Bariatric Journal

About Bariatric Journal

You can listen different topics and current scientific studies about healthy weight, obesity, weightloss treatments and bariatric surgery in this podcast. drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast)

Publisher

Bariatric Journal

Category

health & fitness · science

Language

en

Explicit

No

First episode

1 Nov 2024

Latest episode

12 May 2025

Latest episodes

17 episodes in the feed.

1. 

   12 May 2025

   Can We Reverse Diabetes from the Duodenum?

   Welcome back to another episode of “Health Breakthroughs,” where we explore the latest in medical innovation. Today, we’re diving into something that could be a game-changer for millions of people living with type 2 diabetes – a new outpatient endoscopic treatment called ReCET. Rewiring the Gut Type 2 diabetes has traditionally been managed with medications – pills, injections, insulin – all targeting symptoms. But what if we could go to the source of the problem and start fixing things upstream? That’s exactly what ReCET – short for Re-cellularization via Electroporation Therapy – aims to do. It’s a cutting-edge, non-thermal endoscopic procedure that targets the duodenum, the first part of the small intestine. And no, it doesn’t burn or cut – it uses pulsed electrical fields to regenerate the tissue. So how does it work? * The entire procedure currently takes 30 to 60 minutes, but the goal is to bring it down to just 20 minutes in the future. * It’s outpatient, meaning you can go home the same day. * It’s designed to restore healthy signaling in the gut, which influences how your body manages sugar, insulin, and fat storage. Dr. Barham Abu Dayyeh, who presented this at Digestive Disease Week 2025, describes the duodenum as the “conductor of the metabolic orchestra.” Right now, diabetes treatments focus on fixing individual instruments – like the pancreas or liver. But what if the real solution is to get the conductor back in rhythm? Thanks for reading Bariatric Journal! This post is public so feel free to share it. What did the results show? In a recent clinical trial called REGENT-1, involving 51 people with type 2 diabetes: * HbA1c dropped significantly at 12 and 48 weeks – up to 1.7 percentage points in some patients. * Insulin sensitivity skyrocketed, improving by nearly 5-fold. * Beta-cell function – how well your pancreas makes insulin – also improved. * Weight loss occurred across all groups, especially those receiving higher energy doses. * No serious side effects linked to the device or the procedure. And here’s a shocker: Compared to medications like semaglutide or tirzepatide, ReCET showed better improvement in insulin sensitivity and overall metabolic function in some categories. That’s impressive. What’s the vision for the future? Dr. Abu Dayyeh sees this becoming as routine as a colonoscopy. Primary care doctors or endocrinologists might refer patients to a GI specialist, who performs the procedure and sends them back with a simpler treatment plan – maybe even fewer meds or no insulin at all. Importantly, ReCET isn’t meant to replace medication but to enhance and complement it – especially for those early in their diabetes journey or struggling with control. What’s next? * A large randomized, sham-controlled clinical trial is already underway, with results expected by late 2026. * If successful, ReCET could reshape how we think about type 2 diabetes – not just as a chronic condition to manage, but one we can possibly reverse or modify at its root. Final Thoughts: We’re entering an era where minimally invasive gut-based therapies might rival traditional medications. ReCET offers real hope – not just to lower blood sugar, but to tackle the deeper dysfunction behind type 2 diabetes. Stay tuned, because this is just the beginning of a fascinating new chapter in metabolic health. Thanks for listening. Until next time, stay healthy and stay curious. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

2. 

   11 May 2025

   Breaking New Ground: Understanding Gastric Fundus Mucosal Ablation (GFMA)

   Hello and welcome to our podcast dedicated to exploring innovative solutions in weight management. Today, we’re delving into a groundbreaking procedure that’s making waves in the medical community: Gastric Fundus Mucosal Ablation, or GFMA. This non-surgical technique offers hope for those seeking effective weight loss without the invasiveness of traditional surgery. The Challenge of Obesity Obesity is a chronic condition affecting millions worldwide. Traditional methods like diet and exercise often fall short, and while bariatric surgery has been effective, it’s not suitable for everyone due to its invasive nature and potential risks. This gap has led researchers to seek alternative solutions that are both effective and less invasive. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. Introducing GFMA GFMA is an endoscopic procedure targeting the stomach’s fundus—the upper part responsible for producing the hunger hormone ghrelin. By ablating, or carefully destroying, the mucosal lining of the fundus, GFMA aims to reduce ghrelin levels, thereby decreasing appetite and promoting weight loss. The procedure is performed using an endoscope inserted through the mouth, eliminating the need for external incisions. How GFMA Works During GFMA, a specialized device delivers controlled thermal energy to the fundus’s mucosal layer. This process reduces the number of ghrelin-producing cells, leading to a significant drop in hunger signals. Additionally, the ablation causes the fundus to become less expandable, meaning patients feel full with smaller food portions. Clinical Trials and Findings Recent studies, including the ABLATE I and II trials, have shown promising results: * Weight Loss: Patients experienced an average total body weight loss of 8% within six months post-procedure. * Hormonal Changes: Ghrelin levels decreased by approximately 48%, correlating with reduced appetite. * Stomach Capacity: There was a 42% reduction in gastric capacity, contributing to earlier satiety. * Safety: The procedure demonstrated a strong safety profile, with most patients experiencing only mild, short-term discomfort. Combining GFMA with ESG Endoscopic Sleeve Gastroplasty (ESG) is another non-surgical procedure that reduces stomach volume. When combined with GFMA, the duo has shown enhanced results: * Weight Loss: Patients achieved up to 24% total body weight loss, comparable to surgical sleeve gastrectomy. * Appetite Control: The combination led to sustained reductions in hunger and improved portion control. * Safety and Recovery: Like GFMA alone, the combined procedure is minimally invasive with a quick recovery time. Advantages Over Traditional Surgery GFMA, especially when combined with ESG, offers several benefits over traditional bariatric surgery: * Non-Invasive: No external incisions mean reduced risk of complications and scarring. * Quick Recovery: Most patients return home the same day and resume normal activities shortly after. * Hormonal Balance: Targeting ghrelin production addresses the root cause of hunger, leading to more sustainable weight loss. * Flexibility: The procedure can be repeated or adjusted as needed, offering a customizable approach to weight management. Thanks for reading Bariatric Journal! This post is public so feel free to share it. Future Implications and Ongoing Research The success of GFMA has spurred further research into its applications: * MAINTAIN Trial: Investigating GFMA’s role in maintaining weight loss after discontinuing GLP-1 medications like semaglutide. * REVAMP Trial: Exploring GFMA as a solution for patients who have regained weight after sleeve gastrectomy. These studies aim to solidify GFMA’s place in the spectrum of weight management options, offering hope to those seeking alternatives to surgery or long-term medication use. Conclusion: Gastric Fundus Mucosal Ablation represents a significant advancement in non-surgical weight loss treatments. By directly addressing the hormonal drivers of hunger, GFMA offers a promising solution for sustainable weight management. As research continues, this procedure may become a cornerstone in the fight against obesity, providing patients with effective, less invasive options for achieving their health goals. Thank you for joining us on this exploration of GFMA. Stay tuned for more insights into the evolving world of weight management solutions. Sources: * Istanbul Bariatric Center. (2025). Gastric Fundus Mucosal Ablation (GFMA) Latest News. Retrieved from Istanbul Bariatric Center (https://istanbulbariatriccenter.com/gastric-fundus-mucosal-ablation-gfma-latest-news) * True You Weight Loss. (2024). Gastric Fundus Mucosal Ablation (GFMA). Retrieved from True You Weight Loss (https://trueyouweightloss.com/services/gastric-fundus-mucosal-ablation/) * Business Wire. (2024). True You Weight Loss Announces Two Clinical Trials Exploring Groundbreaking Non-Surgical Weight Loss Procedures. Retrieved from Business Wire (https://www.businesswire.com/news/home/20241216570579/en/True-You-Weight-Loss-Announces-Two-Clinical-Trials-Exploring-Groundbreaking-Non-Surgical-Weight-Loss-Procedures) If you have any questions or would like more information on GFMA or other weight management options, feel free to reach out to us (https://wa.me/+447491068686). Your journey to better health is important, and we’re here to support you every step of the way. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

