maintain more than a three-day supply of blood for transfusions.
"Donating blood is a safe, life-saving and selfless gift that enhances the level of preparedness for each and every community in this nation." ~Ken Murphy, FEMA
Fang You, Baby Boomers!
According to FEMA, baby boomers are the biggest donors, and that's bad news in the long run: as boomers age, they often become less able to donate due to health issues and medications. As baby boomers age, we lose them not only as top donors, we gain them as top users.
The largest demographic cohort ever to move through the population will have more surgeries and health problems that will require more and more donated blood to maintain their own health. Just as blood supplies become increasingly important, they become more quickly depleted, as boomers use more and more of the blood supply they once supported themselves.
A recent study published in Nature Communications and reported on MSNBC's Vitals illustrates, with rodent Benjamin Buttons, how scientists may one day be able to, if not reverse, then slow the aging process with an injection of adult stem cells.
In the study, mice bred to carry the disease progeria - or, rapid age acceleration - were injected with stem cells. Within days, the rapidly aging mice (whose normal 2 year lifespan is cut to just 21 days by disease) began looking and acting younger.
“It was mind boggling.”~ Dr. Johnny Huard, University of Pittsburgh School of Medicine (study co-author)
The stem cells did not fully reverse the aging disease - i.e. the progeria-infected, stem-cell injected mice didn’t live as long as normal mice - however the injected mice nevertheless lived three times longer than mice with progeria and no stem cell treatment.
Adult Stem Cells: A "Fantastic" Cure For Aging?The study authors speculate that additional injections of stem-cells would even further lengthen their lifespans - that more stem cells will provide equal more effect.
Though the stem cell injection was made in the stomach, the stem cell effect was not limited to the gastrointestinal neighborhood. Though the stem cells themselves did not make it to the brain, the stem cells nevertheless improved the health of the brain by increasing the number of blood vessels.
For scientists, this was the coupe de grace, suggesting as it does that normal stem cells are releasing a protein that spurs the growth of healthy cells. The study authors note that 'there is a lot of money being spent in the world trying to delay aging' and that the comparative simplicity of the stem cell 'cure' for aging - a treatment that is non-surgical and non-invasive - would be nothing short of 'fantastic' for humans.
Stem cell treatment to repair damaged hearts, bones and cartilage is currently being conducted by the study's authors.
Although human trials for stem cell treatment are not readily accessible to patients in the United States, leading stem cell researchers in state-of-the-art private hospitals abroad are building open study registries for treatment protocols.
Conditions treated include for congestive heart failure, chronic obstructive pulmonary disease (COPD), Alzheimer's, Parkinson's, joint regeneration and erectile dysfunction.
A number of professional athletes have traveled abroad for stem cell treatment for joint repair, including Cy Young-award winning pitcher Bartolo Colon and Indianapolis Colts quarterback Peyton Manning.
Stem Cell Awareness Day Learn more about anti-aging adult stem cell treatments available through programs certified by the nonprofit stem cell treatment oversight organization dedicated to patient safety, the International Cellular Medicine Society (ICMS).
The Toll of Diabetes: Social and Economic As Well As Physical
A new study has quantified the non-medical costs associated with Type 2 diabetes, which according to the American Diabetes Association affects ~26 million children and adults in the United States, or 8% of the population, with new diagnoses at a rate of 1.9 million cases per year.
The study, published in the journal Health Affairs, tracked 15,000 people diagnosed with either Type 1 or the far more common Type 2 diabetecs from high school through their early 30s, or about 14 years. Results show that people with diabetes can expect to make $160,000 less in earnings over the course of their lifetimes as compared to non-diabetics.
The research reveals that diabetics are less likely to complete high school or attend college; by age 30, a person with diabetes is 10 percent less likely to find employment. , in part because of reduced education.
"Diabetics may be having some negative consequences pretty early on in the course of life,” ~Dr. Michael Richards, study author/Yale University
The researchers estimate that the driving force of the income and opportunity disparities for diabetics is the difficulties experienced in balancing school or job demands with the management of a chronic disease.
In addition, employers may also be less likely to hire someone with diabetes, fearing either (or both) lost productivity due to sick days because and a greater insurance burden relative to non-diabetic workers.
"Job lock" may also be a factor; job lock refers to reluctance to seek out better-paying jobs for fear of losing existing health benefit.
