Tuesday, May 27, 2008

bogus claims in the news - gastric bypass extends life?

Today I was chatting with some friends and someone brought up that some media column writer said you didn't have to put mayonnaise in the fridge. Mayonnaise has eggs in it for one and in my experience, gets rancid fast if not refrigerated. Everyone in the discussion did feel that it _should_ be refrigerated and since a media person said it didn't have to be, everyone seemed to feel that must be right.

Media is seldom if ever right. If they are not selling something, they often do poor research (this is partially because of tight deadlines which precludes doing careful research so they often look up the subject in other media articles which are just as poorly researched - a case of the blind leading the blind?). But the fact remains that too many people actually believe what the media prints regardless of how "over the top" it is!

Case in question. Here is a paragraph I found in one of the blog searches:

A Gastric Bypass Really Can Extend Your Life

If you are contemplating having a gastric bypass then a recent US study might just help you to make up your mind. The study looked at no fewer than 16,000 obese people and found that when people in the study group opted for gastric bypass surgery their long-term mortality rate dropped by as much as 40%. This should not really be a surprise since weight loss surgery also cures, or at least improves, a host of other conditions such as high blood pressure and diabetes and the change in diet and increase in exercise which follows surgery has got to be a good thing. Nevertheless, it is always nice to see what we already know put down in black and white as confirmation.

Of course the study is not cited and it all sounds good - if you don't think about it. A gastric bypass provides for the stomach to be cut into two pieces - one tiny piece which becomes the "pouch" and the rest of it (about 90 percent or more) which is bypassed along with the attached first segment of small bowel. The bowel is cut into pieces and rearranged in a way very different from the way nature made it. All this causes a quick weight loss during the first year or so and lifelong problems including vitamin deficiencies, osteoporosis, anemia, protein deficiencies and much more.

As Dr Terry Simpson put it:

***The RNY [gastric bypass] trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)
So how would this extend your life? Well, the idea here is that fatness is so deadly that any way to slim down regardless of unhealthy it is, is better than being fat. But there are no real studies which prove fatness in itself is deadly! And when they mention all these ills which are supposedly exacerbated by fat, does anyone question that slim people have the same ills i.e. high blood pressure, diabetes etc? I think the problem is people don't question something they read in the media. And that is where the problem starts.

But let's take a closer look at the study they referred to. It was one led by a WLS surgeon, Dr David Flum and he found in the study (which the media happily ignores) that the first month after a gastric bypass, 2 percent die and that another 5-7 percent of patients die within the first year (these were older patients so had bodies less tolerant to the extreme internal rearrangement done in the gastric bypass).

So how does he conclude that gastric bypass extends life? He compared these 16000 healthy fat people in for gastric bypass to 2000 seriously ill fat people in the hospital for other reasons and observed that since there were a small number of more deaths among the seriously ill fat people than the gastric bypass patients, that meant that the gastric bypass must have extended the lives of those who got it.

What he hoped the public would not realize is that had he compared the gastric bypass patients to 2000 seriously ill slim people in the hospital for other reasons, he would have also found that the healthy fat people who had gastric bypass survived better than the seriously ill slim folks. So would that mean that slim people should have a gastric bypass to "extend" their lives?

In another blog article
A nice looking couple is pictured. They are fat but not terribly so - they are both having gastric bypass surgery. The lady, it said, has high blood pressure even with being on 4 medications and the man has bad knees ("worn out from carrying all that weight").

Here's another which should be questioned. Most of the people I know with really bad knees are not fat. Some have never been fat in their lives - so how did their knees get bad without the "great weight" weighing down on them? And if a person's blood pressure is that high with 4 meds, did they really think a gastric bypass is going to bring it down that much? Again I know several slim people with very high blood pressure. The bottom line is, will introducing a surgical disease into their digestive tract make their health better? Perhaps or perhaps not - it all depends on whether their present comorbidities are greater than the comorbidities added by the bypass. But the media tells us that the bypass is some kind of magic bullet which fixes all ills and no one questions this and that is what is of concern.
***** "By doing this surgery, you're creating a medical disease in the body. Before you expose someone to that risk, you have to be absolutely sure that you are treating an illness which is equal to or greater than the one you are creating."
(Dr Edward Livingston, bariatric surgeon in Self Magazine, 4-2001) *****

Today I saw an ad for something about diabetes featuring as a poster kid, Randy Jackson. I did a double take. Jackson had a gastric bypass a year or two ago and that was supposed to have cured his diabetes (if you believe what the media tells us). I read the ad carefully. It said he was taking less diabetes meds now after his bypass but that is a totally different story than his diabetes getting "cured".