3. 

   26 Apr 2025

   Scientific Blind Alleys: Dietary Fat, Sugar, Freud, and Adler

   In science and medicine, the most dramatic explanations often grab headlines – but they can sometimes be wrong. Two classic examples are the mid-20th-century diet-heart hypothesis and early psychoanalytic theory. In the 1950s–60s, researchers convinced the world that saturated fat was the villain behind heart disease, leading governments and food makers to push low-fat diets. Meanwhile, Sigmund Freud’s psychoanalysis – with its emphasis on childhood trauma and unconscious drives – dominated psychology, sidelining Alfred Adler’s more future-oriented ideas. In both cases, decades of public policy, clinical practice and cultural belief were shaped by a compelling but oversimplified cause. Over time we’ve learned these theories were misleading: sugar and other carbohydrates, not just fat, were fueling obesity and diabetes, and goal-driven therapies (like CBT and Adlerian “individual psychology”) often serve patients better than digging endlessly into the past. These stories remind us that early science can latch onto a single, dramatic cause and stay on it for decades, with far-reaching consequences. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. 1. The Fat Fallacy: Keys, Low-Fat Diets, and the Obesity Surge In the post-war era, heart disease was skyrocketing. A 1951 survey called body fat “America’s ‘primary public health problem’.” In 1952 President Eisenhower’s heart attack made heart disease a national crisis . Nutritionists scrambled to explain why. In 1958 Ancel Keys launched his famous Seven Countries Study – a large survey of heart disease risk factors – and emerged as the loudest voice blaming saturated fat. Keys famously concluded that “fat was to blame” for heart disease and that only a low-fat diet would reverse the trend . At around the same time, British researcher John Yudkin noticed that countries with high sugar intake also had high heart disease rates and argued that sugar (sucrose) was a major culprit . Initially Yudkin even admitted both fat and sugar might play roles . But Keys was adamant that fat alone drove the epidemic. Yudkin later accused Keys of “cherry-picking” data to support his low-fat view . By the 1960s–70s, the idea “fat = bad” had won the day: public health guidelines and doctors told everyone to slash butter, eggs and meat fat out of their diets. The food industry rushed to replace fat with cheap carbs; low-fat products were sweetened heavily with sugar to taste good . In a sense, the sugar industry got what it wanted: by promoting the fat hypothesis, sugar became the “hidden” culprit (even as fat got demonized). Over the same decades, obesity and related diseases exploded. US obesity rates more than tripled since the 1960s. Globally the picture was similar. World Health Organization reports show adult obesity nearly tripled from 1975 to 2016 . By 2016 some 650 million adults (≈13% of the world’s population) were obese . If trends continued, models predicted over a billion obese by 2025 . In the US today roughly 42% of adults are obese , up from ~13% in the early 1960s . During these decades many Americans dutifully followed low-fat advice – eating fat-free cookies and high-sugar cereals – while gaining weight. Why didn’t cutting fat stop the epidemic? Modern evidence suggests Keys’s theory was over-simplified. A growing body of research now points to refined carbohydrates and sugar (not fat) as major drivers of obesity, diabetes and heart disease. A 2023 review notes that clinical trials “could never establish a causal link” between saturated fat and heart attacks, and in fact concluded that saturated fats have “no effect on cardiovascular disease” or mortality . In other words, decades of guidelines capping fat intake are being re-evaluated. At the same time, sugar’s dangers have gained renewed attention. The World Health Organization now recommends cutting “free sugars” to under 10% of calories (5% ideal) because excess sugar intake promotes obesity and heart disease . In short, the dramatic focus on fat led us to ignore the growing evidence on sugar – and millions consumed low-fat/high-sugar foods that may have worsened weight gain and metabolic health. This history wasn’t a conspiracy of ignorance – though industry influence played a role. In fact, internal documents reveal that the sugar industry actively paid for early research to downplay sugar’s risks. In the 1960s the Sugar Research Foundation funded Harvard researchers who published a landmark 1967 review in the New England Journal of Medicine, concluding that lowering cholesterol (by cutting fat) was the only dietary fix . That review conveniently dismissed evidence implicating sugar . More recently, uncovered archives show the industry had privately sponsored this work to protect its product . The result: public health messages and food policies were skewed. As one nutrition historian observes, the 1960s–70s saw an obsession with “single nutrient” explanations (good fat vs. bad fat) while “overall attention unquestionably focused on fat” , largely ignoring sugar. Thanks for reading Bariatric Journal! This post is public so feel free to share it. In summary, the Keys era pressed a simple, dramatic culprit (fat) for complex diseases, with huge fallout: low-fat nutrition guidelines, sugar-laden diets, and a continuing obesity epidemic. Only after decades did researchers start correcting course. Modern reviews now urge a balanced view: replace refined carbs with whole foods, and recognize that sugar is a prime factor in today’s health crisis . This reversal shows how a powerful but narrow theory can mislead for generations. 2. Freud’s Empire and the Overlooked Adlerian Way At roughly the same time diet fads were taking hold, psychology was under the sway of another grand narrative. Sigmund Freud (1856–1939), an Austrian neurologist, founded psychoanalysis and became one of the century’s most famous thinkers. His revolutionary idea was that unconscious drives and childhood experiences – especially repressed sexual and aggressive impulses – shape all behavior . In the late 1800s and early 1900s Freud developed techniques like free association and dream analysis to uncover these hidden conflicts . His model of the mind (id, ego, superego) and notions like the Oedipus complex became deeply influential. As a historian notes, Freud’s impact on psychology was so huge that “throughout his life… he worked fervently… His impact on shaping the theoretical and practical approaches to the human mind… cannot be understated” . By mid-century psychoanalysis was the go-to theory for mental illness: many therapists believed that resolving past traumas was the key to treating depression, anxiety, neuroses and more. But Freud was not alone. Among his early circle was Alfred Adler (1870–1937). Adler co-founded the Vienna Psychoanalytic Society with Freud, but in 1911 he broke away from Freud’s theories to form “Individual Psychology” . Adler rejected Freud’s emphasis on sexual drives and inner conflict. Instead, he saw people as primarily goal-directed and motivated to achieve significance and social connection. Adler focused on concepts like “striving for superiority” and “social interest,” believing that we compensate for feelings of inferiority by setting future goals and cooperating with others. For example, Adler stressed empowering children – helping them build confidence and tackle life tasks – rather than endlessly dissecting their childhood guilt or fear . He famously said that healthy growth comes from feeling connected and useful in a community, not from reliving past injuries. Despite Adler’s insights, Freud’s personality and followers dominated the field. In the 1920s–50s, psychoanalysis grew into a massive movement (with institutes, journals and popular culture references), while Adlerian ideas remained on the fringe. Adler’s own biography notes that when he lectured in the US in the 1930s, “his followers found substantial resistance from those who adopted Freud’s psychoanalysis” . In practice, most psychologists and psychiatrists were trained in psychoanalytic or psychodynamic models and viewed Freud as the towering figure of psychology. (Indeed, Freud was the most-cited psychologist of the mid-20th century .) Over time, cracks appeared in the Freudian approach. Psychodynamic therapy (the modern descendant of Freud’s methods) emphasizes resolving past conflicts and unconscious motives . Patients sit in therapy for years, exploring childhood memories, dreams and slips of the tongue. Critics argue this can become self-defeating. The process is