Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘diet’

Prudent diet staves off heart woes (The Gazette, 21 Oct 2008, Page A4)

Posted by Colin Rose on October 21, 2008

Not a surprising finding, Dr. Yusuf. Fifteen years ago Dean Ornish proved that atherosclerosis, the underlying cause of heart attacks, could be reversed with a version of the prudent diet.  So why isn`t everyone doing this? Maybe because the cholesterol myth promoted by drug dealers and doctors on their payrolls convinced the population that all they had to do was take a pill to lower blood cholesterol and they could eat anything. Curiously, there is no mention of cholesterol in the story. Close reading of the paper published in Circulation reveals that there was no correlation between the diet and blood cholesterol, “bad” of “good”. Diet has a powerful effect on atherosclerosis independent of blood cholesterol. Probably something about the prudent diet reduces modification of LDL, so called “bad” cholesterol, in the arterial wall. Another body blow to the cholesterol myth which is slowly dying. Even Pfizer which has spend many $billions promoting the myth has given up on it.


SHARON KIRKEY CANWEST NEWS SERVICE
The Gazette
21 Oct 2008

Hold the fries, samosas or fried won tons: People who eat diets high in fried foods and meat are 35 per cent more likely than ?prudent? eaters to suffer acute heart attacks, a global study led by Canadian researchers shows. And in a surprising…read more…

Posted in atherosclerosis, cardiology, cholesterol, coronary artery disease, diet | Tagged: , , , , , | Leave a Comment »

Heart Attack at Age 19

Posted by Colin Rose on October 15, 2008

Cherepanov is not the first young Russian athlete to die of atherosclerosis. Remember Sergei Grinkov? The Russian diet is highly atherogenic and Russia has one of the highest rates of death from coronary artery disease.

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In 1994 Gordeeva & Grinkov returned to Olympic competition and captured their second gold medal at the 1994 Winter Olympics in Lillehammer, Oppland, Norway. After these Olympics, they returned once again to professional skating and took up residence in Simsbury, Connecticut. During the 1994-95 season, they toured, yet again, with Stars on Ice, this time as headliners. However, tragedy struck in November 1995, when Sergei Grinkov collapsed and died from a massive heart attack in Lake Placid, New York, while he and Ekaterina were practicing for their upcoming performance in the 1995-1996 Stars on Ice tour. Doctors found that Sergei had severely clogged coronary arteries (to the point where his arterial opening was reportedly the size of a pinhole), which caused the heart attack.

“In spite of the autopsy findings, he never sought medical attention for a cardiac problem,” said Pascal Goldschmidt associate professor of cardiology at Johns Hopkins. “His risk for premature coronary artery disease was very low; he was not a smoker, did not use drugs or medications, did not have high blood pressure or diabetes, had normal cholesterol and lipid levels and he trained several hours a day.”


NO AMBULANCE
BY MASON LEVINSON Bloomberg News, with files from Gennady Fyodorov and Natalia Sokhareva, Reuters
National Post
15 Oct 2008

Russian officials opened a probe into the death of New York Rangers? first-round pick Alexei Cherepanov, who collapsed on the bench during a Continental Hockey League game in Russia on Monday. Moscow regional investigator Yulia Zhukova said officials…read more…

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Effectively treating atherosclerosis without angioplasty or bypass

Posted by Colin Rose on September 17, 2008

Below is a example of the issues involved in treating chronic coronary atherosclerosis presented by an intelligent patient who asked questions about treatment and did not accept the mainstream opinion without good evidence.

The vast majority of patients with chronic coronary artery atherosclerosis can be treated as the patient described here. Most cardiologists still believe the profitable myth that heart attacks can be prevented by “treating” those blockages seen on a coronary angiogram. We now have good evidence that such blockages are composed of older, harder plaques that are less likely to rupture and cause a sudden total blockage and a heart attack. Angioplasty, stent or not, and coronary bypass are PALLIATIVE procedures indicated only for intractable symptoms related to decreased coronary blood flow reserve.

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From ProCor

From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

In the late 1960s, Professor G. S. H. Lock was engaged in the development of the artificial heart to address cardiac conditions for which other alternatives were not available. Forty years later he writes, “Today it is difficult to argue that technological intervention on such a scale is really necessary on a routine basis. Even intervention through angioplasty and the insertion of a stent may offer little more than temporary relief.”

