April 4, 2024 • 35 mins
Are you ready to revolutionize your understanding of bariatric surgery? Prepare to have your misconceptions shattered and witness the unveiling of the metabolic miracle. Dr. Maria Iliakova, alongside Tammie Lakose, navigates the transformative journey that bariatric patients undertake. It's not a mere alteration of stomach size - it's a full-body metamorphosis. From discussing the nuanced realities of procedures like the gastric band to addressing how individual health histories shape surgical choices, this episode promises to challenge everything you thought you knew about weight-loss surgery.
Weight loss is just the tip of the iceberg when it comes to the profound hormonal and metabolic shifts post-surgery. Our conversation takes an in-depth look at how these changes can foster enhanced fertility, manage diabetes, and even alleviate PCOS symptoms. It's a path that requires unwavering dedication, akin to the prolonged commitment we see in other major life endeavors. We're peeling back the curtain on the myth that bariatric surgery is a shortcut, revealing the truth about the demanding journey of lifestyle transformation that follows.
As we close this insightful episode, we share our appreciation for your companionship on this educational voyage. Dr. Lamasters has illuminated the intricate details of our bodies' responses to bariatric procedures, and we extend an invitation to you to join the conversation. Your experiences and topics of interest are crucial to the fabric of our narrative, and we're committed to fostering a community rooted in evidence-based learning. Until the next episode, we leave you with a sense of belonging in our bariatric family, eager for the continued shared journey towards understanding and wellness.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics Podcast hosted by
Bariatric Surgeon Dr MariaIliakova and Tammy LaCoste,
bariatric Coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric Podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:26):
Maria, I have not seen your face in so long and
what beautiful faces we have.
I'm excited to see yours.
It's wonderful.
Happy New Year.
Speaker 1 (00:36):
Happy New Year Was yours good.
Speaker 2 (00:38):
It was lovely.
Speaker 1 (00:39):
Do you stay out of trouble?
Speaker 2 (00:40):
Barely, but yes, did you yeah.
Speaker 1 (00:43):
Yeah, a mom of three and not fun.
Speaker 2 (00:48):
You already have had trouble in your past.
That's how we get to threebabies.
So anyway, yes, no, happy NewYear, and I have been reflecting
a lot on this coming year andthe past year and where we want
to grow and where we want tobuild.
Yes, so I'm excited to do thisepisode because I think I
(01:10):
remember you actually mentionedhaving a light bulb moment when
we were in Iowa City at a dinnerthat we had organized for some
Bariatric groups and things likethat.
We brought together folks fromall over Iowa and Dr Teresa
Lamasters was talking and she isthe leader of a Bariatric
program and also a verywell-recognized national leader
(01:31):
in Bariatric surgery and weightmanagement in general, and I
remember you mentioned to meafterwards that your mind was
blown by what you were learningfrom her.
Speaker 1 (01:41):
Still, and what was it that?
Bariatric surgery is not just arestrictive surgery.
Everybody thinks that we'retaking out 80% of your stomach,
and so the whole point of thatis to restrict what you're
putting in Right and even samewith the bypass, that there's
not as much space to put food in.
Apparently, that's not all.
(02:01):
It does Not all it does.
Speaker 2 (02:03):
You're so right.
I think that's super fun torealize for people, because
there's a lot more under thehood than what a lot of people
are led to believe.
And so it's not justrestriction.
And actually that's a hugemisconception even in our field,
because I remember learningthis, even as a fellow and
things like that, and learningthat bands and sleeves are
restrictive whereas bypasses aremetabolic and all this stuff
(02:25):
and the division is actually notlike that at all.
It's not that clear.
So we'll talk about that, andwe'll talk also about the
concept of the magic bullet andthat surgery is not one.
We'll talk about that, and thenalso the impact that Bariatric
surgery has on other healthconditions and then where we're
going in the future.
A lot of things we still don'tknow and there's a lot of things
(02:45):
that we want to know.
So we're going to talk aboutthose things too.
Speaker 1 (02:49):
So sounds good.
Speaker 2 (02:50):
Yeah.
So let's get started again,let's do it.
So, yes, bariatric surgery isnot just about restriction, and
you had a really good way ofdescribing that.
When we're doing sleeves, we'retaking out a certain percent of
the stomach about 70 to 80percent, makes it smaller.
We prefer to that in the pastas a tank, like a gas tank and a
car, getting smaller.
And then same thing for yeah,same thing for bypass and all of
(03:12):
the other surgeries that we do.
They all include some form ofrestricting, meaning making size
smaller, making that tanksmaller, definitely Right.
There's one exception to that,actually.
Do you know what?
It is the band.
So this is not that common.
Oh yeah, yeah, so that's notthat common anymore.
Speaker 1 (03:28):
It's just not a surgery anymore.
Speaker 2 (03:30):
So like I don't even, I mean it is, but we don't talk
about it because it's not donethis much Exactly, and what I'm
talking about is a band thatgoes in around the top part of
your stomach, and it is arestrictive surgery technically,
because it makes the spacesmaller.
It makes it feel smaller, butit doesn't actually change the
size or shape of the stomach,because there's no cutting on
the stomach, there's norearranging of parts or anything
(03:52):
.
But what's interesting this isan interesting thing is, though,
it's restricting and makingthat space feel smaller.
In fact, a lot of times, one ofthe complications of bands that
we're seeing down the road manyyears afterwards is it can
actually cause the top part ofyour stomach to balloon, yeah,
or even your esophagus right.
Speaker 1 (04:09):
Yeah, to get bigger, yes.
Speaker 2 (04:12):
Because that's like a storage place if you eat too
much or too fast, exactlybecause sometimes bands are too
tight, or sometimes if peoplehaven't changed their eating
habits and they're eating a lotstill or eating really big
volumes of things and it justsits there, basically,
absolutely, you can make youresophagus that tube between
mouth and stomach, and then thetop part of the stomach, bigger,
and that can be a really bigproblem.
In fact, when I was a resident,I remember we had a patient who
(04:36):
had had a band for a long timethat was really tight and things
like that, and they didactually end up expanding the
top part of their stomach andtheir esophagus to the point
where their esophagus didn'twork anymore.
The muscles were they'resupposed to push things down.
Yeah, didn't.
And so the person actuallyneeded part of their esophagus
and stomach removed as a resultof that and had to have a
(04:56):
special kind of bypass donecalled an esophagectomy.
Anyway, it was a really bigdeal and really bad and really
hard and that was a humongouschange in that person's quality
of life and problems thereafter.
Not all bands will cause thatproblem, certainly Right.
I want to be super clear If youhave a band, do not rush to
your local surgeon to go take itout or anything like that.
Speaker 1 (05:15):
If it's working for you, yeah, I feel like
everything that we say in ourpodcast is very just pick with a
grain of salt.
Everybody is different.
Everybody's surgeon isdifferent.
Even if two people had a bypassand all things were pretty much
similar, things can bedifferent.
Speaker 2 (05:33):
Exactly, everything is different, exactly.
So if you have a question aboutyour band, that's more specific
than if you have a questionabout your band.
It was good, a good idea, to goto your surgeon and talk to
them about it, or go to yourprogram and talk to them about
it.
But anyways, restriction let'sgo back to this idea of
restriction is a part of all ofthese surgeries.
You have less, that's, lessspace to take in food.
(05:53):
You have less space that'sabsorbing food and less space
that's absorbing fluids.
For all of these surgeries,that is true, but for all of
these surgeries, there's also apart of your metabolism that's
changing too, and we've talkedabout that on some of our prior
episodes, about how your insulin, for instance, changes and how
the release of insulin and whatthat does to your blood sugar
changes.
(06:14):
But there's so much more thanjust insulin.
In fact, even how the long-termimpacts can even impact how
your stem cells in certain partsof your body are working, how
your genes are being alteredabove the level of the genes so
something called phosphorylationand hydroxylation, which is
called epigenetic alteration andeven how well your cells and
(06:38):
genes are preserving themselves.
So there's an impact long-termon what's called cell senescence
, which is how long cellssurvive and cells last.
So it's really interesting andI'm not going to go into the
details on this episode.
We will go into some more.
Yeah, because I'm already um,yes, I know I'm like staring you
, but yes, but we will.
Just brings up the point thatthere's so much more, and we are
(07:01):
going to deep dive in anotherepisode where we go a lot more
into the details on the geneticsof weight and genetics of
weight changes that happen aftersurgery.
But I just want you to knowthat there is a lot happening
under the hood for all of thesesurgeries.
Whether it's a sleeve orwhether it's a bypass, or
whether it's a Sadie or even ina band, when you lose weight,
(07:21):
some of these signaling pathwaysare changing even in that
circumstance, so it's not justabout restriction.
Very importantly, though, whaton earth does that mean for you
as a person?
