ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
viernes, 30 de diciembre de 2011
miércoles, 21 de diciembre de 2011
All calories are not created equal
A widely accepted concept in mainstream nutrition is that weight loss or weight gain is strictly a matter of "calories in versus calories out”. If you "burn" more calories than you take in, you will lose weight regardless of the calorie source and if you eat more calories than you burn off each day, you will gain weight, regardless of the calorie source. In other words, “a calorie is a calorie” whether it comes from protein, fat or carbohydrates.
But in actual fact and practice, are all calories created equal? Well, let’s examine the question from the standpoint of science and from the practical viewpoint of empirical observation.
Common sense observation tells us that all calories are not created equal – or if in scientific jargon they are, then all foods are not created equal. Quite simply, if two groups of people maintain a daily intake of 2000 calories and group A derives the calories from toast, coffee with cream and sugar, hamburger and fries, pizza, ice cream and sugared soft drinks and group B obtains the calories from egg whites, oatmeal, chicken, fish, green vegetables, sweet potatoes, brown rice, and sugar free beverages, it doesn’t take a degree in rocket science (notice we didn’t say ‘nutrition’ as that can sometimes be a mixed bag) to figure out that group B will look better, feel better and perform better than group A.
Given the foregoing example, how is it that any number of registered dieticians, physicians and others in the medical community still hold to the all calories are equal mantra? Could it be that mainstream nutrition hasn’t caught up with modern science? Let’s look at what science says.
In scientific terms, a calorie (kilocalorie or kcal), is the amount of energy required to raise 1 gram of water 1 degree Celsius. According to that definition, bio-chemically speaking, calories from fat, protein or carbohydrates might all be considered equal. But when the physiological and psychological effect of calories from different foods are taking into consideration, the answer changes.
Protein, fats and carbohydrates have primary and secondary nutrient-specific purposes within the body. For example, proteins are used for cellular growth and repair, synthesis of hormones and enzymes, and as a secondary source of energy (proteins can be converted to a form of glucose via gluconeogenesis) while carbohydrates are the body’s primary source of energy. A growing body of research shows that fats, carbohydrates and proteins not only serve different purposes within the body but have different effects on the metabolism via numerous pathways such as their effects on hormones (e.g., insulin, leptin, glucagon, etc), hunger and appetite, heat production, and uncoupling proteins (UCPs) and via the other mechanisms such as thermic effect of food (the heat liberated from a particular food not only of its energy content but also of its tendency to produce heat).
The ‘a calorie is a calorie is a calorie’ school of thought also ignores the ever mounting volume of studies that provide data to indicate that diets with identical calorie intakes but different macro nutrient ratios have different effects on body composition, physical performance, cholesterol levels, oxidative stress, and a host of other physiological factors. Here's some information derived from such studies that show how different foods affect the calories in - calories out equation and the number you see on the scale.
"Let's take a pure food example," says Anne-Marie Nocton, MS, MPH, RD. "If someone were to eat all of her daily caloric requirement as fried onion rings, would the body respond the same way as if all of the calories came from raw spinach? No, because caloric absorption is affected by the composition of the food itself and by the amount of energy it takes the body to process that food. In this example, the body doesn't need to expend many calories to digest and store fat (in the onion rings) because the digestion and storage process isn't very complex. But the spinach contains fiber, and the structure of a fibrous food means that some of the calories will be 'lost' because the body cannot break it all down."
Dr. Rick Mattes, PhD, MPH, RD, professor of foods and nutrition at Purdue University, has similar views. He notes that the simple act of eating raises your metabolism, and eating certain foods raises metabolism even more. “The energy the body uses in the digestion process is called the thermic effect of food (TEF),” he explains. "Protein has a higher TEF relative to carbohydrate and fat.” (Editors note: the thermic effect of protein is about twice that of carbohydrate or fat).
Speaking at an American Dietetic Association conference in Anaheim, California, Dr. Mattes, explained that other factors, such as the form of a specific food, also play roles when you compare calories from different foods. Taking the perspective that calories are equal as chemically processed in the body, Mattes looks at the foods rather than just the calories. When comparing and counting calories, the delivery system matters. For example, are the calories in solid or liquid form? Researchers comparing fruit juice and fruit found that the fruit showed a blunting effect on hunger while juice resulted in only a small decline.