In this article, adapted from a longer feature in The Lown Forum, Professor Lock shares his experiences as a cardiac patient and his observations on the use of medical technology in cardiovascular care. The Lown Forum is a publication of the Lown Cardiovascular Research Foundation; ProCor is one of its programs.

Vikas Saini
President, Lown Cardiovascular Research Foundation
 
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From the patient’s perspective: Effectively treating heart disease through diet, exercise, lifestyle and medication

G.S.H. Lock, Professor Emeritus and former Dean of Interdisciplinary Studies, University of Alberta, Edmonton, Alberta, Canada

My story begins, as it often does, with the onset of mysterious chest pains. My family physician immediately diagnosed it as angina, meriting further investigation. After numerous tests on treadmills and in machines whose operations are still a mystery to me, I was confirmed as a high-risk patient with a plumbing problem, usually described as coronary arterial occlusion. An angiogram was recommended and scheduled within two weeks. However, this seemingly routine procedure created a special problem for me because three of my colleagues had failed to recover from that very procedure. With apprehension, I listened to the consulting physician explain that the risk of complication was minimal (about 1%). I asked if there was an alternative. I shall never forget his answer: “Death.”

Needless to say, I was not reassured by this response from a very able doctor who was obviously bound by prescribed procedure. Even though he was careful enough to prescribe appropriate medication while I waited for the angiogram procedure, I sought a second opinion, at another hospital. This proved to be an equal waste of time. The physician simply described the use of angiography as a “no brainer” because he viewed it as the natural prelude to intervention. No other possibility was even considered.

These experiences led me to conduct my own extensive research on heart disease, its diagnosis, and treatment. The majority of cardiologists seem to favor intervention, with all of the technology that accompanies, if not drives, it. I, however, could not support such an approach except in emergencies or when surgery was clearly the only means by which a patient’s life could be improved if not saved. Through the Lown Cardiovascular Center I was able to confirm that a healthy minority of cardiologists are not interventionists, but believe instead that in the majority of cases, heart disease may be treated more effectively using medical therapy with its four components: diet, exercise, lifestyle, and medication.

At first glance, I thought that each of these would prove to be distasteful – something that would destroy the quality of life – but I found instead the very opposite.

Luckily for me, my wife is an excellent cook – dare I say chef? – and has developed the standard Mediterranean diet into such a variety of dishes that I eat better now than I did two years ago. This alone took my cholesterol level down well below the established safe limit.

Exercise, too, has improved my quality of life. My cardiologist at the Lown Center, Dr. Vinch, is himself and athlete and he reminded me that the heart is a muscle that needs to be nourished and exercised like any other muscle. Under his guidance, I began various walking exercises. At first, using a nitroglycerine spray to decrease the resistance of the peripheral vascular system, I took my daily walks in the river valley where I live. Gradually, the walks became longer and steeper. Today, I can briskly walk up and out of the river valley and then jog up 12 flights of stairs without any angina, and without using the nitroglycerine. 

Clinical Encounter 
Date Posted: 9 April 2008

Posted in atherosclerosis, cardiology, coronary artery disease, diet, drugs, professionalism, surgery | Tagged: , , , , , , , , , | Leave a Comment »

Obesity is not caused by slow metabolism

Posted by Colin Rose on August 20, 2008

A new study reported by the Medical Post further debunks the myth that obese people are genetically predetermined to get fat because they have a “slow metabolism”. This study shows that obese people process food exactly the same way as thin people when they are in a rigidly controlled environment.

Dr. Bessesen says they are “not mentally processing how many calories they are actually consuming.” Indeed in all “diet” trials such as A TO Z and DIRECT in which obese people are given some freedom to choose their food and then report their intake without verification, they can be proven to be lying about their true intake.

Still Dr. Anhalt says, “We need to see if there are targeted gene strategies to identify what keeps thin people thin.” The mirage of a gene for obesity is much more comforting than dealing with addiction to food. Addiction to many substances and activities is the cause of most of the major problems of developed societies. Doctors are not trained to deal with addiction and, by the nature of their training, will look for some panaceia in the form of a drug or operation.