often very lengthy and expensive – a common complaint is that it “has faced criticism for its focus on the past and the length and cost of treatment” . Some therapists and patients found it too passive: rather than learning coping skills, patients were encouraged to keep reliving trauma. As a primer on psychotherapy notes, psychodynamic therapy can indeed help foster insight, but it does so by digging into old wounds rather than building new strategies . By the late 20th century, new schools of therapy were rising. Behaviorism (think Skinner, Watson) and then Cognitive-Behavioral Therapy (CBT) turned attention to present thoughts and behaviors. Aaron Beck’s CBT (1960s onward) was evidence-based and short-term, aiming to change destructive thought patterns now rather than uncover hidden past drives. Today CBT is “extensively researched” and widely recommended – in fact it is regarded as the “gold standard” of psychotherapy in modern guidelines . It treats anxiety, depression and even trauma effectively by targeting current thinking and habits. Likewise, solution-focused and humanistic therapies emphasize future goals, personal agency and strengths. Even forms of psychodynamic therapy have evolved to integrate cognitive and interpersonal elements. Adler’s legacy lives on in these shifts. Though “Adlerian therapy” remains a niche, it has influenced the field. StatPearls notes that Adlerian therapy is an “encouragement-based” approach emphasizing prevention, personal choice and social connectedness . Today therapists who draw on Adler’s ideas help clients set positive goals, recognize their strengths and engage meaningfully with community. Adler’s holistic view – seeing the person as “indivisible” and inherently striving for significance – parallels modern emphasis on holistic wellness and resilience . In practice, most therapists combine approaches: a patient might learn practical CBT skills but also explore life patterns in an Adlerian way. It’s also telling that scholarly attention to Freud has waned. A recent analysis found Freud’s peak influence was decades ago – by the 2010s only about 1% of psychology journal papers cited him . In contrast, CBT is cited in guidelines and textbooks worldwide. This reflects how the profession has moved away from dogmatic focus on the past. As one modern review puts it, Freud’s ideas still exist, but “most clinical psychologists… roll their eyes when Freud’s ideas are brought up,” even though we credit his historic importance . In short, the Freud vs. Adler story is another cautionary tale: an early theory (psychoanalysis) that spotlighted a single narrative (repressed past trauma) came to dominate thinking and training. Alternative frameworks that highlighted future goals and agency were marginalized. When the dust settled, therapists learned that one size does not fit all – many problems respond better to active, present-focused techniques (like CBT) than to decades of introspection alone. Adler’s more optimistic, future-oriented insights are finally being appreciated as a complement to Freudian ideas, rather than dismissed out of hand. 3. Lessons Learned: The Peril of Single-Cause Thinking These two historical episodes – the war on dietary fat and the reign of Freudian psychology – share a common pattern. In each case, early scientists gravitated toward a simple, dramatic cause for complex problems, and it caught on in the public imagination. Keys’s assertion that fat was “the enemy” of health and Freud’s insistence that childhood trauma was “the key” to all neuroses were powerful narratives. They provided clear advice (cut fat; talk about your past) and often aligned with cultural currents (the fitness movement of the 1950s, the introspective tendencies of mid-century therapy). But complex phenomena like heart disease or mental health have many contributing factors. By focusing on one flashy factor, both fields overlooked other critical pieces of the puzzle. The consequences were real. The low-fat craze may have left us with a generation that consumed more sugar and refined carbs, arguably making the obesity and diabetes epidemics worse. Decades of high-carbohydrate processed foods were sold as “healthy” because they were fat-free . In mental health, patients sometimes endured years of expensive psychoanalysis without reaching clear solutions, while therapists debated obscure theory. Sufferers might have benefited sooner from practical coping strategies, medication or behavioral change methods that were shunned or slow to develop under the Freudian model. In both arenas, reputations rose and fell slowly: Keys and Freud each remained influential for decades even as their ideas weakened. Importantly, our modern understanding doesn’t completely invalidate those early theories, but it puts them in context. Saturated fat isn’t a harmless food, but its role in heart disease is more nuanced (some fats are neutral or even beneficial) . And early experiences do matter for personality – but they’re only part of the picture. Personal choice, lifestyle, genetics and current environment all interact with biology and history. Emphasizing one cause oversimplifies. Today’s science is more likely to promote balanced diets (reducing sugar and refined grains, not just fat), and integrative therapies that combine insight with action. Conclusion: Learning from the Past to Build a Healthier Future Looking back, the twin missteps of blaming dietary fat for the obesity crisis and clinging to Freudian psychoanalysis for psychological healing reveal a deep human tendency: we crave simple, dramatic explanations for complex problems. Yet as the obesity epidemic and mental health struggles have shown, single-cause thinking often leads us astray. It can create public health disasters, misguide generations, and delay real solutions. Today, modern science offers a clearer, more nuanced path forward. Nutrition research has largely moved beyond the simplistic “fat is bad” narrative. We now understand that not all fats are harmful, and that sugar and refined carbohydrates play a major role in metabolic diseases. A healthy, sustainable diet isn’t about cutting one nutrient but about balancing whole, minimally processed foods: vegetables, fruits, lean proteins, healthy fats, and unrefined grains. As the American Heart Association and WHO now stress, reducing added sugars and processed carbs is key for both heart health and obesity prevention. Meanwhile, certain fats — like those from fish, nuts, and olive oil — actually promote better health outcomes. Similarly, psychology has evolved beyond Freud’s heavy focus on the unconscious past. Approaches like Cognitive Behavioral Therapy (CBT), which empower individuals to reshape their thoughts and behaviors in the present, have proven highly effective for treating depression, anxiety, eating disorders, and even obesity itself. Instead of endlessly reliving old wounds, CBT and Adlerian-inspired therapies help people envision a better future self — building confidence, resilience, and practical strategies to change their lives step-by-step. When we combine these modern insights, a powerful new model emerges for tackling today’s health crises: * Feed the body with a balanced, whole-food diet, not ruled by fear of fat or obsession with quick-fix products. * Feed the mind with evidence-based psychological tools that teach resilience, goal-setting, and self-compassion, rather than endless backward-looking analysis. If we want to truly reverse the obesity epidemic and cultivate better mental health, we must help individuals think differently about themselves and their future, while giving them the physical nourishment to sustain those changes. Food and thought are not separate battles — they are deeply connected. Studies increasingly show that dietary improvements boost mood and cognitive function, while effective therapy helps reinforce healthier lifestyle choices. Ultimately, the lessons of the past teach us to be skeptical of “one villain” explanations — whether it’s fat, sugar, childhood trauma, or any single factor. Health is multi-dimensional. Successful futures are built not by blaming the past, but by building the skills, habits, and environments that let people thrive going forward. Our scientific understanding is far from perfect — it never will be — but today we have more tools than ever to support real, lasting change. Balanced eating + future-focused thinking = a powerful foundation for a healthier world. The time to embrace it is now. “The past can teach us, but only the future can heal us. Let’s build it wisely.” This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

