Weighing-Down-America-cover

The costs of obesity

A shocking report.  

"Obesity and excess weight is an expanding health problem for more than 60 percent of Americans, and a new study by Hugh Waters and Ross DeVol finds that it's a tremendous drain on the U.S. economy as well. The total cost to treat health conditions related to obesity—ranging from diabetes to Alzheimer's—plus obesity's drag on attendance and productivity at work exceeds $1.4 trillion annually. That's more than twice what the U.S. spends on national defense. The total, from 2014 data, was equivalent to 8.2 percent of U.S. GDP, and it exceeds the economies of all but three U.S. states and all but 10 countries. The report also highlights how this public health challenge can best be addressed."

Is obesity something that we should be tackling?  My gut (no pun intended) says OMG OF COURSE YES, because we are looking at some very preventable disesases.  Those are some cah-razy numbers.  However, does the pharmaceutical industry care?  I mean:  obesity is Big. Money. 

Read the report:

Weighing-Down-America-cover

http://assets1b.milkeninstitute.org/assets/Publication/ResearchReport/PDF/Weighing-Down-America-WEB.pdf

PAC MAN

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.

PAC MAN

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
 

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.

 

I Want It Now GIF

Do you buy brand-names or generic?

When you go to the pharmacy or big-box retailer do you choose brand-name or off-brand generic over the counter medications and pills even with the same active ingredients?

This kind of thing enthralls me.  I love you NPR. 

Why do people choose what they choose when given the option of the same product in different packaging?  

Some of you are SO. INSISTENT

"I MUST HAVE THIS BRAND!"  

"It is the ONLY ONE!"

I Want It Now GIF
Don't EVEN bring it to crazy-town with mayonnaise.   But we're taking about medication today.

My line of thinking (…when making that choice in the aisle) goes to:

  • Is is *exactly the same?*
  • Does it have the same efficacy?
  • Is the generic brand safe and effective?

When side-by-side store branded pills versus big brands aren't all that different, same active ingredients, similar labeling, the only thing that stands out to many of us is the pricing.  So why do you choose the more expensive product, if you do?

If I am being completely honest, I don't buy off-brand super inexpensive pills from big box retailers like Wal-Mart (…or a Dollar Store, shiver!) because quite frankly I am terrified at the potential of an eighty-eight cent price point and where THAT came from.  It's not that I am a brand snob, but just, no.  I read the packaging of every side-by-side product and if the ingredients match by percentage and you can see the source — I do not mind paying less per pill.

I will admit for some things I have brandsnobbery  (…but even so much less lately and not really. I have even downgraded to generic huge tubs of coffee.  RIP Starbucks at home, entirely.  Thanks to blogging not being so, uh, lucrative, don't quit your dayjobs!)  But not for over the counter medications.  I bought approximately three boxes of generic gas medications, gut-fail medications and the like prior-to and during my trip to Portland last week because of desperation and it worked and kept me from ROTTING ON A PLANE THANK YOU VERY MUCH.

generic tylenol

NPR

Why does anyone buy Bayer aspirin — or Tylenol, or Advil — when, almost always, there's a bottle of cheaper generic pills, with the same active ingredient, sitting right next to the brand-name pills?

Matthew Gentzkow, an economist at the University of Chicago's Booth school, recently tried to answer this question. Along with a few colleagues, Gentzkow set out to test a hypothesis: Maybe people buy the brand-name pills because they just don't know that the generic version is basically the same thing.

"We came up with what is probably the simplest idea you've ever heard of," Gentzkow says. "Let's just look and see if people who are well-informed about these things still pay extra to buy brands."

In other words, do doctors, nurses and pharmacists pay extra for Tylenol instead of acetaminophen, or buy Advil instead of ibuprofen?

Gentzkow and his colleagues looked at a huge dataset of over 66 million shopping trips and found that, "lo and behold, nurses, doctors and pharmacists are much less likely to buy brands than average consumers," Gentzkow says. (Their findings are written up here.)

Pharmacists, for example, bought generics 90 percent of the time, compared with about 70 percent of the time for the overall population. "In a world where everyone was as well-informed as pharmacist or nurse, the market share of the brands would be much, much smaller than it is today," Gentzkow says.

I asked several people who had a bottle of Bayer or Tylenol or Advil at home why they'd bought the brand name. One guy told me he didn't want his wife to think he was cheap. A woman told me Bayer reminded her of her grandmother. Another guy, a lawyer, said he just didn't want to spend the time to figure it out, and decided it was worth the extra couple bucks to buy the brand.

In general, we often buy brands when we lack information — when, like that lawyer, we decide it's easier to spend the extra money rather than try to figure out what's what.