Bench Press

He does not have a slow metabolism

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Metabolism alone doesn’t explain how thin people stay thin 
August 19, 2008 | John Schieszer 

More important factors may be differences in food intake and activity, and the fact that people who gain weight may not truly realize how much they consume

 

SAN FRANCISCO | Metabolism alone may not explain why some people are fat or thin, according to a study presented at this year’s annual Endocrine Society meeting here.

It is unclear how some individuals remain thin in the current obesigenic environment that promotes significant weight gain in the majority of people. However, researchers with the University of Colorado Health Sciences Center in Denver say it is not because thin people have a faster metabolism or metabolize their food differently than obese people.

“The causes of obesity are complicated and likely cannot be solely explained on differences in rates of metabolism,” said Dr. Daniel Bessesen, an endocrinologist and professor of medicine at this institution.

To better understand the causes of obesity, he and his colleagues looked at thin people who say they have trouble gaining weight. They tested the theory that these individudals can overeat without gaining weight because they have a higher metabolic rate and thus burn more calories than people who have a problem with weight gain.

The investigators studied 26 naturally thin people, whom they called “obesity-resistant,” and 23 people who had a least one obese close relative and were called “obesity prone.”

The Colorado researchers hypothesized that energy expenditure and fat oxidation would increase following overfeeding in the obesity-resistant group, protecting them from weight gain.

In both groups the investigators tested metabolic rates at two separate times: once after the subjects ate a normal diet and once after three days of eating 40% more food than their body needed.

The obesity-resistant subjects had a body mass index between 19 and 23, no obese first-degree relatives and had self-described difficulty gaining weight. The obesity-prone individuals had BMIs between 23 and 27 and at least one obese first-degree relative. All the subjects underwent two one-week dietary study periods, with four days of a control run-in diet followed by three days of either continued eucaloric feeding or overfeeding.

The researchers monitored metabolic rates by having all the subjects stay for 24 hours in a room calorimeter. This special room controls air going in and coming out, and allows for the measurement of oxygen and carbon dioxide levels. Burning calories requires a certain amount of oxygen. Therefore, a calorimeter provided an accurate way of measuring daily energy expenditure or calories burned, explained Dr. Bessesen. It also measured how much fat the subjects burned in a day.

All the food in the study was provided by a special metabolic kitchen. The researchers determined energy needs from a 24-hour baseline calorimeter stay and dietary composition was identical in all study periods. The food consisted of 20% protein, 30% fat and 50% carbohydrate.

The researchers found both groups had higher metabolic rates at rest after they overate for three days than when they ate a normal diet. However, the increase was not any greater in the thin subjects. “This suggests that differences in hunger, fullness, food intake and physical activity may be more important factors in why some people are thin,” Dr. Bessesen said.

Unaware of intake
He suggested these findings are important because many thin people think they have a “faster metabolism.” However, Dr. Bessesen said his study shows that is simply a myth. He said primary-care physicians often have a significant number of patients coming in for visits and reporting they are eating less but still gaining weight. But it is more likely that these patients are probably not mentally processing how many calories they are actually consuming.

“Overall, we found no evidence that thin people have a higher metabolic rate on a regular diet or that they burn more energy following a period of overfeeding,” Dr. Bessesen said. “The most important take-home message for clinicians is that people who are tending to gain weight may not be getting accurate information on how much they are eating through biologic mechanisms. So self-monitoring might be an important tool for them, such as keeping food diaries and food records, because they may be eating more than they think.”

Dr. Henry Anhalt, a pediatric endocrinologist in Englewood, N.J., described Dr. Bessesen’s study as an important first step. Until now, he said, most studies have focused on why people become obese and what can be done to prevent obesity. Instead, he hopes more studies like this will look at how normal-weight or thin people avoid obesity in today’s fast-food, “super-size me” culture.

“We need to see if there are targeted gene strategies to identify what keeps thin people thin.”

Posted in diet, obesity | Tagged: , , | 1 Comment »

Michael Phelps’ atherogenic diet

Posted by Colin Rose on August 16, 2008

A gold medal diet?