4. 

   21 Jan 2025

   Post-Bariatric Reflux: Diagnosis and Management

   We explore the increasing prevalence of reflux following bariatric surgery, such as sleeve gastrectomy and gastric bypass in this article. It details the multifaceted causes, encompassing behavioural factors like diet, physiological changes in the lower esophageal sphincter, and anatomical issues including hiatal hernias. The article outlines various diagnostic approaches, from endoscopy and imaging to manometry, and discusses a range of treatment strategies, from conservative management (dietary changes and medication) to surgical interventions and revisions. A personalised approach, considering individual patient factors and employing a multidisciplinary team, is emphasised for successful management. Finally, ongoing research and evolving treatment options are highlighted. Understanding and Managing Reflux After Bariatric Surgery (https://istanbulbariatriccenter.com/bariatric-surgery) The rise of obesity surgeries has led to more individuals experiencing reflux after these procedures. This post explores the complexities behind post-bariatric reflux and outlines strategies for managing it effectively. The Rising Incidence of Reflux Following Bariatric Procedures Bariatric surgery, including sleeve gastrectomy and gastric bypass, can lead to reflux. Studies show that rates of reflux can vary widely, from 6% to 28%. Understanding why this happens is key for successful patient care since managing reflux is not just about addressing heartburn. The Multifactorial Etiology of Post-Bariatric Reflux: Beyond Simple Heartburn Reflux after bariatric surgery is often due to multiple factors: * Behavioral Factors: What patients eat and how they eat significantly impact reflux symptoms. Bulky carbs, carbonated drinks, and improperly chewed food can all contribute. * Physiological Changes: Alterations in the function of the lower esophageal sphincter (LES) and the stomach's receptive relaxation may lead to symptoms. * Anatomic Factors: Problems like hiatal hernias and retained fundus can aggravate reflux. A thorough evaluation is necessary to guide treatment plans tailored to each patient’s unique circumstances. Reflux After Sleeve Gastrectomy: Identifying and Addressing Underlying Causes Common Contributing Factors: Behavioral, Physiological, and Anatomic Behavioral Factors: Dietary Habits and Eating Patterns What patients consume affects their reflux. For instance, excessive intake of tough meats or not separating solids and liquids can worsen symptoms. Physiological Changes: Alterations in LES Function and Receptive Relaxation After a sleeve gastrectomy, patients may experience changes in LES function, leading to increased reflux. Anatomic Factors: Hiatal Hernia, Staple Line Migration, and Retained Fundus Hiatal hernias, issues with staple line positioning, or enlarged retained fundus can all play a role in reflux development. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. Diagnostic Approaches and Imaging Techniques Endoscopy: Visualizing Anatomic Abnormalities and Ruling Out Barrett's Esophagus Endoscopic evaluations help identify anatomical problems and exclude serious conditions like Barrett's esophagus. Upper GI Series and CT Scans: Identifying Subtle Hiatal Hernias and Stenosis These imaging techniques reveal hidden issues like hiatal hernias or obstructions not visible in standard tests. Manometry and pH Testing: Assessing Motility and Pathologic Reflux These tests measure the pressure and acidity in the esophagus, providing insights into reflux causes. Treatment Strategies: From Conservative Management to Surgical Revision Conservative Management: Dietary Modification, PPI Trials, and Behavioral Interventions Lifestyle changes and medications, such as proton pump inhibitors (PPIs), can alleviate symptoms for many. Endoscopic Interventions: Seromyotomy for Long Segment Strictures For strictures, endoscopic interventions may help restore normal function. Surgical Interventions: Hiatal Hernia Repair, Fundoplication, and Conversion to Gastric Bypass In persistent cases, surgical options like hiatal hernia repair or conversion to gastric bypass can be considered. Reflux After Gastric Bypass: A Different Approach to Diagnosis and Management Unique Challenges: The Role of Anatomic Factors and Surgical Pathology Reflux following gastric bypass often involves unique challenges due to anatomic complications. Hiatal Hernia and Pouch-Related Issues: Size, Outlet Obstruction, and Torsion A large pouch can cause outlet obstruction, leading to reflux symptoms. Anastomotic Strictures and Gastrogastric Fistulas: Impact on Gastric Emptying and Reflux Strictures and fistulas at the surgical connection site can hinder gastric emptying, aggravating reflux. Roux Limb Length and Bile Reflux: Implications for Nutrient Absorption and Gastric Content Short Roux limbs can lead to bile reflux, complicating the situation further. Diagnostic Workup: Prioritizing Anatomic Evaluation Endoscopy: Assessing Anastomotic Integrity, Pouch Size, and Bile Reflux Endoscopy is essential for examining the anastomosis to ensure there are no blockages or abnormalities. Imaging Studies: CT Scans to Visualize Pouch Size, Hernias, and Obstructions CT scans help visualize potential issues that may contribute to reflux. Upper GI Series: Identifying Gastric Outlet Obstruction and Small Bowel Issues This test is useful for spotting blockages in the gastric outlet or small bowel. Management Options: Surgical Revision and Addressing Specific Anatomic Problems Revisional Surgery: Anastomotic Revision, Pouch Downsizing, and Roux Limb Lengthening Revising the surgical connection or adjusting the pouch size can address unresolved reflux issues. Endoscopic Interventions: Dilatation of Strictures, and Management of Gastrogastric Fistulas Endoscopic methods can help with strictures or fistulas, improving the situation. Addressing Bile Reflux: Roux Limb Lengthening and Bilio-Pancreatic Limb Reimplantation In cases of bile reflux, lengthening the Roux limb or re-implanting the digestive limb may be necessary. The Role of Endoscopy in Diagnosing and Managing Post-Bariatric Reflux The Importance of Endoscopic Evaluation in Both Sleeve and Bypass Patients Endoscopy plays a crucial role in diagnosing reflux and any accompanying complications. Identifying Anatomic Abnormalities and Surgical Pathology During Endoscopy During these evaluations, surgeons can address specific anatomical issues contributing to reflux. The Rising Importance of Endoscopic Surveillance for Barrett's Esophagus Regular surveillance can catch early signs of Barrett's esophagus, a potential precursor to cancer. The Algorithm for Managing Reflux After Bariatric Surgery: A Step-by-Step Approach Initial Evaluation: Comprehensive History, Dietary Assessment, and Symptom Journaling A thorough assessment, including dietary logs, helps identify potential triggers and patterns. Diagnostic Testing: Tailored Approach Based on Clinical Presentation and Initial Findings Testing must be customized based on initial patient findings to ensure effective diagnosis. Treatment Strategy: Conservative Measures Versus Surgical Intervention, Based on Diagnosis Treatment options vary from dietary changes to surgical interventions, guided by specific diagnoses. Conclusion: Personalized Approach to Post-Bariatric Reflux Management Reflux after bariatric surgery requires a careful, individualized approach. Key Takeaways: Comprehensive Evaluation, Multidisciplinary Approach, and Surgical Options for Intractable Cases Patients must undergo thorough evaluations, with a team-based approach for lasting success. Future Directions: Ongoing Research and Evolving Treatment Strategies As research continues, new treatment strategies may emerge, enhancing patient care and outcomes. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