Yeah right, you're like okay,cool, wonderful, my genes are
changing.
How they're getting regulatedis changing, potentially like
all this stuff, but what doesthat mean for me or for you?
What that means is, if you'restruggling, for instance, with
(07:44):
weight changes or not seeing thekind of weight changes that you
would expect, it may not bebecause your surgeon messed it
up.
It may not be because you aredoing something wrong with how
you're eating or moving.
It may be something about howyour metabolism is changing or
not changing and how yoursignaling is changing or not
changing.
Those are good things toespecially if you're off of a
(08:06):
curve, if you're off of whereyou expect to be with your
weight changes, or you'restarting to regain weight.
For instance, afterwards you'restarting to oh my goodness, my
blood pressure is creeping backup and I've been off of blood
pressure meds for a long timenow.
That's a really good chance totalk with your team, with your
health care team, and start tofigure out what's going on.
Right, your restriction may nothave changed, but it's likely
(08:29):
that something about yourmetabolism or some bigger
picture signaling has changed.
We've talked about this inprior episodes as to why
menopause or why pregnancy orwhy other kinds of things in
life can really change.
Even if people are status quo,they haven't changed anything
else, but all of a suddenthey're going through these big
hormonal changes.
That is why that can triggerweight gain or weight changes or
(08:52):
other things to change.
Speaker 1 (08:54):
Absolutely Be aware of that.
Speaker 2 (08:55):
Okay, that's important things.
That's also actually why thesesurgeries have such a big impact
on things like diabetes or PCOS, which is polycystic ovarian
syndrome, and why thesesurgeries can actually be used
as treatments or cures for someof these other conditions.
For instance, in our program,even over the course of a year
(09:16):
and a half, we had a fewpregnancies.
Yes, yes, those pregnancies arenot happening because of
restrictive changes.
They're happening because ofmetabolic changes that are
causing hormone levels to changein people's bodies.
Speaker 1 (09:29):
I like that you said that and said it out blatantly
clear that it's not just becauseof the surgery or the structure
of the surgery that is helpingthese things.
Speaker 2 (09:40):
Exactly, exactly.
I think there's a lot ofconfusion sometimes as to, okay,
weight loss surgery is just avanity thing or it's all just
for people to lose weight, butit's actually for people to have
babies and for people toperform better in the bedroom.
And no babies here.
No babies here.
Okay, no more babies here, Iknow, so be careful.
Yeah, you really got to watchit, tammy, because that's a
(10:02):
thing.
But the other thing to thinkabout is that's why people can
actually come off of theirmedications for high blood
pressure and diabetes and have atreatment for their fatty liver
disease through these surgeriesand for lots of other things
too.
So it's not just aboutrestriction.
It's massively because yourmetabolism and hormones and
everything is changing too.
Yeah, no, all right, let's alsotalk about the magic bullet.
(10:26):
You have heard of this one alot Magic bullet, right.
How do you think of this?
Like?
How do you think in the generalpublic or people when they're
coming in?
What do you think people thinkof surgery?
Is it like one and done, is it?
Oh, I'm going to have to workreally hard at this, is it?
What's your general thoughts onthat?
Speaker 1 (10:42):
No, it's literally the easy way out.
That's what everybody thinks itis.
Speaker 2 (10:45):
Yeah.
Speaker 1 (10:47):
It's.
One of the reasons why I wantedto do this with you is because
I want people to know it's notjust the easy way out.
Again, like I have said in aprevious episode, it just gives
you the tools, just like a hipreplacement gives you the tools
to live a better life and not bein as much pain, but you still
(11:10):
have to work, yeah.
If a person beats the crap outof their hip replacement and not
do the things they're toldthey're going to go backwards.
Speaker 2 (11:19):
If you think about it , anytime you're doing a knee
surgery or hip surgery, you'veprobably, if you've had that
surgery before, you've seensomebody else go through it.
They go through rehabafterwards.
Right, they go through PT,physical therapy, they do
exercises, and really you'resupposed to do those for forever
.
I don't know if anybodyactually does them for forever,
but these kinds of surgeries arethe same in that way.
It's basically you do thesurgery but then there's rehab
(11:42):
afterwards.
Maybe we should call it that orsomething, because you are
changing right Some things tothink about, because you're
changing everything about yourlife.
You're changing how you'reeating, you're changing how
you're drinking, you're changingwhen you're doing those things.
You're paying attention tovitamins, which you never really
did before.
If you're most people rightCalling you out, yeah, never
Calling you out.
Yes, I'm still learning.
Yes, and honestly, I thinkthat's the best way to do it.
(12:02):
Because I think that's the bestway to do it.
I really feel it, because Ihave a difficult time drinking
water on a regular basis and I'mthe person that's supposed to
be living it, and it's hard totell other people to do
something that you yourself finddifficult to do on a regular
basis.
But, yeah, these surgeries aresuper not not magic bullets.
They're really effective,meaning that they work really
(12:22):
well for losing weight andreally well for treating a lot
of other medical conditions.
But it's not.
They're not one and done Right.
And so you got to still put inthe effort over time to make
sure that you're moving yourbody, you're eating and drinking
well and you're really takingcare of your body overall.
Yeah, no, to be honest, it's alifelong thing.
It's a lifelong thing and Ireally do think that getting the
(12:45):
most out of these surgeries andmaking sure that you're not
just having surgery and then,all of a sudden, several years
down the road, you're like whydid I do that in the first place
?
That really wasn't helpful orthat really didn't work very
well.
It is the lifelong commitmentwhich is hard to do, because we
don't actually.
We do take on lifelongcommitments, like marriage can
be a lifelong commitment.
Or kids certainly are lifelongcommitment.
(13:05):
What kids are?
Yeah, certainly kids.
Yeah, but even bosses can comeand go.
Yeah, you're right.
You're right, spaces can comeand go.
But I think of how many thingswe do in life not even
necessarily realizing theirlifelong commitment, like our
choice of what we do for work orchoice of what kind of
education we get, really sets usup on certain tracks, and I
think that may be the best wayto think of it is like this kind
(13:26):
of a surgery or going throughthis process sets you up on a
certain kind of track.
You can totally get off track.
Things can push you off trackJust trains on a track.
You can also crash intosomething.
I do think that there's.
It would be helpful to think ofit as a journey, like you've
said before.
And yeah, and to be honest, Ido think we're really missing
(13:48):
out as an industry, as and Idon't say industry meaning like
a word, like money.
Yeah, you're making money.
We're Titans of industry doingrailroads or something.
No, but I mean about anindustry like healthcare.
Right, I think we are actuallymissing out on that concept of
rehab afterwards, because wemake it super obvious in certain
like for certain things,recovering from any surgery.
But I think maybe we need tomake it super obvious after
(14:11):
these kinds of surgeries toyou're always on to something.
You're always on to somethingtoo, tammy, okay, but I do want
to say so.
Now we're going to starttalking about some medical
conditions too, because this iswhere you get really jazzed
about specifically bariatricsurgery, because it's so
freaking effective at helpingpeople treat what is otherwise
extremely difficult to treat,like diabetes.
(14:31):
Right, and actually this kindof surgery is the most effective
treatment for diabetes, themost effective treatment for
hypertension, high bloodpressure, the most effective
treatment for polycysticalvariant syndrome, PCOS and many
other things, and I don't thinkpeople would ever be like
surgery can help me treatdiabetes until you go to get
yourself.
Speaker 1 (14:51):
No, that's not your first thought.
Your first thought is I needmeds?
Speaker 2 (14:55):
No, it isn't.
And I'm going to say something.
I may regret this 20 years downthe road, but I actually think
we're going to start using thesesurgeries to treat those things
, even if people are notoverweight, down the road.
Speaker 1 (15:06):
Potentially.
Because I think that's howeffective and how important
these things are, and it wouldreally help us take the focus
off of weight, which I actuallylisten to a podcast that had a I
think it was a plastic surgeonthat there was research being
done, that they had two miceagain.
(15:28):
I don't know, I don't like that, but they took the fecal matter
out of the skinny mouse.
Speaker 2 (15:34):
Yes.
Speaker 1 (15:35):
And put it into the overweight mouse lost weight.
Yes, yes.
So this is where we startlooking into gut health.
Yes, and like how it differsfrom places to places.
Yeah, I'm digging into thingsyou don't quite realize.
I love it.
Speaker 2 (15:50):
What you're describing is called the fecal
trans transplant and it soundsdisgusting.
Hold on, hold on.
I love it.
Right, put some poop in someother.
No, anyway, but how it works isthe yes, you take poop from one
person or one animal and youactually clean it and you
process it.
It's not like you just take onepiece of poo and put it in
another person Just like blood.
Speaker 1 (16:09):
Exactly.
Make sure it's a match.
Yes.
Speaker 2 (16:13):
Yes, it's a blood donation versus a poop donation.
