EXTRA EDITION “BARIATRIC SURGERY REVISITED, A FURTHER IN DEPTH ANALYSIS”


A good friend and wise philosopher Walter E. Kurtz.
A good friend and wise philosopher Walter E. Kurtz.

Kurtz: [intercepted radio message] I watched a snail crawl along the edge of a straight razor. That’s my dream; that’s my nightmare. Crawling, slithering, along the edge of a straight razor… and surviving. (Apocalypse Now).

That is what obesity is like, “Crawling slithering along the edge of straight razor… and surviving.” The thinner we get the greater the likelihood of a longer survival. Obesity is in all its myriad forms an insidious disease not to be embraced, ignored, or accepted as the status quo!

According to an article published, in the pamphlet Bariatric and Metabolic Surgery, the “body works to defend it set point, dieting and exercising are rarely effective in helping people with obesity achieve and maintain a healthy weight long-term. When you go on a diet, your body thinks it’s being starved and its survival instincts kick in. As a result, your body stores energy rich body fat, and you can’t lose weight easily. A landmark Swedish study found that, on average, a 200-pound patient fighting obesity with diet and exercise alone would only be able to achieve a sustained weight loss of 4 pounds over 20 years.

7697a0b6872b4d965225c2de2d6e0919When weight is lost, lower body fat levels trigger hormones that encourage the body to get back to its previous weight set-point. The New England Journal of Medicine study showed that while dieters may initially lose weight, their bodies change levels of hormones that encourage weight gain in response to the weight-loss. These hormones increased appetite, decrease feelings of fullness, and slow down metabolism. This study also found that these hormones had not returned to create diet levels even 12 months after the initial weight loss, meaning their bodies were still encouraging  weight regain a year after they stopped dieting. This is a powerful defense mechanism and may explain why the majority of weight-loss attempts fail.

95% of obese people who lose weight with a rigorous weight loss program will regain the weight (or more) within 2 to 5 years. ” (1)

Therefore, all dear fellow travelers this leads us once again to revisit the option to have bariatric surgery. Most insurance and Medicare will cover approved mainstream surgeries if you have a BMI  ≥ to 35 with two comorbid factors e. g. elevated blood pressure, type 2 diabetes, high cholesterol etc. or a BMI  ≥  40 without comorbid factors.

Our Gazette namesake. He approves most heartily.
Our Gazette namesake. He approves most heartily.

As you already know, if you are an august reader of this splendid piece of yellow journalism, the Captain had a sleeve gastrectomy performed November 24, 2014. I am six months out and cannot recommend the surgery enough. Before surgery, I weighed 305 pounds at my heaviest. I lost 64 pounds before surgery but still decided to go ahead with it. Post-surgery I have lost another 52 pounds to date. I now weigh 189 pounds as of this writing and of course am still losing weight. Therefore, when you do the math weight-loss post-surgery in percentage is 17% and that is in just six months’ time! This surgery is most efficacious beating diet alone, diet pills, and all-sundry weight-loss programs.

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Endoscopic view of a sleeve gastrectomy in progress.

As the Captain has said so many times before, this surgery is painless. In the hands of a skilled U.S. or British surgeon with computer assist, you cannot miss. The surgery itself takes about 3 hours; recovery from anesthesia varies. With the gastric sleeve, you are up and walking the same day. I was roaming the halls of the hospital with absolutely no problem, no pain pills, and no pain. It is an overnight stay with this surgery.

I knew I needed a tool that would put the brakes on my bad behavior having lost the ability to binge and starve. That tool was a sleeve gastrectomy. My bad behavior started as a teenager but the weight only caught up with me when I hit my forties then the weight slowly crept up to 305 pounds at the age of 64. I have been on the thin side most of my life. It was quite a shock to see a fat, morbidly obese blob in the mirror.

Besides high cholesterol, high triglycerides, shortness of breath with exertion, and elevated blood pressure, I was an inveterate binge eater. Three weaknesses were sandwiches, pizza, and double portions for dinner. I could eat half-pound sandwiches or a large pizza without any problem, double portions I expected it. These problems do not magically disappear however, I still order pizza but can only consume two slices as to the sandwiches I have virtually given them up, they are too hard for me to consume and the double portions forget about it. Portion size is now totally controlled by the size of my sleeve. I can consume approximately 4 to 6 ounces of food at a sitting comfortably if I go over that I become terribly uncomfortable. Another problem I have is eating too fast and not allowing myself to feel full. This again is taken care by the sleeve size; it physically metes out the punishment for my indiscretion by making me feel full before I have even finished my 6 ounces of food. That said, my eating behaviors have dramatically improved and I am definitely on the road to recovery.