If Michael Phelps’s diet is really as reported and he continues to eat like this, his risk of atherosclerosis and probably some cancers are elevated. While no detailed nutrient breakdowns are available, one can infer that a large fraction of his calories are coming from saturated fat and refined carbohydrate, nutrient poor calories. The “energy drinks” are liquid candy. He consumes few vegetables and no fruit. His intake is low in fiber, and could be low or borderline in other nutrients. While such a diet may rapidly supply the calories he needs for Olympic gold medals, in the long run his health will suffer. If he thinks he can eat chocolate chip pancakes as long as he exercises enough, he is dead wrong. And what kind of example does he set for the children of the USA and the world? “Hey Mom, I can eat chocolate chip pancakes instead of broccoli, just like Michael Phelps.”

Posted in atherosclerosis, diet | Tagged: , , , , , , , | 1 Comment »

DIRECT. More obese liars.

Posted by Colin Rose on July 16, 2008

We have already commented on a similar diet study, A to Z. Again with DIRECT (DIetary RandomizEd Controlled Trial) we have another attempt to prove the Atkins diet is better but is really another demonstration of lying by most overweight and obese people. Any study on diet and energy balance that cannot first demonstrate that the First Law of Thermodynamics is obeyed from self-reported data is totally unreliable and unreproducible and should never be published.

While the data as presented are hard to interpret in terms of detailed energy balance because daily energy intake and expenditure is not reported, as it should have been, the subjects claimed to be doing more exercise and eating less but only lost 10 pounds in two years. The prescribed diets contained 1800kcal for men and 1500kcal for women. These values are close to the basal metabolic rates of these mostly obese people. They should have lost weight continuously and markedly during the trial. Let’s see how much they should have lost if they were reporting accurately. They claimed to be eating about 500 kcal less than baseline per day on all diets. Even doing the same amount of exercise they should have lost about a pound per week (one pound of fat is about 3500 kcal) or about 50 pounds per year or 100 pounds in 2 years. Since they claimed to be doing more exercise they should have lost even more. If they had been telling the truth, most participants should have starved to death well before the end of the study! Ergo, most overweight and obese people lie about food intake and exercise; they tell investigators what the investigators want to hear.

Obesity is and always has been caused by junk food addiction. Until we deal with that, the pandemic of obesity and its terrible consequences will only worsen. Unlike most infectious diseases, there is no vaccine against  addictions. We all must make the right choices as to what we put into our bodies. In developed capitalist democracies resisting the self-destructive temptation to consume all manner of cheap addictive substances or to adopt addictive behaviours readily supplied by highly profitable enterprises is the hardest task we have. And how to deal with it is not taught in medical school.

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That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day, about 40% less than they actually ate, but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

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Disney World

Is she on a low-fat or low-carb diet?

Posted in diet, obesity | Tagged: , , , , , , , , , , , , , | 25 Comments »

Canadian Cardiologists Advise “healthy eating habits” but Eat Junk

Posted by Colin Rose on July 2, 2008

“Example is not the main thing in influencing others. It is the only thing.”
                  –Albert Schweitzer

In his editorial in the latest issue of the CJC (June, 2008) Dr. Lyall Higginson states, “If we intend to have a lasting impact on this country’s well-being in the future, we must have increased funding to help us reduce avoidable risk factors by zeroing in on healthy eating habits…”

With the emphasis on lifestyle advocated by the CCS one would expect that members of the CCS would be exemplary in their food choices.

Here are some photos of the “food” served CCC sponsored events included in the registration fee last year at the Canadian Cardiovascular Congress in Quebec City.

Cardiologists' Food, Pastries
Pastries

 

Cardiologists' Food, Foccacia Bread with Montreal Smoked Pastrami

Foccacia Bread with Montreal Smoked Pastrami

At the Soirée Québec the only fresh vegetables were in the decorative glass jars. Except for small decorations, there were no fresh fruit.

How can he CCS have any legitimacy in demanding “increased funding” to “reduce avoidable risk factors” unless the CCS and its members show that they practice what they preach? Or is it because seven out of eight cardiologists take a statin and think they can eat anything.

We would hope that at this year’s CCC in Toronto more care will be given to “zeroing in on healthy eating habits” when food is part of a planned event.

If the CCC Toronto organizing committee would like help in arranging healthy food selections, we would be happy to assist them myself or arrange for such assistance.