Earlier research confirms that chronic disease and other health indicators - for example, being overweight, can pose barriers in the job market - obesity has long been linked to lower earnings.
Although Type 2 diabetes is more often encountered among older Americans, who can face age-related discrimination, the study controls for age, and shows the deleterious effects of diabetes are independent of age: high school students with diabetes were 6% more likely to drop out, and 10% less likely to find a job.
The study also controlled and adjusted for the effect of being overweight, as well as race and other environmental and demographic factors, with results clearly showing diabetes having a negative effect on income independent of other factors.
Intergenerational effects were also noted: children of diabetics were 6% less likely to attend college if they had a diabetic parent, possibly due to the financial impact of diabetes on the family income/savings.
Diabetes: Stealing The Future of Our Children?
Current estimates place obesity rates among adolescents between 16-32%, a statistic that has the A panel of experts appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics recently released a report recommending screening for Type 2 Diabetes should begin before age 10 for children who are overweight and/or have a family history of diabetes.
The problem of childhood obesity is so severe the New England Journal of Medicine has opined that the next generation of children may be the first in history to have a shorter life expectancy than their parents.
First Lady Michele Obama's Let's Move initiative to reduce childhood obesity is aptly named; recent research has discovered an 'exercise hormone' (nicknamed "irisis" by scientists). The hormone helps transform inert white fat into metabolically active brown fat; while overweight people who exercise may not lose weight, they experience the benefit of the hormone making them weight-gain and diabetes resistant.
Diabetes is the 7th leading cause of death in the US, and will likely move up the mortality ladder given that nearly 80 million Americans are currently classified by the ADA as "prediabetic".
Type 2 diabetes is the leading cause of kidney failure and adult blindness, and is linked to increases incidence of heart disease, stroke, cancer diagnosis and death.
The current gold standard of bariatric surgery for obesity has the welcome side effect of resolving Type 2 diabetes. The popular Dr. Oz was recently quoted in Prevention Magazine recommending gastric bypass surgery, a procedure he considers essential in the fight against obesity.
Dr. Oz points out that an obese 50-year old has the same mortality rate as a cancer patient - most would not hesitate to operate for cancer, and the same should be true of obesity. "If you get people to start losing 5% of their excess body weight, you're really taking a big whack out of (a serious health problem that is affecting) the two-thirds of Americans," he notes.
How does health affect work, and how does work affect health?
A gym membership is the most common and, as it happens, least interesting health perk a company can provide. That's what the Fit to Perform survey conducted among 554 executives reveals.
The executives were asked how they support the health and well-being of their workforce.
Fully 60% rated free or subsidized health care as the most important perk in perkdom. These results are the preliminary findings as part of a wide-ranging investigation into the critical health care issues around the world. Maternity leave continues to not be commonly provided but to be commonly thought important.
It is part of the GE "Health of Nations" research and analysis program , created by the Economist Intelligence Unit.
Quality health care doesn't need to be subsidized if it's affordable in the first place - something employers are learning is the case with international health care.
Private health care in places as diverse as Thailand, India and Malaysia - and as close as Mexico, Argentina, Panama and Costa Rica (where 15% of annual visitors are actually dental tourists, according to the Costa Rican government) - is often less than half US costs - that's even with all the perks and extras that most US patients would like to expect from domestic health care, including modern 5-star facilities, private patient rooms, top surgeons and nursing staffs and US medical devices.
Join the Health Travel Guides mailing list to learn more.
Some brands are so well-known they become the generic references for a whole category - think Kleenex, Jello-O and Hula Hoop (did Hula Hoop have any competitors?).
LAP-BAND® is like the Band-Aid of bariatric surgery, the Allergan-branded system is basically ubiquitous for minimally invasive adjustable gastric banding surgery.
More than 650,000 LAP-BANDs® have been placed, and with more than one third of Americans (that's about 60 million people) meeting the medical definition of obesity (a BMI of 30 or more), and two of every three Americans overweight, this number is likely to increase.
Being overweight increases the risk for diseases such as type 2 diabetes (Read: 10 Truths About Diabetes), heart diseases, stroke, sleep apnea, respiratory problems and some cancers. Research from the National Institutes of Health has shown that obesity will decrease average life expectancy by nearly five years.