Yay, but no, it's true, and youknow what this is actually used
for currently.
This is an actual treatmentthat we use on real human beings
.
Do you know what we use it for?
For C diff?
Yes, we use it for C diff, yes,yes, and it's not like people
that have C diff tend to get itover and over.
That's right, and it's in partbecause it's gut bacteria that's
(16:35):
out of whack with itself, andgetting good bacteria and less
bad bacteria basically intosomeone's gut through a fecal
transplant can be a really goodway to treat it.
So this is a thing, it's a realthing.
It's a real thing, it's a realthing.
And so the idea basically beingif we can do the same for
people with weight or othermetabolic issues, your gut
(16:57):
health, the bacteria that's allthroughout your body in fact,
there's more bacteria on yourbody than there are cells of you
, anyway.
So, oh, yeah, in your stomach,yes, so, like stomach and small
intestines and colon andeverywhere, and they nasty, but
they do good things, they dovery important things.
You're absolutely right.
Fecal transplants, I thinkyou're right, are going to also
be used in bariatric care in thefuture.
(17:19):
Yes, sorry, side track.
I love it.
There's always side tracks.
This is a train on a track andthen we've got all these little
side tracks Always.
So let's talk about one Ireally want to dive into, and
that's diabetes, because I thinkdiabetes is one of the things.
First of all, it's reallycommon in the US.
Yes, somewhere close to a thirdof the population is either at
risk, is pre diabetic ordiabetic, which is one in three.
(17:41):
That's crazy, that's a lot.
Yeah, that's a lot, and thatnumber is probably going to go
up over time.
Oh for sure, absolutely, yeah.
So one in three, that's a lotof people.
So if it's not you, it's not me.
Then there's a third person.
Speaker 1 (17:50):
It might be that third person Right.
Speaker 2 (17:52):
So diabetes really common and really creates a lot
of issues for people down theroad.
So it can affect everythingfrom blood supply to your
fingers and toes and how wellyour you perform sexually.
It for effects fertility.
Certainly.
It affects how your heart andlungs work, how your kidneys
work.
(18:13):
Literally, there's no how youreyes work.
You can go blind from diabetes.
Yeah, so there's quiteliterally no body system that is
not affected when diabetes isis your malady.
It's also super expensive, somedications for diabetes can be
hard to get can be totally.
In fact, they're really fancy.
Ozempic and manjarro and allthose things that cost an arm
(18:35):
and a leg are actually diabetesmedications.
And then we all are veryfamiliar with the fact that
insulin is very expensive too,Right Now this is side track
again.
Speaker 1 (18:45):
Do you think that maybe down the road the value to
diagnose diabetes is going tobe different?
Speaker 2 (18:51):
Like lower.
Yeah, I think so.
I think you're right, becauseright now it's like what?
Speaker 1 (18:56):
eight or seven?
You're a one seed.
Speaker 2 (19:01):
Your A1C is 6.5 and over 6.5 to diagnose.
Speaker 1 (19:04):
Okay, yeah, but you think that number might go down
in the future.
Speaker 2 (19:08):
Right now we have this range that's funky called
pre-diabetes, which is 5.7 toright before low 6.5 until you
reach that threshold, and it's arisk, basically for diabetes
it's not true diabetes, butyou're at higher risk for
developing this and it's moredifficult to slow.
Speaker 1 (19:23):
These medications help with pre-diabetes?
Speaker 2 (19:26):
Yes, they do, but insurance are not free to pre-.
No preventive care.
What's the way?
I'm looking for.
Preventive care, yes, andhonestly, that is a huge problem
because we could do.
It's always a pound ofprevention, sorry, pound of yes.
Prevention is worth an ounce ofcure, right?
If we could prevent diabetes,great, right?
Exactly, yeah, we don't seem todo that very well, but OK.
(19:48):
So let's talk about how surgeryaffects diabetes and there's
different kinds of diabetes.
Typically, we talk about a type1, type 2, but there's a lot
more nuance to it than that andwe call it insulin-dependent or
insulin-independent, but again,that's more terminology than
really reality of how it works.
But in general, what happens isyou have insulin resistance.
(20:10):
That happens so, even thoughinsulin, which is trying to pull
blood sugar into cells and helpyour cells use it for all kinds
of activity that they're doing,what happens is your body
doesn't really recognize theinsulin, doesn't produce enough
insulin.
It just doesn't allow it towork very properly and so too
much blood sugar stays in yourbloodstream and has all of these
downstream effects, quiteliterally on all your body
(20:32):
organs?
Yes, and the longer it happens.
It's a bit of a feed forwardmechanism, a downward spiral
there, where your body just hassome resistance and it keeps
getting worse and worse untilyour body just really doesn't
respond appropriately to bloodsugar at all.
It doesn't regulate it verywell.
Speaker 1 (20:48):
I feel like we can use the example of antibiotics,
right you?
Don't want to use theantibiotics too much, because
you could become resistant tothem.
I just want to.
Speaker 2 (20:57):
I love that.
I don't want to dumb it down,but simple it.
I love that.
I love that.
Yeah, so basically it'sactually like alarm fatigue If
you set your too many alarms ortoo many notifications I've been
doing that more and you all ofa sudden don't even register
alarms or any of that anymorebecause there's so many of them.
Think about email notificationsor text notifications or
(21:17):
whatever.
Yeah, it's the same idea.
Speaker 1 (21:18):
Your body just goes.
It goes off and I'm just likean Apple watch.
It vibrates, but we get used toit Exactly.
Speaker 2 (21:25):
We get used to all of that and your body does the
same thing.
It gets used to that and itgets used to it being a problem,
but it can't do anything aboutthe problem and so it just gets
worse and worse over time.
So what happens with surgerywhich is interesting is you have
a reprogramming going on of allof the signaling and, instead
of having your entire pathwaywhere the insulin and how it's
(21:48):
accepted and all of thedifferent things that help to
make that work all of thatworking abnormally it starts to
work more normally and itactually starts to get regulated
in a positive way.
You have signaling of certainkinds of genes changing as
people lose weight and as peoplehave these surgeries and their
metabolism starts to change,where you actually have
(22:09):
different cells that are helpingto control inflammation and
you're lowering the kinds ofcells that actually encourage
inflammation.
So you have more balance interms of less inflammation
happening and being able to dealwith it better, and that has an
enormous impact on thesesignaling pathways that impact
how blood sugar is stored in thecells and goes to the cells
(22:30):
rather than stays in thebloodstream, and it even affects
things like leptin, which isconsidered to be ingrelin, which
are considered to be hormonesof whether we feel full or
hungry, and things like that,and these pathways are really
specific.
I'm going to talk about themmore in our genetics podcast on
bariatrics because they'recomplicated, but there's a lot
(22:53):
and we'll actually be includingsome links in this podcast also
that go into more of the detailsfor people who are interested.
But just for the scientists outthere yeah, just for the
scientists and the doctors outthere and things like that.
The specific pathways we'retalking about are the insulin
receptor substrate pathways, thePI3K pathways and MAP kinase
pathways, as well asmitochondrial pathways that
(23:13):
involve TNF-alpha and reactiveoxide species, as well as
pro-inflammatory andanti-inflammatory macrophages
and beta cell dysfunction.
So for anyone who wants to hearthe actual mumbo jumbo, science
jargon, that's it Just look ata little thing like that yes,
big words, yes, exactly, but thecrazy thing is that a lot of
(23:38):
these kinds of pathways and alot of this kind of damage is
reversible through surgery, andso what happens is the beta
cells that produce insulinactually start to work better
after surgery.
Your body starts to be lessresistant to insulin if it had
insulin resistance.
It starts to be less resistantto leptin if it had developed
resistance in the past, andbetween 35 and about 90% of
(24:02):
people have diabetes.
That goes into completeremission a year after surgery.
Remission means cure.
Essentially it goes completelyaway, meaning no meds, no
monitoring, no, nothing, which Ithink is nuts, because there is
absolutely no.
Yeah, there's no medication outthere that does that.
There is no lifestyle changethat does that.
There's quite literally nothingout there that replicates that
(24:25):
even close, and even the GLP-1medications don't have that
effect.
Speaker 1 (24:32):
No, because once you stop taking it.
Speaker 2 (24:34):
Exactly, you're going back Exactly, and this is
surgery.
Again, surgery is not one anddone.
Surgery involves lifestylechanges and things to maintain
it.
But surgery plus those things,and between a third and almost
all of people can veryeffectively treat or cure their
diabetes with surgery Prettycool and medications alone and
prevent it and prevent andprevent it from getting in the
(24:57):
way of the patients in thefuture having lower risk for
life.
Basically, as a result of that,and if you compare that to just
medications that are used fordiabetes management, the chances
of treating or curing diabetes,especially going into remission
at a year is less than 40%.
