Archive for the ‘Metabolic Syndrome’ Category


Friday, July 23rd, 2010

According to a recent study in the New England Journal of Medicine,  China has surpassed India as the world’s leader in diabetes.

Over 92 million adults in China are afflicted with type 2 diabetes, a disease primarily related to obesity, high calorie diets and sedentary lifestyle. Yang Wenyng, chairman of endocrinology at the China Japan Friendship Hospital in Beijing, lead a team of researchers studying more than a dozen Chinese hospitals across 2007 and 2008 to determine the prevalence of type 2 diabetes. In addition to their findings that over 92 million Chinese individuals currently suffer with type 2 diabetes, they further report that an estimated 148 million Chinese have pre-diabetes (this is a condition that leads to full blown diabetes and time and is measured by higher than normal circulating blood glucose levels and abnormal glucose tolerance tests).

This study and other reports related to diabetes in China, indicate a massive economic and social toll from the disease. A high toll of early cardiovascular death is expected from the rapid rise in type 2 diabetes across China and poses a major public health problem.

In the United States there are estimated to be around 26 million diabetes sufferers or around 12% of the population. There are many more than this number who are pre-diabetic and will develop diabetes as the years progress. As the epidemic of obesity widens, these numbers will markedly increase over time. Obesity and diabetes are sometimes together refered to as “diabesity” post a major, worldwide, public health challenge.


Wednesday, July 7th, 2010

In a new study released by the University of California, Davis has found a proposed mechanism by which bariatric surgery resolves type 2 diabetes in humans. In the study, a specific line of rats known as the UC Davis type 2 diabetes mellitus rat was studied. A model was created which a surgical procedure that mimics malabsorptive human bariatric surgical procedures was employed in this special group of rats. After the procedure, a dramatic reduction in the onset of type 2 diabetes was noted 120 days later. 78% of the control group rats developed the diabetes as expected while only 38% of the rats that had undergone the surgical procedure developed diabetes.

The researchers described a hypothesis in which two specific hormones are implicated in the resolution of diabetes or the prevention of type 2 diabetes. These two hormones are known as GLP1 (Glucagon- like peptide-1) and PYY (peptide YY). These two hormones have been previously identified and are involved in regulation of insulin secretion and appetite. GLP1 is believed to increase insulin secretion and increase insulin sensitivity in the tissues, which would lead to improvement or resolution- or in this case prevention- of type 2 diabetes.

The study is important in part because some of the findings about blood sugar regulation after weight loss surgery appears to contradict the hypothesis that the phenomenon is purely weight related. While long term studies of gastric banding and gastric bypass demonstrate similar rates of diabetes resolution, short term studies indicate the gastric bypass, a malabsorptive procedure with greater hormonal changes, produces faster and earlier improvements in type 2 diabetes. The explanation for this phenomenon may lie with hormonal changes such as those that occur with GLP-1.

Undoubtedly future studies on these hormones in both animals and humans will shed greater light on the subject and help us understand how and why weight loss surgery exerts is powerful effects. In addition, such studies may lead us to new drugs, pharmaceutical solutions to the problem that will involve drugs that mimic the actions of GLP-1 or block other hormones that create harmful effects and perhaps allow a way to chemically produce the effects of weight loss surgery.

Some researchers in the field of obesity postulate that within ten years we will have a whole array of new drugs that produce some of these effects, but obesity is likely to remain a complex, multi-factorial disease with many psychological, behavioral, genetic and cultural factors that play a role.

Increased Difficulty And Expense In Transporting Obese Patients

Wednesday, March 31st, 2010

The Washington Post recently reported it is becoming increasingly common for paramedics and ambulances to be called upon to transport patients weighing 350 pounds or more. In fact, this has become a daily occurrence. According to the article, every few months patients weighing as much as 600 pounds require emergency transportation.

The super-sized patients require super-sized equipment as well as additional training to avoid injuries among the emergency medical personnel and paramedics. Expensive equipment upgrades have lead paramedic communities to increase their fees for transporting patients who are obese.

I know from my own experiences talking with hospital and emergency medical personnel that back injuries are a serious concern for these workers when transporting obese patients.