The latest news in LAP-BAND® is the Green Zone LAP-BAND®, a variation on the procedure conducted with the new FDA-approved Endoflip system, which provides the obesity surgeon with multiple, real-time images of the gastrointestinal tract, enabling precision band placement and thus, opitmal weight loss.
Most interesting to patients is the fact that the first band 'fill' takes place inter-operatively; while 'regular' LAP-BAND® patients must weight up to three months for their first fill, patients having a Green Zone LAP-BAND® get their first fill before they even leave the OR; often, the next fill is not needed until five months post-surgery.
It's a win-win for both surgeons and patients: an advancement that results in more and faster weight loss, a quicker reduction of the more serious complications of obesity such as Type 2 Diabetes, while reducing the overall risk of complication.
Why Mexico is the Land of LAP-BAND®
Thanks to a sometimes glacially slow FDA approval process, the LAP-BAND® was available in Mexico a good five years before the United States. As a result, top gastroenterologist surgeons in Mexico placed thousands of LAP-BANDS® before American surgeons had placed even one. Rock star surgeons like the Allergan-certified "little Giant of LAP-BAND®" - Dr. Juan Lopez Corvala - visited as many as 100 US research hospitals proctoring the procedure. His patient roster now includes about 6,000 gratefully thinner Americans.
The pattern holds true for this latest LAP-BAND® as well - as of this writing, Green Zone LAP-BAND® is available exclusively in Mexico's top private hospital network, where regular surgical clinics are held for US surgeons to train on the use of the EndoFlip.
Although geographically speaking it's now just as easy to have a LAP-BAND® in Missouri as Mexico, the economics still significantly favor Mexico, where the procedure costs $5,200 at a top private hospital - less than half the average cost for having the procedure in a clinic in the US. With medical travel facilitators like Health Travel Guides on hand to handle all the details, it's not only cheaper to have the procedure in Mexico, it's often easier as well.
Is LAP-BAND® Getting a Bad Rap?
Watch this animated video about Green Green Zone LAP-BAND® and be the judge!
Want to find out if you're a candidate for Green Zone LAP-BAND®? Submit a secure online medical history and receive information about the Green Zone LAP-BAND® procedure.
Can't beat the 'beatis, my grandpa used to grumble. Meaning, he felt powerless against his diabetes.
It's a different world now, one that includes insulin pumps and a TSA. How to keep these two entities from making your life miserable during holiday travel is our subject today, with a little help from the CDC's just-released Tip Sheet, Managing Diabetes During the Holidays.
Packing Medical Supplies
If you read these guidelines carefully, you might spot a theme:
pack at least twice as much medication as you think you'll need
pack the right amount of blood-testing supplies - then double that too
if you're traveling to a place with limited medical resources, double down again
If you're traveling long distances, make sure you move around or get up and walk every 30 minutes, to combat your increased risk for blood clots.
For time (zone) travelers, experts recommend Type 2 Diabetes patients ease into their new schedule by beginning to adjust medication times for insulin in increments in the 3-5 days prior to your departure.
However, if the time change is greater than four hours, ask your doctor to revise your dosing schedule to reflect your new time zone, to reduce the chance for a dosage error.
XO, RX
Carrying a prescription (in the original packaging) along with a letter from your doctor specifically outlining your treatment plan (e.g. "take prescribed medication every 3 hours, take insulin shots 3 times per day") will reduce the chance of TSA hassles, like confiscation of syringe or other medical devices.
Pump Up Your Caution
The CDC reports research that has shown changes in airliner cabin pressure during flights can cause insulin pumps to deliver too much insulin when the plane is climbing. Therefore, diabetics who are extremely sensitive to insulin should disconnect the pump before take-off. Always check an airborne insulin supply for air bubbles, even after deplaning.
What do obesity and pin-thin Ryan Gosling have to do with each other? Well, a lot, according to Google. Seems "obesity", and "Ryan Gosling workout" are among the top two topics among Internet searchers in 2011.
With more than two-thirds of the population overweight, and one third obese, America is flabbier than ever. But that may be about to change, if the search topics of 2011 are an indication: among the most searched terms were "high protein diet" the "Thor" workout, the “Ryan Gosling workout,” the “Chris Hemsworth workout,” and the “Captain America workout.”