Yeah, yeah, so it's less than.
It's essentially the flip side.
So one in three to all have aremission with surgery and less
(25:18):
than 40% have a remission withmedications alone.
And one of the massive benefitsof these surgeries is the
impact it has on some of theseother medical conditions that
people have that are related,because it really is a much more
complex approach than justrestriction, like we talked
(25:38):
about.
It's making these metabolicchanges and hormonal changes
that are having impact on allthese other medical conditions.
And also one thing I want tomention is these changes oh,
hello there, my husband'swalking in.
I love it.
No, it's all good.
You do live in a house, it isokay.
Yeah, okay, you do have otherpeople in this house, it's okay,
don't worry.
So the other thing I wanted tomention is that people sometimes
(26:02):
wonder why a bypass is moreeffective than a sleeve at some
of this treatment for diabetes.
And that is true.
So, even though with a sleeveyou can treat or cure diabetes,
it's more likely to happen ifyou have a surgery that actually
rearranges body parts andthat's a bypass, or like a ruin
my bypass or a seedy or adoodial switch, and the reason
(26:24):
is interesting because we don'tknow all of the reasons for it.
But even the way that like bilesalt which I don't know if
you've ever heard of that, butthat's what helps your body
absorb fats and like more fatsand things like that, and in
what you're digesting, there's adifference in how those things
actually get processed in yourbody.
With those kinds of surgeriesand some of those inflammatory
(26:46):
markers and how the genes arebeing regulated, is even
stronger of a change with abypass or a seedy or any of
those other things than with asleeve.
So that's, we think, why that'sa more effective treatment when
people have diabetes and othermetabolic issues.
Speaker 1 (27:00):
Yeah, so I know that's a lot of jargon, no, but
it makes sense for people thatare really wanting to know why a
powder tool works and verypowerful.
Speaker 2 (27:12):
Yeah, I mean it's incredible because it's so cool.
This is why I'm so jazzed aboutbariatric surgery and why I'm
such a.
I just think it's incredible,right, I think this is why we're
such advocates of this isbecause it is a tool, that it's
like a handyman tool for all thethings potentially, and for so
many more than just one thing,and it's really effective and it
(27:32):
really works for people.
Also, I wanted to touch onfuture directions.
Where are we going with all ofthis?
I mentioned that there's a lotof things we don't know and
there's a lot of things thatwe're figuring out, like why,
with every single thing in themedical field.
Exactly and honestly, thisfield is a big one and you're
noticing that, even if you don'tcare about it, because you're
(27:54):
hearing about all these newmedications that are coming out
to help treat weight and thingslike that.
So there's definitelydevelopment of medications.
That's a big one and we'refiguring out how we use
medications, potentially withsurgery sometimes, or just by
themselves, or before and aftersurgery, like all kinds of
things in combination.
Potentially we're figuring outhow to make medications more
effective, because right now themedications we have are
(28:16):
effective, but they'redefinitely nowhere near as
effective as surgery.
So there's that, evendeveloping surgery techniques.
So, for instance, we've talkedabout different kinds of
bypasses and sleeves and thingslike that.
We are totally just scratchingthe surface of how these
surgeries work and what can wedo to make them better.
And how do we choose whichsurgery is the best option for
(28:37):
which person, because there'sguidelines on this stuff and
there's good ways to choose,pick and choose with patients,
but they're not perfect.
Speaker 1 (28:46):
Things have come a long way Already.
A long way because I think Iwas incorrect me, if I'm wrong
that back in the day theythought making the sleeve
smaller will make people moresuccessful, when in reality
that's probably not the.
Speaker 2 (29:02):
There's definitely a limit to how small you can go.
In fact, there's been someresearch into that not too long
ago and it showed you make ittoo small and you actually give
people a lot of complications,without benefits of weight loss
or weight changes, and then youleave it too big and oftentimes,
yeah, you won't have enoughchange too.
So there's definitely like asize has an impact, but we're
(29:23):
not exactly sure what theperfect size is.
There's that, exactly, and notonly that.
But okay, so the bypass is forone quick second and again I'm
going to go for the audiencethat is in healthcare or is
interested in the stuff.
I'm going to deep dive just fora second.
So when we're talking aboutbypasses, we're actually
rearranging the intestines andhow they connect to the stomach,
(29:44):
and so we're creating differentlimbs.
We're literally creatingdifferent tracks, if you will
like, different train tracks,and the length of those train
tracks actually affects how wellthese surgeries work.
But think of it this way we'rerearranging the railroad, but we
actually don't know each personyou and me and anyone else will
have different lengths ofrailroad in their bodies.
(30:06):
And so when we do these kindsof surgeries and we actually
create different tracks withdifferent lengths and things
like that.
For one person, if you do acertain length, that will be a
lot of their train track and ifyou do it in a different person,
that won't be that much oftheir train track.
And if you can imagine, thebigger the bypass for someone,
the more effect.
So I know this is getting intothe weeds, but we don't even
(30:29):
know necessarily what theperfect length is for everyone,
because everyone's train trackis different length.
Hey, all right, so, yeah.
So there's a lot ofinvestigation and innovation
going on there.
Speaker 1 (30:44):
And I just want to add that, because we're talking
about all these surgeries, wewill have a video that you made
available for those that will bein our yes.
Yes, I don't know if it'll be aPatreon.
I don't know what it will beDiscord Circle, any of that, but
anybody that is in thatcommunity we're gonna make that
(31:05):
video available to them tounderstand what each was.
Speaker 2 (31:10):
Yes.
Speaker 1 (31:11):
Because even as much research as I did you had to
explain that to me.
Speaker 2 (31:16):
And it's a longer video and you do not have to
watch it at all, but just knowthat we are just scratching the
surface, thank you, but we'rejust scratching the surface of
figuring out, like how thesesurgeries work and why and what
we can do to make them better,or even totally different
techniques.
So I think it surprises somepeople when they learn that
bypasses were originally usedactually to treat reflux, not
(31:37):
weight.
So that's where that came from.
And then we noticed that peopleasked for it.
You know that either, right,and then sleeves only became
part of the whole picture in thepast, like less than 15 years.
So the first, 2009 that thefirst sleeve was actually
approved as a weight lossprocedure by an insurance
company, so that's less than 15years ago.
Yeah, crazy.
(31:57):
And it used to be part of theduodenal switch and anyway, we
don't need to go into all thedetails, but the whole idea is
there.
This is a newer field relativeto a lot of others and there's
still a lot that we don't knowand a lot that we're
investigating.
Stay tuned.
Speaker 1 (32:12):
And you are good at investigating.
Speaker 2 (32:13):
Thank you.
Cool Questions are good andwe're curious.
So stay curious, my friends.
Yes, and then, lastly, just tomention at the very end of this
that not every.
There's some limitations tosurgery, and I just want to
breeze through these real quick,because this is going to be a
completely different episode tooat some point, but just for now
.
Not every surgery is right foreverybody, okay, so just a
(32:37):
sleeve is not the right choicefor everyone.
A bypass is not the rightchoice for everyone.
A surgery is not the rightchoice for everyone, okay, very
good.
And not everyone will have thesame outcome from the same
surgery.
You touched on it earlier, andthere's lots of reasons both.
Why, oh yeah, there's so manyreasons, and so not everyone
will have the same outcome, evenif they have the exact same
(33:00):
surgery as their friend or theirfamily member or someone else.
Okay, it also does not meanthat you will lose weight and
drop your weight below a BMI of25.
We can't do that.
In fact, there's no healthy wayto do that, for, whether with
surgery or whether with meds orwhether with anything, there
just isn't a healthy way to dothat.
Speaker 1 (33:20):
Your body will always determine where you'll be.
Speaker 2 (33:23):
Exactly, exactly, and there's safe places that we can
go and there's not a lot beyondthat Right, and pushing beyond
that typically means doing somedamage along the road.
Exactly, and then thesesurgeries also can cause
problems like being dehydratedor not getting your nutrition or
(33:44):
having reflux or other things.
So it is always very importantto prepare for surgery, to know
what those risks are before youget into it, and to be on the
lookout for problems as you goafter surgery and keep up on
your labs and stuff, exactly.
Speaker 1 (33:59):
So your surgeon can mean mug you about not taking
your vitamins.
Speaker 2 (34:02):
I love it.
This is all actually an episodeto mean mug you for 30 minutes.
I love it, but no, so I'mreally glad that we talked today
about understanding bariatricsurgery a little more and
understanding that I learnedmore too, thank you.
But understanding, there's onelimitations.
Two, we don't know everythingand we're working on it and we'd
love for everyone to helpbecause we need that.
Three, that this is a surgery,kind of surgery.
(34:23):
They can have a really bigimpact on other medical
conditions.
That it's not a magic bulletand that it works in mysterious
ways, some of which we know insome of the videos.