Posted in cardiology, diet, obesity, professionalism | Tagged: , , , , , , , , , , , , , , , | Leave a Comment »

COURAGE demolishes the myth of the “widow maker” and the “time bomb” but does not use optimal medical therapy

Posted by Colin Rose on March 26, 2007

For 30 years since the development of a balloon-tipped catheter to dilate coronary arteries, now known as PCI (percutaneous coronary intervention), it has been revealed truth from “experts”, most of whom paid their mortgages by doing PCI’s, that all significant coronary narrowings should be dilated to prevent a heart attack. In spite of overwhelming evidence that heart attacks are caused by rupture or early, unstable, non-obstructive plaques, most cardiologists still believe that heart attacks (sudden complete blockage of a coronary artery) occur at the site of the largest plaques. Patients are shown angiograms and told they have a “widow maker” or are “sitting on a time bomb”. I refused to do angioplasties until there was some proof for this superficial but very lucrative theory. Again, it turns out I was right. Even in patients with major narrowings and symptoms, PCI does not prolong life or prevent heart attacks. Chronic symptoms were slightly more improved in the PCI group but most medically-treated patients had symptom improvement just with pills.

 

Legal Addictions

The COURAGE type subject

All cardiologists give lip service to the necessity for lifestyle change as the ultimate cure for atherosclerosis, but in this study there was no attempt at lifestyle change. Most patients were overweight or obese, gained weight over the five year study. 20% smoked and did not stop. While the authors claim to using “optimal” medical therapy, they did not even try significantly changing lifestyle, the obvious cause of the patients’ atherosclerosis. No doubt even better results that could have been obtained with just lifestyle change, without pills or PCI, as Dean Ornish showed many years ago.

If you want an explanation for why, except for a feeble attempt to raise HDL by exercise, NO attempt was made to change lifestyle meaningfully before using statins or PCI you need look no further than the source of funding and the disclosure statements of the authors. Those who recieve substantial income from drug dealers are not keen on proving that cost-free lifestyle change alone will do the same or better than expensive drugs.

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Now, why has it taken 30 years to finally prove the futility of PCI in patients with stable or stabilized coronary disease? Unlike new drugs, there are no rules and no government agency mandating that surgical procedures have to undergo clinical trials before being done on the general population. Any surgeon can develop some operation that seems superfically rational and he and his colleagues can do many thousands of those operations, costing millions or billions of dollars and risking many lives until someone gets around to actually testing it to see if the outcome is really as advertised.

Doctors profess to want to practice “evidence-based medicine” but when change negatively affects bank accounts habits change very slowly if at all. Angioplasty in stable CAD can always be rationalized by the classic, “my patient is different than those in the controlled trial”. We can predict that angioplasties in patients with stable CAD will not decline significantly until most of those trained in the procedure have retired. The system could save a lot of money by giving each of them $one million and a house in Mexico to retire to.

Posted in angioplasty, atherosclerosis, coronary artery disease, diet, drugs, professionalism, statins | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , , , , | 1 Comment »

A TO Z trial. Atkins tops?

Posted by Colin Rose on March 12, 2007

The recent publication of the results of the A TO Z trial of four weight-loss “diets” made headlines around the world: “ATKINS DIET TOPS”. The group on the Atkins diet lost about 10 pounds, a few more pounds than the others, after one year of “dieting”.

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Did anyone, including the paper’s reviewers, actually look at the numbers behind this conclusion? Table 1 shows the baseline parameters.

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Note that the average BMI was about 32. One is considered to be obese above a BMI of 30. So most were obese. Note also the weights. About 85 kg. Now look at the results in Table 2 (below). Remember that these numbers are derived by SELF REPORTING of food consumption and exercise. The subject could tell the investigators anything. There was no check on what they said. They were paid, so the subjects had an incentive to the investigators what the subjects thought the investigators wanted to hear. The subjects claimed to be eating about 1900 kcal/day at the outset of the trial. Any adult who eats only 1900 kcal/day is UNLIKELY TO GET OBESE in the first place. During the trial they claimed to be eating only about 1500 kcal/day. So even if they hadn’t increased exercise they should have had a deficit of 400 kcal/day, 2800 kcal/wk. One pound of fat is about 3500 kcal. So, if we are to believe what they reported, they should have lost at least 3 pounds per month or 36 pounds per year. But even the Atkins group only lost 10 pounds. It gets worse. They reported total energy expenditure of about 35 kcal/kg/day. Multiply by their weight and you get about 3000 kcal/day. But they claimed to be eating only 1500 kcal/day. So they should have lost two to three pounds per week, at least 100 pounds per year. Also note that total calorie intake remained about the same in all groups in spite or a wide range of percentages of protein, fat and carbohydrate and by the end of the trial these percentages tended towards the same fraction in all groups. The First Law of Thermodynamics says energy cannot be created or destroyed. Any study of energy flows that cannot first show that energy is conserved should never be published. The methods employed by the study are fatally flawed. No conclusion can be drawn from this data. Many interpretations are possible. So, if all groups ate the same REPORTED calories on the average and burnt the same REPORTED calories on average, why did the Atkins group lose a little more weight? Maybe the Atkins group did a little more exercise. Who knows? They were lying about everything. Or, maybe, for some reason those presumably following the Atkins diet were slightly less proficient liars as the others.

