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Scientists and physicians who study the treatment of obesity have been puzzled for some years over bariatric surgery and its benefits.âStomach staplingâ surgery was long seen as a âplumbing adjustmentâ that prompts weight loss by restricting the stomachâs capacity. But mounting evidence demonstrates that it does much more than that. Bariatric surgery appears to set in motion a host of physiological and psychological changes beyond weight loss, in many cases resolving type 2 diabetes, righting problematic cholesterol readings, and not just curbing, but changing, appetites.
How it does all that, however, has remained a mystery that researchers are just beginning to pry open. In a series of experiments conducted on mice and reported this week in the journal Nature, new research suggests that a newly popular bariatric procedure called vertical sleeve gastrectomy sets in motion a cascade of signaling changes in the gut and elsewhere. Those changes, in turn, reshape the mix of gut bacteria in ways that appear to turn up metabolic function, lipid metabolism and signals that tell the brain it’s time to stop eating.
In vertical sleeve gastrectomy, the surgeon staples off roughly four-fifths of the stomach to create a banana-shaped tube where once a large pouch existed. The procedure accomplishes much of what the more complicated Roux-en-Y gastric bypass operation does, but does so more simply. For that reason â and because gastric banding is increasingly seen as less effective in promoting weight loss â surgeons are performing more sleeve gastrectomies in bariatric practices around the United States.
Researchers have already observed that certain bile acids circulate more copiously in the guts and blood of patients in the wake of bariatric surgery, but could only guess at why. They also have observed that the community of bacteria colonizing the guts of obese patients changes in the wake of bariatric surgery. But they could only guess at how.
A team of researchers from Sweden, Denmark and the University of Cincinnati in Ohio found that one link between these two changes is a genetic “switch,” or transcription factor, called FXR. Increased bile acid unlocks FXR, which improves metabolic function directly. But improved FXR signaling also promotes the growth of gut bacteria that help regulate fat metabolism, and suppresses gut bacteria that is linked to weight gain and metabolic disturbance, the group showed.
In their experiments, mice specially bred to lack the FXR genetic switch (and fed enough to make them obese) initially ate less and lost weight after they got a vertical sleeve gastrectomy. But within a week, their appetites rebounded, they showed a preference for consuming fat, and they quickly regained the weight.
By comparison, when the obese mice with a functioning FXR signaling system got the sleeve gastrectomy, they consistently ate less, showed a marked preference for consuming protein and carbohydrates over fat, lost weight and kept it off.
Finally, researchers conducted a census of the bacteria living in the mice’s gastrointestinal tracts. They found that compared to obese mice who got no sleeve gastrectomy, or got it but had been bred to lack the FXR switch, those who got the surgery and had an intact FXR signaling pathway had smaller populations of Bacteroides in their guts (a change that other studies have linked to fat loss and improved glucose control). Those mice also had more gut bacteria in the Porphyromonidaceae,Roseburia, Lactobacillus and Lactococcus families (all of which have been linked to better metabolic function).
“I really like this study,” said Dr. Jonathan Q. Purnell, an endocrinologist at Oregon Health & Sciences University who was not involved in the study. The authors, he said, have found one key link â there are probably more, Purnell added â between the increased bile acids and the enhanced gut microbiomes seen in bariatric surgery patients. Other studies have found that bariatric surgery effects changes in the appetite hormone ghrelin and activates other transcription factors that turn genes on and off, Purnell said.
The discovery that FXR signaling is key to bariatric surgery’s positive effects does several things, said study co-author Randy K. Seeley, professor of endocrinology at University of Cincinnati’s College of Medicine: it lays to rest any lingering belief that bariatric procedures induce weight loss only by shrinking the stomach’s capacity, Seeley said; it undermines any argument that metabolic improvements seen in bariatric surgery patients are simply a consequence of weight loss; and it bolsters the growing belief that gut bacteria may hold the key to weight control and healthy metabolic function.
The discovery also gives researchers a handle on how the broad benefits of bariatric surgery might be attained without the cost or risk of surgery, said Seeley.