The most searched diet term: the “Dukan diet” (also known as the Kate Middleton pre-wedding diet, and also also known (by the British Dietetic Association) as one of the top 5 worst celebrity diets to avoid). The “four-hour diet” and “17-days diet" were also in the top three.
With more than two-thirds of the population overweight, and one third obese, America is flabbier than ever. But that may be about to change, if the search topics of 2011 are an indication.
The most popular search terms at Health Travel Guides: obesity, diet, diabetes, joint replacement, and fertility treatment. Our most popular articles include:
Popular New York Times Health Searches
The New York Times reports the most highly searched health topics include alternative therapies, the brain and mental health, and happy relationships. Below are some links to the Times' most searched articles of the year:
“How Meditation May Change the Brain”
People who meditated 30 minutes a day for eight weeks had changes in parts of the brain associated with memory, sense of self, empathy and stress.
“Go Easy on Yourself, a New Wave of Research Urges”
A new area of psychological research suggests that self-compassion, a measure of how kindly people view themselves, may be the first step toward better health.
“One Sperm Donor, 150 Sons and Daughters”
As the number of children born through artificial insemination increases, concern is growing about having many children fathered by the same donors.
“Can Exercise Keep You Young?”
A new study finds that exercise reduced or eliminated signs of aging in mice genetically programmed to grow old at an accelerated pace.
“Expert on Mental Illness Reveals Her Own Struggle”
Across the country, people with severe mental illness live what appear to be normal, successful lives. Now, a small number of them are openly discussing their struggles.
“Alzheimer’s Therapy Focuses on Care”
Science is weighing in on many aspects of taking care of dementia patients, applying evidence-based research to what used to be considered subjective and ad hoc.
“Calcium and Vitamin D – Who Needs It, and How Much”
New recommendations for calcium and vitamin D have left many people wondering whether they are getting enough, or perhaps too much, in their diets and supplements.
“The Hazards of the Couch”
Increasingly, research is focusing not on how much exercise people get, but how much of their time is spent in sedentary activity, and the harm that does.
Erectile dysfunction - that is, difficulty maintaining an erection sufficient for successful intercourse -affects approximately 30 million American men. That's 50% of men in the 40-70 age cohort.
While erectile dysfunction (ED) is indubitably inconvenient, and potentially ego-deflating, men should know that it is one of the most overlooked early symptoms of heart disease.
Often, ED turns out to be a sign of a more serious health condition involving the blood vessels. For men under the age of 50, ED can be a clue that arthreosclerosis -the main cause of chronic heart disease - is present.
Researchers at the Journal of the American Heart Association found erectile dysfunction to be a strong predictor of death in men with cardiovascular disease. Most worrying, men with ED have been found to be more than one and a half times more likely to suffer from heart attack, stroke or other serious cardiovascular problem.
Age is also a factor, of course. In men under 50, ED more than likely a sign of cardiac disease (in men over 70, this is less likely)
If You Suffer From ED
Our society's penchant for "a pill for every ill" is a disservice to men when it comes to ED. While ED drugs may initially address the problem, they do not protect against cardiovascular disease or other illnesses.
Talk to a doctor about getting a cardiology work-up to assess whether you show signs of arthreosclerosis and determine the proper treatment. Be prepared for a lifestyle change that involves first and foremost to stop smoking. It will also involve a healthy diet that limits cholesterol, as well as integrating regular exercise into your routine.
Adult Stem Cell Transplant for ED
Studies have shown that injection of adult stem cellshas been shown to be effective in treating ED. Regenerative Medicine Institute at Hospital Angeles currently treats ED with its proprietary adult autologous stem cell therapy program.
To find out if you are a candidate for treatment, fill out this secure online personal medical history. A Health Travel Guides (Toll Free 866.978.2573) will contact you to communicate the medical team's decision regarding next steps.
Bariatric surgeons and patients have known for years that the gastric bypass procedure has one effect that is often more immediate even than the weight loss it is designed for: an improvement in blood sugar levels that often results in the resolution of Type 2 diabetes. Now research has given us the ‘why’.
According to a study published in Science Translational Medicine the key lies in amino acids: the gastric bypass procedure significantly reduces the amount of branched-chain amino acids circulating in the blood. This decrease results in an improvement in the body’s response to insulin.