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That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

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The real cause of obesity is food addiction. Like alcoholics food addicts will deny they consume too much and/or exercise too little. See my photo essay on the topic. Which diet is this lady on?

Food Addiction

Is she on a low-fat or low-carb diet?

Posted in cholesterol, diet, exercise | Tagged: , , , , , , , , , , , , , , , | Leave a Comment »

Bariatric Surgery – Psychic Surgery?

Posted by Colin Rose on March 9, 2007

 

Except for the anus, the smallest lumen of the entire gastrointestinal system is the esophagus, just after your mouth. No "bariatric" surgical procedure can make the lumen smaller than the esophagus; otherwise you would inhale your food instead of swallowing it.

 

Finally a commentator has had the guts to attack the bariatric surgery myth (see below).

We have been arguing for years that these operations to reduce stomach size in various ways cannot possibly have any physiological effect on caloric intake and that their effect is purely psychological. “I have been anesthetized, I have scars on my stomach and I have been told that I can’t eat as much as before”. Some sort of vague threat is implied. If they eat too much they will get abdominal pain, nausea or vomiting. But patients eventually figure out that they can indeed eat as much as before without pain or nauseas and the weight is regained. The reason is that the esophagus is the smallest part of the GI tract. It is impossible to make any part further along smaller than the esophagus or food will back up in the esophagus and cause aspiration of food into the lungs which can be fatal. So, whatever will go down the esophagus will go through the stomach no matter how small it is made as long as it is bigger than the esophagus and from there right into the small bowel where it is rapidly broken down by the digestive enzymes.

The only type of bariatric surgery that makes physiological sense is bypass of the small intestine to cause malabsorption, a much bigger and more hazardous procedure with many side effects.

The duodenal switch operation in which most of the small intestine is bypassed. This is the only sort of intestinal surgery that can reduce calorie intake by creating malabsorption. If one eats too much one gets massive diarrhea.

Bariatric Surgery. Psychic Surgery?

The lap band device, the latest in the surgical scams for treating obesity. There is no way this device per se will have the slightest effect on calorie intake; it only extends the esophagus by a few centimetres.

Remembering Susan

In the era before antibiotic treatment of ulcers, many gastrectomies were done to reduce stomach acid production and patient did not lose weight dramatically. Why? Because they were not told they had to eat less.

Here is a typical instruction to patients undergoing bariatric surgery (http://www.obesitysurgery.ca/faq.php ). Note that the patient MUST be “committed to your new lifestyle.”
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Q: How much weight will I lose?

A: Studies show that most LAP-BAND patients successfully lose between one-half and two-thirds of their excess weight. Results vary due to numerous factors. You need to be committed to your new lifestyle and eating habits. We expect that your weight loss will be gradual (2 – 3 pounds per week). Twelve to 18 months after the operation, the rate of weight loss usually slows down. Losing weight too fast creates health risks and can lead to a number of problems. The goal is to have a weight loss that prevents, improves, or resolves the health problems connected with severe obesity.
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And another from a review article in the NEJM by Dr Eric DeMaria in reference to his recommendation for bypass surgery in a case presentation.

“She should be required to make a commitment to an appropriate postoperative regimen of diet, exercise, and medical and surgical follow-up care.”