Speaker 1 (34:31):
It's not just restriction Exactly exactly.
Thanks for explaining, thanksfor letting me see your
beautiful face, you too, tammy,and don't forget to follow us.
Don't forget to comment ifthere's something you want us to
talk about, or even you to comewith us and talk about it.
Speaker 2 (34:50):
We are so open to having guests and patients and
providers and all of that, yes,for this episode we will also
have some links to some of thecitations and materials, because
I really want those folks whoare interested in that to see
that we're not just talking hotsmoke, that this is very well
supported in research and thatwe really want to share that
with those folks who want todive into it.
Speaker 1 (35:12):
Absolutely Well, until next time, maria Mwah.
See you soon, bye, bye.
Welcome to Core Bariatrics Podcast hosted by
Bariatric Surgeon Dr MariaIliakova and Tammy LaCoste,
bariatric Coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatric Podcast doesnot offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:26):
Maria, I have not seen your face in so long and
what beautiful faces we have.
I'm excited to see yours.
It's wonderful.
Happy New Year.
Speaker 1 (00:36):
Happy New Year Was yours good.
Speaker 2 (00:38):
It was lovely.
Speaker 1 (00:39):
Do you stay out of trouble?
Speaker 2 (00:40):
Barely, but yes, did you yeah.
Speaker 1 (00:43):
Yeah, a mom of three and not fun.
Speaker 2 (00:48):
You already have had trouble in your past.
That's how we get to threebabies.
So anyway, yes, no, happy NewYear, and I have been reflecting
a lot on this coming year andthe past year and where we want
to grow and where we want tobuild.
Yes, so I'm excited to do thisepisode because I think I
(01:10):
remember you actually mentionedhaving a light bulb moment when
we were in Iowa City at a dinnerthat we had organized for some
Bariatric groups and things likethat.
We brought together folks fromall over Iowa and Dr Teresa
Lamasters was talking and she isthe leader of a Bariatric
program and also a verywell-recognized national leader
(01:31):
in Bariatric surgery and weightmanagement in general, and I
remember you mentioned to meafterwards that your mind was
blown by what you were learningfrom her.
Speaker 1 (01:41):
Still, and what was it that?
Bariatric surgery is not just arestrictive surgery.
Everybody thinks that we'retaking out 80% of your stomach,
and so the whole point of thatis to restrict what you're
putting in Right and even samewith the bypass, that there's
not as much space to put food in.
Apparently, that's not all.
(02:01):
It does Not all it does.
Speaker 2 (02:03):
You're so right.
I think that's super fun torealize for people, because
there's a lot more under thehood than what a lot of people
are led to believe.
And so it's not justrestriction.
And actually that's a hugemisconception even in our field,
because I remember learningthis, even as a fellow and
things like that, and learningthat bands and sleeves are
restrictive whereas bypasses aremetabolic and all this stuff
(02:25):
and the division is actually notlike that at all.
It's not that clear.
So we'll talk about that, andwe'll talk also about the
concept of the magic bullet andthat surgery is not one.
We'll talk about that, and thenalso the impact that Bariatric
surgery has on other healthconditions and then where we're
going in the future.
A lot of things we still don'tknow and there's a lot of things
(02:45):
that we want to know.
So we're going to talk aboutthose things too.
Speaker 1 (02:49):
So sounds good.
Speaker 2 (02:50):
Yeah.
So let's get started again,let's do it.
So, yes, bariatric surgery isnot just about restriction, and
you had a really good way ofdescribing that.
When we're doing sleeves, we'retaking out a certain percent of
the stomach about 70 to 80percent, makes it smaller.
We prefer to that in the pastas a tank, like a gas tank and a
car, getting smaller.
And then same thing for yeah,same thing for bypass and all of
(03:12):
the other surgeries that we do.
They all include some form ofrestricting, meaning making size
smaller, making that tanksmaller, definitely Right.
There's one exception to that,actually.
Do you know what?
It is the band.
So this is not that common.
Oh yeah, yeah, so that's notthat common anymore.
Speaker 1 (03:28):
It's just not a surgery anymore.
Speaker 2 (03:30):
So like I don't even, I mean it is, but we don't talk
about it because it's not donethis much Exactly, and what I'm
talking about is a band thatgoes in around the top part of
your stomach, and it is arestrictive surgery technically,
because it makes the spacesmaller.
It makes it feel smaller, butit doesn't actually change the
size or shape of the stomach,because there's no cutting on
the stomach, there's norearranging of parts or anything
(03:52):
.
But what's interesting this isan interesting thing is, though,
it's restricting and makingthat space feel smaller.
In fact, a lot of times, one ofthe complications of bands that
we're seeing down the road manyyears afterwards is it can
actually cause the top part ofyour stomach to balloon, yeah,
or even your esophagus right.
Speaker 1 (04:09):
Yeah, to get bigger, yes.
Speaker 2 (04:12):
Because that's like a storage place if you eat too
much or too fast, exactlybecause sometimes bands are too
tight, or sometimes if peoplehaven't changed their eating
habits and they're eating a lotstill or eating really big
volumes of things and it justsits there, basically,
absolutely, you can make youresophagus that tube between
mouth and stomach, and then thetop part of the stomach, bigger,
and that can be a really bigproblem.
In fact, when I was a resident,I remember we had a patient who
(04:36):
had had a band for a long timethat was really tight and things
like that, and they didactually end up expanding the
top part of their stomach andtheir esophagus to the point
where their esophagus didn'twork anymore.
The muscles were they'resupposed to push things down.
Yeah, didn't.
And so the person actuallyneeded part of their esophagus
and stomach removed as a resultof that and had to have a
(04:56):
special kind of bypass donecalled an esophagectomy.
Anyway, it was a really bigdeal and really bad and really
hard and that was a humongouschange in that person's quality
of life and problems thereafter.
Not all bands will cause thatproblem, certainly Right.
I want to be super clear If youhave a band, do not rush to
your local surgeon to go take itout or anything like that.
Speaker 1 (05:15):
If it's working for you, yeah, I feel like
everything that we say in ourpodcast is very just pick with a
grain of salt.
Everybody is different.
Everybody's surgeon isdifferent.
Even if two people had a bypassand all things were pretty much
similar, things can bedifferent.
Speaker 2 (05:33):
Exactly, everything is different, exactly.
So if you have a question aboutyour band, that's more specific
than if you have a questionabout your band.
It was good, a good idea, to goto your surgeon and talk to
them about it, or go to yourprogram and talk to them about
it.
But anyways, restriction let'sgo back to this idea of
restriction is a part of all ofthese surgeries.
You have less, that's, lessspace to take in food.
(05:53):
You have less space that'sabsorbing food and less space
that's absorbing fluids.
For all of these surgeries,that is true, but for all of
these surgeries, there's also apart of your metabolism that's
changing too, and we've talkedabout that on some of our prior
episodes, about how your insulin, for instance, changes and how
the release of insulin and whatthat does to your blood sugar
changes.
(06:14):
But there's so much more thanjust insulin.
In fact, even how the long-termimpacts can even impact how
your stem cells in certain partsof your body are working, how
your genes are being alteredabove the level of the genes so
something called phosphorylationand hydroxylation, which is
called epigenetic alteration andeven how well your cells and
(06:38):
genes are preserving themselves.
So there's an impact long-termon what's called cell senescence
, which is how long cellssurvive and cells last.
So it's really interesting andI'm not going to go into the
details on this episode.
We will go into some more.
Yeah, because I'm already um,yes, I know I'm like staring you
, but yes, but we will.
Just brings up the point thatthere's so much more, and we are
(07:01):
going to deep dive in anotherepisode where we go a lot more
into the details on the geneticsof weight and genetics of
weight changes that happen aftersurgery.
But I just want you to knowthat there is a lot happening
under the hood for all of thesesurgeries.
Whether it's a sleeve orwhether it's a bypass, or
whether it's a Sadie or even ina band, when you lose weight,
(07:21):
some of these signaling pathwaysare changing even in that
circumstance, so it's not justabout restriction.
Very importantly, though, whaton earth does that mean for you
as a person?
Yeah right, you're like okay,cool, wonderful, my genes are
changing.
How they're getting regulatedis changing, potentially like
all this stuff, but what doesthat mean for me or for you?
What that means is, if you'restruggling, for instance, with
(07:44):
weight changes or not seeing thekind of weight changes that you
would expect, it may not bebecause your surgeon messed it
up.
It may not be because you aredoing something wrong with how
you're eating or moving.
It may be something about howyour metabolism is changing or
not changing and how yoursignaling is changing or not
changing.
Those are good things toespecially if you're off of a
(08:06):
curve, if you're off of whereyou expect to be with your
weight changes, or you'restarting to regain weight.
For instance, afterwards you'restarting to oh my goodness, my
blood pressure is creeping backup and I've been off of blood
pressure meds for a long timenow.