Somehow this drop in amino acids (the building blocks of proteins) improves the body's response to insulin with the end result of normalizing blood sugar and correcting diabetes.
The blood sugar of the gastric bypass patient is also stabilized due to decreased food intake. Patients having the gastric bypass experience a surgical reduction of stomach size – after the procedure, the remaining stomach pouch typically holds only 1 ounce.
Insulin resistance continues to improve over time as the gastric bypass patient loses weight as a result of reduced stomach capacity as well as the malabsorption of nutrients created by re-routing of the intestines (food that is consumed bypasses the segment of the small intestine closest to where it attaches to the stomach).
Additionally, anatomical changes resulting from the gastric bypass procedure result in hormonal changes which also effects insulin resistance.
Gastric Bypass: The Gold Standard
Although adjustable gastric banding – ubiquitously referred to as Lap-Band – has rapidly become the most popular weight loss surgery, the gold standard for obesity surgery remains the gastric bypass.
This surprised me – after all, Lap-Band is a much less invasive procedure with far fewer risks to the patient. The Lap-Band takes just 20 minutes and can be performed as an outpatient procedure. The stomach is reduced through the placement of a silicone band that is adjusted, or filled, with water to create a sensation of fullness in the patient.
By comparison the gastric bypass is a far more serious procedure, involving intestinal re-routing and up to 80% of the stomach permanently removed. That doctors sworn to ‘first do no harm’ would prefer a maximally invasive operation over the minimally invasive Lap-Band seems counter-intuitive, to say the least.
It turns out that surgeons have different criteria for gold standard than patients which on reflection is not surprising. Patients value convenience (will I have to miss a lot of work? Will I be in a lot of pain?) While surgeons, of course, are focused first and foremost on patient safety – i.e. reducing the risk and potential seriousness of complications.
The gold standard of any surgical procedure is all about the availability of long-term tracking data and outcomes; the gold standard is a benchmark against which newer lesser known procedures are measured quality and effectiveness.
Long-term studies have clearly demonstrated that the gastric bypass regularly results in significant long-term loss of weight and recovery from Type 2 diabetes.
As well, gastric bypass results in improvement in other obesity correlates that pose serious health problems, for example cardiovascular risk factors and premature mortality. Dr. Oz Advocates for Gastric Bypass Surgery
Most of us have heard weight loss surgery referred to as ‘the easy way out’, an attitude that suggests that healthy ‘normal’ weight loss can and should be achieved solely through diet and exercise. Perhaps not surprisingly, Dr. Oz does not agree.
“We probably do only 1% of the gastric bypass surgeries we should do." ~Dr. Oz
USA Today and Prevention magazine both quote Dr. Oz as having no qualms recommending gastric bypass surgery, a procedure he considers essential in the fight against obesity.
Dr. Oz points out that a 50-year old with a BMI of more than 40 (the medical definition for obesity, usually constituting more than 100 lbs of excess weight) has the same mortality rate as a cancer patient. Most would not hesitate to operate for cancer, and the same should be true of obesity, says Dr. Oz.
“You have to do it with counseling and full awareness of what you're doing, of course. But if you get people to start losing 5% of their excess body weight, you're really taking a big whack out of the two-thirds of Americans."
Lifestyle Changes After Gastric Bypass
Full awareness of what you’re doing includes, of course, the permanent limitations patients face post-RNY gastric bypass, which are substantial:
·You can eat only a few ounces of food at a time.
·You must eat very slowly and thoroughly or risk the vomiting and pain of food getting ‘stuck
·No room at the inn – you will not be able to drink before, during or after meals
·A lifetime of vitamins and supplements to prevent bone and hair loss (due to malabsorption of nutrients caused by intestinal re-routing)
·Avoiding simple sugars – candy, soft drinks, ketchup, etc – which move quickly through the stomach and intestines to cause dumping syndrome.
Gastric Bypass Cost
The bad news: for many patients, gastric bypass is financially out of reach: the cost of gastric bypass in the US is typically more than $30,000, rarely covered by insurance or Medicare. However, the globalization of medical care offers patients an opportunity to get the gastric bypass procedure with the world's most experienced obesity surgical teams, at a state-of-the-art hospital, for only a fraction of the US cost.
