My ebook Metabolism.com is now available; I think you will find it a great resource for many of the common problems members have asked me about over the past 15 years. Buy it now and use it for years to come. Don’t forget to check out the Weight Loss and Weight Gain Programs included for free!
Chapter 1: What Is Metabolism? 9
Turning Food into Energy 10
The Importance of Hormones 11
Role of Metabolism in Weight Loss or Gain 14
Is My Metabolism Healthy? 16
Chapter 2: What Makes Your Metabolism Fast or Slow? 17
The Role of the Thyroid 22
Chapter 3: How to Increase or Decrease Metabolism 25
Problems with Losing Weight 25
Problems with Gaining Weight 34
A Pleasurable Exercise Routine is a Must 39
Chapter 4: Fact vs. Fictionâ€”Smoking and Weight Loss 41
Chapter 5: Thyroid Treatment 47
How Are T3 and T4 Regulated? 48
Types of Thyroid Diseases 49
Hyper- and Hypothyroidism 49
Thyroid Nodules 51
Is Your Thyroid Nodule Hot? 53
Thyroid Treatments 54
Using Thyroid Function Tests To Diagnose Disease 56
Hyperthyroidism Treatments 57
Hypothyroidism Treatments 58
T3 Plus T4 Combination Therapy 59
How to Talk to Your Endocrinologist 66
The Recent Shortage of Armour Thyroid 67
Chapter 6: Diabetes Treatment 73
The Bad Newsâ€”Major Stumbles in the Treatment of Diabetes 74
The Call for Tight Glycemic Control 74
2010 Diabetes Treatment Guidelines Lack Credibility 76
Setbacks in Diabetes Drug Development 81
The Failure of Inhaled Insulin 86
Dangerous Commercial Weight Loss Programs 87
Perhaps the Biggest Stumble of Th em All 89
The Good Newsâ€”What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Chapter 7: Hormone Treatments 99
Hormone Replacement Therapyâ€”Estrogen 101
Heart Health 101
Breast Cancer 103
Benefits of Estrogen: Brain Function and Blood Pressure 104
Testosterone Replacement for Men 106
Testosterone Replacement Options 107
Benefits of Testosterone Replacement 108
Potential Risks 109
Human Growth Hormone in Adults 111
Diagnosing Growth Hormone Deficiency 113
Benefits of Growth Hormone Supplementation 113
Adrenal Fatigue: Fact or Fiction? 115
The Birth Of Metabolism.com 119
My Path Into Endocrinology 121
Recent Contributors On Metabolism.com 125
Appendix 1: Personal Nutrition Profile 127
Appendix 2: Ultimate Weight Gain Program 145
Appendix 3: Food Journal 165
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. Lukeâ€™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.
No where is weight loss more essential to health than in those with obesity related Type 2 diabetes and Metabolic Syndrome. Metabolic Syndrome can be thought of as Type 2 Diabetes before the blood sugar levels become elevated. Experts are now turning more often to surgery when convential treatment with diet, exercise and medication fails to control these diseases. Different forms of surgery are available to cause rapid weight loss which frequently results in a “cure” or at least substantial improvement in diabetes.
One type of surgery often done laparoscopically aims to reduce the size of the stomach. By reducing the stomach size less food is consumed and hunger reduced. In another type of surgery much of the small bowel is “by-passed” so less of the food is absorbed and more is passed out of the body through the large intestine.
In Brazil a new procedure is being pioneered by Dr. Aureo DePaula and colleagues which utilizes both techniques. This procedure involves making a “sleeve gastrectomy” as well as by-pass. Dr. DePaula removes a part of the stomach and sews the remaining piece to the end portion of the small intestine called the ileum.
According to Dr. DePaula the benefit of this procedure extends beyond the mere mechanical reduction of the size of the stomach and bowel. The piece of the stomach and bowel eliminated by the sleeve procedure are responsible for making hormones that stimulate appetite and interfering with the function of insulin and cause insulin resistance. So far the Brazilian team has demonstrated great success to reverse the metabolic problems of diabetics and those with metabolic syndrome. Almost 90% of men and women in their recent study were able to discontinue taking diabetic medication after undergoing the surgery.
The procedure is still considered experimental
Surgical teams around the world are now preparing to try to duplicate the success of Dr. DePaula. According to reports, in the United States one team is being established at Mt Sinai Hospital in New York.
Those interested in this procedure may learn more in November when there is a meeting of the International Congress of Endocrinology in Rio de Janeiro, Brazil. Here experts are expected to analyze available information on the sleeve procedure and make recommendations for its use.
Recent studies are confirming that weight loss surgery canÂ provide dramatic improvements in treatment ofÂ people with Type 2 Diabetes.Â One such recent study compared the results of many other studies of weight loss surgery andÂ was publishedÂ in the JAMA. Â Type 2 diabetes, or adult onset diabetes,Â is generally seen in over-weight adults. When an individual gainsÂ weight the body must produce more and more insulin to compensate for the additional fat. Once the pancreas has reached maximum porduction and cannot produce enough to keep the blood sugar normal,Â the result is called Type 2 diabetes.Â By causing rapid weight loss via gastric by-pass or gastric banding surgery the body declines in size to a point where the pancreas is now again able to supply the proper amounts of insulin and the diabetes is “cured”.Â Â If the person regains the weight the diabetes will return.Â Some experts believe that gastric surgery also improves other hormones that effect blood sugarÂ and that weight loss itself is not even necessary to see better blood sugar levels.
Weight loss surgery is not like cosmetic surgery. The risks are seen as relativelyÂ greater than cosmetic surgeryÂ and there are frequent complications involving the digestive system.Â Costs of surgery are high and are generally not covered by insurance. For this reason many peopleÂ travel outside of the US to obtain the surgery and wind up saving money.
Currently in the US the guideline for consideration for surgical treatment of diabetes is a BMI (search this term in metabolism.com) of greater than 40 or a BMI of 35 or more associated with some complication of diabetes such as leg ulceration.Â Doctors are now struggling to decide if these guidelines should be relaxed so more people with diabetes would qualify for weight loss surgery.
Gary Pepper, M.D.
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