Jesse Shapiro, one of the co-authors of the headache paper, told me he buys Heinz ketchup rather than the generic brand. He likes Heinz. He thinks it's better than the generic, but he's not sure. "I couldn't promise that, if you blindfolded me, I could tell them apart," he says.

980071_10200430861668742_162013876_o

Ow. WADA Test and I thought I’d at least get dinner before you stuck a needle where?

Yesterday at early-o-clock I went into Boston in preparation for my WADA testing.  This test (like I explained before…) checks the effects of putting the halves of my brain to sleep each side at a time in preparation for eventual epilepsy surgery to remove a section of brain that is suspect for seizure trigger.

The WADA –

The test begins with an angiogram, a test that examines the flow of a dye through the blood vessels. A thin plastic tube (catheter) is introduced through an artery in the inner portion of the upper thigh. A local anesthetic is given to numb the area, and a needle is then inserted into the artery. The tube is threaded through the needle, and the needle is removed. There is some mild discomfort during the local anesthesia, but the rest of the test is painless. The tube is guided up to the carotid artery in the neck. A small amount of contrast dye is injected through the tube into the artery, and x-rays are taken to study the flow of blood in the brain. Some warmth or flashing lights may be experienced with the injection of the dye. Next, the radiologist injects the amobarbital, which quite literally puts almost half of the cerebral hemisphere to sleep for several minutes.

Immediately after the amobarbital injection, tests are given to see how well language and memory are working with half of the brain sleeping. This provides information on the functions of the cerebral hemisphere that is sleeping and the hemisphere that is awake. The same procedure is usually repeated on the opposite side after a delay to ensure that the patient’s level of alertness has returned to normal. 

980071_10200430861668742_162013876_o
Soon after reaching the hospital, I got on my fancy headgear (EEG) to measure brain activity and then spent many hours WAITING for the test.

And waiting.  And waiting.  And waiting. 

Which was fine, because then this happened, while totally awake –


Tumblr_inline_mjynl9Regu1qz4rgp

Let me tell you – in everything I read prior to this procedure I was AWARE that I would be awake and functioning during the test. I knew that I would "feel" it. I knew that it was only local anesthetic.

BUT HOLY HELL.

Tumblr_mdosl3vVmx1qi6ke5o2_500
That first part (as shown in the video…) hurt like a bitch. The only way I could describe it, because my outer skin was numbed, and I was totally non-sedated – was a spinal tap. I've had MANY of those. It was the creepiest, crawliest, burniest, leg-crampiest, GET OUT OF MY HIP WITH THAT GOD DAMNED NEEDLE YOU MOTHERFUCKER feeling, EVER.

I cringed, winced, bit my lip, at one juncture there was a tear – and I was told not to move.  I have been sick with allergies and was trying NOT to cough because if that NEEDLE MOVED — I was thinking I would knick something and bleed to death.  The EEG tech came over after the procedure was over and said that I made him cringe a little, I think he had a camera over my facial expressions.I was not prepared for pain.  I was prepared for discomfort.  However, it passed as soon as the radiologist got through the hip area and threaded the wires past the bony area of ME.  I did not feel any actual pain from the wires/tube after that, I only felt creepy/crawlies from the tiny tube later on.

Once the wire/tube was in place at the brain artery – I was dosed with medications – repeatedly – this doctor explains it very, very well… listen — EXCEPT - 

You watched it right? You understand what was *SUPPOSED TO HAPPEN?  Brains go to sleeps! Listen to it if you did not.  I will wait.

What do you THINK happened because I am BETH and nothing is ever simple?  Neurology nurses might know.  

That's the next post.  I'm waiting on the doctor to call with what we do next because Beth is very special.  

After weight-loss surgery, new gut bacteria keep obesity away?

ENTHRALLING –

New York Times

The research also suggests that a popular weight-loss operation, gastric bypass, which shrinks the stomach and rearranges the intestines, seems to work in part by shifting the balance of bacteria in the digestive tract. People who have the surgery generally lose 65 percent to 75 percent of their excess weight, but scientists have not fully understood why.

Now, the researchers are saying that bacterial changes may account for 20 percent of the weight loss.

The findings mean that eventually, treatments that adjust the microbe levels, or “microbiota,” in the gut may be developed to help people lose weight without surgery, said Dr. Lee M. Kaplan, director of the obesity, metabolism and nutrition institute at the Massachusetts General Hospital, and an author of a study published Wednesday in Science Translational Medicine.

Not everyone who hopes to lose weight wants or needs surgery to do it, he said. About 80 million people in the United States are obese, but only 200,000 a year have bariatric operations.