It is an increasing problem not only in the paramedic/ambulance situation, but within the hospital itself. A great number of these workers who themselves are often becoming overweight, suffer increased strains and lumbar and cervical spine difficulties as a result of having to lift and transfer heavier and heavier patients. Purchasing expensive equipment upgrades provides only a partial solution, but it does not really solve the day-to-day needs of transferring a patient say from a gurney to a bed. This normally requires human hands and human bodies. With the shortage of personnel, healthcare dollar cutbacks and lower staffing models, there are fewer people available to help with these tasks. More often than not, a two person team will be forced to perform the transfer even if the patient is obese.

Vaccines Not As Effective In Obese People – Using A Longer Needle Helps

Wednesday, March 24th, 2010

A vaccine is most effective when given in the intramuscular position, meaning the vaccine substance and molecules enter the muscle tissue where the immune fighting antibodies can be activated. If the vaccine is simply injected into the subcutaneous fat then it is probably less effective at generating immunity. We have long known that vaccines were less effective in obese individuals, probably as a result of this fact. Now recent studies indicate that vaccines are more effective when a longer needle is used, presumably because the vaccine can enter directly into the muscle tissue and not be wasted in the subcutaneous fat.
It is striking to me that virtually every facet of health and disease is adversely affected by obesity, even preventive efforts such as vaccinations. In this most recent study analyzing the effect of Hepatitis B vaccines, the Baylor College of Medicine researches compared the antibody levels with short needles compared to long needles. The antibody numbers when short needles were used were about half of that when a longer needle is used. The authors note that there already exists a CDC recommendation to use longer needles (usually 1.5-inch long) in obese individuals.

Drinking Sugared Soft Drinks Doubles The Risk Of Pancreatic Cancer

Monday, March 15th, 2010

A recent study out of Singapore, which examined over 60,000 people over the course of fourteen years, found that those subjects who drank two or more sugared soft drinks per week had doubled the risk of developing pancreatic cancer than those who did not.

It is not known why increased soft drink consumption could lead to an increased risk of pancreatic cancer or whether this effect is going to be born out in other studies. Some facts we do know about cancer: many cancers are markedly increased in obesity. Colorectal, breast cancer, endometrial cancer and others double or more than double among obese individuals when compared to normal weight individuals. We know there is an association between soft drink and sugar consumption in obesity, so it stands to reason that some link may exist between the soft drinks and cancer development. Pancreas cancer in particular may be one that has some special sensitivity to the elevations and hormonal surges of insulin, leptin and other hormones associated with carbohydrate consumption and obesity.

Whether some subtle toxin could be present in soda cans or whether there is something specific about the soft drinks as opposed to other sugar drinks like fruit juices remains to be seen.

What is known is that drinking lots of sugared soft drinks is bad for your health. It leads to weight gain and obesity, which increases cancer risks markedly. This latest study is one more, small piece of data that should discourage drinking high carbohydrate soft drinks.

