Bradley Waggoner, MD

Component in Common Dairy Foods May Cut Diabetes Risk

Scientists at the Harvard School of Public Health (HSPH) and collaborators from other institutions have identified a natural substance in dairy fat that may substantially reduce the risk of type 2 diabetes. The compound, trans-palmitoleic acid, is a fatty acid found in milk, cheese, yogurt, and butter. It is not produced by the body and so only comes from the diet.

Reporting in the December 21, 2010, issue of Annals of Internal Medicine, investigators led by Dariush Mozaffarian, associate professor in the Department of Epidemiology at HSPH and Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, and Gökhan S. Hotamisligil, J.S. Simmons Professor of Genetics and Metabolism and chair of the Department of Genetics and Complex Diseases at HSPH, explain that trans-palmitoleic acid may underlie epidemiological evidence in recent years that diets rich in dairy foods are linked to lower risk of type 2 diabetes and related metabolic abnormalities.  Health experts generally advise reducing full-fat dairy products, but trans-palmitoleic acid is found in dairy fat.

The HSPH researchers examined 3,736 participants in the National Heart, Lung, and Blood Institute-funded Cardiovascular Health Study, who have been followed for 20 years in an observational study to evaluate risk factors for cardiovascular diseases in older adults. Metabolic risk factors such as blood glucose and insulin levels, and also levels of circulating blood fatty acids, including trans-palmitoleic acid, were measured using stored blood samples in 1992, and participants were followed for development of type 2 diabetes.

At baseline, higher circulating levels of trans-palmitoleic acid were associated with healthier levels of blood cholesterol, inflammatory markers, insulin levels, and insulin sensitivity, after adjustment for other risk factors. During follow-up, individuals with higher circulating levels of trans-palmitoleic acid had a much lower risk of developing diabetes, with about a 60% lower risk among participants in the highest quintile (fifth) of trans-palmitoleic acid levels, compared to individuals in the lowest quintile.

“This type of observational finding requires confirmation in additional observational studies and controlled trials, but the magnitude of this association is striking,” said Mozaffarian, lead author of the study. “This represents an almost three-fold difference in risk of developing diabetes among individuals with the highest blood levels of this fatty acid.”

In contrast to the types of industrially produced trans fats found in partially hydrogenated vegetable oils, which have been linked to higher risk of heart disease, trans-palmitoleic acid is almost exclusively found in naturally-occurring dairy and meat trans fats, which in prior studies have not been linked to higher heart disease risk.

“There has been no clear biologic explanation for the lower risk of diabetes seen with higher dairy consumption in prior studies. This is the first time that the relationship of trans-palmitoleic acid with diabetes risk has been evaluated,” said Mozaffarian. “We wonder whether this naturally occurring trans fatty acid in dairy fats may partly mimic the normal biologic role of its cis counterpart, cis-palmitoleic acid, a fatty acid that is produced in the body. In animal experiments, cis-palmitoleic acid protects against diabetes.” 

“Unfortunately, with modern diets, synthesis of cis-palmitoleic acid is now driven by high amounts of carbohydrate and calories in the diet, which might limit its normal protective function. We wonder whether trans-palmitoleic acid may be stepping in as a “pinch hitter” for at least some of the functions of cis-palmitoleic acid,” said Mozaffarian.

Hotamisligil, the study’s senior author, also emphasized the magnitude of the risk reduction. “This is an extremely strong protective effect, stronger than other things we know can be beneficial against diabetes. The next step is to move forward with an intervention trial to see if there is therapeutic value in people.”

Because trans-palmitoleic acid, also known as trans-palmitoleate, is a natural compound, Hotamisligil said that conducting clinical trials should be possible. “This study represents the power of interdisciplinary work bridging basic science with population studies to realize exciting translational possibilities,” he said.

Support for the study was provided by the National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the National Institutes of Health Office of Dietary Supplements and National Institute of Neurological Disorders and Stroke. A subset of additional fatty acid measurements were supported by a Searle Scholar Award.