That's a really good chance totalk with your team, with your
health care team, and start tofigure out what's going on.
Right, your restriction may nothave changed, but it's likely
(08:29):
that something about yourmetabolism or some bigger
picture signaling has changed.
We've talked about this inprior episodes as to why
menopause or why pregnancy orwhy other kinds of things in
life can really change.
Even if people are status quo,they haven't changed anything
else, but all of a suddenthey're going through these big
hormonal changes.
That is why that can triggerweight gain or weight changes or
(08:52):
other things to change.
Speaker 1 (08:54):
Absolutely Be aware of that.
Speaker 2 (08:55):
Okay, that's important things.
That's also actually why thesesurgeries have such a big impact
on things like diabetes or PCOS, which is polycystic ovarian
syndrome, and why thesesurgeries can actually be used
as treatments or cures for someof these other conditions.
For instance, in our program,even over the course of a year
(09:16):
and a half, we had a fewpregnancies.
Yes, yes, those pregnancies arenot happening because of
restrictive changes.
They're happening because ofmetabolic changes that are
causing hormone levels to changein people's bodies.
Speaker 1 (09:29):
I like that you said that and said it out blatantly
clear that it's not just becauseof the surgery or the structure
of the surgery that is helpingthese things.
Speaker 2 (09:40):
Exactly, exactly.
I think there's a lot ofconfusion sometimes as to, okay,
weight loss surgery is just avanity thing or it's all just
for people to lose weight, butit's actually for people to have
babies and for people toperform better in the bedroom.
And no babies here.
No babies here.
Okay, no more babies here, Iknow, so be careful.
Yeah, you really got to watchit, tammy, because that's a
(10:02):
thing.
But the other thing to thinkabout is that's why people can
actually come off of theirmedications for high blood
pressure and diabetes and have atreatment for their fatty liver
disease through these surgeriesand for lots of other things
too.
So it's not just aboutrestriction.
It's massively because yourmetabolism and hormones and
everything is changing too.
Yeah, no, all right, let's alsotalk about the magic bullet.
(10:26):
You have heard of this one alot Magic bullet, right.
How do you think of this?
Like?
How do you think in the generalpublic or people when they're
coming in?
What do you think people thinkof surgery?
Is it like one and done, is it?
Oh, I'm going to have to workreally hard at this, is it?
What's your general thoughts onthat?
Speaker 1 (10:42):
No, it's literally the easy way out.
That's what everybody thinks itis.
Speaker 2 (10:45):
Yeah.
Speaker 1 (10:47):
It's.
One of the reasons why I wantedto do this with you is because
I want people to know it's notjust the easy way out.
Again, like I have said in aprevious episode, it just gives
you the tools, just like a hipreplacement gives you the tools
to live a better life and not bein as much pain, but you still
(11:10):
have to work, yeah.
If a person beats the crap outof their hip replacement and not
do the things they're toldthey're going to go backwards.
Speaker 2 (11:19):
If you think about it , anytime you're doing a knee
surgery or hip surgery, you'veprobably, if you've had that
surgery before, you've seensomebody else go through it.
They go through rehabafterwards.
Right, they go through PT,physical therapy, they do
exercises, and really you'resupposed to do those for forever
.
I don't know if anybodyactually does them for forever,
but these kinds of surgeries arethe same in that way.
It's basically you do thesurgery but then there's rehab
(11:42):
afterwards.
Maybe we should call it that orsomething, because you are
changing right Some things tothink about, because you're
changing everything about yourlife.
You're changing how you'reeating, you're changing how
you're drinking, you're changingwhen you're doing those things.
You're paying attention tovitamins, which you never really
did before.
If you're most people rightCalling you out, yeah, never
Calling you out.
Yes, I'm still learning.
Yes, and honestly, I thinkthat's the best way to do it.
(12:02):
Because I think that's the bestway to do it.
I really feel it, because Ihave a difficult time drinking
water on a regular basis and I'mthe person that's supposed to
be living it, and it's hard totell other people to do
something that you yourself finddifficult to do on a regular
basis.
But, yeah, these surgeries aresuper not not magic bullets.
They're really effective,meaning that they work really
(12:22):
well for losing weight andreally well for treating a lot
of other medical conditions.
But it's not.
They're not one and done Right.
And so you got to still put inthe effort over time to make
sure that you're moving yourbody, you're eating and drinking
well and you're really takingcare of your body overall.
Yeah, no, to be honest, it's alifelong thing.
It's a lifelong thing and Ireally do think that getting the
(12:45):
most out of these surgeries andmaking sure that you're not
just having surgery and then,all of a sudden, several years
down the road, you're like whydid I do that in the first place
?
That really wasn't helpful orthat really didn't work very
well.
It is the lifelong commitmentwhich is hard to do, because we
don't actually.
We do take on lifelongcommitments, like marriage can
be a lifelong commitment.
Or kids certainly are lifelongcommitment.
(13:05):
What kids are?
Yeah, certainly kids.
Yeah, but even bosses can comeand go.
Yeah, you're right.
You're right, spaces can comeand go.
But I think of how many thingswe do in life not even
necessarily realizing theirlifelong commitment, like our
choice of what we do for work orchoice of what kind of
education we get, really sets usup on certain tracks, and I
think that may be the best wayto think of it is like this kind
(13:26):
of a surgery or going throughthis process sets you up on a
certain kind of track.
You can totally get off track.
Things can push you off trackJust trains on a track.
You can also crash intosomething.
I do think that there's.
It would be helpful to think ofit as a journey, like you've
said before.
And yeah, and to be honest, Ido think we're really missing
(13:48):
out as an industry, as and Idon't say industry meaning like
a word, like money.
Yeah, you're making money.
We're Titans of industry doingrailroads or something.
No, but I mean about anindustry like healthcare.
Right, I think we are actuallymissing out on that concept of
rehab afterwards, because wemake it super obvious in certain
like for certain things,recovering from any surgery.
But I think maybe we need tomake it super obvious after
(14:11):
these kinds of surgeries toyou're always on to something.
You're always on to somethingtoo, tammy, okay, but I do want
to say so.
Now we're going to starttalking about some medical
conditions too, because this iswhere you get really jazzed
about specifically bariatricsurgery, because it's so
freaking effective at helpingpeople treat what is otherwise
extremely difficult to treat,like diabetes.
(14:31):
Right, and actually this kindof surgery is the most effective
treatment for diabetes, themost effective treatment for
hypertension, high bloodpressure, the most effective
treatment for polycysticalvariant syndrome, PCOS and many
other things, and I don't thinkpeople would ever be like
surgery can help me treatdiabetes until you go to get
yourself.
Speaker 1 (14:51):
No, that's not your first thought.
Your first thought is I needmeds?
Speaker 2 (14:55):
No, it isn't.
And I'm going to say something.
I may regret this 20 years downthe road, but I actually think
we're going to start using thesesurgeries to treat those things
, even if people are notoverweight, down the road.
Speaker 1 (15:06):
Potentially.
Because I think that's howeffective and how important
these things are, and it wouldreally help us take the focus
off of weight, which I actuallylisten to a podcast that had a I
think it was a plastic surgeonthat there was research being
done, that they had two miceagain.
(15:28):
I don't know, I don't like that, but they took the fecal matter
out of the skinny mouse.
Speaker 2 (15:34):
Yes.
Speaker 1 (15:35):
And put it into the overweight mouse lost weight.
Yes, yes.
So this is where we startlooking into gut health.
Yes, and like how it differsfrom places to places.
Yeah, I'm digging into thingsyou don't quite realize.
I love it.
Speaker 2 (15:50):
What you're describing is called the fecal
trans transplant and it soundsdisgusting.
Hold on, hold on.
I love it.
Right, put some poop in someother.
No, anyway, but how it works isthe yes, you take poop from one
person or one animal and youactually clean it and you
process it.
It's not like you just take onepiece of poo and put it in
another person Just like blood.
Speaker 1 (16:09):
Exactly.
Make sure it's a match.
Yes.
Speaker 2 (16:13):
Yes, it's a blood donation versus a poop donation.
Yay, but no, it's true, and youknow what this is actually used
for currently.
This is an actual treatmentthat we use on real human beings
.
Do you know what we use it for?
For C diff?
Yes, we use it for C diff, yes,yes, and it's not like people
that have C diff tend to get itover and over.
That's right, and it's in partbecause it's gut bacteria that's
(16:35):
out of whack with itself, andgetting good bacteria and less
bad bacteria basically intosomeone's gut through a fecal
transplant can be a really goodway to treat it.
So this is a thing, it's a realthing.
It's a real thing, it's a realthing.
And so the idea basically beingif we can do the same for
people with weight or othermetabolic issues, your gut
(16:57):
health, the bacteria that's allthroughout your body in fact,
there's more bacteria on yourbody than there are cells of you
, anyway.