“We need to figure out other ways you can do this,” Seeley said. Only 1% of patients who might benefit from such surgery are currently getting it, and that number is unlikely to ever get above 4%, experts estimate. As a result, Seeley said, scientists need to find ways to mimic bariatric surgery’s molecular effects in the body with a pill, a genetic “switching” device or by manipulating the bacteriological community in patients’ guts.
Everyone has times when they feel like they are plateauing in their weight loss surgery journey, so here are some tips to overcome the hurdles!
1. Do you have room for improvement?
When your nutrition habits have room for improvement irrelevant of your weight, you may lose weight!
2. Do you bounce back fast?
Get back on track with your healthy habits at the next meal rather than the next day!
3. Do you treat yourself or trigger yourself?
Everyone needs a treat from time to time but be savvy and never choose a âtriggerâ food, that is a food that you canât stop eating and you feel out of control with!
4. Do you need to just do a liquid diet?
No. Solid food is slower to digest and your body and brain feels more satisfied!
5. Do you chew slow?
Chewing your food a lot produces more satisfaction chemicals in your brain that consuming the same amount with less chewing!
6. Are you replacing your water with coffee, tea or soda?
Stop and get the water in; to increase your energy, change your mood, and metabolize fat!
7. Do you coach yourself to success?
Learn to coach yourself with positive self observation; criticism rarely creates successful long term weight control!
Bariatric surgery can help obese people lose weight, and excess weight is a big risk factor for Type 2 diabetes. So it makes sense to try to figure out whether the surgery could help control diabetes, too.
So far the answer is yes, at least for some people and for three years. But surgery doesn’t work for everyone, and the long-term implications remain unclear.
More than one-third of the people who had gastric bypass surgery met glycemic control targets three years out, compared with 24 percent who had a different type of bariatric surgery called sleeve gastrectomy. And just 5 percent of people in a group treated with medication alone were able to meet that standard.
It’s one of the first randomized controlled trials to look at bariatric surgery as a treatment for Type 2 diabetes, which affects 23 million adults.
We love eggs because they are one of the best protein foods! Combining whole eggs with egg whites makes this recipe nutritious and bariatric friendly! Enjoy anytime of the day or make ahead for your busy week!
â¢ 2 tsp olive oil
â¢ 1 medium onion, diced
â¢ 1-1/2 cups (7 oz) zucchini, diced into matchsticks
â¢ 4 large eggs
â¢ 4 large egg whites
â¢ 1/4 cup Asiago cheese, grated
â¢ salt and fresh pepper
â¢ 2 medium (about 8 oz) vine ripe tomatoes, cored and thinly sliced crosswise
Preheat oven to 400Â°F.
Heat oil in a 10-inch skillet over medium-low heat. Stir in onion and cook until slightly golden, about 8 to 10 minutes. Add zucchini, increase heat to medium-high, season with salt and pepper and cook 2 to 3 minutes or until the moisture dries up, stirring occasionally.
In a medium bowl whisk eggs, egg whites, Asiago, salt and pepper.
Pour the eggs into the skillet making sure they cover all the vegetables. Arrange tomatoes in an overlapping pattern on top and season with salt and pepper. When the edges begin to set (about 2 minutes) move skillet to oven. Cook about 16 to 18 minutes, or until frittata is completely cooked. Serve warm, cut into 4 pieces.
Recipe by Skinnytaste.com
Servings: 4 â¢ Size: 1/4 â¢ Old Points: 4 pts â¢ Weight Watcher Points+: 4 pt
Calories: 172 â¢ Fat: 10 g â¢ Carb: 8 g â¢ Fiber: 2 g â¢ Protein: 13 g â¢ Sugar: 3 g
Sodium: 204 mg â¢ Cholest: 186 mg
The Khalili Centerâs Dr. Kai Nishi appears on this weekâs edition of Dr. Lisa Mastersonâs popular podcast Health in Heels. Dr. Nishi will be discussing the latest innovations in robotic surgery among other things. In addition to being one of the leading weight loss surgeons in the nation, Dr. Nishi is also a recognized authority on robotic surgery. Dr. Masterson, meanwhile, is a popular personality in the healthcare media, having formerly been a regular on the hit television show The Doctors.