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Harvard School of Public Health, (2010, December 20).

Journal Reference: “Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in U.S. Adults,” Dariush Mozaffarian, Haiming Cao, Irena B. King, Rozenn N. Lemaitre, Xiaoling Song, David S. Siscovick, and Gökhan S. Hotamisligil, Annals of Internal Medicine, December 21, 2010.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Limiting Salt Lowers Blood Pressure and Health Risks in Diabetes

For patients living with diabetes, reducing the amount of salt in their daily diet is key to warding off serious threats to their health, a new review of studies finds.

In the Cochrane review, the authors evaluated 13 studies with 254 adults who had either type 1 or type 2 diabetes. For an average duration of one week, participants were restricted to large reduction in their daily salt intake to see how the change would affect their blood pressure.

“We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure,” said lead reviewer Rebecca Suckling. “However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced.”

Suckling is part of the Blood Pressure Unit at St. George’s Hospital Medical School, in London.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Patients with diabetes need to be extra cautious to maintain their blood pressure at an acceptable range of less than 130/80 mmHg. However, in the 2003-2004 period, 75 percent of adults with diabetes had blood pressure greater than or equal to 130/80 mmHg or used prescription hypertension medications, according to the American Diabetes Association (ADA).

High salt intake is a major cause for increased blood pressure and, in those with diabetes, elevated blood pressure can lead to more serious health problems, including stroke, heart attack and diabetic kidney disease. The ADA also reports that diabetic kidney disease is the leading cause of chronic kidney disease, accounting for 44 percent of new cases in 2005.

In the Cochrane review, the participants’ average salt intake was restricted by 11.9 grams a day for those with type 1 diabetes and by 7.3 grams a day for those with type 2.

The reviewers wrote that reducing salt intake by 8.5 grams a day could lower patients’ blood pressure by 7/3 mmHg. This was true for patients with both type 1 and type 2 diabetes. The reviewers noted that this reduction in blood pressure is similar to that found from taking blood pressure medication.

Suckling acknowledged that studies in the review only lasted for a week and that the type of salt restriction probably would not be manageable for longer periods.

“The majority of studies were small and only of a short duration with large changes in salt intake,” she said. “These studies are easy to perform and give information on the short-term effects of salt reduction.”

However, Suckling said, the review also found that in studies greater than two weeks, where salt was reduced by a more achievable and sustainable amount of 4.5 grams a day, blood pressure was reduced by 6/4 mmHg.

Diabetes specialist Todd Brown, M.D., of the Division of Endocrinology and Metabolism at Johns Hopkins University, said that practicing low-salt diets of these types is quite challenging for most patients with diabetes even though they know the health risks.

“The effects of salt on blood pressure are well known to health professionals and most patients, but what is less well known is where the salt comes from in our diet,” Brown said.

“The overwhelming majority comes from the processed foods that we eat,” he said. “If we are going to realize the benefits of sodium reduction on blood pressure and other health outcomes, we should focus less on the salt shaker and more on what we buy in the supermarket and at chain restaurants.”

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Health Behavior News Service, Part of the Center for Advancing Health (2010, December 7). 

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Bariatric Surgery in Diabetic Adults Improves Insulin Sensitivity Better than Diet

Gastric bypass surgery improves Type 2 diabetes by other mechanisms in addition to weight loss and does so better than a low-calorie diet despite achieving equal weight loss, a new study finds. The results will be presented Monday at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Our study shows that in the short term, weight loss by diet alone does not achieve the same improvements in diabetes as gastric bypass surgery,” said the presenting author, Judith Korner, MD, PhD, assistant professor of medicine at Columbia University College of Physicians and Surgeons, New York.

Korner and her colleagues found that gastric bypass surgery better improved insulin sensitivity, the body’s ability to successfully clear glucose sugar from the bloodstream into the cells. Insulin sensitivity is impaired in people with Type 2 diabetes, and obesity adds to this problem. The result is a buildup of sugar in the blood.