5. 

   15 Dec 2024

   Sleep Deprivation and Metabolic Imbalances

   University of Chicago sleep researcher Eve Van Cauter and her colleagues reveal the devastating impact of sleep deprivation on metabolic function and brain health, leading to pre-diabetic states and physical damage.

6. 

   18 Nov 2024

   Could Weight Loss Medications Replace the Bariatric Surgery?

   We would like to discuss the potential of weight loss injections, such as semaglutide and tirzepatide, as an alternative to obesity surgery. Whether these medications might eventually replace or diminish the role of surgery, discussing factors like patient suitability, cost, and long-term effectiveness. While these medications demonstrate promising weight loss results, particularly when compared to gastric band surgery, they still fall short of the effectiveness of procedures like sleeve gastrectomy and bypass. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. The article highlights that surgery remains the preferred option for patients with extremely high BMIs, those requiring rapid weight loss, and those who have not responded well to medication. The article concludes that a combination of approaches, including lifestyle changes, medication, and surgery, may be necessary for sustainable weight management. Effectiveness: While GLP-1 analogs like semaglutide and tirzepatide are effective for weight loss, obesity surgery generally results in greater weight reduction. Tirzepatide, for example, can lead to an average weight loss of 23%, while sleeve gastrectomy or bypass surgery can achieve 30%-35% weight loss. However, GLP-1 analogs are comparably effective to gastric band surgery. Sustainability: Weight loss achieved through surgery is considered more sustainable than weight loss from medication.This is because medications only work as long as they are taken, while surgical alterations are more permanent. With drug therapy, sustainability relies on continued medication use combined with lifestyle changes. However, the long-term sustainability (10-20 years) of GLP-1 analogs is still unknown as these medications haven't been available for that long. Patient suitability plays a significant role in determining the best approach. For individuals with a BMI over 50 or those requiring rapid weight loss for medical reasons, surgery may be more appropriate. Cost is another factor to consider. While bariatric surgery is usually covered by insurance in Germany, GLP-1 analogs are not, making surgery a more accessible option for many patients. Combination therapy is possible. GLP-1 analogs can be used before surgery to reduce surgical risks and after surgery to minimise weight regain. Ultimately, the choice between GLP-1 analogs and obesity surgery depends on individual patient characteristics, needs, and circumstances. To read the article: Could weight loss medications replace bariatric surgery? (https://istanbulbariatriccenter.com/could-weight-loss-injections-replace-obesity-surgery) Advantages and Disadvantages of Using GLP-1 Analogs Before Bariatric Surgery The sources offer some insights into the potential advantages and disadvantages of using GLP-1 analogs prior to bariatric surgery. Advantages: Reduced Surgical Risks: The sources suggest that using GLP-1 analogs like semaglutide before bariatric surgery can be beneficial in reducing surgical risks by facilitating weight loss before the procedure. Improved Surgical Outcomes: Although not explicitly stated in the sources, weight loss achieved through GLP-1 analogs before surgery may potentially lead to improved surgical outcomes. This is because a lower BMI often correlates with fewer complications and better recovery. Patient Preparation and Motivation: While not mentioned in the sources, initiating GLP-1 analog treatment prior to surgery could provide patients with an opportunity to adjust to lifestyle modifications necessary for long-term weight management, thus potentially enhancing their preparedness and motivation for post-surgery success. Disadvantages: Cost and Access: The sources highlight that access to GLP-1 analogs is limited, particularly in Germany, where health insurance does not cover the costs. This financial barrier might make pre-surgical use of these medications inaccessible for many patients. Delayed Surgery: Initiating GLP-1 analog treatment before surgery would inevitably delay the surgical procedure. This delay might be detrimental for patients requiring rapid weight loss for urgent medical reasons. Potential for Inadequate Response: It's important to consider that not all patients respond equally well to GLP-1 analogs. For some, the weight loss achieved through medication alone might be insufficient to warrant delaying surgery, particularly if they are good candidates for the procedure. Conclusion: Using GLP-1 analogs before bariatric surgery presents potential advantages, such as reduced surgical risks and potentially improved outcomes. However, disadvantages like cost barriers and potential treatment delays must be considered. The decision to use GLP-1 analogs pre-surgery should be made on a case-by-case basis, taking into account individual patient characteristics, needs, and access to these medications. Remember to consult a healthcare professional for personalised advice and guidance on this matter. Click for a free Consultation (https://calendly.com/drmuratustun/30min) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

7. 