Matte also noted that solid foods have greater compensatory responses than fluids. "Fluids add to the diet rather than replacing other foods,” he says. “This is called a weak compensatory response. And soda isn't the only problem drink - it's fluid calories in general, whether from juice or even milk. In other words, be careful of liquid calories, which may add to your total calorie intake rather than substituting for other foods.
Mattes stated that high-protein food has the highest satiety rating, therefore eating a high-protein diet could theoretically help you feel fuller and stay satisfied longer. While high-protein foods are valuable for their fullness factor, foods such as nuts that are rich in fat and protein have also garnered attention. Many studies have shown that nuts, though high in calories, have high dietary compensation and may even increase metabolism. Mattes illustrated one study that found subjects' resting energy expenditure was 11% higher after nut consumption.
Along these same lines, researchers at the City of Hope Medical Center in Duarte, California studied two groups of overweight people, both on medically supervised low-calorie liquid diets. One group added 3 ounces of almonds to their daily diet, while the other group added the same amount of calories from complex carbs like popcorn and Triscuit crackers. Both groups ate the same number of calories daily, about 1,000. During the 24-week study, the almond-eating group lost more weight even though they ate the same number of calories as the carb group. Same calories, different results.
Dr. David Ludwig, from Children’s Hospital Boston is another authority who debunks the ‘all calories are created equal’ theory. “The idea that ‘a calorie is a calorie is a calorie’ doesn’t really explain why conventional weight-loss diets usually don’t work for more than a few months,” says Dr. Ludwig. “Almost anyone can lose weight in the short-term but very few keep it off in the long-term. That’s given rise to the notion that the body has a ‘setpoint’ and that when you diet, internal mechanisms work to restore your weight to that setpoint.” Low-carb diets,” he continues, “may work better with these internal biological responses to create the greatest likelihood of long-term weight loss.”
“Our data suggest that the type of calories consumed - independent of the amount -can alter metabolic rate,” says Dr. Ludwig.
Finally, we like to reference the work of Richard Feinman, PhD, Professor of Biochemistry at the State University of New York Downstate Medical Center. In an article published in Nutrition Journal 2004, 3:9 with his colleague, Eugene Fine, MD, Dr. Feinman puts the all calories are equal issue to rest by addressing the first and second laws of thermodynamics. “The first law of thermodynamics is the one that's easy to understand, it's the conservation of energy," says Dr. Feinman. "There's a fixed amount of energy in the world, and in the context of nutrition it means that any energy that you take in in the form of food must either show up as work that you do, or heat that you generate, or the chemical transformation that you carry on in your body, making new protein, and so on; and the rest will be leftover as fat. So that's always true. The second law of thermodynamics, however, is a much more difficult law to understand, and it's a dissipation law. It's a law of efficiency. It says that not all processes are equally efficient."
Dr. Feinman, says getting the body's fuel – glucose - from protein is less efficient than getting it from carbs, which means low carb diets make the body use more energy. "Your brain and some cells in your body have to have glucose, and there are several ways they can get that glucose," he explains. "You take in sugar or starches, that's a direct supply of glucose. You can make that glucose from protein. If you do that, that's a very inefficient process, you're going to use energy to turn protein into glucose, and in the end you're going to have to get that energy from burning something, usually fat." Essentially, then, the more inefficient the diet is at turning calories into glucose, the more effective it should be for weight loss.
Now to the topic at hand. Dr. Feinman also states that not all calories are created equal. "For many years nutritionists have been saying, 'a calorie is a calorie,' " Feinman said. "That is, weight gained or lost only depends on the calories in the diet, regardless of the macronutrient composition, that is, protein, carbohydrate, fat. We knew this was not true, so we set out to show that this was not true. I think the bottom line is once you have the idea that all calories are the same, you're not going to try to find the best diet. And I think it's very important to try to find out what's going to be most effective. We don't know that yet, but unless we work at it, we won't find it."
According to Dr. Feinman, A calorie is a calorie" violates the second law of thermodynamics. And we don’t want to do that, do we?
Arley Vest
But in actual fact and practice, are all calories created equal? Well, let’s examine the question from the standpoint of science and from the practical viewpoint of empirical observation.