The study compared the effects on diabetic adults of a low-calorie diet versus Roux-en-Y gastric bypass, the most common gastric bypass procedure. Roux-en-Y gastric bypass decreases the size of the stomach and reroutes the digestive tract to bypass most of the stomach and part of the small intestine. After gastric bypass, many diabetic patients achieve normal blood glucose control or vastly improved control, and some may no longer require diabetes medications.

In the study, seven obese patients with Type 2 diabetes received a daily 800-calorie liquid diet and no surgery, while seven other obese diabetic adults underwent gastric bypass surgery. The study ended when both groups lost the same amount of weight: an average of 8 percent of body weight. However, the surgery-treated patients lost the weight faster: in about 3.5 weeks compared with 8 weeks for the dieters.

Surgical patients were able to discontinue all of their diabetes medications by the study’s end, but the dieters reduced their medication use by 55 percent, Korner reported.

The researchers found significant improvements in the surgery group in measures of insulin sensitivity and function of beta cells, the insulin-producing cells in the pancreas. Improvements in insulin sensitivity in the low-calorie diet group were not statistically significant and beta cell function improved to a lesser extent.

Korner speculated that hormonal changes may be responsible for the improvements resulting from Roux-en-Y surgery in individuals with Type 2 diabetes.

“It will be important to understand how surgery works to produce these results so that we can develop medical therapies of equivalent efficacy,” she said.

The National Institute of Diabetes and Digestive and Kidney Diseases funded this study.

 

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Source: The Endocrine Society . http://www.endo-society.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Finds Obese Women Who Undergo Bariatric Procedures Before Pregnancy Are Three Times Less Likely to Have Gestational Diabetes

Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to new research findings published in the August issue of the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.

Gestational diabetes affects at least seven percent of all pregnancies in the United States, with rates as high as 14 percent among certain populations. Its prevalence is increasing among reproductive-age women, parallel to increasing rates of obesity and type 2 diabetes. Currently, 33 percent of women over 19 years of age meet the criteria for obesity (body mass index [BMI] > 30 kg/m2) and seven percent for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.

“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, assistant professor of obstetrics and gynecology at the Johns Hopkins University School of Medicine in Baltimore, Md.

“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study.

Researchers performed a retrospective study to compare rates of GDM and related outcomes between a group of women who had bariatric operations before pregnancy (n=346) and a group who had bariatric operations after delivery (n=354) between 2002 and 2006. Women who delivered after bariatric procedures had lower incidences of GDM (8 percent vs. 27 percent, odds ratio (OR) 0.23) and cesarean section (28 percent vs. 43 percent, OR 0.53) than those who delivered before bariatric procedures.

Women who delivered after bariatric operations were slightly older (32.5 years vs. 31.1 years, p < 0.001). The median time from surgical procedure to delivery was 19.6 months, which meant that the majority of women did not adhere to the current recommendation to defer pregnancy for two years after bariatric procedures were performed. Deliveries before bariatric operations  occurred at a median time of 16.5 months, meaning that most women waited more than a year after delivery before having bariatric procedures. The majority of women in each group had a bypass procedure (75 percent in the prebariatric delivery group and 87 percent in the postbariatric delivery group). Women who had a prebariatric delivery were more likely to have an adjustable banding procedure than women with a postbariatric delivery (9 percent vs. 3 percent).

 

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Source: American College of Surgeons . http://www.facs.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Patients With Diabetes May Need Fewer Medications After Bariatric Surgery

Bariatric surgery appears to be associated with reduced use of medications and lower health care costs among patients with type 2 diabetes, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

"The rapidly growing epidemics of obesity and diabetes threaten to overburden the world's health care systems," the authors write as background information in the article. "From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent."