Gastric bypass medical travel programs through Health Travel Guides are all-inclusive, with prices starting at $10,215. Work with surgeons that have performed thousands of gastric bypass procedures on US health travelers demanding more value for their health dollar. Submit a secure online medical profile; the results go directly to a top obesity surgical team for review, and a Health Travel Guide will contact you to answer any questions.
I read a story today that reminded me of a recent exchange with a Starbucks barista who, in response to my order of a small cafe mocha, inquired brightly,
“Would you like whipped cream on that?” She smiled conspiratorially. “It's only 10 calories!”
Sure, I said. What, after all, is 10 calories?
Well, according to obesity researcher Dr. Kevin D. Hall of the National Institute of Diabetes and Digestive and Kidney Diseases, the daily addition of those 10 calories with my coffee will raise the body weight of the average person by 20 pounds in 30 years.
And just in case you are thinking that a calorie is a calorie is a calorie, these researchers (whose study, published in The Lancet, was also summarized in the New York Times article Why Even Resolute Dieters Fail) also found that saying “yes” to the whipped cream will result in more pounds gained by a heavier person than by a lean one.
Adding insult to injury, the heavier person will gain not only more weight but more ‘fat’ weight vs. ‘lean’ weight. That’s right – not just more fat, but fatter fat.
The two phased approached suggested by these researchers on how to achieve lasting weight loss might classify as the closest thing to a scientifically proven way to lose it for good, so I reprint here:
Phase 1 implement a temporary, aggressive change in behavior
Phase 2 segue to more relaxed but permanent behavioral changes that can prevent the weight regain
For some facing serious and long-term consequences of excess weigh (such as Type 2 Diabetes), a surgical procedure is the best way to implement Phase 1 - anything from the non-invasive 20-minute outpatient gastric banding (LAP-BAND) procedure, to the significantly more invasive RNY gastric bypass procedure featuring stomach resection (80% removed) and intestinal re-routing.
Because the number of weight loss surgeries has increased so dramatically (more than 500,000 LAP-BANDS placed since 1993), the number and type of surgical options has expanded as well. One of the latest innovations of bariatric medicine offers patients more weight loss opportunity with less risk: the Green Zone Gastric Plication, an evolution of the surgery for GERD (reflux) that shows very promising weight loss results with less risk of early and acute complication.
For weight loss maintenance, research results from the National Weight Control Registry suggest two tactics:
- continuing physical activity
- regular weigh-ins
Why Diets Don't Work According to the research, there is a good reason most people can’t stick to their diets; diets actually don’t work. Let’s look at the numbers to prove it: if a pound is comprised of 3500 calories, then creating a caloric deficit of 3500 calories over 7 days (a 500 calorie reduction each day) should result in a weight loss of one pound per week.
Not so, according to Dr. Hall et al, who built a model for weight loss that demonstrates obese people actually have to cut more calories to lose weight than it took to gain the extra pounds in the first place.
The research authors note that typical weight-loss programs result in significant losses over a period 6-8 months, at which point most dieters (more than 95%) reach a sort of universal plateau. Then, prompted by an internal set point - most dieters begin, unconsciously, start to eat a little more - a couple of saltine crackers here, a banana there, half a cookie in between.
Though an extra 100 daily calories would be undetectable on a day to day basis for most of us, the weight game, as most of us know, is all about time.
Let’s Move Though the claim that one’s physical activity does not have much, if any, effect on weight loss tends to hover around dieters like bees around honey, Dr. Hall’s model suggests otherwise. Turns out First Lady Michelle Let's Move anti-obesity initiative is aptly named. According to Dr. Hall’s weight loss model calculations, physical activity is critical to weight loss and especially to weight maintenance.
For example: A man weighing 220 pounds who runs an additional 12.5 miles a week at a moderate pace would lose more weight at a faster rate than if he cut calories alone.
Low-Carb Mania So all diets are equally bad? Not so fast, say the researchers, who conclude
"some diets can lead to reduced hunger, improved satiety, and better overall diet adherence”
Is Atkins one of them? Dr. Hall et al are circumspect on this score. Although there have been numerous studies indicating low-carb, high protein diets are more effective for losing weight, the researchers say little is known about the long-term effect of such diets and how they compare to more balanced distributions of fat, protein and carbohydrate in terms of weight maintenance or health of the dieter. Stay tuned!