Again a good line bears repeating and repeating often, “95% of obese people who lose weight with a rigorous weight loss program will regain the weight (or more) within 2 to 5 years.” (1)

The Captain highly recommends the last section of this article on the misconceptions concerning gastric surgery. It will enlighten and disabuse any and all of the untruths that are bandied about by the unknowing to the unknowing.

We shall now move on to the three main types of bariatric surgery, taken from the American Society for Metabolic and Bariatric Surgery, ASMBS,  that are usually covered by Medical Insurance.

Gastric Bypass

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery and is the most commonly performed bariatric procedure worldwide.

The Procedure

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Roux-en-Y Gastric Bypass. Click to enlarge

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Advantages

  1. Produces significant long-term weight loss (60 to 80 percent excess weight loss)
  2. Restricts the amount of food that can be consumed
  3. May lead to conditions that increase energy expenditure
  4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety
  5. Typical maintenance of >50% excess weight loss

Disadvantages

  1. Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates
  2. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate
  3. Generally has a longer hospital stay than the AGB
  4. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

The Procedure

Laparoscopic Sleeve Gastrectomy. Click to enlarge
Laparoscopic Sleeve Gastrectomy. Click to enlarge

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to reduce significantly the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Short-term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

  1. Restricts the amount of food the stomach can hold
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
  4. Involves a relatively short hospital stay of approximately 2 days
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages

  1. Is a non-reversible procedure
  2. Has the potential for long-term vitamin deficiencies

Adjustable Gastric Band

The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.

The Procedure

 Adjustable Gastric Band. Click to enlarge
Adjustable Gastric Band.
Click to enlarge

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged. Studies show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed, as it would be normally.

The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.

Advantages

  1. Reduces the amount of food the stomach can hold
  2. Induces excess weight loss of approximately 40 – 50 percent
  3. Involves no cutting of the stomach or rerouting of the intestines
  4. Requires a shorter hospital stay, usually less than 24 hours, with some centers discharging the patient the same day as surgery
  5. Is reversible and adjustable
  6. Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures
  7. Has the lowest risk for vitamin/mineral deficiencies

Disadvantages

  1. Slower and less early weight loss than other surgical procedures
  2. Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed
  3. Requires a foreign device to remain in the body
  4. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients
  5. Can have mechanical problems with the band, tube or port in a small percentage of patients
  6. Can result in dilation of the esophagus if the patient overeats
  7. Requires strict adherence to the postoperative diet and to postoperative follow-up visits
  8. Highest rate of re-operation (2)

Bariatric Surgery Misconceptions

Misconception: Most people who have metabolic and bariatric surgery regain their weight.

Truth:

As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight-loss long-term. ‘Successful’ weight-loss is arbitrarily defined as weight-loss equal to or greater than 50 percent of excess body weight. Often, successful results are determined by the patient, by their perceived improvement in quality of life. In such cases, the total retained weight-loss may be more, or less, than this arbitrary definition. Such massive and sustained weight reduction with surgery is in sharp contrast to the experience most patients have previously had with non-surgical therapies.

Misconception: The chance of dying from metabolic and bariatric surgery is more than the chance of dying from obesity.

Truth:

As your body size increases, longevity decreases. Individuals with severe obesity have a number of life-threatening conditions that greatly increase their risk of dying, such as type 2 diabetes, hypertension and more. Data involving nearly 60,000 bariatric patients from ASMBS Bariatric Centers of Excellence database show that the risk of death within the 30 days following bariatric surgery averages 0.13 percent, or approximately one out of 1,000 patients. This rate is considerably less than most other operations, including gallbladder and hip replacement surgery. Therefore, in spite of the poor health status of bariatric patients prior to surgery, the chance of dying from the operation is exceptionally low. Large studies find that the risk of death from any cause is considerably less for bariatric patients throughout time than for individuals affected by severe obesity who have never had the surgery. In fact, the data show up to an 89 percent reduction in mortality, as well as highly significant decreases in mortality rates due to specific diseases. Cancer mortality, for instance, is reduced by 60 percent for bariatric patients. Death in association with diabetes is reduced by more than 90 percent and that from heart disease by more than 50 percent. Also, there are numerous studies that have found improvement or resolution of life-threatening obesity-related diseases following bariatric surgery. The benefits of bariatric surgery, with regard to mortality, far outweigh the risks. It is important to note that as with any serious surgical operation, the decision to have bariatric surgery should be discussed with your surgeon, family members and loved ones.