   17 Nov 2024

   Bariatric Tourism Burden on NHS

   Summary A recent study by the Bariatric and Obesity Metabolic Surgery Society (BOMSS) has revealed that bariatric tourism, where individuals travel abroad for weight-loss surgery, is costing the UK's National Health Service (NHS) significantly more than the cost of performing the surgery itself. The study, which followed 35 patients who experienced complications after bariatric surgery abroad, found that the average cost of treating these complications was £16,006 per patient, a figure that could have funded 110 bariatric surgeries in the UK. This has prompted concerns about the NHS's role in providing care for patients who undergo surgery abroad, particularly given that many of these patients would not have qualified for surgery in the UK due to not meeting the National Institute for Health and Care Excellence (NICE) criteria. The BOMSS has issued a public warning about the risks of bariatric tourism, urging individuals to carefully consider the potential savings against the risks, and the Department of Health is working to develop advice to inform people about the potential challenges and risks associated with medical tourism. Financial and Healthcare Implications of Bariatric Tourism for the NHS The sources highlight several financial and healthcare implications of bariatric tourism for the NHS: Increased costs: The NHS incurs significant costs treating complications arising from bariatric surgeries performed abroad. A study of 35 patients in five London hospitals found that the cost of treating complications was £16,006 per patient, totaling £560,234 in 2022. This amount could have funded approximately 110 bariatric surgeries within the UK. Strain on resources: Patients returning with complications from bariatric tourism require extensive medical care, including prolonged hospital stays, further surgeries, and revisional surgeries. The average hospital stay for the 35 patients in the study was 22 days, and five patients required feeding tubes. This influx of patients needing complex care puts additional strain on NHS resources and staff. Ethical considerations: The sources raise ethical questions regarding the NHS's obligation to treat patients who develop complications after undergoing bariatric surgery abroad, particularly when those patients may not have met the criteria for surgery within the NHS. Over half of the 35 patients studied would likely have been ineligible for surgery on the NHS, and almost 60% did not meet the National Institute for Care and Excellent (NICE) criteria. This raises concerns about whether the NHS is inadvertently incentivising bariatric tourism by providing a safety net for patients who experience complications. The sources also outline the reasons behind the rise of bariatric tourism: Long NHS waiting lists: Patients may opt for surgery abroad due to lengthy wait times for bariatric surgery within the NHS. Lower costs: Bariatric surgery is significantly cheaper in countries like Turkey, where it can cost as little as £2,000, compared to £10,000-£15,000 for private surgery in the UK. While the sources acknowledge the NHS's duty to treat patients in need, they also emphasize the need for a broader public policy discussion on how to address the challenges posed by bariatric tourism (http://Www.flytocure.com) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

8. 

   13 Nov 2024

   Fainting after Bariatric Surgery

   Summary: Syncope, or fainting, is a common complication after bariatric surgery. It details the risk factors contributing to syncope, including dehydration, electrolyte imbalances, cardiac arrhythmias, and the vasovagal response. The text also discusses the symptoms of syncope, ranging from lightheadedness and dizziness to more serious manifestations like seizures and loss of consciousness. Finally, it provides guidance on treatment and prevention, emphasising the importance of hydration, a healthy diet, avoiding triggers, regular exercise, and adherence to prescribed medications. Syncope After Bariatric Surgery Syncope, also known as fainting, is a temporary loss of consciousness (LOC) that is caused by a brief interruption of blood flow to the brain. It is a common complication after bariatric surgery, occurring in up to 10% of patients. Syncope can be a serious problem, as it can lead to falls, injuries, and even death. There are a number of factors that can contribute to syncope after bariatric surgery, including: * Dehydration: Bariatric surgery can lead to dehydration, which can decrease blood volume and blood pressure. This can make it more difficult for the heart to pump blood to the brain, leading to syncope. * Electrolyte imbalances: Bariatric surgery can also lead to electrolyte imbalances, which can disrupt the heart's electrical activity. This can also lead to syncope. * Cardiac arrhythmias: Bariatric surgery can increase the risk of cardiac arrhythmias, which are abnormal heart rhythms. Cardiac arrhythmias can lead to syncope by causing the heart to stop beating or by causing the heart to beat too slowly or too fast. * Vasovagal response: The vasovagal response is a reflex that causes the blood vessels to dilate and the heart rate to slow down. This can lead to a drop in blood pressure and syncope. The vasovagal response can be triggered by a number of factors, including pain, anxiety, and dehydration. Symptoms of Syncope The symptoms of syncope can vary depending on the severity of the episode. Mild episodes may only cause a brief loss of consciousness, while more severe episodes can cause a prolonged loss of consciousness and even seizures. The most common symptoms of syncope include: * Lightheadedness * Dizziness * Nausea * Vomiting * Blurred vision * Confusion * Weakness * Numbness or tingling in the arms or legs * Seizures * Loss of consciousness Treatment of Syncope The treatment of syncope depends on the underlying cause. In most cases, treatment will involve addressing the underlying cause, such as dehydration, electrolyte imbalances, or cardiac arrhythmias. Treatment for syncope may include: * Intravenous fluids: Intravenous fluids can be used to treat dehydration and electrolyte imbalances. * Medications: Medications can be used to treat cardiac arrhythmias and vasovagal responses. * Lifestyle changes: Lifestyle changes, such as increasing fluid intake and avoiding triggers, can help to prevent syncope. Prevention of Syncope There are a number of things that can be done to prevent syncope after bariatric surgery, including: * Stay hydrated: Drink plenty of fluids, especially water, before and after surgery. * Eat a healthy diet: Eat a healthy diet that is rich in fruits, vegetables, and whole grains. * Avoid triggers: Avoid triggers that can cause syncope, such as pain, anxiety, and dehydration. * Get regular exercise: Get regular exercise to help improve your overall health and fitness. * Take medications as directed: Take your medications as directed by your doctor. Conclusion Syncope is a common complication after bariatric surgery, but it can be prevented and treated. By following the tips above, you can help to reduce your risk of syncope and improve your overall health and well-being. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

9. 