The use of bariatric surgery—that results in long-term weight loss, improved lifestyle and decreased risk of death—has tripled in the past five years, the authors note. Martin A. Makary, M.D., M.P.H., and colleagues at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, studied 2,235 U.S. adults (average age 48.4) with type 2 diabetes who underwent bariatric surgery during a four-year period, from 2002 to 2005. They used claims data to measure the use of diabetes medications before and after surgery, along with health care costs per year.

Of the 2,235 patients, 1,918 (85.8 percent) were taking at least one diabetes medication before surgery, with an average of 4.4 medications per patient. Six months after surgery, 1,669 of 2,235 patients (74.7 percent) had eliminated their diabetes medications. Of the 1,847 patients with available data one year after surgery, 1,489 (80.6 percent) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was observed in all classes of diabetes medications.

"We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected," the authors write. "This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery."

Health care costs averaged $6,376 per year in the two years before surgery, and the median or midpoint cost of the surgery and hospitalization was $29,959. Total annual health care costs increased by 9.7 percent ($616) in the year following the procedure, but decreased by 34.2 percent ($2,179) in year two and by 70.5 percent ($4,498) in year three.

"Based on these data, we have identified several important implications for health care delivery and public policy," the authors conclude. "Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management. Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health."

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Source: Reprinted from materials provided by JAMA and Archives Journals. http://pubs.ama-assn.org/media/

Journal Reference: Martin A. Makary; Jeanne M. Clarke; Andrew D. Shore; Thomas H. Magnuson; Thomas Richards; Eric B. Bass; Francesca Dominici; Jonathan P. Weiner; Albert W. Wu; Jodi B. Segal. Medication Utilization and Annual Health Care Costs in Patients With Type 2 Diabetes Mellitus Before and After Bariatric Surgery. Arch Surg, 2010; 145 (8): 726-731

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Finds Lap-Band Weight Loss Surgery in Very Obese Adults Improves Mental Health

One year after weight loss surgery with laparoscopic gastric banding, extremely obese adults demonstrate not only better physical health but also improved psychological health, a new study shows. The results were presented recently at The Endocrine Society’s 92nd Annual Meeting in San Diego.

“Surgical treatment, such as laparoscopic gastric banding, is increasingly recognized as the most effective means of achieving weight loss and improving blood sugar control in morbidly obese patients with Type 2 diabetes,” said study co-author Andrew Johnson, MD, of Southmead Hospital in Bristol, U.K.

“However, until now, the long-term psychological status of morbidly obese individuals undergoing gastric banding has been unclear despite its increasing use,” said Johnson, a consultant physician specializing in diabetes and endocrinology.

Laparoscopic gastric banding, also called the “Lap-Band” procedure, is a minimally invasive weight loss surgery. It involves repeated adjustment of a band to gradually make the stomach smaller and limit food consumption.

Four men and 21 women (ranging in age from 30 to 58 years) participated in the study and had the weight loss surgery. Of these 25 patients, 16 had Type 2 diabetes and nine did not. All had a body mass index (BMI, a measure of body fat) that classified them as morbidly obese.

Participants completed psychological testing before surgery and six and 12 months after surgery. These tests measured general anxiety and depression, quality of life, and social anxiety, that is, anxiety related to what others might think of one’s appearance.

Compared with before surgery, patients’ psychological test scores improved significantly at both six and 12 months after surgery. They had better psychological and physical quality of life, reductions in levels of general anxiety and depression, and reductions in their levels of social anxiety.

As shown in other studies, gastric banding significantly reduced BMI and hemoglobin A1c, a measure of blood sugar control over time.

“These results provide evidence one year after gastric banding that psychological health improves in parallel with physiological health,” Johnson said.

Researchers at the University of the West of England in Bristol also contributed to this study.

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Source: The Endocrine Society. http://www.endo-society.org

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

The Remarkable Effects of Fat Loss on the Immune System

Australian scientists have shown for the first time that even modest weight loss reverses many of the damaging changes often seen in the immune cells of obese people, particularly those with Type 2 diabetes.

