Obesity Survey

[sixfoot]

Well Fizz you have made a point and defended it with energy and conviction and from an informed standpoint.

Fair play to you and i wish you well in your pursuit

Good luck
Dave P

 

[Fizzwizz]

Hi again all

I'm just popping in to say I'm going to go quiet on this forum for a while, I've found I've really enjoyed the debate but I must get some other work done. When my professor asks me for evidence of how I've spent my week I'm sure my posts here won't suffice.

I really have enjoyed being part of this community and your input has been fantastic. When I have completed my study I'll gladly share with you the results and I'm sure we'll be up for more debate again ;-)

I will continue to pop in, the information contained here seems to be better informed than most fora I have visited, and I feel I can learn much from you all.

Thank you once again for all your input, very best wishes to all. ... Fizz

 

[ally5555]

I have several private clients who have had surgery and it isnt an easy option at all. They have a very limited diet post surgery and still struggle with the food issues they had before - its not a magic bullet.

 

[IanD]

Fizz, I suggest you use us as a support group. Hope we can help.

First step, reveal your typical day's diet, with the analysis.

Second, what was your low carb diet, again with analysis?

You can see our diets, with Ally's analysis here. The analysis starts on p. 9.

 

[Trinkwasser]

I realise you would probably be failed if you were to think out of the current box

Not at all, the vast majority of the course in self learning, and a huge emphasis is placed on research, challenging theories, and thinking outside the box. The theoretical part of my course is finished, the Senior Clinical Project gives me the freedom to explore a subject of personal interest. My dissertation challenges, very strongly, pre-conceptions about obesity.

That's excellent news! So much dietary research seems based on dogma rather than facts.

There's little doubt that the bariatric surgery works, the question is how? It appears to *cure* Type 2 completely in some individuals, one theory is that it hacks into some system which has not yet been elucidated and may respond to drugs that haven't been invented yet.

Here's one of many threads on the subject which Gys has been researching

groups.google.co.uk/group/alt.support.diabetes/browse_thread/thread/e712af2503866180?hl=en&q=Gastrectomy+is+an+effective+operation+for+the+treatment+of+T2+with+BMI+21-29+group:alt.support.diabetes#977a423d42cff4c2

Other than that, what an interesting thread! And welcome!

Would be interesting to see what results you got from doing this

alt-support-diabetes.org/NewlyDiagnosed.htm

it may be that your BG is spiking when you aren't looking, it may equally be that your BG *isn't* spiking due to hyperinsulinemia

If I was doing research I'd be looking at the connections between insulin/resistance and leptin/resistance

 

[Fizzwizz]

There's little doubt that the bariatric surgery works, the question is how? It appears to *cure* Type 2 completely in some individuals.

This I find amazing. I attended an obesity clinic recently and was amazed that every post bariatric patient I saw who had formerly been diabetic was completely cured. I only became aware of this due to your post, so thank you.

What astounded me the most was that the cure is independent of weight loss, One gentleman I spoke to had been over 30 stone, and was receiving both insulin and metformin for Type 2 DM. He came off all medication within a week of surgery. This has indeed peaked my interest and I see a future career emerging.

Would be interesting to see what results you got from doing this

alt-support-diabetes.org/NewlyDiagnosed.htm

Thanks for this, I went out and bought a BM meter to try this out. My results were

Fasting: 5
1 hour after meal: 6.4
2 hours after meal 5.2

Best wishes ... Fizz

 

[hanadr]

I have done your survey, but I am with a couple of other posters in that I came to the conclusion years ago that weight gain( not linked to excessive eating of fast foods) and hyperinsulinaemia are both symptoms of an endocrine problwm. Not cause and effect.
alongside that I will add an endorsemnt of the criticism of the STUPID dietary advice given to us in Britain. Telling us to eat plenty of carbs and cut fats is criminally negligent. Criminal, because it leads people to risk health, not to say life. Negligent, because surely Healhcare professionals have a duty to keep up with current Scientifically tested information.
Even the much vaunted and quoted UKPDS did not look at the benefits of reduced carbohydrates.
this is what is needed.
THe FSA is due to be looking into carbohydrates, but in closed meeting. I'm looking forward to their report.

 

[fergus]

Hi Fizz,

I've also completed your survey but haven't posted on this thread to date.
I think what I and many others find frustrating is the collective myopia afflicting healthcare policy makers regarding carbohydrates in the diet.
For many decades certain observations have been well established. To name only a few, that obesity and hyperinsulinemia are closely linked, that elevated insulin levels are also present in all the conditions known collectively as metabolic syndrome. That homeostasis is severely compromised by this hormonal imbalance and that other serious health issues may also be linked to this, including cancers, Alzheimer's disease, hypertension and others.
The puzzling thing from our point of view is that so little energy is expended in exploring the health outcomes which result from reducing insulin levels to normal levels, established by Yallow and Berson many decades ago.
There is also a significant disconnect between the understanding of fat metabolism and these health issues. I'm afraid I've met a number of Drs. who seem to have forgotten that insulin inhibits fat mobilisation which I would have thought was well known.
I think that most efforts to counter the spread of obesity will continue to be wasted as long as the failed dogma that carbohydrates should be the basis of a healthy diet persists.

All the best,

fergus

 

[hanadr]

Fizz you are being negative and shooting yourself in the foot.
Low carbing is sustainable if combined with comparatively high fat. Following that makes sure you are not hungry. In addition there is sa huge range of foods you can eat and if you learn to cook and shop, you don't need to spend too much. Fresh veggies are not expensive and are tasty.

 

[Trinkwasser]

There's little doubt that the bariatric surgery works, the question is how? It appears to *cure* Type 2 completely in some individuals.

This I find amazing. I attended an obesity clinic recently and was amazed that every post bariatric patient I saw who had formerly been diabetic was completely cured. I only became aware of this due to your post, so thank you.

What astounded me the most was that the cure is independent of weight loss, One gentleman I spoke to had been over 30 stone, and was receiving both insulin and metformin for Type 2 DM. He came off all medication within a week of surgery. This has indeed peaked my interest and I see a future career emerging.

There's a lot of recent stuff which was previously unknown and the interractions are still being studied: Leptin, ghrelin, incretins, anandamide for a few, and their relationships to insulin levels etc. Whether the surgery hacks one of these systems in an unknown way or hacks an unknown system I'm not sure.

I did read (don't have the reference) that some patients who didn't undergo the surgery but were treated as if they had (in terms of diet and meal size etc.) lost weight also, but I don't think this concerned diabetes.

Trinkwasser wrote:Would be interesting to see what results you got from doing this

alt-support-diabetes.org/NewlyDiagnosed.htm



Thanks for this, I went out and bought a BM meter to try this out. My results were

Fasting: 5
1 hour after meal: 6.4
2 hours after meal 5.2

You must be doing something right then!

Gys (who dug up a lot of this research) is one of those people for whom food in general, not just carbs, is a major problem. He seems to lack the off switch when he eats. Others implicate cortisol and adrenal problems to this also.

Best of luck to you anyway!

 

[hanadr]

Have you resarched Prader-Willi patients?

 

[ShyGirl]

I was about to fill in the survey but I won't now ,as I disagree that the only cure for obesity
is via surgical methods. I know someone who had lap band surgery who only lost weight once she
received therapy two years later.

 

[Fizzwizz]

Fizz you are being negative and shooting yourself in the foot.
Low carbing is sustainable if combined with comparatively high fat. Following that makes sure you are not hungry. In addition there is sa huge range of foods you can eat and if you learn to cook and shop, you don't need to spend too much. Fresh veggies are not expensive and are tasty.

Soory if I don't respond to each comment in a timely fashion, I'm trying to write up my findings and don't get as much time to visit this thread as I'd like

In response to this comment, unfortunately the evidence doesn't back up what you are saying. It has been shown that in the long term most people regain their weight (for a variety of reasons already discussed). I know the theory is sound, but unfortunately most people fall of the wagon, as they do with all dietary modification techniques.

 

[Fizzwizz]

I was about to fill in the survey but I won't now ,as I disagree that the only cure for obesity
is via surgical methods. I know someone who had lap band surgery who only lost weight once she
received therapy two years later.

Please don't not fill in the form because you disagree with bariatric surgery. ALL opinions are wanted.

Indeed, bariatric surgery is not a miracle cure. It also has a failure rate (as well as a mortality rate). There are many people who have not lost weight after surgery. Banding is one of the 'least' successful too, though the least invasive. However, it is still the most successful treatment statistically, and quite profoundly so. It has been proven in several trials that if your BMI is greater than 35 with co-morbidities, or greater than 40 and healthy, the benefits will outweigh the risk of having the surgery. this is not just opinion, it is now a guidline laid down by NICE, and is the conclusion drawn by a systematic Cochrane review (considered to be the most reliable form of clinical evidence).

Glenny AM, O'Meara S, Melville A, Sheldon TA, Wilson C. The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997;21(9):715-37

 

[Fizzwizz]

I think I should clarify that I don't for one minute advocate that anyone should abandon their efforts to loose weight provided they have a sensible diet. Every minute you spend at a lower weight means you are healthier. There is good evidence that in the short term dietary modification works.

What I do advocate is people are armed with the correct information upon which to make a decision about their own health. Especially people whose health is at serious risk.

Non of the information I have imparted is based on my opinion, it is based on the information I have gathered and become privvy to as a student Doctor (4 mnths left and counting). I do confess though that my personal opinion has been changed by my research.

I sincerely wish you well with your diet, and can remind you that there is a percentage that make it work long term.

When I have finished my work I will post a link to it here (after it has been published). It contains all the refernces and resources from where I have gathered my info.

Thanks ... Fizz

 

[Fizzwizz]

Have you resarched Prader-Willi patients?

I haven't done any research, but I've been taught about it. It is related to the theory of 'Set Point'. I haven't mentioned it yet but I'll quickly run through the details then rush back to my write up.

In biology we have a concept known as homeostasis. This refers to the body's ability to regulate things. e.g. temperature, blood pH, etc.

If we get too hot, our body starts to sweat, and our blood vessels rise to the skin's surface in order to cool down. If we get too cold our blood vessels sink deeper and we start to shiver to warm up. These two mechanisms work together to maintain the ideal temperature of 36.7 degrees. This is the temperature set point.

We also have a weight set point. If we consume too much food our satiety centre is triggered and we are put off food so don't eat. If we don't consume enough food our body triggers the hunger response and we eat. The two work together to maintain our ideal body weight (even with abundant supplies of food).

What happens in obesity is the set point becomes derranged. The set point can move from 14 stone to 25 stone for example. In this case a person is driven by all the hunger responses to consume food to gain that weight, and they do. Remember, hunger is designed to motivate a caveman to get upfrom his nice warm comfortable fire to go out into the cold and hunt/gather food. It has to be a very strong motivator.

What we do when we diet is ignore the hunger response. This is the equivalent to a normal weight person trying to starve themselves. Almost like a hunger strike. The problem is the hunger response is quite the nag, and will constantly nag you to eat. This nag actually causes depression, and makes you feel less happy (content). Dieting is like swimming against the current. You can swim faster than the current, but eventually you tire and get swept back to the source of the river again (your set point weight).

The secret to weight loss is to reset the set point. Some diets do have an effect on set point (low carb is one of them) but unless your set point is only slightly derranged it cannot reset it to your ideal so most low carb dieters gain easy weight loss to a degree then they are back to swimming against the current to lose more.

Bariatric surgery is the most successful at altering set point but is still not perfect. It can reset it by 55 - 75% but not 100%. But what is important is that the surgery is not causing weight loss by malabsorption (though that does play a part) it is causing weight loss by altering set point. How? That is still a mystery but is being actively researched. Many believe it's by losing nerve innervation from the stomach to the hunger centre in the brain, or by stimulating nerves that go to the satiety centre in the brain (e.g. banding).

In Prader-Will there is no satiety response at all so the set point is far to the right. These people literally eat themselves to death. Very sad, because even with dietary control they are miserably hungry.

Back to work ... Fizz

 

[Fizzwizz]

I did read (don't have the reference) that some patients who didn't undergo the surgery but were treated as if they had (in terms of diet and meal size etc.) lost weight also,

That would make perfect sense I think. Bariatric surgery is supposed to work by supressing appetite, not by causing malabsorption. the idea is to reduce the set point (i.e. the point at which the patient feels content with the food they have eaten).

Losing weight is theoretically easy. All one needs to do is eat less and exercize more. It works for everyone. It's hunger that stops this from being easy in practice, it's the hunger that needs treating.

You must be doing something right then!

I think I have a healthy diet, I just eat too much. What I did notice while doing this test was that I vary rarely go without food for 2 hours so had to ignore my hunger until the 2 hour post meal test. I relised that because I'm always eating my baseline blood sugar throughout the day is probably around the 6.5 mark which is worse than some people with treated diabetes. Even in the absense of diabetes I'm summizing I can eat myself into a state of psuedo diabetes.

Thanks ... Fizz

 

[fergus]

Very interesting discussion, Fizz.

The one unbreakable principle that is always invoked in the weight loss argument is the first law of thermodynamics: Change in weight = energy in - energy out.
Two things which might indicate that this isn't the whole picture are: 1. that this equation applies to a closed system, whereas the human metabolism is anything but, and 2. that equation only suggests an association, not a cause.
So, anecdotally at least, we see that in many cases, the first law is being bent by hormonal responses. Some examples. When I was first diagnosed with Type 1, I lost a large amount of weight very quickly, regardless of the fact that I ate and drank at least as much and probably more than previously. The chronic lack of insulin clearly shifted my metabolism from making fat to burning fat regardless of the energy in or energy out parts of the equation (no-one bothers to measure the energy lost through glycosuria!)

Further, we have examples on this forum of diabetics put on 'semi-starvation' diets in order to lose weight (600KCal per day!) yet this has no effect. When the same person consumed a greater number of calories (1500-1800KCal I think Jem?) but changed the type of calories, weight loss began.

My point is that the effect of insulin upon the first law in the human metabolism is sufficient to significantly change the outcome.

Now, it might be possible to make a fundamental change in the lipolysis and lipogenesis balance simply by measuring the effect of insulin levels upon the 'closed system'. For example, it might be possible to study the effect on weight in patients where serum insulin levels were identical, but the type of calories consumed were different. One might look at weight and hunger on 30 units per day from principally carbohydrate sources. Another might measure the outcome if those calories were taken in proteins and fats.

That would be one helluva interesting thesis, possibly groundbreaking!

fergus

 

[candy1567]

Hi

It depends on what surgery you have, from experience of a friend who has had this surgery done, she had a duodenal switch this has left her with difficulty in absorbing food hence the weight loss.

She has to take a variety of pills aday just to live, the complications are horrendous and it doesn't just stop there after the surgery it is not a miracle cure.

Yes i agree she has lost the weight, she was 26 stone, she is now 13 stone but she looks ill and now has a problem with excess skin. According to the doctors she has about 2 stone of excess skin, but they wont do surgery to remove it till she is 11 stone as she is still classed as obese, but when the remove the skin she will be the ideal weight of 11 stone, madness.

Although her physical health appears to have improved due to weight loss, she is still suffering the after effects of the surgery taking suppliments everyday and now has more psychological problems due to excess skin on her body which is still making her a recluse so she has gone from one extreme to another.

Whilst i agree that the surgery made the weight loss possible she wasn't prepared for the after effects, yes for some surgery is the only option available to allow them to live on a daily basis, but who knows what effect this surgery has on them long term.

Juliexx

 

[Thirsty]

Fizz, could you point me in the direction of the relevant research regarding the success of surgery in treating obesity? I ask because I know a couple of people who have gone through the procedure, lost a lot of weight, and then regained all of it and more within a few years. (I'm aware that two cases aren't particularly significant.)