“There is a need for other therapies,” Dr. Kaplan said. “In no way is manipulating the microbiota going to mimic all the myriad effects of gastric bypass. But if this could produce 20 percent of the effects of surgery, it will still be valuable.”

In people, microbial cells outnumber human ones, and the new studies reflect a growing awareness of the crucial role played by the trillions of bacteria and other microorganisms that live in their own ecosystem in the gut. Perturbations there can have profound and sometimes devastating effects.

One example is infection with a bacterium called C. difficile, which sometimes takes hold in people receiving antibiotics for other illnesses. The drugs can wipe out other organisms that would normally keep C. difficile in check. Severe cases can be life-threatening, and the medical profession is gradually coming to accept the somewhat startling idea that sometimes the best therapy is a fecal transplant — from a healthy person to the one who is sick, to replenish the population of “good germs.”

Dr. Kaplan said his group’s experiments were the first to try to find out if microbial changes could account for some of the weight loss after gastric bypass. Earlier studies had shown that the microbiota of an obese person changed significantly after the surgery, becoming more like that of someone who was thin. But was the change from the surgery itself, or from the weight loss that followed the operation? And did the microbial change have any effects of its own?

Because it would be difficult and time-consuming to study these questions in people, the researchers used mice, which they had fattened up with a rich diet. One group had gastric bypass operations, and two other groups had “sham” operations in which the animals’ intestines were severed and sewn back together. The point was to find out whether just being cut open, without having the bypass, would have an effect on weight or gut bacteria. One sham group was kept on the rich food, while the other was put on a weight-loss diet.

In the bypass mice, the microbial populations quickly changed, and the mice lost weight. In the sham group, the microbiota did not change much — even in those on the weight-loss diet.

Next, the researchers transferred intestinal contents from each of the groups into other mice, which lacked their own intestinal bacteria. The animals that received material from the bypass mice rapidly lost weight; stool from mice that had the sham operations had no effect.

Exactly how the altered intestinal bacteria might cause weight loss is not yet known, the researchers said. But somehow the microbes seem to rev up metabolism so that the animals burn off more energy.

A next step, Dr. Kaplan said, may be to take stool from people who have had gastric bypass and implant it into mice to see if causes them to lose weight. Then the same thing could be tried from person to person.

“In addition, we’ve identified four subsets of bacteria that seem to be most specifically enhanced by the bypass,” Dr. Kaplan said. “Another approach would be to see if any or all of those individual bacteria could mediate the effects, rather than having to transfer stool.”

A second study by a different group found that overweight people may be more likely to harbor a certain type of intestinal microbe. The microbes may contribute to weight gain by helping other organisms to digest certain nutrients, making more calories available. That study was published Tuesday in the Journal of Clinical Endocrinology & Metabolism.

The study involved 792 people who had their breath analyzed to help diagnose digestive orders. They agreed to let researchers measure the levels of hydrogen and methane; elevated levels indicate the presence of a microbe called Methanobrevibacter smithii. The people with the highest readings on the breath test were more likely to be heavier and have more body fat, and the researchers suspect that the microbes may be at least partly responsible for their obesity.

This type of organism may have been useful thousands of years ago, when people ate moreroughage and needed all the help they could get to squeeze every last calorie out of their food. But modern diets are much richer, said an author of the study, Dr. Ruchi Mathur, director of the diabetes outpatient clinic at Cedars-Sinai Medical Center in Los Angeles.

“Our external environment is changing faster than our internal one,” Dr. Mathur said. Studies are under way, she said, to find out whether getting rid of this particular microbe will help people lose weight.

Bariatric surgery for diabetes tops innovation rankings

Cleveland Clinic announced its list of Top 10 Medical Innovations that will have a major impact on improving patient care within the next year. The list of breakthrough devices and therapies was selected by a panel of Cleveland Clinic physicians and scientists and announced today during Cleveland Clinic’s 2012 Medical Innovation Summit.

And, number one —

Via Cleveland Clinic

1. Bariatric Surgery for Control of Diabetes 
Exercise and diet alone are not effective for treating severe obesity or Type 2 diabetes. Once a person reaches 100 pounds or more above his or her ideal weight, losing the weight and keeping it off for many years almost never happens.

While the medications we have for diabetes are good, about half of the people who take them are not able to control their disease. This can often lead to heart attack, blindness, stroke, and kidney failure.

Surgery for obesity, often called bariatric surgery, shrinks the stomach into a small pouch and rearranges the digestive tract so that food enters the small intestine at a later point than usual.

Over the years, many doctors performing weight-loss operations found that the surgical procedure would rid patients of Type 2 diabetes, oftentimes before the patient left the hospital.

Many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes —and not as a last resort.