The immune system is made up of many different kinds of cells that protect the body from germs, viruses and other invaders. These cells need to co-exist in a certain balance for good health to be maintained. Many factors, including diet and excess body fat, can tip this balance, creating immune cells that can attack, rather than protect, our bodies.

It has been known for some time that excess body fat, particularly abdominal fat, triggers the production of ‘pro-inflammatory’ immune cells, which circulate in the blood and can damage our bodies. In addition, other inflammatory immune cells, known as macrophages, are also activated within fat tissue.

The recent study¹ looked at obese people with Type 2 diabetes or prediabetes who were limited to a diet of between 1000 and 1600 calories a day for 24 weeks. Gastric banding was performed at 12 weeks to help restrict food intake further. The study determined the effects of weight loss on immune cells.

Undertaken by Dr Alex Viardot and Associate Professor Katherine Samaras from Sydney’s Garvan Institute of Medical Research, the results showed an 80% reduction of pro-inflammatory T-helper cells, as well as reduced activation of other circulating immune cells (T cells, monocytes and neutrophils) and decreased activation of macrophages in fat. They are published in the prestigious Journal of Clinical Endocrinology Metabolism, now online.

“Excess weight disorders now affect 50% of adult Australians, with obesity being the major cause of Type 2 diabetes and some cancers,” said Associate Professor Samaras.

“The situation has reached crisis point, and people must be made aware that excess fat will affect their immune systems and therefore their survival.”

“We have found that a modest weight loss of about 6 kg [approximately 13.23 pounds] is enough to bring the pro-inflammatory nature of circulating immune cells back to that found in lean people.”

“These inflammatory cells are involved in promoting coronary artery disease and other illnesses associated with obesity.”

“This is the first time it has been shown that modest weight reduction reverses some of the very adverse inflammatory changes we see in obese people with diabetes.”

“We also showed that the activation status of immune cells found in fat predicted how much weight people would lose following a calorie restricted diet and bariatric surgery. Those with more activated immune cells lost less weight.”

“It’s the first time this has been described and is important because it helps us understand why some people lose weight more easily than others, and that inflammation is involved in regulating the response to bariatric surgery.”

The Garvan study reinforces a message we hear regularly – to optimise your health, keep your weight and waist in the healthy range.

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¹Garvan Institute. http://www.garvan.org.au/

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

Study Shows Exercising Just Got Easier for Busy People

If you’re the type of person who invokes the “not enough time” clause when it comes to exercising, it’s time to find a new excuse. Researchers who have been studying interval training have found that it not only takes less time than what is typically recommended, but the regimen does not have to be “all out” to be effective in helping reduce the risk of such diseases at Type 2 diabetes.

The study appears in the March issue of The Journal of Physiology.

“What we’ve been able to show is that interval training does not have to be ‘all out’ in order to be effective and time-efficient,” says Martin Gibala, professor and chair of the Department of Kinesiology at McMaster University. “While still a very demanding form of training, the exercise might be more achievable by the general public—not just elite athletes—and it certainly doesn’t require the use of specialized laboratory equipment.”

Since Gibala’s first study on interval training was published five years ago, a growing body of research has zeroed in on this particular style of exercise in which you train hard but for less time.

Previous research by the McMaster group involved 30 seconds of maximal pedaling on a special bike followed by four minutes of recovery, and repeated 4-6 times. The new study involves eight to 12 one-minute bouts of exercise on a standard stationary bicycle at a relatively lower intensity with rest intervals of 75 seconds, for a total of 20-25 minutes per session. The workload was still above most people’s comfort zone —about 95% of maximal heart rate — but only about half of what can be achieved when people sprint at an all-out pace.

“That is the trade-off for the relatively lower intensity,” says Gibala. “There is no free lunch; duration must increase as intensity decreases.”

While the total amount of exercise performed was higher than in Gibala’s previous interval training studies, the overall time commitment was still lower than what is typically recommended by public health agencies.

