Category Archives: weight loss

Changes in Hormones After Gastric By-Pass Speed Weight Loss and Lower Blood Sugar

It seems obvious that cutting away part of the stomach and intestine should cause weight loss. With a smaller stomach and less intestine fewer calories can be absorbed per day causing weight loss. Surgeons who perform gastric by-pass were puzzled however, by how fast their patients showed metabolic improvement after undergoing this procedure. They noticed many of their diabetic patients could be taken off diabetic medication immediately after surgery before weight had been lost. Scientists looking into this phenomena discovered unsuspected ways gastric by-pass improved metabolism.

The intestines produce hormones which regulate blood sugar and appetite. GLP-1 is among the best known of these intestinal hormones. GLP-1 is the basis of a whole new generation of medications used to treat diabetes such as Byetta, Victoza, Januvia and Onglyza. GLP-1 lowers blood sugar, stimulates the pancreas and reduces appetite. After gastric by-pass increased amounts of GLP-1 are produced by the remaining intestine. In a study published in the Journal of Clinical Endocrinology and Metabolism (95:4072-4076, 2010), researchers at St. Luke’s Hospital in New York discovered that levels of oxyntomodulin, another intestinal hormone that suppresses appetite and acts like GLP-1 on blood sugar levels, is doubled after gastric by-pass.

These exciting discoveries help explain why obese diabetics can often be sent home without any medication to control blood sugar immediately after undergoing gastric by-pass surgery. Although most insurance plans do not cover gastric by-pass surgery, dramatic improvements in patients after the procedure with greatly reduced medication costs may convince insurance companies that paying for the procedure will result in better outcomes and save them money in the long run.

Gary Pepper, M.D.

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Chubby Neck Becomes the New Normal

After reading the latest research on the metabolic hazards associated with chubby necks I am more sensitive to the size of people’s necks then ever. Of course I look at the size of my patient’s neck but people who I pass in the street or supermarket may find me staring. Watching TV a few days ago I was startled by a series of people in one commercial for Quicken Loans who definitely qualify for the metabolic high risk category based on neck chubbiness. One after another the characters in this commercial walk on, outdoing each other in this physical trait. Has the chubby neck become the new normal? If so, the incidence of diabetes and heart disease is sure to continue to rise.

Let me know if you agree with my impression, or am I biased by being an endocrinologist?

Gary Pepper, M.D.

Beware the Zombie Thyroid!!

Beware the Zombie Thyroid!!

Periodically, I update with interesting problems from my medical practice. Last week I was reminded of a particular thyroid disease which is little known and deserves more attention. In my patient’s case, she had an inactive thyroid (hypothyroid) due to Hashimoto’s thyroiditis for several years which, on its own switched to become an over-active thyroid (hyperthyroid). I call this event a “Zombie Thyroid”. Don’t bother trying to look this term up since ‘Zombie Thyroid’ is my own terminology. A Zombie Thyroid is, of course, one which returns from the dead. Most times when the thyroid is destroyed by either natural forces or by human intervention, the destruction is complete and irreversible. Rarely however, a thyroid which ceased function for years resumes producing thyroid hormone and may even becoming “hyper” or over-functioning. Such was the case of my patient last week. Confusion may result because the newly risen thyroid begins adding thyroid hormone to the blood of someone already taking thyroid hormone replacement for hypothyroidism (under-functioning thyroid). Recognizing the Zombie Thyroid can take months or years due to the rarity of the condition and the subtlety of the changes that occur on blood testing.