So, oh, yeah, in your stomach,yes, so, like stomach and small
intestines and colon andeverywhere, and they nasty, but
they do good things, they dovery important things.
You're absolutely right.
Fecal transplants, I thinkyou're right, are going to also
be used in bariatric care in thefuture.
(17:19):
Yes, sorry, side track.
I love it.
There's always side tracks.
This is a train on a track andthen we've got all these little
side tracks Always.
So let's talk about one Ireally want to dive into, and
that's diabetes, because I thinkdiabetes is one of the things.
First of all, it's reallycommon in the US.
Yes, somewhere close to a thirdof the population is either at
risk, is pre diabetic ordiabetic, which is one in three.
(17:41):
That's crazy, that's a lot.
Yeah, that's a lot, and thatnumber is probably going to go
up over time.
Oh for sure, absolutely, yeah.
So one in three, that's a lotof people.
So if it's not you, it's not me.
Then there's a third person.
Speaker 1 (17:50):
It might be that third person Right.
Speaker 2 (17:52):
So diabetes really common and really creates a lot
of issues for people down theroad.
So it can affect everythingfrom blood supply to your
fingers and toes and how wellyour you perform sexually.
It for effects fertility.
Certainly.
It affects how your heart andlungs work, how your kidneys
work.
(18:13):
Literally, there's no how youreyes work.
You can go blind from diabetes.
Yeah, so there's quiteliterally no body system that is
not affected when diabetes isis your malady.
It's also super expensive, somedications for diabetes can be
hard to get can be totally.
In fact, they're really fancy.
Ozempic and manjarro and allthose things that cost an arm
(18:35):
and a leg are actually diabetesmedications.
And then we all are veryfamiliar with the fact that
insulin is very expensive too,Right Now this is side track
again.
Speaker 1 (18:45):
Do you think that maybe down the road the value to
diagnose diabetes is going tobe different?
Speaker 2 (18:51):
Like lower.
Yeah, I think so.
I think you're right, becauseright now it's like what?
Speaker 1 (18:56):
eight or seven?
You're a one seed.
Speaker 2 (19:01):
Your A1C is 6.5 and over 6.5 to diagnose.
Speaker 1 (19:04):
Okay, yeah, but you think that number might go down
in the future.
Speaker 2 (19:08):
Right now we have this range that's funky called
pre-diabetes, which is 5.7 toright before low 6.5 until you
reach that threshold, and it's arisk, basically for diabetes
it's not true diabetes, butyou're at higher risk for
developing this and it's moredifficult to slow.
Speaker 1 (19:23):
These medications help with pre-diabetes?
Speaker 2 (19:26):
Yes, they do, but insurance are not free to pre-.
No preventive care.
What's the way?
I'm looking for.
Preventive care, yes, andhonestly, that is a huge problem
because we could do.
It's always a pound ofprevention, sorry, pound of yes.
Prevention is worth an ounce ofcure, right?
If we could prevent diabetes,great, right?
Exactly, yeah, we don't seem todo that very well, but OK.
(19:48):
So let's talk about how surgeryaffects diabetes and there's
different kinds of diabetes.
Typically, we talk about a type1, type 2, but there's a lot
more nuance to it than that andwe call it insulin-dependent or
insulin-independent, but again,that's more terminology than
really reality of how it works.
But in general, what happens isyou have insulin resistance.
(20:10):
That happens so, even thoughinsulin, which is trying to pull
blood sugar into cells and helpyour cells use it for all kinds
of activity that they're doing,what happens is your body
doesn't really recognize theinsulin, doesn't produce enough
insulin.
It just doesn't allow it towork very properly and so too
much blood sugar stays in yourbloodstream and has all of these
downstream effects, quiteliterally on all your body
(20:32):
organs?
Yes, and the longer it happens.
It's a bit of a feed forwardmechanism, a downward spiral
there, where your body just hassome resistance and it keeps
getting worse and worse untilyour body just really doesn't
respond appropriately to bloodsugar at all.
It doesn't regulate it verywell.
Speaker 1 (20:48):
I feel like we can use the example of antibiotics,
right you?
Don't want to use theantibiotics too much, because
you could become resistant tothem.
I just want to.
Speaker 2 (20:57):
I love that.
I don't want to dumb it down,but simple it.
I love that.
I love that.
Yeah, so basically it'sactually like alarm fatigue If
you set your too many alarms ortoo many notifications I've been
doing that more and you all ofa sudden don't even register
alarms or any of that anymorebecause there's so many of them.
Think about email notificationsor text notifications or
(21:17):
whatever.
Yeah, it's the same idea.
Speaker 1 (21:18):
Your body just goes.
It goes off and I'm just likean Apple watch.
It vibrates, but we get used toit Exactly.
Speaker 2 (21:25):
We get used to all of that and your body does the
same thing.
It gets used to that and itgets used to it being a problem,
but it can't do anything aboutthe problem and so it just gets
worse and worse over time.
So what happens with surgerywhich is interesting is you have
a reprogramming going on of allof the signaling and, instead
of having your entire pathwaywhere the insulin and how it's
(21:48):
accepted and all of thedifferent things that help to
make that work all of thatworking abnormally it starts to
work more normally and itactually starts to get regulated
in a positive way.
You have signaling of certainkinds of genes changing as
people lose weight and as peoplehave these surgeries and their
metabolism starts to change,where you actually have
(22:09):
different cells that are helpingto control inflammation and
you're lowering the kinds ofcells that actually encourage
inflammation.
So you have more balance interms of less inflammation
happening and being able to dealwith it better, and that has an
enormous impact on thesesignaling pathways that impact
how blood sugar is stored in thecells and goes to the cells
(22:30):
rather than stays in thebloodstream, and it even affects
things like leptin, which isconsidered to be ingrelin, which
are considered to be hormonesof whether we feel full or
hungry, and things like that,and these pathways are really
specific.
I'm going to talk about themmore in our genetics podcast on
bariatrics because they'recomplicated, but there's a lot
(22:53):
and we'll actually be includingsome links in this podcast also
that go into more of the detailsfor people who are interested.
But just for the scientists outthere yeah, just for the
scientists and the doctors outthere and things like that.
The specific pathways we'retalking about are the insulin
receptor substrate pathways, thePI3K pathways and MAP kinase
pathways, as well asmitochondrial pathways that
(23:13):
involve TNF-alpha and reactiveoxide species, as well as
pro-inflammatory andanti-inflammatory macrophages
and beta cell dysfunction.
So for anyone who wants to hearthe actual mumbo jumbo, science
jargon, that's it Just look ata little thing like that yes,
big words, yes, exactly, but thecrazy thing is that a lot of
(23:38):
these kinds of pathways and alot of this kind of damage is
reversible through surgery, andso what happens is the beta
cells that produce insulinactually start to work better
after surgery.
Your body starts to be lessresistant to insulin if it had
insulin resistance.
It starts to be less resistantto leptin if it had developed
resistance in the past, andbetween 35 and about 90% of
(24:02):
people have diabetes.
That goes into completeremission a year after surgery.
Remission means cure.
Essentially it goes completelyaway, meaning no meds, no
monitoring, no, nothing, which Ithink is nuts, because there is
absolutely no.
Yeah, there's no medication outthere that does that.
There is no lifestyle changethat does that.
There's quite literally nothingout there that replicates that
(24:25):
even close, and even the GLP-1medications don't have that
effect.
Speaker 1 (24:32):
No, because once you stop taking it.
Speaker 2 (24:34):
Exactly, you're going back Exactly, and this is
surgery.
Again, surgery is not one anddone.
Surgery involves lifestylechanges and things to maintain
it.
But surgery plus those things,and between a third and almost
all of people can veryeffectively treat or cure their
diabetes with surgery Prettycool and medications alone and
prevent it and prevent andprevent it from getting in the
(24:57):
way of the patients in thefuture having lower risk for
life.
Basically, as a result of that,and if you compare that to just
medications that are used fordiabetes management, the chances
of treating or curing diabetes,especially going into remission
at a year is less than 40%.
Yeah, yeah, so it's less than.
It's essentially the flip side.
So one in three to all have aremission with surgery and less
(25:18):
than 40% have a remission withmedications alone.
And one of the massive benefitsof these surgeries is the
impact it has on some of theseother medical conditions that
people have that are related,because it really is a much more
complex approach than justrestriction, like we talked
(25:38):
about.
It's making these metabolicchanges and hormonal changes
that are having impact on allthese other medical conditions.
And also one thing I want tomention is these changes oh,
hello there, my husband'swalking in.
I love it.
No, it's all good.
You do live in a house, it isokay.
Yeah, okay, you do have otherpeople in this house, it's okay,
don't worry.