Subjects used in the study performed six training sessions over 14 days. After the two week training period, the subjects showed the same benefits that Gibala’s team has previously observed after traditional, long-duration endurance training: improved exercise performance and muscular adaptations that are linked to reduced risk of diseases such as Type 2 diabetes.

The study was made possible by funding from the Natural Sciences and Engineering Research Council of Canada.

Gibala is currently taking his research a step further by studying the effects of interval training on middle-aged and elderly participants who are non-traditional exercisers.

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¹McMaster University. http://www.mcmaster.ca/opr/html/opr/media/main/NewsReleases/news_releases.html

Medical Advice Disclaimer: The content of this blog entry is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, or other qualified health provider with any questions you may have regarding a medical condition.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

To contact us for more information and/or to reserve your seat for the next free seminar, please click here.

New Study May Explain How Weight-loss Surgery Reverses Type 2 Diabetes

A team of researchers, led by a UC Davis veterinary endocrinologist, has shown for the first time that a surgical procedure in rats that is similar to bariatric surgery in humans can delay the onset of type 2 diabetes.¹ The researchers also have identified biochemical changes caused by the surgeries that may be responsible for that delay.

Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.

Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.

“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.

“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”

"This study confirms our clinical observations that metabolic regulation -- specifically homeostasis of glucose -- occurs quickly after gastric bypass surgery," said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. "It's clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.

“UC Davis has the perfect environment for collaboration between basic and clinical scientists to take this discovery to the next step, which is identifying the molecular signals that set these physiologic changes in motion," said Ali, who was not a participant in this study, but has collaborated with Havel on previous research.

About Bariatric Surgery in Humans
In severe cases of obesity -- usually when the patient is 80 to 100 or more pounds overweight -- bariatric surgery is used to alter or reconstruct the stomach and/or the intestinal tract. In such cases, obesity is not just a weight issue but also a life-threatening health problem that often leads to type 2 diabetes, heart disease and sleep apnea.

There are several types of bariatric surgeries available in the United States. The most commonly performed surgical procedure, known as Roux-en-Y gastric bypass surgery, limits the amount of food the stomach can hold and reroutes the digestive tract, resulting in changes in intestinal function and hormones produced by the gastrointestinal tract.

In 2008, about 220,000 people with severe obesity in the U.S. had bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery.

The New Study
Havel and colleagues set out to test a hypothesis that certain bariatric surgical procedures were successful in improving type 2 diabetes, at least in part, because the procedures increased the flux of unabsorbed nutrients to the far end of the small intestine and, in doing so, triggered increased secretion of two hormones. Those hormones -- glucagon-like peptide-1 (GLP-1) and peptide-YY (PYY) -- are known to have a role in controlling food intake and improving insulin secretion and insulin sensitivity, thereby helping to stabilize blood sugar levels.

To test the hypothesis, the researchers carried out a surgical procedure known as ileal interposition in a line of rats that were predisposed to obesity and type 2 diabetes. The rat model, developed in Havel’s laboratory, was known as the UC Davis Type 2 Diabetes Mellitus (UCD-T2DM) Rat. The pathology of type 2 diabetes in these animals is more similar to type 2 diabetes in humans than other existing rodent models of the disease.

The ileal interposition procedure involves relocating a short portion of the small intestine known as the ileum further forward in the intestinal tract. Then the researchers compared how long it took for the animals to develop diabetes, compared with a control group of rats that had surgery but without rearrangement of the intestines.

They found that the rats receiving the ileal interposition surgery developed type 2 diabetes 120 days later than did the rats in the control group. Furthermore, by the time the rats were one year old, 78 percent of the control group rats were diabetic while only 38 percent of the rats that had received the ileal interposition procedure had developed diabetes.

Havel said the delay in onset of diabetes in the rats would be similar to delaying the age of onset of diabetes by approximately 10 years in a person, which would be expected to significantly decrease the amount of time for diabetic complications to develop, and to reduce the health care costs associated with treating this costly and prevalent disease.