Misconception: Surgery is a ‘cop-out’. To lose and maintain weight, individuals affected by severe obesity just need to go on a diet and exercise program.

Truth:

Individuals affected by severe obesity are resistant to long-term weight-loss by diet and exercise. The National Institutes of Health Experts Panel recognize that ‘long-term’ weight-loss, or in other words, the ability to ‘maintain’ weight-loss, is nearly impossible for those affected by severe obesity by any means other than metabolic and bariatric surgery. Bariatric surgeries are effective in maintaining long-term weight-loss, in part, because these procedures offset certain conditions caused by dieting that are responsible for rapid and efficient weight regain following dieting. When a person loses weight, energy expenditure (the amount of calories the body burns) is reduced. With diet, energy expenditure at rest and with activity is reduced to a greater extent than can be explained by changes in body size or composition (amount of lean and fat tissue). At the same time, appetite regulation is altered following a diet increasing hunger and the desire to eat. Therefore, there are significant biological differences between someone who has lost weight by diet and someone of the same size and body composition to that of an individual who has never lost weight. For example, the body of the individual who reduces their weight from 200 to 170 pounds burns fewer calories than the body of someone weighing 170 pounds and has never been on a diet. This means that, in order to maintain weight-loss, the person who has been on a diet will have to eat fewer calories than someone who naturally weighs the same. In contrast to diet, weight-loss following bariatric surgery does not reduce energy expenditure or the amount of calories the body burns to levels greater than predicted by changes in body weight and composition. In fact, some studies even find that certain operations even may increase energy expenditure. In addition, some bariatric procedures, unlike diet, also causes biological changes that help reduce energy intake (food, beverage). A decrease in energy intake with surgery results, in part, from anatomical changes to the stomach or gut that restrict food intake or cause malabsorption of nutrients. In addition, bariatric surgery increases the production of certain gut hormones that interact with the brain to reduce hunger, decrease appetite, and enhance satiety (feelings of fullness). In these ways, bariatric and metabolic surgery, unlike dieting, produces long-term weight-loss.

Misconception: Many bariatric patients become alcoholics after their surgery.

Truth:

Actually, only a small percentage of bariatric patients claim to have problems with alcohol after surgery. Most (but not all) who abuse alcohol after surgery had problems with alcohol abuse at some period of time prior to surgery. Alcohol sensitivity, (particularly if alcohol is consumed during the rapid weight-loss period), is increased after bariatric surgery so that the effects of alcohol are felt with fewer drinks than before surgery. Studies also find with certain bariatric procedures (such as the gastric bypass or sleeve gastrectomy) that drinking an alcoholic beverage increases blood alcohol to levels that are considerably higher than before surgery or in comparison to the alcohol levels of individuals who have not had a bariatric procedure. For all of these reasons, bariatric patients are advised to take certain precautions regarding alcohol:

  • Avoid alcoholic beverages during the rapid weight-loss period
  • Be aware that even small amounts of alcohol can cause intoxication
  • Avoid driving or operating heavy equipment after drinking any alcohol
  • Seek help if drinking becomes a problem

If you feel the consumption of alcohol may be an issue for you after surgery, please contact your primary care physician or bariatric surgeon and discuss this further. They will be able to help you identify resources available to address any alcohol-related issues.

Misconception: Surgery increases the risk for suicide.

Truth:

Individuals affected by severe obesity who are seeking bariatric and metabolic surgery are more likely to suffer from depression or anxiety and to have lower self-esteem and overall quality of life than someone who is normal weight. Bariatric surgery results in highly significant improvement in psychosocial well-being for the majority of patients. However, there remain a few patients with undiagnosed preexisting psychological disorders and still others with overwhelming life stressors who commit suicide after bariatric surgery. Two large studies have found a small but significant increase in suicide occurrence following bariatric surgery. For this reason, comprehensive bariatric programs require psychological evaluations prior to surgery and many have behavioral therapists available for patient consultations after surgery.

Misconception: Bariatric patients have serious health problems caused by vitamin and mineral deficiencies.