So why can’t obese patients commit to a new lifestyle WITHOUT the surgery? What is really effective, the surgery or the post-op diet and exercise. The only way to tell is to do a SHAM-OPERATED RANDOMIZED CONTROLLED TRIAL. Obese patients wanting surgery are randomly assigned to one group has some form of bariatric surgery or another group that is anesthetized, the same incisions made bowel is manipulated but no bypass or stapling is done. The post-op care team is blinded to the type of surgery and both groups get the same post op attention. Only after such a trial can we know if the effects of surgery are physiological of psychological, if bariatric surgery is just not another form of psychic surgery.

But there are a number of obesity “experts” who promote bariatric surgery as the ultimate answer to the obesity epidemic. One of these is Arya M. Sharma, MD, FRCPC, Professor of Medicine, Canada Research Chair for Cardiovascular Obesity Research & Management, McMaster University (http://www.cardio.on.ca/obesity) who is paid handsomely from taxpayer dollars and drug companies to promote the myth of bariatric surgery and various drugs for obesity. He refuses to even entertain the thought of doing a randomized, sham-controlled trial of bariatric surgery before spending billions of taxpayer dollars on the procedures with no proven benefit in a controlled trial.

Here is Dr. Sharma. “I think that much can be derived from careful objective observational studies, and indeed the majority of our knowledge in medical practice comes from empirical observation and NOT from controlled trials (the field of cardiology being the exception – this may be largely, because the field of cardiology lends itself best to such studies). These are far more difficult in other areas of medical practice, especially when dealing with long-term outcomes in low-risk populations. While providing the best possible care, we need to ensure that we do not degrade our patients to the level of laboratory animals just to prove a point that is reasonably obvious and biologically plausible based on what we already know. When you have no Class A evidence the right thing to do is to base your decisions on Class B or even Class C evidence, rather than do nothing. I come back to the point about checks and balances that need to be in place, but I also say that the time to act is now – the clock is ticking…..”

The same has been said about every treatment in the history of medicine; unethical not to do it, improved surgical techniques, can’t do a randomized trial, can’t wait for randomized trials, obviously effective, calculated benefit based on case controlled studies, Medicare pays for it, etc. If we continued to subscribe to the intuitive approach we would still be using blood-letting for pneumonia. Any treatment for any disease (other than hormone deficiency) must be subject to rigorous scientific investigation. Patients are NOT treated like “laboratory animals.” There are very detailed ethical guidelines about conducting controlled trials. Many “obvious and biologically plausible” treatments have turned out to be useless or harmful when subjected to controlled trial. Modern medicine like to pride itself on practicing evidence-based medicine. But when it comes to deeply held beliefs in the power of a treatment, particularly when it is good for one’s bank account, the search for evidence becomes less imperative.

The Roux-En-Y operation, a riskier type of "bariatic surgery." No controlled trials.

Dr. David D’Alessio of the University of Cincinnati says, bariatric surgery is “kind of the Wild West…huge demand, no regulation [and] patients are willing to do whatever it takes to get it.”

It is a mystery to me why the populace insists that its government scrutinize new drugs in great detail and insist on years of testing before they are licensed but any surgeon can come up with a superficially attractive operation and he and his colleagues can perform thousands of them at great expense in money and possibly lives before anyone gets around to doing an experiment to prove that the operation’s benefits outweigh its risks or have some benefit over medical treatment. See my blog on angioplasty for a classic example of billions of dollars spent on a procedure with no benefit. The latest surgical scam is the “liberation” treatment for multiple sclerosis upon which billions of dollars will be spent for a totally unproven, scientifically absurd procedure. Perhaps surgeons are the modern high-tech shamans. Surgery still maintains an aura of supernatural healing; evil spirits are being extirpated. To subject surgical procedures to controlled trials disturbs faith in its magical powers.

Will making the stomach smaller cure this women? The chocolate-coated ice cream bar will melt in the esophagus and pass through any orifice larger than a the diameter of a pin and pass rapidly through a gastic pouch no matter how small. The only cure for this women in mastering her food addiction. See my photo essay on food addiction.