Common sense observation tells us that all calories are not created equal – or if in scientific jargon they are, then all foods are not created equal. Quite simply, if two groups of people maintain a daily intake of 2000 calories and group A derives the calories from toast, coffee with cream and sugar, hamburger and fries, pizza, ice cream and sugared soft drinks and group B obtains the calories from egg whites, oatmeal, chicken, fish, green vegetables, sweet potatoes, brown rice, and sugar free beverages, it doesn’t take a degree in rocket science (notice we didn’t say ‘nutrition’ as that can sometimes be a mixed bag) to figure out that group B will look better, feel better and perform better than group A.
Given the foregoing example, how is it that any number of registered dieticians, physicians and others in the medical community still hold to the all calories are equal mantra? Could it be that mainstream nutrition hasn’t caught up with modern science? Let’s look at what science says.
In scientific terms, a calorie (kilocalorie or kcal), is the amount of energy required to raise 1 gram of water 1 degree Celsius. According to that definition, bio-chemically speaking, calories from fat, protein or carbohydrates might all be considered equal. But when the physiological and psychological effect of calories from different foods are taking into consideration, the answer changes.
Protein, fats and carbohydrates have primary and secondary nutrient-specific purposes within the body. For example, proteins are used for cellular growth and repair, synthesis of hormones and enzymes, and as a secondary source of energy (proteins can be converted to a form of glucose via gluconeogenesis) while carbohydrates are the body’s primary source of energy. A growing body of research shows that fats, carbohydrates and proteins not only serve different purposes within the body but have different effects on the metabolism via numerous pathways such as their effects on hormones (e.g., insulin, leptin, glucagon, etc), hunger and appetite, heat production, and uncoupling proteins (UCPs) and via the other mechanisms such as thermic effect of food (the heat liberated from a particular food not only of its energy content but also of its tendency to produce heat).
The ‘a calorie is a calorie is a calorie’ school of thought also ignores the ever mounting volume of studies that provide data to indicate that diets with identical calorie intakes but different macro nutrient ratios have different effects on body composition, physical performance, cholesterol levels, oxidative stress, and a host of other physiological factors. Here's some information derived from such studies that show how different foods affect the calories in - calories out equation and the number you see on the scale.
"Let's take a pure food example," says Anne-Marie Nocton, MS, MPH, RD. "If someone were to eat all of her daily caloric requirement as fried onion rings, would the body respond the same way as if all of the calories came from raw spinach? No, because caloric absorption is affected by the composition of the food itself and by the amount of energy it takes the body to process that food. In this example, the body doesn't need to expend many calories to digest and store fat (in the onion rings) because the digestion and storage process isn't very complex. But the spinach contains fiber, and the structure of a fibrous food means that some of the calories will be 'lost' because the body cannot break it all down."
Dr. Rick Mattes, PhD, MPH, RD, professor of foods and nutrition at Purdue University, has similar views. He notes that the simple act of eating raises your metabolism, and eating certain foods raises metabolism even more. “The energy the body uses in the digestion process is called the thermic effect of food (TEF),” he explains. "Protein has a higher TEF relative to carbohydrate and fat.” (Editors note: the thermic effect of protein is about twice that of carbohydrate or fat).
Speaking at an American Dietetic Association conference in Anaheim, California, Dr. Mattes, explained that other factors, such as the form of a specific food, also play roles when you compare calories from different foods. Taking the perspective that calories are equal as chemically processed in the body, Mattes looks at the foods rather than just the calories. When comparing and counting calories, the delivery system matters. For example, are the calories in solid or liquid form? Researchers comparing fruit juice and fruit found that the fruit showed a blunting effect on hunger while juice resulted in only a small decline.
Matte also noted that solid foods have greater compensatory responses than fluids. "Fluids add to the diet rather than replacing other foods,” he says. “This is called a weak compensatory response. And soda isn't the only problem drink - it's fluid calories in general, whether from juice or even milk. In other words, be careful of liquid calories, which may add to your total calorie intake rather than substituting for other foods.
Mattes stated that high-protein food has the highest satiety rating, therefore eating a high-protein diet could theoretically help you feel fuller and stay satisfied longer. While high-protein foods are valuable for their fullness factor, foods such as nuts that are rich in fat and protein have also garnered attention. Many studies have shown that nuts, though high in calories, have high dietary compensation and may even increase metabolism. Mattes illustrated one study that found subjects' resting energy expenditure was 11% higher after nut consumption.
Along these same lines, researchers at the City of Hope Medical Center in Duarte, California studied two groups of overweight people, both on medically supervised low-calorie liquid diets. One group added 3 ounces of almonds to their daily diet, while the other group added the same amount of calories from complex carbs like popcorn and Triscuit crackers. Both groups ate the same number of calories daily, about 1,000. During the 24-week study, the almond-eating group lost more weight even though they ate the same number of calories as the carb group. Same calories, different results.