On the podcast, Dr. Nishi delves into the mechanics of robotic surgical techniques, particularly as they relate to bariatric surgery procedures. At the Khalili Center, Dr. Nishi has been a pioneer in using robotic surgical techniques as a component of weight loss surgery.
In addition to discussing robotic surgery, Dr. Nishi covers a range of other topics on the show including the importance of maintaining a healthy diet and how despite commonly held beliefs, it is important to consume a certain amount of saturated fats. Dr. Nishi also speaks to the importance of a healthy diet in order to better prevent the onset of not just obesity, but also cancer and other serious health conditions. Hear it here!
Get more Protein, a staple in any Bariatric diet, into your âon-the-goâ day with these fresh snack ideas!
1. Edamame baggie
2. Hard cooked egg â de-shelled from grocer
3. Turkey jerky â low sodium, low fat from healthy store
4. Greek yogurt topped with baggie of fresh, raw sunflower seeds
5. Light string cheese with 10 fresh, raw almonds
6. Hummus â Â¼ cup with veggie sticks
7. Cottage cheese with Sugar free jam
8. Deli turkey slices -2, rolled with light Laughing cow cheese
9. Tofu teriyaki cubes or low fat meatballs squired with toothpicks
10. Egg salad cup â pre made from Trader Joes
A wonderful bariatric friendly summer salad made with lump crab meat, summer tomatoes, sweet charred roasted corn, cilantro, hot peppers and zesty lime juice. Serve this over mixed greens or tostadas as a main dish or you can put this in martini glasses as a fancy appetizer.
This is perfect to bring to a potluck, or you can halve the recipe for less servings. Fresh crab is always best but if that’s not available near you, canned lump crab would do. For the corn, you can roast the corn on the grill, or if you are lucky enough to live near a Trader Joe’s, they sell roasted frozen corn which is such a convenience. A good tip, if you make grilled corn on the cob often and have leftovers, cut it off the cob and freeze it!
Summer Tomatoes, Roasted Corn, Crab and Avocado Salad
Servings: 7 â¢ Serving Size: 1 cup â¢ Old Points: 2 pt â¢ Points+: 3 pt
Calories: 130.8 â¢ Fat: 6.1 g â¢ Protein: 8.8 g â¢ Carb: 11.7 g â¢ Fiber: 4.0 g â¢ Sugar: 2.6
Sodium without salt: 263.4 mg
â¢ 12 oz lump crab meat
â¢ 1 pint grape tomatoes, cut in half
â¢ 1 hass avocado, diced
â¢ 2 hot peppers such as serrano or jalapeÃ±os, diced fine (seeds removed for mild)
â¢ 1 1/2 cups roasted corn kernels
â¢ 1/3 cup chopped red onion
â¢ 2 limes, juice of (or more to taste)
â¢ 1 tsp olive oil
â¢ 2 tbsp chopped cilantro
â¢ salt and fresh pepper to taste
In a small bowl combine red onion, lime juice, olive oil, pinch of salt and pepper. Let them marinate at least 5 minutes to mellow the flavor of the onion.
In a large bowl combine chopped crab meat, avocado, tomatoes, hot pepper and corn. Combine all the ingredients together, add cilantro and gently toss. Adjust lime juice, salt and pepper to taste.
Can you reverse the signs of aging by paying more attention to what you eat? Research points to, YES!!!
How it Works
Antioxidants from good foods abolish the free radicals in your body. Free radicals are unstable cells that can cause pre-mature aging, heart disease, cancer, osteoporosis, Alzheimerâs, and others.