Fact remains, we are suffering from many old age diseases including worn out knees and high blood pressure because now we are living to the age where people start wearing out, fat or slim.

I commented on the widespread practice of smoking in Indonesia. "Doesn't that shorten their lifespan," I asked my hubby. He answered, "They don't live long enough to die from the repercussions of smoking."

I have known countless people who had gastric bypass to fix their knees only to find that the malnutrition and vitamin deficiencies made things worse if anything.

We need to start questioning seriously what we read in the media. If we follow their advice to not refrigerate our mayonnaise, we might get an upset stomach. But if we follow their advice to get a gastric bypass, the repercussions can be much more devastating.

Thursday, May 15, 2008

Dr Oz sells out to the Weight loss surgery industry!

I looked forward to Dr Oz's new program "The Oz Files" on Discovery Health. This week's episode was entitled "Defeating Obesity". Dr Oz is a cardiac surgeon and although some of the things he has said about obesity are questionable, I felt he was basically mainstream health conscious.

But the Oz Files was a great disappointment. Interestingly enough, Dr Roizen, his partner who has joined him on most other shows was missing. As the show wore on, I had to wonder whether Dr Roizen didn't approve of the slant of the show which was doing anything but advocating health!

The scenario of the show was that four fat people were picked to lose a lot of weight in 6 months. Located all over the country, they were given little guidance on how to do this - just cameos with Dr Oz cooking a healthy food or telling them they should exercise. Instead of guidance in a more healthy lifestyle, the people were told things like their bodies were dying from the obesity (untrue) and if they didn't lose weight immediately, they would get diabetes (untrue - how does Dr Oz explain the 33 percent of type II diabetics who have never been fat in their lives?) and that the "omentum" was "poisoning" their livers and kidneys.

The "Omentum" has been a favorite of Dr Oz's. If you look it up on the web, it appears a sort of sheathing for the abdominal cavity but beyond that, no one knows what it really does so Dr Oz declaring that it somehow poisons the organs in a fat person, is more than a bit over the top since this is NOT based on science.

Bottom line, the four people were made to feel terrible about their weight, and their future but only told to "eat less and exercise more" (wow, what a revelation! NOT).

One of them had a gastric bypass. She was 5'6" and not even 300 lbs.

One of them was "lagging" on her weight loss after a couple of months so was put on the diabetic medication, Metformin to help kill her appetite. To put a healthy person on a diabetic specific medication is very questionable.

And the two other people, battled it alone. It was emphasized throughout the show that they were not doing their part in losing the weight. Also the husband of the gastric bypass patient was taken to task for "not keeping up with his wife", Dr Oz, totally ignoring that the quick weight loss period in a gastric bypass patient is NOT from living healthy but simply from fasting because they cannot eat due to the massive surgical changes made to their digestive tracts.

At the end of 6 months, the results were predictable and Dr Oz announced them with glee.

The gastric bypass patient had lost 70 lbs (but remember, less than 30 lbs of that was likely fat because gastric bypass patients are on a fasting diet the first few months after surgery as their bodies heal - their bodies can only get sugar out of body fat and must cannibalize muscle and bone and organs for the rest, a fact totally ignored by Dr Oz who gleefully pointed out how the gastric bypass patient lost that weight through "changing her lifestyle to diet and exercise" and how he applauded her because she did what she needed to do and "partnered with science".

The person on metformin lost 45 lbs and Oz "lauded" her also saying she was now a slim person (she wasn't really). But the fact is, without medication that her body did not need, she would _not_ have lost that much weight and when the medication is discontinued she will likely gain back.

The other two people did not do well on their weight loss, but Oz patronizingly said they learned a lot from participation.

The content message of the show was clearly, the only way a person can lose a large amount of weight is having a gastric bypass!

Where is the "healthy lifestyle" here? Vitamin deficiencies on the long term which made the inventor of the gastric bypass stop doing the surgery he invented, in 1980? 40 percent serious complications within five years of surgery? And worse yet, we now have two studies which found that the weight loss at the 10 year point after a gastric bypass was somewhat unimpressive. 16 percent of the original weight? (Swedish Obesity Study).

I am confused. Is Dr Oz really deluding himself that the gastric bypass is a healthy and effective way to lose weight? Perhaps but if that is so, he's in for a rude awakening when he finds out the dark side of the surgery, how few people can stay healthy and keep off the weight.