Disney World

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http://www.theglobeandmail.com/servlet/story/LAC.20060726.REYNOLDS26/TPStory/?query=reynolds

July, 26, 2006
Taxpayers the losers in weight-loss surgery funding

NEIL REYNOLDS

OTTAWA — ‘I n one form or another, the corset has swaddled women since Cleopatra laced herself breathless for Caesar. Medieval women used leather and wood plates to flatten bulges. In Shakespearean times, 13 inches — no more, no less — was deemed the proper circumference of a feminine waist. And 18th century ladies cinched themselves to the point of frequent fainting. The 1890s produced the hourglass silhouette made famous by [actress and singer] Lillian Russell. If modern fashion has its way, the stage joke of a husband lacing his wife’s corset will repeat itself endlessly in connubial bedrooms across the country.” – Life magazine 1948.
For centuries, women handled fat the old-fashioned way. They hid it. More precisely, they shaped it to a particular aesthetic form. Corsets served strictly architectural purposes. Throughout the Victorian era, corsets used vertical steel rods to keep the female figure rigidly aligned with the blueprint, though the use of whalebone continued into the 20th century. These rods were appropriately called stays, defined by Oxford as “appliances used to hold up part of a structure.” Corsets worked and they were cheap. Eatons listed an economy corset in its 1901 catalogue at 28 cents.
With lightweight plastic stays, as Life magazine’s postwar essay suggests, corsets became modern appliances. With further refinements, they remained (along with girdles) essential woman’s wear well into the 1960s when they were rendered obsolete, first by fashion and now, finally, by surgeons with vacuum pumps.
Men used corsets, too, both for aesthetic deception and for medical reasons (wounded by gunshot in 1968, Andy Warhol wore a corset every day for the last 20 years of his life). But corsets primarily shaped the lives of women, just as cosmetic surgery now primarily shapes the lives of women. Casual tummy surgery is probably preferable to corsets — people who have experienced neither really can’t say. But the public policy issue here isn’t the change in fashion.
It’s the difficulty in distinguishing cosmetic alteration from medical procedure — and in determining who pays.
Start with the soaring use of weight reduction surgery in the U.S. These operations range from minimalist procedures (say 10 pounds) to heavy-duty surgery (say 50 pounds or more). On the one hand, cosmetic surgeons insist they do shapes, not weights. But who determines real motives — doctor or client? Since it’s now the client who pays for most of these procedures, the distinction is mostly moot. On the other hand, weight-loss operations performed on the “morbidly obese” — any person 100 pounds or more overweight — are deemed medically necessary. Eighty seven per cent of these patients are women.
In the early 1990s, U.S. doctors performed 16,000 of these bariatric (meaning weight) operations a year. In 2004, they performed more than 100,000. This year, they will perform 200,000. Obesity is, after all, ballooning. And doctors now perform these operations on adolescents. The cost averages $30,000 (U.S.) per operation. Perform it 100,000 times and you have an invoice for $3-billion.
This is an interesting calculation because there are more than 100,000 people in Ontario alone who qualify, by medical definition, for this operation — perhaps 150,000. Last year, the Ontario Health Insurance Plan paid $15-million (Canadian) to send a mere 600 of them to the States for this surgery at an average cost of $25,000. In a study released Monday, however, the U.S. government reported that four bariatric operations in 10 result in serious complications within six months — driving the cost in these cases as high as $65,000 (U.S.).
But, ominous as these costs appear, no one should think that the provinces will be able to restrict medicare access to weight-loss surgery for long. Now that governments are paying for the removal of fat from people who are “morbidly obese,” it’s only a matter of time before they extend coverage. People 90 pounds overweight will want coverage, then people 80 pounds overweight.
Restrictions will finally be deemed discriminatory — violations, no doubt, of the Charter of Rights and Freedoms. Self-indulgent people who eat too much and exercise too little will inevitably come to regard shape and weight as entitlements.
Weight-loss surgery is a dubious proposition. In one Canadian study, Dr. Raj S. Padwal at the University of Alberta Hospital in Edmonton found that bariatric patients shed between 35 and 60 per cent of their baseline weight in these operations — and, 10 years later, may maintain a loss of only 16 per cent. This simply means that a 300-pound person will become — in the long run — a 255 pound person, almost as fat as when he or she started. This person could achieve the same result by losing 4.5 pounds a year.
Fifty per cent of Canadians are now deemed overweight. Depending on your perspective, this means either 17 million people or 17 million patients. What to do with them? A few years back, Dr. Kenneth Walker, the Canadian medical columnist, facetiously suggested the use of force — that fat people be locked up in prison camps until they lose weight. In the end, though, there’s only one responsible option. Self-government. And, perhaps, corsets.
nreynolds@xplornet.com

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