Truth:

Bariatric operations can lead to deficiencies in vitamins and minerals by reducing nutrient intake or by causing reduced absorption from the intestine. Bariatric operations vary in the extent of malabsorption they may cause, and vary in which nutrients may be affected. The more malabsorptive bariatric procedures also increase the risk for protein deficiency. Deficiencies in micronutrients (vitamin and minerals) and protein can adversely affect health, causing fatigue, anemia, bone and muscle loss, impaired night vision, low immunity, loss of appropriate nerve function and even cognitive defects. Fortunately, nutrient deficiencies following surgery can be avoided with appropriate diet and the use of dietary supplements, i.e. vitamins, minerals, and, in some cases, protein supplements. Nutrient guidelines for different types of bariatric surgery procedures have been established by the ASMBS Nutritional Experts Committee and published in the journal, Surgery for Obesity and Other Related Disorders. Before and after surgery, patients are advised of their dietary and supplement needs and followed by a nutritionist with bariatric expertise. Most bariatric programs also require patients to have their vitamins and minerals checked on a regular basis following surgery. Nutrient deficiencies and any associated health issues are preventable with patient monitoring and patient compliance in following dietary and supplement (vitamin and mineral) recommendations. Health problems due to deficiencies usually occur in patients who do not regularly follow-up with their surgeon to establish healthy nutrient levels.

Misconception: Obesity is only an addiction, similar to alcoholism or drug dependency.

Truth:

Although there is a very small percentage of individuals affected by obesity who have eating disorders, such as binge eating disorder syndrome, that may result in the intake of excess food (calories), for the vast majority of individuals affected by obesity, obesity is a complex disease caused by many factors. When treating addiction, such as alcohol and drugs, one of the first steps is abstaining from the drugs or alcohol. This approach does not work with obesity as we need to eat to live. Additionally, there may be other issues affecting an individual’s weight, such as psychological issues. Weight gain generally occurs when there is an energy imbalance or, in other words, the amount of food (energy) consumed is greater than the number of calories burned (energy expended) by the body in the performance of biological functions, daily activities and exercise. Energy imbalance may be caused by overeating or by not getting enough physical activity and exercise. There are other conditions, however, that affect energy balance and/or fat metabolism that do not involve excessive eating or sedentary behavior including:

  • Chronic sleep loss
  • Consumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat (sugar, high fructose corn syrup, trans fat, processed meats and processed grains)
  • Low intake of fat-fighting foods (fruits, vegetables, legumes, nuts, seeds, quality protein)
  • Stress and psychological distress
  • Many types of medications
  • Pollutants

Obesity also ‘begets’ obesity, which is one of the reasons why the disease is considered ”progressive.” Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation and obesity. Such obesity-associated changes reduce fat utilization, increase the conversion of sugar to fat, and enhance the body’s capacity to store fat by increasing fat cells size and numbers and by reducing fat breakdown. Such defects in fat metabolism mean that more of the calories consumed are stored as fat. To make matters worse, obesity affects certain regulators of appetite and hunger in a manner that can cause an increase in the amount of food eaten at any given meal and the desire to eat more often. There are many causes for obesity and that the disease of obesity is far more than just an ‘addiction’ toward food. The treatment of obesity solely as an addiction may be beneficial for a very small percentage of individuals whose only underlying cause for obesity is excessive and addictive eating, but would be unlikely to benefit the multitudes, particularly those individuals affected by severe obesity. (3)

Dear readers, if you have read this far, the Captain would be most heartened if you would rate this and future articles and/or leave a comment at the top of the blog posts whether positive or negative. In this way, “The Fat Bastard Gazette” may better serve you and our entire readership.


  1.  (Bariatric and Metabolic Surgery, 2012)
  2.  (ASMBS, 2015)
  3.  (ASMBS, 2015)

ASMBS. (2015). Bariatric Surgery Misconceptions. Retrieved May 29, 2015, from ASMBS American Society for Metabolic and Bariatric Surgery: http://asmbs.org/patients/bariatric-surgery-misconceptions

ASMBS. (2015). Bariatric Surgery Procedures. Retrieved May 29, 2015, from ASMBS American Society for Metabolic and Bariatric Surgery: http://asmbs.org/patients/bariatric-surgery-procedures

Bariatric and Metabolic Surgery. (2012). Bariatric and Metabolic Surgery. Ethicon.