The researchers also found that, when compared with the control group, the rats receiving the ileal interposition surgery had:

• lower fluctuations in blood sugar levels;


• improved insulin production, making them better able to metabolize sugar; and


• decreased levels of lipids (cholesterol and triglyceride) in the bloodstream,which are known to be risk factors for cardiovascular disease in humans.

“In addition, results from the study also demonstrated that the ileal interposition surgery increases production of bile acids, which are involved in fat metabolism and can increase the production of GLP-1, the hormone that improves insulin secretion and insulin sensitivity,” Havel said. “This could contribute to the delay in the onset of type 2 diabetes that we observed in the rats in this study.”

He noted that further studies are needed to better understand how surgically induced improvements of metabolism can be achieved in order to discover new methods for preventing and treating type 2 diabetes. Havel, postdoctoral researcher Bethany Cummings and their colleagues have received funding from a National Institutes of Health Challenge Grant to continue to pursue research on the effects of bariatric surgical procedures in the UCD-T2DM model of diabetes.

Collaborating with Havel on this study were Cummings, Kimber Stanhope, James Graham, Jennifer Lee and Helen Raybould, all at UC Davis; April Strader of Southern Illinois University School of Medicine; and Denis Baskin of the Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle.

Funding for the study was provided by UC Davis, the National Institutes of Health and the American Diabetes Association.

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¹University of California/UC Davis. http://www.news.ucdavis.edu/

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

Contact Bradley Waggoner, MD:

• If you are ready to set-up an appoint to discuss your weight loss options.
• Reserve your seat at the next free informational seminar outlining your obesity surgery options (including lap-band system procedures) and meet Bradley Waggoner in person.

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Overweight in 20s could lead to serious problems in 40s

People who are obese and have type 2 diabetes in their 20s will be at higher risk of having a heart attack or stroke in their 40s if they do not change their lifestyle.

"If your blood pressure is 136/88 and you’re a man with a waist over 40 or a woman with a waist over 35 it spells trouble," said Dr. Dale J. Hamilton, diabetes clinical services chief at The Methodist Hospital in Houston. "These are two of the five symptoms of metabolic syndrome, a problem that can lead to type 2 diabetes. All you need is three to begin seeing increased atherosclerosis."

"High triglyceride levels over 150, insulin resistance and a low LDL (good cholesterol) are factors of metabolic syndrome, along with high blood pressure and central obesity. According to the American Heart Association more than 47 million Americans have it. Many of these patients will end up suffering with type 2 diabetes, which can eventually lead to coronary artery disease and stroke.

"Small changes every day can help curb big problems later on," Hamilton said. "Losing five to 10 pounds will help lower blood pressure. Reducing saturated fats, carbohydrates, and eating about two-thirds the amount you eat now will help you lose weight around the middle. Walk 45 minutes a day instead of 30."

Some experts believe replacing sugar with high fructose corn syrup in processed foods in the United States and Canada in the 1990s has played a role in the rise of type 2 diabetes cases. High fructose corn syrup is made by changing the sugar in corn starch to fructose, another form of sugar. It has become popular because it extends the shelf life of processed foods and is cheaper than sugar. It has also become a popular ingredient in many sodas and fruit-flavored drinks.

"The problem with high fructose corn syrup is that it promotes central obesity," Hamilton said. "Another problem with it is that it fools your body into thinking you are hungry. I don’t think you need to eliminate it from your diet, you just need to be aware of how much of it you are consuming on a daily basis because too much can lead to serious weight gain."

Keep in mind, he said, type 2 diabetes symptoms often go untreated because there are few or no symptoms until it is too late.

"Having three or more of the risk factors associated with type 2 diabetes over an extended period of time is the equivalent of already having a heart attack," Hamilton said. "These risk factors need to be treated aggressively in order to curb the problem and give you a better chance at a longer, healthier life."

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Story Source: Adapted from materials provided by  The Methodist Hospital - Houston.

Medical Advice Disclaimer: The content of this blog entry is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, or other qualified health provider with any questions you may have regarding a medical condition.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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