   11 Nov 2024

   Updated Guidelines on Bariatric Surgery: A Comprehensive Overview

   The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) updated guidelines for bariatric surgery, marking a shift from the previous National Institute of Health (NIH) criteria set over 30 years ago. These updates aim to align patient eligibility and care standards with advancements in surgical techniques, patient safety, and new research findings on metabolic and bariatric surgery (MBS) outcomes. This research paper, a collaborative effort between the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders, presents a comprehensive review of the indications for metabolic and bariatric surgery (MBS). Using systematic reviews and a Delphi survey of experts, the paper examines the evidence supporting MBS for various patient populations, including those with different BMIs, age groups, and co-morbidities. The authors analyse the efficacy and safety of MBS in these groups, considering aspects such as weight loss, complications, and resolution of obesity-related conditions. Overall, the paper provides a strong foundation for evidence-based decision-making regarding the use of MBS in clinical practice. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. Why Update the Guidelines? Since the original 1991 guidelines, bariatric surgery has evolved significantly: • Introduction of less invasive techniques, such as sleeve gastrectomy • Improved patient safety through accreditation and specialized MBS training • Enhanced follow-up care, reducing adverse events and promoting lasting health improvements The old NIH criteria, however, remained in use, limiting surgery access for certain patient groups who could benefit from modern bariatric options. Key Changes in the Guidelines 1. Expanded Eligibility: • Lower BMI Thresholds: MBS is now recommended for those with a BMI of 30-34.9 if they have Type 2 diabetes or another obesity-related medical condition. • No Comorbidities Required for Higher BMI: Individuals with a BMI of 35-40 can now be considered for surgery even if they don’t have obesity-associated complications, provided they undergo a thorough multidisciplinary assessment. 2. Inclusion of the Asian Population: • Given the increased metabolic risks at lower BMIs in Asian populations, the guidelines now recognize a BMI of 25 as a criterion for considering MBS in Asian patients. 3. Older Adults: • There is no longer an upper age limit for eligibility, but a patient’s overall health, including frailty, should be assessed to balance surgery benefits against possible risks. Supporting Evidence for Changes The updated guidelines are supported by systematic reviews and expert consensus (Delphi surveys), covering: • Comparative studies on MBS outcomes across different BMI ranges • Evidence on remission rates for Type 2 diabetes, hypertension, and weight loss • Nutritional and post-operative complications, indicating specific risks for hypoabsorptive procedures but also clear benefits for most surgery types Outcomes of Bariatric Surgery According to the New Criteria The findings emphasized consistent benefits across different surgical options (e.g., Roux-en-Y, sleeve gastrectomy) with weight loss outcomes meeting or exceeding expectations. The remission rates for Type 2 diabetes and hypertension post-surgery ranged widely, with studies reporting 33-100% and 28-100% remission, respectively. Conclusion: Bariatric Surgery as a Key Treatment for Obesity-Related Conditions These guidelines reflect an evolved understanding of obesity’s impact on health, positioning bariatric surgery as a preventative and therapeutic option for a broader patient population. While MBS remains a significant intervention, these guidelines ensure it’s more accessible for patients who can gain long-term health benefits. For a detailed read, refer to the original study in Obesity Surgery here (https://doi.org/10.1007/s11695-024-07370-7). This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

10. 

    9 Nov 2024

    Sleeve Gastrectomy: A Comprehensive Guide

    Sleeve gastrectomy has become one of the most popular bariatric surgeries for treating obesity. Known for its relatively simple approach and effectiveness, this procedure has gained widespread adoption due to its success in helping patients achieve sustainable weight loss and improve overall health. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. What Is Sleeve Gastrectomy? In a sleeve gastrectomy, the surgeon removes approximately 80% of the stomach, leaving a tube-shaped “sleeve.” Unlike some other weight-loss surgeries, it doesn’t reroute the intestines, making it less complex and with a shorter surgery time. By reducing stomach capacity, patients feel fuller faster and consume fewer calories, which supports significant weight loss. Benefits of Sleeve Gastrectomy 1. Significant Weight Loss: Patients can expect to lose 60-70% of their excess weight within the first 12-18 months. 2. Improvement in Obesity-Related Conditions: Many patients see improvements in Type 2 diabetes, high blood pressure, sleep apnea, and more. 3. Reduced Hunger: Sleeve gastrectomy decreases the production of ghrelin, a hormone that stimulates hunger, making it easier to manage cravings and adopt a healthier diet. Who Is a Candidate? Sleeve gastrectomy is typically recommended for individuals with a BMI of 40 or higher or a BMI of 35-40 with obesity-related health issues, such as Type 2 diabetes or hypertension. Candidates should also be ready for lifestyle changes that include healthier eating habits, regular exercise, and follow-up care. How the Surgery Works The procedure is performed laparoscopically, with small incisions and the aid of a camera. After creating a small “sleeve” of the stomach, the larger section is removed, and the new stomach is sealed. This minimally invasive technique allows for a quicker recovery, often with just 1-2 days in the hospital. Life After Surgery After a sleeve gastrectomy, patients follow a structured diet, beginning with liquids and gradually reintroducing solid foods over several weeks. A key component of post-surgery life is a commitment to a balanced diet, physical activity, and regular medical follow-ups. Patients also need lifelong vitamin and mineral supplements, as their smaller stomachs may limit nutrient absorption. Potential Risks While the risks are lower than in more complex procedures, sleeve gastrectomy is still a major surgery with potential complications like infection, bleeding, or acid reflux. Additionally, patients may experience “dumping syndrome” if they consume high-sugar foods, leading to discomfort and nausea. Is Sleeve Gastrectomy Right for You? As with any weight-loss surgery, the decision should be made after a thorough consultation with a bariatric surgeon and understanding the commitment to long-term lifestyle changes. Sleeve gastrectomy is an effective tool, but its success depends heavily on the patient’s adherence to healthy habits and follow-up care. Contact us for a comprehensive evaluation and a free consultation via +44 7491068686 Final Thoughts Sleeve gastrectomy can be transformative for individuals struggling with severe obesity, providing a pathway to improved health and well-being. However, it’s essential to approach this surgery as part of a broader commitment to a healthier lifestyle. With proper guidance and support, sleeve gastrectomy patients can enjoy a significantly improved quality of life and manage their weight more effectively over time. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

11. 

    8 Nov 2024

    Early-Life Sugar Restriction Can Reduce Diabetes and Hypertension Risk!