Dr. David Ludwig, from Children’s Hospital Boston is another authority who debunks the ‘all calories are created equal’ theory. “The idea that ‘a calorie is a calorie is a calorie’ doesn’t really explain why conventional weight-loss diets usually don’t work for more than a few months,” says Dr. Ludwig. “Almost anyone can lose weight in the short-term but very few keep it off in the long-term. That’s given rise to the notion that the body has a ‘setpoint’ and that when you diet, internal mechanisms work to restore your weight to that setpoint.” Low-carb diets,” he continues, “may work better with these internal biological responses to create the greatest likelihood of long-term weight loss.”
“Our data suggest that the type of calories consumed - independent of the amount -can alter metabolic rate,” says Dr. Ludwig.
Finally, we like to reference the work of Richard Feinman, PhD, Professor of Biochemistry at the State University of New York Downstate Medical Center. In an article published in Nutrition Journal 2004, 3:9 with his colleague, Eugene Fine, MD, Dr. Feinman puts the all calories are equal issue to rest by addressing the first and second laws of thermodynamics. “The first law of thermodynamics is the one that's easy to understand, it's the conservation of energy," says Dr. Feinman. "There's a fixed amount of energy in the world, and in the context of nutrition it means that any energy that you take in in the form of food must either show up as work that you do, or heat that you generate, or the chemical transformation that you carry on in your body, making new protein, and so on; and the rest will be leftover as fat. So that's always true. The second law of thermodynamics, however, is a much more difficult law to understand, and it's a dissipation law. It's a law of efficiency. It says that not all processes are equally efficient."
Dr. Feinman, says getting the body's fuel – glucose - from protein is less efficient than getting it from carbs, which means low carb diets make the body use more energy. "Your brain and some cells in your body have to have glucose, and there are several ways they can get that glucose," he explains. "You take in sugar or starches, that's a direct supply of glucose. You can make that glucose from protein. If you do that, that's a very inefficient process, you're going to use energy to turn protein into glucose, and in the end you're going to have to get that energy from burning something, usually fat." Essentially, then, the more inefficient the diet is at turning calories into glucose, the more effective it should be for weight loss.
Now to the topic at hand. Dr. Feinman also states that not all calories are created equal. "For many years nutritionists have been saying, 'a calorie is a calorie,' " Feinman said. "That is, weight gained or lost only depends on the calories in the diet, regardless of the macronutrient composition, that is, protein, carbohydrate, fat. We knew this was not true, so we set out to show that this was not true. I think the bottom line is once you have the idea that all calories are the same, you're not going to try to find the best diet. And I think it's very important to try to find out what's going to be most effective. We don't know that yet, but unless we work at it, we won't find it."
According to Dr. Feinman, A calorie is a calorie" violates the second law of thermodynamics. And we don’t want to do that, do we?
Arley Vest
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
domingo, 11 de diciembre de 2011
Obesity
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
viernes, 9 de diciembre de 2011
New study tips the scale in favor of weight loss for obese pregnant women
Though some women may use pregnancy as an excuse to indulge a little, some health experts caution that obese pregnant women should be more mindful of their eating habits and perhaps actually strive to lose some extra pounds.
The new study, published by Australian resesearchers in the journal Obstetrics and Gynecology, examined the results of four clinical trials that included 537 obese pregnant women. The study participants were randomly assigned to either a control group or a dietary intervention group that received counseling on healthful eating and calorie tracking. Women in the intervention group gained, on average, 14 fewer pounds than those in the control group. Importantly, limiting their weight gain did not cause harm to these women or to their babies.
Currently, the Institute of Medicine recommends that obese women gain no more than 11 to 20 pounds during pregnancy, which is significantly less than the 25- to 35-pound gain recommended for normal-weight women. However, the latest research now suggests that obese women should strive to maintain their weight, or even shed some pounds, since modest weight loss is not associated with any adverse health effects in the mother or the baby.
The new study, published by Australian resesearchers in the journal Obstetrics and Gynecology, examined the results of four clinical trials that included 537 obese pregnant women. The study participants were randomly assigned to either a control group or a dietary intervention group that received counseling on healthful eating and calorie tracking. Women in the intervention group gained, on average, 14 fewer pounds than those in the control group. Importantly, limiting their weight gain did not cause harm to these women or to their babies.