New York Times Article on Food Labels

Tuesday, January 5th, 2010

In an interesting article by Tara Parker-Pope, food labels get a new look. A consumer advocacy group called the Center for Science in the Public Interest proposes giving the standard food labels a makeover. Miss Parker-Pope does a nice job illustrating what the new food labels would look like and itemizes how each of these changes would occur.
The Nutrition Labeling and Education Act passed almost twenty years ago and is the law governing the descriptions that we now read on the foods we buy. Many of us have noted the problems with food labeling and my pet peeve has always been that food producers can still play fast and loose by choosing ridiculously small serving sizes and thus offering a misleading low amount of calories and carbohydrates. The new food labels would put calorie and serving size information in larger type at the top of the label. It would make changes in the ingredient list by separating them with bullets instead of allowing all the ingredients to run together. Similar ingredients would be grouped together and their percentage shown by weight. Miss Parker-Pope notes this would be especially important for sugars including things like sugar, corn syrup, high fructose corn syrup and grape juice from concentrate, all of which are forms of sugar that would be listed under a catch-all heading of sugars. In addition, the new labeling proposal would add the word “high” if a particular food had more than 20% of the daily recommended allowance for fat, sugar, sodium or cholesterol. It would also display the percentage of whole grains contained in the product. The proposed food label would also list the milligrams of caffeine contained in the product.
All in all, the new label makes some improvements. It will highlight the serving size more prominently and make is somewhat less easy to mislead consumers with unrealistically small serving sizes chosen. It is unlikely, however, to end this practice. The recommendations though do make a good deal of sense and highlighting which products are “high” in fat, sugar, sodium and cholesterol may help consumers make better decisions.
These recommendations do make a big assumption that fat, cholesterol, sugar and sodium are all similarly important to highlight and presumably for consumers to reduce or control consumption for these nutrients. It’s not entirely clear that is in fact the case. The best evidence would certainly suggest that calories alone would be the most important thing to highlight and control followed closely by sugars. For some people, especially those with hypertension, controlling sodium also makes sense. Controls on consumed fat and consumed cholesterol may be a bit harder to justify from a scientific basis, but the concept may have some validity. It does confuse body fat and serum cholesterol with consumed fat and consumed cholesterol and the link is not nearly as clear in science as such labeling would suggest.
Nonetheless, I support the proposed labeling makeover for the most part. In my position as head of organizations aimed at combating obesity and preventing childhood obesity, I would like to see greater emphasis placed on highlighting the serving size and preventing food manufacturers from choosing misleading and unrealistically low serving sizes. I would also like to see more emphasis on calories and sugar and less emphasis on consumed fat, cholesterol and caffeine, none of which have anywhere near the kind of impact on obesity and diabetes as calories and sugars.
What are your thoughts?

Should Calories Be Taxed?

Thursday, December 17th, 2009

As we move into unprecedented levels of obesity, diabetes and disease, it is worth asking how the buckling healthcare budgets will manage to suffice in the future. As other aspects of healthcare are examined it must be considered how the social policies could potentially influence or at least finance what will be a huge healthcare burden in the future due to obesity related disease. So with more and more states in the United States lurching towards populations that one-third of which are obese (BMI over 30) how will these societies prepare to pay for unprecedented demand for healthcare for the burgeoning type II diabetes population, increased needs for cardiovascular treatments, CPAP machines, insulin injections, ER visits for stroke and kidney failure and cancer treatments all obesity related.

One proposal that has emerged and as was discussed recently on national public radio on the Diane Rehm Show, is taxation on calories or carbohydrates or some specific nutrients. The logic goes something like this: unprecedented costs arise from obesity. Obesity arises from excess consumption of calories, specifically carbohydrate calories. Therefore taxation on the consumption of these calories may both curb behavior in a healthier direction and lays funds to support the demand for medical services.

Is this just? Is it fair? Does it make sense?

Remission Of Diabetes After Adjustable Gastric Banding Surgery

Thursday, September 17th, 2009

An interesting study just released looks at the long-term remission rates of type 2 diabetes mellitus after laparoscopic adjustable gastric banding.  The study reported by Dr. Samuel Sultan demonstrated that after five years of follow-up 40 percent of previously diabetic patients were now off of all diabetes medicines and had normal blood sugars and normal hemoglobin A1c levels.  In a total of 80 percent of patients the diabetes was improved (as defined by a reduction of diabetes medicine) or was totally resolved.

Not surprisingly the patients in the study who maintained the resolution of their diabetes were the same patients who maintained their weight loss over that time period and who exhibited a greater magnitude of weight loss at the five year mark.

I think what this study says about long-term resolution of diabetes after lap-band surgery is that the key is, in fact maintaining the weight loss for the long-term.  We know that the keys for maintaining that weight loss long-term are committing fully and completely to changing, adapting a new life style, participating in ongoing long-term follow-up with the bariatric surgeons office and continuing to have band fills and adjustments on a regular basis.  We also think that coaching, attendance at a support group and more active participation in activities, such as regular walking groups, contribute to the long-term success that leads to total, long-term resolution of diabetes.

Swine Flu and Obesity

Wednesday, September 16th, 2009

Recently scientists have pointed to some concerning data from the Center of Disease Control in Atlanta, indicating that after swine flu infection, more deaths have occurred in obese individuals than would be expected statistically.  This has led some scientists to opine that overweight or obese individuals may have grater risks when it comes to a serious flu infection.

Based upon the extensive volume of data from many other disease states, it is logical to expect swine flu to carry greater risks for a person who is overweight or obese than a person who has normal weight.  Any adverse health condition must be fought off by the human body with all of its organ systems functioning and coordination to sustain health and rid the body of the disease.