The Zombie Thyroid occurs in the setting of either autoimmune thyroid disease such as Hashimoto’s thyroiditis or a structural thyroid disease, multinodular goiter. Hashimoto’s is the most common cause of naturally occurring hypothyroidism in women under the age of 60 years. Hashimoto’s occurs when the body creates an antibody to the thyroid, resulting in destruction or impairment of the thyroid tissue. It is thought that the thyroid can ‘return from the dead’ if the body begins to produce more of another type of antibody that results in stimulation of the thyroid tissue. The switch from under active to over-active can take months or years. During this time the combination of taking thyroid hormone pills for Hashimoto’s plus the new supply of the body’s own thyroid hormone production can result in disturbing and seemingly unexplainable high thyroid levels. Once it is clear that the thyroid is producing thyroid hormone again it is possible to make appropriate adjustments in medication to return the situation back to normal.

Another situation involving the Zombie Thyroid is seen in elderly people who have had an enlarged and lumpy (nodular) thyroid for years. Some of these “multinodular goiters” produce adequate amounts of thyroid hormone but others can be associated with thyroid hormone deficiency (hypothyroid). When the multinodular goiter causes hypothyroidism, the patient will be treated with thyroid hormone replacement just like the Hashimoto’s patient. Over time the nodules may slowly begin to wake up and begin producing thyroid hormone. If the patient is already taking thyroid hormone due to the previous diagnosis of hypothyroidism, the combination of the two sources of thyroid hormone can result in excess or “hyper” thyroidism. In the elderly the doctor may suspect the elevated thyroid hormone levels are the result of a medication error perhaps due to the patient’s forgetfulness. If no action is taken serious complications of hyperthyroidism can develop such as irregular heart beat, congestive heart failure, excessive fatigue, and mental or mood impairment. Some elderly patients become withdrawn and lose weight mimicking depression, a situation known as “apathetic hyperthyroidism”. Recognition of the Zombie Thyroid is essential to restoring the thyroid levels and the patient’s clinical status back to normal.

Don’t let yourself or loved one become a victim of this ‘back from the dead’ thyroid. Alertness is the key to recognizing and treating the Zombie Thyroid. Ask your own physician for advice if you suspect this condition.

This article is for educational purposes only and is not meant as medical advice. The disclaimer of applies to this and all my blogs.

Gary Pepper, M.D., Editor-in-Chief,

A Lazzara, member, comments on Gastric By-Pass Surgery

A. Lazzara, member of, posts the following to the discussion of gastric by-pass surgery for weight loss.

Thank you for posting this but you havent posted all the information just parts of it.

Most people who have bariatric surgery really DO it as a last resort.

While you are right about that the one sole gastric bypass surgery is NOT a quick solution to the problem, however there are other bariatric procedures that are available to consider. One of them being the latest one called vertical sleeve which just cuts your stomach smaller and does not do all the plumbing that the drastic gastric bypass does. Another form is the popular lapband which is just a band thats inserted over your abdominal to restrict the food.

Any of the bariatric doctors do WARN the patient that with the gastric bypass that you run the risk of malabsorption and that can be detrimental in the long run.

As far as bariatric procedures are concerned I know TEN people who had various bariatric surgeries. I know 8 of them that are doing great! I know my cousin had the gastric bypass and she didnt do well. She has to go back in and get it removed because it was dangerous for her. But this was when gastric bypass first started out as a new procedure. The other person i dont know what procedure she had done but her situation is that she stopped taking the vitamins that she was supposed to take so she became ill. Shes doing better now that she is taking her supplements.

I”ve been to many bariatric seminars and i strongly recommend the vertical sleeve. Out of the ten i mentioned I know two of them had that done and are doing fantastic. They do not get malabsorption and just mainly control what they eat. If people are concerned then i suggest they opt for the lapband and if its not for them they can have it removed.

I personally cannot have ANY of these procedures even if i had the money for it. In 1996 I had acute pancreatitis(which left me diabetic) and they did abdominal surgery on me therefore the bariatric doctors will not touch anyone who had any kind of abdominal surgery due to that it might cause complications. How i dont know though. I’m hoping to find out.

Do know this that you can have any surgery and STILL gain the weight back. You can still eat tons of milk shakes with the lapband or constantly eat small portions with the vertical sleeve and re-stretch out your stomach. So they aren’t a cure all.