 

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

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WHAT HAPPENS TO THE ENDOCRINE SYSTEM WHEN YOU SKIP MEALS. TAKE HEED CAPTAIN, TAKE HEED!


insulingraphic
Click to enlarge

A study of mice, posted in the Journal of Nutritional Biochemistry, led researchers, including members of Ohio State University, Columbus, Ohio, to the possible conclusion that skipping meals triggers a series of metabolic missteps that can result in abdominal weight gain.

“In the study, mice that ate all of their food as a single meal and fasted the rest of the day developed insulin resistance in their livers – which scientists consider a telltale sign of prediabetes. When the liver doesn’t respond to insulin signals telling it to stop producing glucose, that extra sugar in the blood is stored as fat.”

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The insulin resistant mice were first put on a calorie- restricted diet and lost weight compared to control mice that had unlimited access to food. The calorie-restricted diet mice regained weight as more food was added back to their diet, catching up to the control mice at the end of the study.

However, the fat around their abdomen—the equivalent to human belly fat – weighed more  in the mice that had the restricted diet than in the control mice who were free to eat all day long.

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Martha Belury

“This does support the notion that small meals throughout the day can be helpful for weight loss, though that may not be practical for many people,” said Martha Belury, professor of human nutrition at The Ohio State University and senior author of the study. “But you definitely don’t want to skip meals to save calories because it sets your body up for larger fluctuations in insulin and glucose and could be setting you up for more fat gain instead of fat loss.”

Belury and fellow researchers were able to correlate their findings to many people who skipped meals – based on previous work — in the mice on the calorie-restricted diets. These mice, for three days, ate half the calories that were eaten daily by the control mice. Food was added daily so that by day six the mice received the same quantity of food.

The mice on the calorie-restricted diets developed gorging behavior that continued throughout the study, meaning they finished their amount of food in about four hours and then ended up fasting for the next 20 hours.

“With the mice, this is basically bingeing and then fasting,” Belury said. “People don’t necessarily do that over a 24-hour period, but some people do eat just one large meal a day.”

funny-fat-people-pictures“The gorging and fasting in these mice affected a host of metabolic measures that the researchers attributed to a spike and then severe drop in insulin production. In mice that gorged and then fasted, the researchers saw elevations in inflammation, higher activation of genes that promote storage of fatty molecules and plumper fat cells – especially in the abdominal area – compared to the mice that nibbled all day.”

The researchers used a refined technique to check for insulin resistance assessing glucose production. The liver puts out glucose when it receives messages that insulin levels are low, as when people sleep the liver supplies glucose to the brain. However, the production of glucose stops after eating a meal. The pancreas then releases insulin and the insulin binds to cell receptors on the cell pushing the glucose that is in the bloodstream, through facilitated diffusion (a passive process ) or actively transporting (requiring energy)  the glucose, into the cells for energy absorption.

Belury et al. found glucose remained in the blood of mice that gorged and fasted. This meant that the liver was ignoring the insulin message.

IS-vs-IR
Click to enlarge

“Under conditions when the liver is not stimulated by insulin, increased glucose output from the liver means the liver isn’t responding to signals telling it to shut down glucose production,” Belury said. “These mice don’t have type 2 diabetes yet, but they’re not responding to insulin anymore and that state of insulin resistance is referred to as prediabetes.”

Gaining abdominal fat, white fat tissue, which stores energy, also increases the risk of insulin resistance.

“Even though the gorging and fasting mice had about the same body weights as control mice, their adipose (fat) depots (a place where body products not actively involved in metabolic processes are accumulated, deposited, or stored) were heavier. If you’re pumping out more sugar into the blood, adipose is happy to pick up glucose and store it. That makes for a happy fat cell – but it’s not the one you want to have. We want to shrink these cells to reduce fat tissue,” Belury said.


Short-term food restriction followed by controlled refeeding promotes gorging behavior, enhances fat deposition, and diminishes insulin sensitivity in mice, Kara L. Kliewer, et al., The Journal of Nutritional Biochemistry, doi:10.1016/j.jnutbio.2015.01.010, published online 14 March 2015, abstract.

The Ohio State University news release, accessed 21 May 2015.

 

 

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

CRISPR technology to treat human genetic disease, A Brave New World? VOL.1 NO.28


Aldous Huxley
Aldous Huxley

“One believes things because one has been conditioned to believe them.”

“…most men and women will grow up to love their servitude and will never dream of revolution.”

“No social stability without individual stability.”

“Most human beings have an almost infinite capacity for taking things for granted.”