So, if health deterioration has occurred in many other aspects of the body when a new disease strikes, the body is less able to sustain itself and fight off the new problem.  Think of pneumonia (a new infection in the lungs) occurring in an old or disabled person.  This person lacks the strength and robustness of all the organ systems to adequately fight off this disease state that would have been a relatively easy battle in a health twenty-year-old.

This certainly is true for obese individuals facing all kinds of serious illnesses including: cancer, heart disease, diabetes, even an automobile accident or other trauma.  The individual in a car accident who is seriously overweight faces much higher risks because of deconditioning, poor lung function, impaired mechanics of breathing, strains on the heart to pump the blood through the body, liver congestion, kidney impairment and a host of other issues.  All of these other organ problems may have resided under the radar screen until the trauma occurred, but now they serve as an ominous background upon which the disease must play out.  Compared to a normal weight individual, the risks of the body failing to fight off the disease or trauma are significantly higher.

With H1N1 flu, there could also be an immunological affect based upon the increased adipose tissue or fat tissue carried by the individual.  The hormonal changes that we see in obesity (resistance to insulin and leptin along with increased levels of inflammatory cytokines and leptin) could potentially leave the body more vulnerable to attack from the virus.  It might be that these adverse states of relative immune susceptibility only incur a very slight, increased risk of say, one percent over an overweight individual.  If a flu virus like swine flu, afflicts millions of people that one percent increased risk among obese individuals translates to a significant number of victims suffering real and serious consequences from the flu.

Lastly, the findings have increased death rates after swine flu infection among obese individuals could also stem not from a specific cause that is related to the increased fat cells in the body, but rather due to the secondary diseases that we know stem from obesity.  For example: since so many more people with obesity have diabetes and high blood pressure, it is possible that these secondary conditions of obesity are what confers the added risk of swine flu death.  More sophisticated studies that control for these variables would help us understand if indeed that is an independent risk due to obesity and excess fat, above and beyond the associated adverse health conditions of obesity.

What ever the exact cause or mechanism it comes as no surprise that as we head into the swine flu season, overweight and obese individuals face greater risks.

Diabetes and “Radical” Solutions

Thursday, September 10th, 2009

I am occasionally struck by the comments from medical physicians or from people in the health care community who comment that some of what I do to help people lose weight and solve their diabetes is so “radical”. Usually when they say this they are referring to Roux-N-Y-Gastric Bypass surgery, which does involve a fairly permanent rerouting of the stomach and upper intestinal system. Even though the procedure is done with a laparoscopy, or minimally invasive technique, and usually involves a one hour surgery and overnight hospital stay, I certainly agree that it is a major decision to undergo the procedure and not something to be taken lightly.

I am ,however, troubled by the real lack of understanding of the nature of the diseases of both obesity and diabetes among those making this kind of comment. I have even had, for example, people in my office who were considering weight loss surgery and brought along their skeptical spouse or significant other to talk with me. Here I would be, speaking with a person who has tried for decades to lose weight and is now seriously overweight struggling with insulin shots, umpteen medications, severe pain in the spine and weight bearing joints, high blood pressure, breathing difficulties and yet the spouse or significant other would be very discouraging, saying things like, “the surgery is too radical”. I wonder just what solution would be appropriate given the “radical” nature of the disease that is leading to such diminished quality of life for the person in such a dramatic shortening of life span with early onset of these devastating diseases. What we seek in medicine and all health interventions is proportionality wherever possible. This means that we prefer that the treatments, or intervention, be proportional to the seriousness of the disease. For example, radical brain surgery would only be considered appropriate if the disease being treated was a life threatening brain tumor. We would not recommend craniotomy surgery and its attendant risks and recovery time for a less severe brain condition, like say, headaches.

So, is weight loss surgery a proportional treatment for this disease? I would argue that it is quite acceptable in terms of this concept of being proportional, especially when compared to so many other kinds of treatments across the spectrum of so many other diseases. And especially as weight loss surgery has moved increasingly to the minimally invasive and even to the outpatient realm, it has become far less radical than the disease it treats and in many cases cures.

Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

Copyright © 2007-2010 Kent Sasse, M.D. All Rights Reserved.

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