Or is it as Dr Ernsberger once wrote:

"In my experience, most physicians, especially academic physicians, disapprove of these operations. However, they will only admit this in private, because of an unwritten law in medicine that forbids one to speak ill of another's procedure. Thus, there is no one with an MD after their name who will appear on camera and criticize the operation."

Paul Ernsberger, PhD, Department of Nutrition,
Case Western Reserve School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4906

In any case, I am very disappointed in Dr Oz that he could make a show which only had a thin veneer of teaching health and actually was just- yet another- infomercial for gastric bypass.

Tuesday, May 06, 2008

Can you be fat and fit? Latest spin says "No"

Based on a "data dredge" study (meaning they took existent data which was not designed for THAT study so is outdated and also doesn't usually have the right information), some of those in the diet industry are now telling us that we cannot be fat and fit.

The study, like other epidemiological studies boasted big numbers, 39,000 women classified as normal weight, overweight or obese (BMI 30 or over). It was published in the Archives of Internal Medicine, April 28, 2008 issue.

I looked up the article, because the news service headlines read "Fitness does not reduce risk if you are fat". The media told us that people who were obese had a 50 percent greater rate of heart attack even if they exercised than people who were not obese.

If the study had really suggested this, it would be very questionable ... the exercise habits were self reported and people often exaggerated their level of fitness (mostly exaggerate it!). Also overweight and obese women are often weight cycling (popularly called "yo yo dieting") because the body produces all kinds of hormones to force weight gain if it thinks your weight is too low (and too low varies for every different body). And of course, several CLINICAL studies have suggested that any kind of dieting increases heart disease risk by 50 percent.

However, in looking up the abstract, the study did NOT suggest that there was no benefit for an obese person to be fit. On the contrary, the last line of the abstract reads:

The risk of CHD associated with elevated body mass index is considerably reduced by increased physical activity levels.
The media ignored this statement and picked up the next line in the conclusion:

However, the risk is not completely eliminated, reinforcing the importance of being lean and physically active.

Ok, that's fine except it is a meaningless statement because a reduction in risk doesn't mean no risk... regardless of weight. However, it made a great statement for the media to base yet another article of misinformation on.

Now if we look at the study further, we find that although researchers wanted the expenditure of 1000 calories in exercise a week (which isn't very much... about 3 x a week, 40-60 minutes each time), the average expenditure in calories in exercise for those considered "active" (remember this is self reported) was 550 calories a week which isn't for most people, even twice a week. And even that small amount, said the researchers, reduced the risk of CHD significantly regardless of weight (34 percent, they stated).

It should be remembered that many people feel NON cardio is exercise to be counted like gardening and likely reported that as "activity" even if it didn't fit in the categories which were basically cardio exercise (I guess gardening could be reported in the "walking" category if you stretched it).

So although this wasn't the best designed study (to put it mildly) the results were not what the news media reported them to be. Exercise does significantly reduce the heart disease risk... regardless of weight.

Rudy Leibel, obesity researcher said "there probably is a benefit to being of 'normal weight' but there is no proof that people forcing their weight down below their set point enjoy that advantage". This is kind of a no brainer and I have no problems with it. Although right now, according to CDC statistics, people in the BMI category of 25-35 are living longer than those in the so called "normal weight" category.

Another strange thing in our society is that although most of us have had friends who exercise a lot of cardio, are lean but smoke cigarettes, drop dead rather early in life, I have not noticed any studies suggesting what we already know to be true - that smoking may cancel out the good effects of exercise in some individuals (regardless of weight or fitness level).

And in fact, many people who smoke, are doing so to keep their weight down because they are under the false conclusion that doing anything unhealthy is better than being fat. And of course, where do they learn that but from our media.

The Cooper Institute studies of 50,000 people over the last 30 years or so, suggested that people who were obese and fit had only a 00.08 greater risk of heart disease than those who were normal weight and fit. And those studies also suggested that being lean (under normal weight) was at the highest risk even if fit. But of course you will never see that in the media which is, bottom line, hard selling a diet.

One more comment about this study. Most people do not keep up a fitness program more than a year or two but in a self reported study, those people may not have reflected the change (stopping exercising) in their surveys.

Exercise greatly cuts risk of illness regardless of what people weigh but cutting risks doesn't mean no risk, of course. And to enjoy that reduction of risk, people must make cardio at least 3 times a week (and 5 times a week is way better) a part of their lives FOR life.

And it seems the greatest risk to our health may be believing the media which when not lying, is incorrectly reporting health topics.