So the other thing I wanted tomention is that people sometimes
(26:02):
wonder why a bypass is moreeffective than a sleeve at some
of this treatment for diabetes.
And that is true.
So, even though with a sleeveyou can treat or cure diabetes,
it's more likely to happen ifyou have a surgery that actually
rearranges body parts andthat's a bypass, or like a ruin
my bypass or a seedy or adoodial switch, and the reason
(26:24):
is interesting because we don'tknow all of the reasons for it.
But even the way that like bilesalt which I don't know if
you've ever heard of that, butthat's what helps your body
absorb fats and like more fatsand things like that, and in
what you're digesting, there's adifference in how those things
actually get processed in yourbody.
With those kinds of surgeriesand some of those inflammatory
(26:46):
markers and how the genes arebeing regulated, is even
stronger of a change with abypass or a seedy or any of
those other things than with asleeve.
So that's, we think, why that'sa more effective treatment when
people have diabetes and othermetabolic issues.
Speaker 1 (27:00):
Yeah, so I know that's a lot of jargon, no, but
it makes sense for people thatare really wanting to know why a
powder tool works and verypowerful.
Speaker 2 (27:12):
Yeah, I mean it's incredible because it's so cool.
This is why I'm so jazzed aboutbariatric surgery and why I'm
such a.
I just think it's incredible,right, I think this is why we're
such advocates of this isbecause it is a tool, that it's
like a handyman tool for all thethings potentially, and for so
many more than just one thing,and it's really effective and it
(27:32):
really works for people.
Also, I wanted to touch onfuture directions.
Where are we going with all ofthis?
I mentioned that there's a lotof things we don't know and
there's a lot of things thatwe're figuring out, like why,
with every single thing in themedical field.
Exactly and honestly, thisfield is a big one and you're
noticing that, even if you don'tcare about it, because you're
(27:54):
hearing about all these newmedications that are coming out
to help treat weight and thingslike that.
So there's definitelydevelopment of medications.
That's a big one and we'refiguring out how we use
medications, potentially withsurgery sometimes, or just by
themselves, or before and aftersurgery, like all kinds of
things in combination.
Potentially we're figuring outhow to make medications more
effective, because right now themedications we have are
(28:16):
effective, but they'redefinitely nowhere near as
effective as surgery.
So there's that, evendeveloping surgery techniques.
So, for instance, we've talkedabout different kinds of
bypasses and sleeves and thingslike that.
We are totally just scratchingthe surface of how these
surgeries work and what can wedo to make them better.
And how do we choose whichsurgery is the best option for
(28:37):
which person, because there'sguidelines on this stuff and
there's good ways to choose,pick and choose with patients,
but they're not perfect.
Speaker 1 (28:46):
Things have come a long way Already.
A long way because I think Iwas incorrect me, if I'm wrong
that back in the day theythought making the sleeve
smaller will make people moresuccessful, when in reality
that's probably not the.
Speaker 2 (29:02):
There's definitely a limit to how small you can go.
In fact, there's been someresearch into that not too long
ago and it showed you make ittoo small and you actually give
people a lot of complications,without benefits of weight loss
or weight changes, and then youleave it too big and oftentimes,
yeah, you won't have enoughchange too.
So there's definitely like asize has an impact, but we're
(29:23):
not exactly sure what theperfect size is.
There's that, exactly, and notonly that.
But okay, so the bypass is forone quick second and again I'm
going to go for the audiencethat is in healthcare or is
interested in the stuff.
I'm going to deep dive just fora second.
So when we're talking aboutbypasses, we're actually
rearranging the intestines andhow they connect to the stomach,
(29:44):
and so we're creating differentlimbs.
We're literally creatingdifferent tracks, if you will
like, different train tracks,and the length of those train
tracks actually affects how wellthese surgeries work.
But think of it this way we'rerearranging the railroad, but we
actually don't know each personyou and me and anyone else will
have different lengths ofrailroad in their bodies.
(30:06):
And so when we do these kindsof surgeries and we actually
create different tracks withdifferent lengths and things
like that.
For one person, if you do acertain length, that will be a
lot of their train track and ifyou do it in a different person,
that won't be that much oftheir train track.
And if you can imagine, thebigger the bypass for someone,
the more effect.
So I know this is getting intothe weeds, but we don't even
(30:29):
know necessarily what theperfect length is for everyone,
because everyone's train trackis different length.
Hey, all right, so, yeah.
So there's a lot ofinvestigation and innovation
going on there.
Speaker 1 (30:44):
And I just want to add that, because we're talking
about all these surgeries, wewill have a video that you made
available for those that will bein our yes.
Yes, I don't know if it'll be aPatreon.
I don't know what it will beDiscord Circle, any of that, but
anybody that is in thatcommunity we're gonna make that
(31:05):
video available to them tounderstand what each was.
Speaker 2 (31:10):
Yes.
Speaker 1 (31:11):
Because even as much research as I did you had to
explain that to me.
Speaker 2 (31:16):
And it's a longer video and you do not have to
watch it at all, but just knowthat we are just scratching the
surface, thank you, but we'rejust scratching the surface of
figuring out, like how thesesurgeries work and why and what
we can do to make them better,or even totally different
techniques.
So I think it surprises somepeople when they learn that
bypasses were originally usedactually to treat reflux, not
(31:37):
weight.
So that's where that came from.
And then we noticed that peopleasked for it.
You know that either, right,and then sleeves only became
part of the whole picture in thepast, like less than 15 years.
So the first, 2009 that thefirst sleeve was actually
approved as a weight lossprocedure by an insurance
company, so that's less than 15years ago.
Yeah, crazy.
(31:57):
And it used to be part of theduodenal switch and anyway, we
don't need to go into all thedetails, but the whole idea is
there.
This is a newer field relativeto a lot of others and there's
still a lot that we don't knowand a lot that we're
investigating.
Stay tuned.
Speaker 1 (32:12):
And you are good at investigating.
Speaker 2 (32:13):
Thank you.
Cool Questions are good andwe're curious.
So stay curious, my friends.
Yes, and then, lastly, just tomention at the very end of this
that not every.
There's some limitations tosurgery, and I just want to
breeze through these real quick,because this is going to be a
completely different episode tooat some point, but just for now
.
Not every surgery is right foreverybody, okay, so just a
(32:37):
sleeve is not the right choicefor everyone.
A bypass is not the rightchoice for everyone.
A surgery is not the rightchoice for everyone, okay, very
good.
And not everyone will have thesame outcome from the same
surgery.
You touched on it earlier, andthere's lots of reasons both.
Why, oh yeah, there's so manyreasons, and so not everyone
will have the same outcome, evenif they have the exact same
(33:00):
surgery as their friend or theirfamily member or someone else.
Okay, it also does not meanthat you will lose weight and
drop your weight below a BMI of25.
We can't do that.
In fact, there's no healthy wayto do that, for, whether with
surgery or whether with meds orwhether with anything, there
just isn't a healthy way to dothat.
Speaker 1 (33:20):
Your body will always determine where you'll be.
Speaker 2 (33:23):
Exactly, exactly, and there's safe places that we can
go and there's not a lot beyondthat Right, and pushing beyond
that typically means doing somedamage along the road.
Exactly, and then thesesurgeries also can cause
problems like being dehydratedor not getting your nutrition or
(33:44):
having reflux or other things.
So it is always very importantto prepare for surgery, to know
what those risks are before youget into it, and to be on the
lookout for problems as you goafter surgery and keep up on
your labs and stuff, exactly.
Speaker 1 (33:59):
So your surgeon can mean mug you about not taking
your vitamins.
Speaker 2 (34:02):
I love it.
This is all actually an episodeto mean mug you for 30 minutes.
I love it, but no, so I'mreally glad that we talked today
about understanding bariatricsurgery a little more and
understanding that I learnedmore too, thank you.
But understanding, there's onelimitations.
Two, we don't know everythingand we're working on it and we'd
love for everyone to helpbecause we need that.
Three, that this is a surgery,kind of surgery.
(34:23):
They can have a really bigimpact on other medical
conditions.
That it's not a magic bulletand that it works in mysterious
ways, some of which we know insome of the videos.
Speaker 1 (34:31):
It's not just restriction Exactly exactly.
Thanks for explaining, thanksfor letting me see your
beautiful face, you too, tammy,and don't forget to follow us.
Don't forget to comment ifthere's something you want us to
talk about, or even you to comewith us and talk about it.
Speaker 2 (34:50):
We are so open to having guests and patients and
providers and all of that, yes,for this episode we will also
have some links to some of thecitations and materials, because
I really want those folks whoare interested in that to see
that we're not just talking hotsmoke, that this is very well
supported in research and thatwe really want to share that
with those folks who want todive into it.
Speaker 1 (35:12):
Absolutely Well, until next time, maria Mwah.
See you soon, bye, bye.
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