What to expect from a Nutrition Consultation

What exactly is a Nutrition Consultation? That is Question Number One from the public! Well, a nutrition consultation is something that takes into account someone’s medical and weight history; blood work/laboratory values; activity; habits; Calorie, protein, carbohydrate, fat and fluid needs; nutrition support needs and personal goals. A good nutrition assessment will take all of this into account in order to get a full picture of a client and what their specific needs and recommendations are.

A very common issue is that people think they are eating way too much at night and want to cut down on their intake a night. Most of the time, these folks aren’t eating enough during the day and find themselves so hungry at night that they make up for missed meals and more! In this case, I teach that food is the best appetite suppressant around! If you eat good, solid, healthy meals and snacks, you won’t feel so hungry later on in the night.

Of course, sometimes people experience “emotional eating” where they are counting on food to meet an emotional need that they have. At first it may feel like the need is fulfilled. Food is comforting, nurturing, it can seem like a “companion”. HOWEVER, food is fuel, not emotional support. When we mistake food for emotional support, we stop looking for the real, underlying emotional issues that need our attention. That is when food becomes a distraction, a past time, even an addiction. I urge clients to look at food as food and not an emotional crutch or distraction.
On the other end of the spectrum are the folks who need to gain weight and can’t seem to gain no matter what they do. A nutrition consultation will provide an assessment of exactly how many Calories they need to maintain and to gain weight. It will provide guidance for consuming healthy foods and not empty Calories, as well as recommendations for maintaining lean body mass.

Some folks need nutrition support, especially if they are on medications that deplete nutrients. My professional opinion is that the majority of people in this country do not even meet the RDA’s for many nutrients and I believe that the RDA’s need to be updated to reflect current knowledge and research in the science of nutrition.

A Nutrition Consultation will also help dispel the numerous misleading concept about nutrition that are out there floating around on the internet and in the media. I teach people some very basic concepts so that when they look at the latest headlines or listen to what other people have to say about nutrition, they will be armed with knowledge that will help them to judge what it truly best for themselves. So that is a Nutrition Consultation in a NUTshell.
And as always,
Consider having an individualized consultation!

Beth Ellen DiLuglio

Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N
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Gastric Bypass- A not-so-quick solution.

Hi,  just wanted to open up the discussion about gastric bypass from the perspective of a nutritionist.  Maintenance of a healthy weight, and HEALTHY LEAN BODY MASS is absolutely essential to our overall health and well being.  That goes for our biological, biochemical, social and psychological health.  Many people strive to achieve a healthy weight but is weight loss at any cost worth it?  There are cases where the weight loss becomes necessary to control blood pressure and blood glucose.  There are cases when gastric bypass may be a last option but it should be considered a last option after a 6 month trial of HEALTHY NUTRITION INTERVENTION and a reasonable activity schedule has been tried.  It can take at least 6 months to reprogram good habits into a person’s life when nutritionally poor habits have been dominant for most of their lives.

The main issues with gastric bypass revolve around the fact that one can easily return to eating unhealthy foods, just in small portions and the fact that normal digestion and assimilation is disrupted.  Without adequate hydrochloric acid (HCl) in the stomach proteins won’t get digested properly and can putrefy and cause discomfort and reflux.  Without adequate HCl bad bacteria like H.Pylori won’t be killed off, minerals won’t be extracted from food and the small intestine won’t receive the proper signal to produce digestive enzymes.  Also, following gastric bypass the carrier for vitamin B12 is not produced efficiently and absorption is compromised.  Sublingual methylcobalamin should then be taken on a regular basis along with a full spectrum multivitamin/mineral supplement.

SO, maybe this isn’t such a quick note but it is an important one!  A HEALTHY DIET and REGULAR EXERCISE can’t be beat!

And as always,

Consider having an individualized nutrition consultation!

Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N

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