“The Savage interrupted him. “But isn’t it natural to feel there’s a God?”

“You might as well ask if it’s natural to do up one’s trousers with zippers,” said the Controller sarcastically. “You remind me of another of those old fellows called Bradley. He defined philosophy as the finding of bad reason for what one believes by instinct. As if one believed anything by instinct! One believes things because one has been conditioned to believe them. Finding bad reasons for what one believes for other bad reasons–that’s philosophy. People believe in God because they’ve been conditioned to.”

― All quotes Aldous Huxley, Brave New World

“A group of 18 scientists and ethicists today warned that a revolutionary new tool to cut and splice DNA should be used cautiously when attempting to fix human genetic disease, and strongly discouraged any attempts at making changes to the human genome that could be passed on to offspring” (Sanders, 2015).

“Among the authors of this warning is Jennifer Doudna, the co-inventor of the technology, called CRISPR-Cas9, which is driving a new interest in gene therapy, or “genome engineering.” She and colleagues co-authored a perspective piece that appears in the March 20 issue of Science, based on discussions at a meeting that took place in Napa on Jan. 24. The same issue of Science features a collection of recent research papers, commentary and news articles on CRISPR and its implications” (Sanders, 2015).

The bacterial enzyme Cas9 is the engine of RNA-programmed genome engineering in human cells. (Graphic by Jennifer Doudna/UC Berkeley)
The bacterial enzyme Cas9 is the engine of RNA-programmed genome engineering in human cells. (Graphic by Jennifer Doudna/UC Berkeley)

“Given the speed with which the genome engineering field is evolving, our group concluded that there is an urgent need for open discussion of the merits and risks of human genome modification by a broad cohort of scientists, clinicians, social scientists, the general public and relevant public entities and interest groups,” the authors wrote.” (Sanders, 2015).

William Shakespeare
William Shakespeare

“The lady doth protest too much, methinks.” (Hamlet Act 3, scene 2, 230). Yes indeed, the Captain does think that Jennifer Doudna and cohorts protest too much. Does one think with a technology called CRISPR-CS9, acronym for clustered regularly interspaced short palindromic repeats-Cas system9 (Cas9 protein), commercially available since 2013, that it will not be used to edit select sections of embryonic human DNA? One need only type in CRISPER –CS 9 and a myriad of bio labs pop up, offering their services to mutate genetically any living thing you have short of a human sample. Do Doudna et al. honestly believe that any or all-sundry bio labs will not eventually tinker with the entire human genome? Some rogue or rogue state, including China, Iran, Pakistan etc.; will try to do it with an extremely good chance of success.

Here is update fellow travelers. According to The New York Times of April 24, 2015 The Chinese have tried to edit the genes of a human embryo without success.

The experiment was unsuccessful in ways that had been foretold by scientists against human experimentation.

“The Chinese researchers did not plan to produce a baby — they used defective human embryos — but did hope to end up with an embryo with a precisely altered gene in every cell but no other inadvertent DNA damage. None of the 85 human embryos they injected fulfilled those criteria. In almost every case, either the embryo died or the gene was not altered. Even the four embryos in which the targeted gene was edited had problems. Some of the embryo cells overrode the editing, resulting in embryos that were genetic mosaics. And speckled over their DNA was a sort of collateral damage — DNA mutations caused by the editing attempt.”

So this takes us back to the question the Captain posed before this article was written; will some rogue state not try to alter the human genome? Well it has happened!

“The New York Times” article is well written as usual and understandable to all. The Captain recommends you click on the hyperlink and read this article in full.

Below is a piece from Wikipedia on CRISPER technology for all you bioscience geeks, and the Captain is one of them. This makes a great bioscience crossword puzzle with the answers!

Sanders, R. (2015, March 19). Scientists urge caution in using new CRISPR technology to treat human genetic disease. Retrieved from Berkeley News: http://news.berkeley.edu/2015/03/19/scientists-urge-caution-in-using-new-crispr-technology-to-treat-human-genetic-disease/

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

WHAT HAPPENS TO ALL THAT FAT WHEN YOU LOSE WEIGHT?


 

_origin_Atomieroci-NEVAR-2According to an article in “The British Journal of Medicine,” it is time to blow the lid off the confusion and misconceptions about how we lose weight. Most individuals believe that fat is changed into energy or heat thereby losing weight. This goes against the law of conservation of mass. Other misconceptions are that substances produced from fat are excreted in kaka duty or changed into muscle. It is time for a little refresher course or introduction to Anatomy and Physiology /Biochemistry.

 

bigstock-Fat-woman-eating-a-hamburger-12163661Excess carbohydrate or protein is converted to triglyceride (glycerol ester) and stored in lipid droplets (fat globules) of adipocytes (fat cells). The excess fat from diet needs no conversion other than lipolysis of fats into fatty acids and glycerol, as by lipase (an enzyme excreted by the pancreas) and re- esterification. “People who wish to lose weight while maintaining their fat-free mass is, biochemically speaking, attempting to metabolise the triglycerides stored in their adipocytes.”

 

  • Lipid is any of a group of organic compounds that are greasy to the touch, insoluble in water, and soluble in alcohol and ether: lipids comprise the fats and other esters with analogous properties and constitute, with proteins and carbohydrates, the chief structural components of living cells.
  • Ester is a compound produced by the reaction between an acid and an alcohol with elimination of a molecule of water.
  • Fatty acid is any of a large group of organic acids, especially those found in animal and vegetable fats and oils. Fatty acids are mainly composed of long chains of hydrocarbons ending in a carboxyl group. A fatty acid is saturated when the bonds between carbon atoms are all single bonds. It is unsaturated when any of these bonds is a double bond.
  • Glycerol (an alcohol) is a sweet, syrupy liquid obtained from animal fats and oils or by the fermentation of glucose.
  • Triglyceride is and ester obtained from glycerol by the esterification of three hydroxyl groups with fatty acids, naturally occurring in animal and vegetable tissues: an important energy source for much of the fat stored by the body.
  • Lipolysis is the hydrolysis (chemical decomposition in which a compound is split into other compounds by reacting with water) of fats into fatty acids and glycerol, as by lipase (excreted by the pancreas).

 

Therefore, we can roughly scratch out a formula in English that describes where the average triglycerides in fat go in an exothermic reaction:

Triglycerides + Oxygen  —> Carbon Dioxide + Water + Energy.

 

The equation shows the metabolic results of fat oxidation, but leaves us in a quandary about their proportion of mass that leave as carbon dioxide and water during ones weight-loss. This is important because of what was stated earlier about the conservation of mass!

 

exhaled weight loss
When somebody loses 10 kg of fat (triglyceride), 8.4 kg is exhaled as CO2. The remainder of the 28 kg total of CO2 produced is contributed by inhaled oxygen. Lungs are therefore the primary excretory organ for weight loss. (This calculation ignores fat that may be excreted as ketone bodies under particular (patho)physiological conditions or minor amounts of lean body mass, the nitrogen in which may be excreted as urea)

 

Simply put after all the molecular weight computations are completed, it shows that 84% of the triglyceride molecules’ mass exhaled is carbon dioxide. 16% of mass becomes water.

The results clearly show that the lungs are the primary excretory organ for weight-loss. The water made may be excreted in the pee pee, pooh pooh, sweat, breath, tears or other fluids.

So fellow travelers, we are about to dispel the mystery on weight-loss with an example provided by the bmj. “At rest, an average 70 kg (154 lb.) person consuming a mixed diet exhales about 200 ml (7 oz.) of CO2 in 12 breaths per minute. Each of those breaths therefore excretes 33 mg (1 oz.) of CO2, of which 8.9 mg (.00032 oz.) is carbon. In a day spent asleep, at rest, and performing light activities that double the resting metabolic rate, each for 8 hours, this person exhales 0.74 kg of CO2 so that 203 g (7 oz.) of carbon are lost from the body. For comparison, 500 g (18 oz.) of sucrose (C12H22O11) provides 8400 kJ (2000 kcal) and contains 210 g (7 oz.) of carbon. Replacing one hour of rest with exercise that raises the metabolic rate to seven times that of resting by, for example, jogging, removes an additional 39 g (1.4 oz.) of carbon from the body, raising the total by about 20% to 240 g (8.5 oz.). For comparison, a single 100 g (3.5 oz.) muffin represents about 20% of an average person’s total daily energy requirement. Physical activity as a weight loss strategy is, therefore, easily foiled by relatively small quantities of excess food.

Our calculations show that the lungs are the primary excretory organ for fat. Losing weight requires unlocking the carbon stored in fat cells, thus reinforcing that often heard refrain of “eat less, move more.””

 

Once again, we are confronted with the fact that gaining weight is much easier than losing weight. The body wants to be in a state of homeostasis (balance) and works hard to conserve energy. Exercise is only 20% of the equation the remaining 80% is diet. The question remains, why we insist on stuffing ourselves when the consequences are so dire to health and take so much effort to undo.

 


 

The American Heritage® Science Dictionary. Retrieved May 11, 2015, from Dictionary.com website:http://dictionary.reference.com/browse

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g7257 (Published 16 December 2014)

 

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.

 

 

 

“THE FAT BASTARD GAZETTE” more Coca-Cola shenanigans VOL. 1 NO. 25


Well, so much for separation of church and state fellow travelers. The article, “Coke as a sensible snack? Coca-Cola works with dietitians who suggest cola as snack,” begs the question of another example of blatant collusion, denial, obfuscation. So transparent is this collusion between the food and beverage industry and the health sector that it becomes more laughable than lamentable. Once a particular company, in this case dr. smokingCoca Cola, hires a group of individuals, in this case nutritionists or dietitians, they no longer remain independent agents and become representatives or consultants. Is this not obvious, even to the most casual observer? This reminds one of the tobacco industry using doctors in the thirties and forties as representatives for cigarettes touting their mildness and the healthful benefits of cigarette smoking.

Portion control is another variation on an old theme. The standard size for a bottle of Coca-Cola in 1950 was eight ounces. To suggest that Coca-Cola is as Vendo-81-Coke-tn1healthful as a pack of almonds, is utterly preposterous. Sugar is sugar is sugar, nothing more than empty calories. In addition, Coca-Cola can make more money on the smaller size than the larger size.

The article then goes on to discuss the meaning of “sponsored content.” The phrase speaks for itself, supported information. In this case since Coca-Cola is sponsoring the article using its “consultants” whether paid or not, and we will put money on the fact they are being paid, the article becomes nothing more than a drawn out commercial filled to the brim with biased information. There is nothing “opaque” about this at all. It is a blatant case of a magician’s sleight of hand. However, lamentable The Academy of Nutrition and Dietetics will not come out and state that ethics are violated equating the equivalency of nutrition founded in Coca-Cola and almonds.

The dietician involved with this article denies that sugar causes obesity, what a poor excuse of an denialeducated woman. She is denying scientific, medical fact selling out to the highest bidder. Then there is the case of another delusional female dietician rationalizing the importance of colluding with the food and beverage industry, again involving Coca-Cola. She cannot even remember if Coca-Cola paid her for expert consultation. How naïve do, they think we fellow travelers are.

 

 

 

Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon
Captain Hank Quinlan, Owner and Publisher, Chief Curmudgeon with Sam Borsalino, Assistant Publisher

Dear Hail-Fellows well met, “The Fat Bastard Gazette” is written and edited by your favorite curmudgeons Captain Hank Quinlan and

Flatfoot  Willie, Corespondent at Large with fellow Staff Writers
Flatfoot Willie, Correspondent at Large with fellow Staff Writers

Staff (monkeys in the back room). We offer an ongoing tirade to support or offend anyone of any large dimension, cultural background, religious affiliation, or color of skin. This gazette rails against an eclectic mix of circus ring ne’er do wells, big ring fatty and fatso whiners, congenital idiots, the usual motley assortment of the profoundly dumbfounded, and a favorite of intelligent men everywhere, the

May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .
May the Most Venerable H. L. Mencken bless our unworthy but earnest attempts at tongue in cheek jocularity .

“Great Booboisie.” Nor shall we ignore the wide assortment of shirkers, layabouts, and slugabeds.

Latest office staff confab at Fat Bastard HQ.
Latest office staff confab at Fat Bastard HQ.

All this and more always keeping our major focus on “Why so fat?”  Enough said? We at “The Fat Bastard Gazette” think so. If you like what you read, and you know whom you are, in this yellow blog, tell your friends. We would be elated with an ever-wider readership. We remain cordially yours, Captain Hank Quinlan and the Monkeys in the back room

“The Fat Bastard Gazette” does not purport to offer any definitive medical or pharmaceutical advice whatsoever in any explicit or implied manner. Always consult a qualified physician in all medical or pharmaceutical matters. “The Fat Bastard Gazette” is only the opinion of informed nonprofessionals for the general edification and entertainment of the greater public. 

No similarities to any existing names or characters are expressed or implied. We reserve the right to offend or support anybody, anything, or any sacred totem across the globe.