Currently, the Institute of Medicine recommends that obese women gain no more than 11 to 20 pounds during pregnancy, which is significantly less than the 25- to 35-pound gain recommended for normal-weight women. However, the latest research now suggests that obese women should strive to maintain their weight, or even shed some pounds, since modest weight loss is not associated with any adverse health effects in the mother or the baby.
http://www.acsh.org
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
miércoles, 7 de diciembre de 2011
10 Ways to Succeed with the Lap Band
Here are some helpful tips to help you succeed with the Lap-Band on a long-term basis.
Before you have the Gastric Lap Band:
1. Search for the Right Doctor for You
Many companies or groups claim to be the Best Experts in Lap Band surgery. However, it is important to check the qualifications and experience of your surgeon before making your decision. Find out whether the doctor is a member of any medical organizations and whether they have any experience in bariatric surgery. Make sure to research the company and the Doctor´s credentials, and look into the facilities and medical team. You can also check with the companies that manufacture the lap band products, like Allergan or Johnson & Johnson, to find more recommendations. It is very important to be in the right hands when you have surgery. The experience of your surgeon can make a big difference in your weight loss outcome. Surgery can be life-changing – Don´t play with your health. Look for the right doctor, and not just the cheapest deal.
2. Double-check the Doctor´s Coordinators
Some coordinators will say anything to convince you that their team and services are the best. The personality of the coordinators or the medical team can tell you a lot about the kind of work they do. When talking on the phone, check for signs of aggressiveness, or whether they speak poorly of other bariatric teams or surgeons. If they tell you that they know “everything” about Lap Bands or bariatric surgery, this is probably not true. Take your time to analyze their ethics and professionalism, and keep your ears and eyes open. Be cautious of coordinators that seem too pushy or don´t respect your requests. These coordinators are not looking out for your best interests – they are just looking for your money. Instead, look for coordinators that demonstrate clear communication and professionalism, honesty, friendliness and a helpful and caring attitude.
3. Avoid companies that are just “moving patients through the border”
Some “coordinators” may contact you to promote weight loss surgery without an actual connection to a qualified bariatric surgeon. They may not even work for the Doctor that they are promoting, and are just looking to make money. They do not have your best interests in mind – you are a merchandize for them. They might make promises that they can´t follow through with, and may get any Doctor for your surgery as long as they get paid for arranging things for you. When researching into the company, find out as much as you can about all the details, including any hidden costs or fees. Be sure that you feel confidant and comfortable with the people that you are working with before you make your final decision.
4. Communicate with other Banded Patients
Often, the best source of information is someone that has already gone through the experience before. You can find out answers by asking other people that have had the lap band procedure. Search for online forums, chat rooms, or message boards. Some questions you might ask could be:
What kind of surgical weight loss procedure did they receive?
Was the surgery what they expected?
How did the Doctor and his medical team treat them?
Did they have any complications after surgery?
How long did the surgery process take?
How have they adjusted to life with the lap band?
Did they see the results that they were expecting or hoping for?
How soon did they see results?
Would they recommend their doctor to someone else looking for the same surgery?
After you have the Gastric Lap Band Procedure:
5. Begin the Journey: Develop Good Habits
After Lap Band surgery, you will need to make some changes to your diet and activity. Small actions can results in big changes and lead to successful weight loss with your new lap band. Make sure that you learn about what foods to eat and what foods to avoid after your surgery, and determine if you can make these changes. You will also see better results if you include physical activity in your daily routine. If you are always used to driving in the car or riding the bus, try going for a short walk or getting off the bus earlier. If you do walk, try walking faster. Park your car farther away from where you are going so you can get some extra steps into your day. Use any excuse to move your body, like taking the dogs out or doing some gardening. Do anything that will help you to develop new, healthy habits.
6. Your Lap Band Expectations
Imagine yourself at the end of the “Lap Band Road” and keep Focused on that image. The vast majority of banded patients expect the band to work alone by itself, without changing any of their old habits. But the truth is that you do need to put a lot of energy into yourself and encourage yourself to improve your eating habits and activities in order to each your weight loss goals. The Lap Band is a tool to help you, but it won’t do the job alone. For the best results, you need to be committed to positive change.