    A study examining historical data from the UK, where sugar was rationed after World War II, found that limiting sugar intake during early life—both in utero and throughout infancy—significantly lowered the risk of developing type 2 diabetes and hypertension in adulthood. Additionally, this sugar restriction appeared to delay the onset of these conditions. By leveraging a unique historical perspective, the researchers were able to isolate sugar consumption from other potential confounding factors, leading them to conclude that early-life sugar restriction could be an effective strategy for promoting long-term health. A recent study revealed that restricting sugar intake starting in utero reduces the risk and delays the onset of type 2 diabetes and hypertension in adulthood. Adults who experienced early-life sugar rationing in the UK for at least 19 months (including in utero) had a 38% lower risk of type 2 diabetes (HR 0.62, 95% CI 0.55-0.69) and a 21% lower risk of hypertension (HR 0.79, 95% CI 0.74-0.85) compared to those who never experienced rationing, reported Tadeja Gracner, PhD, from the University of Southern California, at the ObesityWeek annual meeting. These findings were also published in Science. Thanks for reading Dr Murat Ustun Bariatric Blog! Subscribe for free to receive new posts and support my work. The researchers noted that in-utero exposure alone accounted for about a third of the overall reduction in risk for type 2 diabetes and hypertension, relative to those exposed both in utero and up to age 1. Moreover, adults who were exposed to sugar rationing from prenatal stages through their first year experienced delays of about four years in type 2 diabetes diagnosis and two years in hypertension diagnosis. John Clark, MD, PhD, from Sharp Rees-Stealy Medical Group, commented that while the study cannot confirm causation, the clarity of the longitudinal data makes this a compelling addition to the evidence connecting early-life sugar exposure with chronic diseases. Despite dietary guidelines advising that sugar should constitute less than 10% of an adult’s total energy intake and that children under two should avoid added sugars entirely, 70% of pregnant people reportedly consume above this threshold, averaging about 20 teaspoons per day. Similarly, 61% of infants and 98% of toddlers regularly consume added sugars, with baby foods often containing high levels of sugar. Gracner highlighted that the first 1,000 days of life are crucial for optimal development, and research supports the association between high sugar intake and increased chronic disease risk, as well as a stronger preference for sweetness in adulthood. Leveraging historical UK data from 1942 to 1953, when sugar was rationed at 6.5% of total daily energy intake, the researchers were able to isolate sugar consumption from other factors. When rationing ended in 1953, sugar intake almost doubled, providing a clear contrast in dietary patterns. Using data from the UK Biobank, the study analyzed type 2 diabetes and hypertension risk among 60,183 adults born before and after the rationing period. Those born from October 1951 to June 1954, who experienced rationing in their early lives, had consistently lower disease risk and delayed onset compared to those born afterward. For adults exposed only to prenatal sugar rationing, the risk reduction was 16% for type 2 diabetes (HR 0.84, 95% CI 0.75-0.95) and 6% for hypertension (HR 0.94, 95% CI 0.88-1.00), with delayed diagnoses by 1.46 years for diabetes and 0.53 years for hypertension. Additionally, those exposed to sugar rationing both prenatally and through their first year of life saw a 31% reduced obesity risk compared to non-rationed peers (HR 0.69, 95% CI 0.60-0.80). The researchers concluded that early-life sugar restriction could be a powerful tool for long-term health. This historical study adds depth to the hypothesis that sugar consumption significantly influences the development of chronic diseases, with rationing data offering an unusually clear view of this association in humans. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

12. 

    7 Nov 2024

    Gastric Bypass: The Boss in the Bariatric Surgery

    Understanding Gastric Bypass Surgery: Comprehensive Overview Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is one of the most well-established weight-loss surgeries. It’s primarily aimed at patients with severe obesity (BMI over 40, or 35 with obesity-related health conditions) and is often considered when other methods, such as diet, exercise, and medications, haven’t provided the needed results. Gastric bypass works by altering the digestive system to restrict food intake and reduce nutrient absorption, ultimately leading to substantial and long-term weight loss. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. How Gastric Bypass Works In a gastric bypass procedure, the surgeon creates a small stomach pouch and reroutes part of the small intestine. Here’s a breakdown of the key steps: 1. Creating a Smaller Stomach Pouch: The stomach is divided, forming a small pouch about the size of an egg. This pouch can hold only a small amount of food, limiting how much you can eat at once. 2. Bypassing Part of the Small Intestine: The surgeon connects the new stomach pouch directly to the middle portion of the small intestine, bypassing the first segment (the duodenum). This reduces calorie and nutrient absorption, promoting weight loss. Together, these changes significantly reduce food intake and absorption, which leads to a decrease in body weight and, often, improvement in weight-related conditions like diabetes, hypertension, and sleep apnea. Types of Gastric Bypass Procedures 1. Roux-en-Y Gastric Bypass: This is the most common form, where the stomach and intestine are restructured as described above. 2. Mini-Gastric Bypass: A simpler variation, it involves creating a longer and narrower stomach pouch, which is then attached further down the small intestine. It’s generally faster to perform but may have different risks and benefits. Benefits of Gastric Bypass Surgery 1. Significant Weight Loss: Patients can lose around 60-80% of their excess weight within a year or two after surgery. 2. Improvement in Health Conditions: Conditions like type 2 diabetes, high blood pressure, high cholesterol, and obstructive sleep apnea often improve dramatically. 3. Improved Quality of Life: Beyond physical health, many patients experience better mobility, energy, and self-confidence. 4. Longevity Benefits: Studies show that gastric bypass may lead to a longer lifespan for patients with obesity by reducing the risk of serious health conditions. Potential Risks and Complications 1. Nutrient Deficiencies: Because it alters the digestive tract, gastric bypass can lead to deficiencies in vitamins and minerals, including iron, calcium, and B12. Lifelong supplementation is often necessary. 2. Dumping Syndrome: This is a common side effect where food moves too quickly from the stomach to the intestine, causing symptoms like nausea, sweating, and diarrhea, especially after eating high-sugar foods. 3. Surgical Risks: As with any major surgery, risks include infection, bleeding, and blood clots. 4. Ulcers and Gastrointestinal Issues: Patients may be prone to developing ulcers, particularly if they use NSAIDs or smoke. Some may also experience acid reflux or bowel obstructions. 5. Psychological Adjustment: Rapid weight loss and lifestyle changes can impact mental health, requiring support from counseling or therapy. The Process: From Preparation to Recovery 1. Pre-Surgery Preparation: Before surgery, patients undergo a thorough health evaluation, including blood tests, imaging, and consultations with specialists. Pre-operative guidelines may include a specific diet, lifestyle changes, and sometimes weight loss to prepare for the procedure. 2. The Surgery: Gastric bypass is performed laparoscopically (minimally invasive) in most cases, with patients under general anesthesia. It typically takes 2-4 hours, followed by a hospital stay of about 2-3 days. 3. Recovery and Aftercare: Recovery involves a phased diet, starting with liquids, then progressing to pureed, soft, and eventually solid foods over several weeks. Regular follow-ups with the healthcare team are essential to monitor weight loss, address potential deficiencies, and support adjustments to the new lifestyle. Long-Term Considerations Gastric bypass is not a “quick fix” and requires commitment to lifelong lifestyle changes. Patients need to: • Follow a Nutrient-Dense Diet: Prioritize high-protein, low-sugar foods to sustain energy levels and avoid dumping syndrome. • Stay Hydrated: Dehydration is common post-surgery, so patients are encouraged to sip water throughout the day. • Take Lifelong Supplements: Multivitamins and other specific supplements are essential to avoid deficiencies. • Attend Regular Check-Ups: Regular appointments help manage any complications and ensure nutrient levels remain adequate. • Embrace Physical Activity: While diet is key, regular exercise helps maintain weight loss and improves overall health. Who is a Good Candidate for Gastric Bypass? