Its Entirely Natural – Blog

Not as easy or problem free as they’d have us believe

First, a couple of statistics: in the United States, which has a population of 300 million people, we have over 66 million who are technically defined as “obese.”  This in not a criticism of their character or a slur against them, it’s a physiologic fact.  “Obese” is defined as having a BMI—or Body Mass Index—of 30% or more.  That means that to be obese, one’s body needs to be at least 30% fat by weight—an enormous amount by any measure.

Within this group of obese people is a subset known as the “morbidly obese,” with a BMI of 40 or greater.  These are typically the people who weigh double or more their normal body weight.  For example, a woman who is 5 feet 2 inches tall and weighs 200 pounds, but should weight 110 to be in the normal range, is morbidly obese.  A man who is six feet tall should weigh about 175.  If he is morbidly obese, that means that he weighs at least 280 pounds.  In both cases, these people are at least 80 to 100 pounds overweight.

What are the consequences of being overweight?  The popular press talks about appearance and heart disease, but more subtle and deadly diseases can follow from obesity.  The biggest danger is from diabetes, which can come on because we’re overweight.  This type of obesity-caused diabetes is referred to as Type-II diabetes, as contrasted to Type-I, or “juvenile onset” diabetes.  The former comes from chronic obesity and lack of exercise, while the latter is generally caused by an overactive immune response (generally in childhood) to one’s own body organs.

Now for another statistic (I promise that this is the last one): over 12 million people in the US suffer from Type-II diabetes.  Most of those who do don’t even know that they have it.  They can live with the symptoms for years—symptoms which include

• Sweating
• Tiredness
• Constant thirst
• Irritability
• Hunger for sweet things
• Feelings of faintness

These symptoms occur because Type-II diabetics are producing too much insulin and have too little glucose in their bloodstream.

So how exactly—and without more statistics—does diabetes follow obesity?  The mechanism is pretty straightforward.  Your liver and your pancreas are the key players here.  The stomach digests the food, while your small intestine absorbs the nutrients—everything from sugars and starches to proteins and fats.  The liver converts what the body needs to glucose, while storing the rest as fat.  The liver knows how much glucose the body needs through the signals it receives from the pancreas—signals in the form of insulin.  The more insulin, the more glucose the liver pushes out into the bloodstream. 

When you’re obese, you eat too much all the time.  That means that the liver, overwhelmed, pushes out more glucose than the body needs.  The pancreas, in an effort to keep up with all that glucose, pushes out more insulin than the body needs.  As a result of this “insulin push,” the body’s cells become resistant to the signals.  Insulin-resistant diabetes results.

Tags: bariatric surgery, body mass index, diabetes, glucose, insulin resistance, obesity, type 2 diabetes

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Nothing is a total cure, other than losing weight naturally

We’ve all read about “cures” for obesity, from the fantastic to the unbelievable.  For those of us who are truly overweight—over 30% body fat, defined as “obese”—there seem to be new ways to lose weight through surgery that can help the pounds ‘melt off’ and the patient resume a normal life.  How real is this surgery, and is it as problem-free as we read in the ads?  Two answers: the surgery is very real, and growing, but it is a lifelong commitment that can have serious side effects.  In short, don’t try bariatric surgery unless you’re truly desperate to lose weight.

Why is bariatric surgery so difficult?  First of all, surgery of all kinds—even laparoscopic surgery—is more dangerous than surgery on people at normal weights.  That’s because their bodies are already under more stress, their health conditions not as good.  Then there’s the physical fact that there can be six to twelve inches or more of fat that the surgeon needs to penetrate in order to get to the stomach, before the core part of the operation can take place.

Surgeons take one of three approaches.  The best-known, and most popular, is the Roux-en-Y procedure. That cuts the stomach down to 10% of its normal size, while sending the rest to a shortened small intestine.  As you can imagine, the Roux-en-Y makes it difficult to eat more than a few spoonfuls at a time.  Since the small intestine is smaller as well, there are fewer nutrients absorbed.  The key drawbacks—and these are lifelong—include

• Vitamin deficiency, as fewer vitamins are absorbed in the small intestine.
• Continual feelings of nausea and fullness, whether one has eaten or not.
• 20% of those who receive Roux-en-Y find a way to get around it and get the extra calories, using methods as draconian as putting peanut butter in the microwave and drinking it warm.
• Over time, the stomach can grow to a larger size, which makes overeating more possible.

The newer laparoscopic bands, known as “lap bands,” do the same thing, but in a more minimally-invasive way.  These operations consist of the surgeon installing a clothespin-like device at the top of the stomach, again closing all but a portion of the stomach to food.  While the lap band procedure can be reversed, it poses many of the problems with the Roux-en-Y procedure.

Finally, the duodenal switch leaves the stomach much larger (and therefore the natural flow of food to the small intestine through the pylorus).  Rather than bypass the food from the stomach, the “switch” takes the bile acids and pancreatic fluids and bypasses a significant part of the small intestine.  Without those juices, fatty foods don’t get absorbed.  This operation is much less drastic, but can still lead to feelings of fullness and nausea in patients, without some of the side-effects related to vitamin deficiency.  There is some suggestion that the duodenal switch operation also reverses the effects of diabetes—an effect that needs further clinical research.

Tags: bariatric surgery, body fat, diabetes, duedenal switch, laparoscopic bands, laparoscopic surgery, obesity

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