7. Find the optimum Lap Band Fill
My advice is to reach a “fill point” where you can keep enjoying the foods you like, while still being able to lose or maintain your weight. Too much tightness or restriction will have you at the border line for being de-banded, and stomach erosion can happen frequently in patients with large fills. Do not compete with the Lap Band by trying to force food to pass through the band. If you feel excessive restriction, visit your doctor to have your band adjusted.
8. Maintain Good Communication with your Doctor
This is the most important of the 10 “keys for success.” Make sure you can reach your Doctor whenever you need him or her. The Bariatric Surgeons and Doctors are different than General Surgeons in the follow-up care.
Don’t hesitate to call your Doctor if you have any of the following symptoms: Heartburn, pain at the port area or in the abdomen, frequent vomiting, difficulty swallowing or reflux.
9. Have a Barium Swallow or an Endoscopy atleast once a year
This can help to indicate the condition of your stomach, esophagus, and the lap band system, including the positioning of the band and port. This may also help to detect any problems earlier, which can allow for more time to solve the problem.
10. Have your Fills done under Fluoroscopy as often as possible
Office fills do not detect early, easily-correctable problems until it may be too late. Slippage and erosion are more frequently seen in patients that have never had follow-ups under fluoroscopy. Check with your Doctor to find out their process for lap band fills – if they only do office fills, ask your Doctor to recommend someone that can provide fills under fluoroscopy for you.
Before you have the Gastric Lap Band:
1. Search for the Right Doctor for You
Many companies or groups claim to be the Best Experts in Lap Band surgery. However, it is important to check the qualifications and experience of your surgeon before making your decision. Find out whether the doctor is a member of any medical organizations and whether they have any experience in bariatric surgery. Make sure to research the company and the Doctor´s credentials, and look into the facilities and medical team. You can also check with the companies that manufacture the lap band products, like Allergan or Johnson & Johnson, to find more recommendations. It is very important to be in the right hands when you have surgery. The experience of your surgeon can make a big difference in your weight loss outcome. Surgery can be life-changing – Don´t play with your health. Look for the right doctor, and not just the cheapest deal.
2. Double-check the Doctor´s Coordinators
Some coordinators will say anything to convince you that their team and services are the best. The personality of the coordinators or the medical team can tell you a lot about the kind of work they do. When talking on the phone, check for signs of aggressiveness, or whether they speak poorly of other bariatric teams or surgeons. If they tell you that they know “everything” about Lap Bands or bariatric surgery, this is probably not true. Take your time to analyze their ethics and professionalism, and keep your ears and eyes open. Be cautious of coordinators that seem too pushy or don´t respect your requests. These coordinators are not looking out for your best interests – they are just looking for your money. Instead, look for coordinators that demonstrate clear communication and professionalism, honesty, friendliness and a helpful and caring attitude.
3. Avoid companies that are just “moving patients through the border”
Some “coordinators” may contact you to promote weight loss surgery without an actual connection to a qualified bariatric surgeon. They may not even work for the Doctor that they are promoting, and are just looking to make money. They do not have your best interests in mind – you are a merchandize for them. They might make promises that they can´t follow through with, and may get any Doctor for your surgery as long as they get paid for arranging things for you. When researching into the company, find out as much as you can about all the details, including any hidden costs or fees. Be sure that you feel confidant and comfortable with the people that you are working with before you make your final decision.
4. Communicate with other Banded Patients
Often, the best source of information is someone that has already gone through the experience before. You can find out answers by asking other people that have had the lap band procedure. Search for online forums, chat rooms, or message boards. Some questions you might ask could be:
What kind of surgical weight loss procedure did they receive?
Was the surgery what they expected?
How did the Doctor and his medical team treat them?
Did they have any complications after surgery?
How long did the surgery process take?
How have they adjusted to life with the lap band?
Did they see the results that they were expecting or hoping for?
How soon did they see results?
Would they recommend their doctor to someone else looking for the same surgery?
After you have the Gastric Lap Band Procedure:
5. Begin the Journey: Develop Good Habits
After Lap Band surgery, you will need to make some changes to your diet and activity. Small actions can results in big changes and lead to successful weight loss with your new lap band. Make sure that you learn about what foods to eat and what foods to avoid after your surgery, and determine if you can make these changes. You will also see better results if you include physical activity in your daily routine. If you are always used to driving in the car or riding the bus, try going for a short walk or getting off the bus earlier. If you do walk, try walking faster. Park your car farther away from where you are going so you can get some extra steps into your day. Use any excuse to move your body, like taking the dogs out or doing some gardening. Do anything that will help you to develop new, healthy habits.
6. Your Lap Band Expectations
Imagine yourself at the end of the “Lap Band Road” and keep Focused on that image. The vast majority of banded patients expect the band to work alone by itself, without changing any of their old habits. But the truth is that you do need to put a lot of energy into yourself and encourage yourself to improve your eating habits and activities in order to each your weight loss goals. The Lap Band is a tool to help you, but it won’t do the job alone. For the best results, you need to be committed to positive change.
7. Find the optimum Lap Band Fill
My advice is to reach a “fill point” where you can keep enjoying the foods you like, while still being able to lose or maintain your weight. Too much tightness or restriction will have you at the border line for being de-banded, and stomach erosion can happen frequently in patients with large fills. Do not compete with the Lap Band by trying to force food to pass through the band. If you feel excessive restriction, visit your doctor to have your band adjusted.
8. Maintain Good Communication with your Doctor
This is the most important of the 10 “keys for success.” Make sure you can reach your Doctor whenever you need him or her. The Bariatric Surgeons and Doctors are different than General Surgeons in the follow-up care.
Don’t hesitate to call your Doctor if you have any of the following symptoms: Heartburn, pain at the port area or in the abdomen, frequent vomiting, difficulty swallowing or reflux.
9. Have a Barium Swallow or an Endoscopy atleast once a year
This can help to indicate the condition of your stomach, esophagus, and the lap band system, including the positioning of the band and port. This may also help to detect any problems earlier, which can allow for more time to solve the problem.
10. Have your Fills done under Fluoroscopy as often as possible
Office fills do not detect early, easily-correctable problems until it may be too late. Slippage and erosion are more frequently seen in patients that have never had follow-ups under fluoroscopy. Check with your Doctor to find out their process for lap band fills – if they only do office fills, ask your Doctor to recommend someone that can provide fills under fluoroscopy for you.
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
martes, 6 de diciembre de 2011
Colon cancer prognosis worse for the obese, type 2 diabetics
Two new studies that looked at the impact that body-mass index (BMI) and a diagnosis of type 2 diabetes had on survival rates after a colon cancer diagnosis found that both factors influence whether or not someone survives colorectal cancer. In addition, both studies found that deaths from any cause, including heart disease, were also increased in those who were obese or had type 2 diabetes.
Results of the studies were published online in the Journal of Clinical Oncology.
"The message here is to avoid obesity and type 2 diabetes because they have negative health outcomes. We don't know for sure that losing weight or increasing physical activity will help, but we know they're good for trying to avoid other diseases, like cardiovascular disease, that can come up down the road," said Dr. Jeffrey Meyerhardt, author of an accompanying editorial in the same journal, and an associate professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School in Boston.
There are more than 1 million people who've survived a colon cancer diagnosis living in the United States, and mortality from colorectal cancer has gone down over the past two decades, according to background information in the studies.
And, while previous research has linked a higher BMI and type 2 diabetes to the development of colorectal cancer in the first place, it hasn't been clear how these factors influence the course of colorectal cancer once someone has been diagnosed.
The first study included 2,303 people involved in an ongoing study that began in 1992. Between that time and 2007, the study participants had been diagnosed with colorectal cancer. Follow-up continued through December 2008.
During the study, 851 people with colorectal cancer died. Of those, 380 died as a result of colorectal cancer, while 153 died of heart disease, according to the study. The remaining 318 people died of other causes.
The risk of all-cause mortality was 30 percent higher for people who were considered obese at the start of the study vs. those of a normal weight. The risk of dying from colorectal cancer was 35 percent higher, and the risk of dying from heart disease was 68 percent higher.
Meyerhardt explained that the researchers tried to adjust the data for important factors, such as physical activity, red meat intake (a known risk factor for colorectal cancer), family history and blood pressure levels. Even after adjusting the data, obesity increased the risk of dying.
"In and of itself, obesity does seem to have some effect," Meyerhardt said.
In the second study, researchers recruited 2,278 people who'd been diagnosed with non-metastatic colon or rectal cancer between 1992 and 2007. In this group, there were 842 deaths. Of those, 377 were from colorectal cancer and 152 were from heart disease, according to the study.