Limit or Avoid Pro-inflammatory Foods:
- Saturated and trans-fatty acids
- Red meat
- Processed meats
Eat Plenty of Anti-inflammatory Foods:
- Fresh raw or cooked fruits and vegetables – Consume as many as you can, but ideally more than 7 fruits and vegetables (combined)/day
- Tea – Drink 1-2 cups of black or green teas – excellent source of antioxidants
- Fresh, pure water – Drink 70-80oz daily, from a glass or quality plastic container
- Cold-water fish – Eat omega-3-rich fish, such as salmon and tuna, at least twice/week; omega-3 fats may help to improve mood and attitude, and help prevent chronic inflammation
- Whole grains – When you eat starchy carbs, eat the kind with whole grains to help blood cholesterol levels and provide more antioxidants
- Legumes – 3-4, Â½ cup servings/week – vitamins, minerals, natural fiber and protein, without fat
- Yogurt – Eat it every day for the calcium, vitamin D, probiotics and protein to encourage a healthy gastrointestinal system with healthy absorption
- Nuts – Include nuts as a snack or in foods you prepare for the B vitamins and selenium â essential for your heart and brain
- Lean protein – Eat lean cuts of meat to maintain and build muscle, which enhances immunity
- Healthy oils – canola and olive oils
- Flaxseeds – Grind and stir into yogurt, cereal, etc; 1 tsp ground flaxseeds provide heart healthy fat and fiber
- Fresh herbs and spices – Use them – provide excellent source of antioxidants
- Dark chocolate – Consume to help keep blood vessels healthy, but do NOT overdo itâno more than 3 ounces/week or you will reverse the benefit!
Other Anti-Aging Tips:
- Divide your plate so that you fill two thirds with fruits, vegetables, and small amount of whole grains, and the remaining one third with lean protein
- Lose weight if you are overweight – extra weight puts stress on the body, reducing life span, and increasing risk of many diseases
- Exerciseâ impossible to overemphasize the importance of keeping active
- Try to eat 4 small meals each day to keep your blood glucose levels steady throughout the day
- Drink plenty of low-calorie or calorie-free fluids
References and recommended readings
Bortz S. The anti-aging diet: the importance of fluids. Available at:http://www.50plus.org/Libraryitems/2_4_anti_agingdiet.html. Accessed April 20, 2009.
Braverman E. The younger you diet. Available at: http://www.pathmed.com/anti-aging-diet.php. Accessed April 20, 2009.
Eating Well, Inc. Healthy aging diet. Available at:http://www.eatingwell.com/health/health_diet_centers/healthy_aging_diet.html. Accessed April 20, 2009.
Eating Well, Inc. The search for the anti-aging diet. Available at:http://www.eatingwell.com/health/health_diet_centers/antiaging_diet_3.html. Accessed April 20, 2009.
Hearst Communications, Inc. About the anti-aging diet. Available at:http://www.goodhousekeeping.com/health/diet/about-anti-aging-diet. Accessed April 20, 2009.
Hearst Communications, Inc. Best anti-aging foods. Available at: http://www.goodhousekeeping.com/health/diet/anti-aging-diet-tips. Accessed April 20, 2009.
Hearst Communications, Inc. The seven-day anti-aging diet meal plan. Available at:http://www.goodhousekeeping.com/health/diet/anti-aging-diet-plan. Accessed April 20, 2009.
Zelman KM. The anti-aging diet: can what you eat help you age gracefully? Available at:http://www.webmd.com/healthy-aging/guide/anti-aging-diet. Accessed April 20, 2009.
Review Date 5/09
Whether you serve this green egg salad as a lettuce wrap, on a healthy cracker or in a cup, you will love this perfectly bariatric friendly meal! Serve on Saint Patrickâs Day and enjoy the holiday, healthy!
4 large hard-boiled eggs, chopped
4 hard boiled egg whites, chopped (discard the rest)
1 medium hass avocado, cut into 1/2-inch pieces
1 tbsp light mayonnaise
1 tbsp fat free plain yogurt
1/2 tablespoon finely chopped chives
2 teaspoons red wine vinegar
1/2 tsp Kosher salt
Pinch freshly ground pepper
Combine the egg yolks with the avocado, light mayo, yogurt, chives, vinegar, salt and pepper. Mash with a fork. Combine with egg whites and adjust salt as needed.
Servings: 6, Size: 1/2 cup
Protein: 9.3 grams
Carb: 4.6 grams
Fat: 11.7 grams
Keep an eye out for Dr. Nishi and the Khalili Center for Bariatric Care on NBC! Watch one of the spots below:
The information presented in the blog pages of Khalili Center is for educational and informational purposes only and should not considered personal medical advice. Consult with your personal physician/care giver regarding your own personal medical care.