People with type 2 diabetes had a 53 percent higher risk of dying from any cause and a 29 percent higher risk of dying from colorectal cancer compared to people without type 2 diabetes. The risk of dying from heart disease was 2.16 times higher in people with type 2 diabetes and nearly four times higher in people with type 2 diabetes who used insulin, compared with people without type 2 diabetes, the study found.
"Insulin use in type 2 diabetes usually indicates longer-standing diabetes, which is usually associated with worse outcomes," Meyerhardt noted.
Obesity, elevated body-mass index and diabetes are associated with worse disease states across the board," said Dr. David Bernstein, chief of gastroenterology at North Shore University Hospital in Manhasset, N.Y. "But, we don't know if you lose weight if that risk will go down. I don't counsel patients who've been diagnosed with colorectal cancer to lose weight, because weight loss tends to be a worry in people undergoing cancer treatment anyway. I do counsel my patients that haven't been diagnosed with cancer to lose weight. The medical community needs to spend more time counseling prevention."
Meyerhardt added that it's also not clear from these studies whether or not obese people or those with type 2 diabetes would benefit from changes in the treatment they receive for colorectal cancer.
http://yourlife.usatoday.com
Results of the studies were published online in the Journal of Clinical Oncology.
"The message here is to avoid obesity and type 2 diabetes because they have negative health outcomes. We don't know for sure that losing weight or increasing physical activity will help, but we know they're good for trying to avoid other diseases, like cardiovascular disease, that can come up down the road," said Dr. Jeffrey Meyerhardt, author of an accompanying editorial in the same journal, and an associate professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School in Boston.
There are more than 1 million people who've survived a colon cancer diagnosis living in the United States, and mortality from colorectal cancer has gone down over the past two decades, according to background information in the studies.
And, while previous research has linked a higher BMI and type 2 diabetes to the development of colorectal cancer in the first place, it hasn't been clear how these factors influence the course of colorectal cancer once someone has been diagnosed.
The first study included 2,303 people involved in an ongoing study that began in 1992. Between that time and 2007, the study participants had been diagnosed with colorectal cancer. Follow-up continued through December 2008.
During the study, 851 people with colorectal cancer died. Of those, 380 died as a result of colorectal cancer, while 153 died of heart disease, according to the study. The remaining 318 people died of other causes.
The risk of all-cause mortality was 30 percent higher for people who were considered obese at the start of the study vs. those of a normal weight. The risk of dying from colorectal cancer was 35 percent higher, and the risk of dying from heart disease was 68 percent higher.
Meyerhardt explained that the researchers tried to adjust the data for important factors, such as physical activity, red meat intake (a known risk factor for colorectal cancer), family history and blood pressure levels. Even after adjusting the data, obesity increased the risk of dying.
"In and of itself, obesity does seem to have some effect," Meyerhardt said.
In the second study, researchers recruited 2,278 people who'd been diagnosed with non-metastatic colon or rectal cancer between 1992 and 2007. In this group, there were 842 deaths. Of those, 377 were from colorectal cancer and 152 were from heart disease, according to the study.
People with type 2 diabetes had a 53 percent higher risk of dying from any cause and a 29 percent higher risk of dying from colorectal cancer compared to people without type 2 diabetes. The risk of dying from heart disease was 2.16 times higher in people with type 2 diabetes and nearly four times higher in people with type 2 diabetes who used insulin, compared with people without type 2 diabetes, the study found.
"Insulin use in type 2 diabetes usually indicates longer-standing diabetes, which is usually associated with worse outcomes," Meyerhardt noted.
Obesity, elevated body-mass index and diabetes are associated with worse disease states across the board," said Dr. David Bernstein, chief of gastroenterology at North Shore University Hospital in Manhasset, N.Y. "But, we don't know if you lose weight if that risk will go down. I don't counsel patients who've been diagnosed with colorectal cancer to lose weight, because weight loss tends to be a worry in people undergoing cancer treatment anyway. I do counsel my patients that haven't been diagnosed with cancer to lose weight. The medical community needs to spend more time counseling prevention."
Meyerhardt added that it's also not clear from these studies whether or not obese people or those with type 2 diabetes would benefit from changes in the treatment they receive for colorectal cancer.
http://yourlife.usatoday.com
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
viernes, 2 de diciembre de 2011
Obesity in America
ArturoRodriguez, MD
md@thebariatric.comhttp://www.thebariatric.com
http://www.bandstersforum.com
Phone: 011-52-81-8378-3177
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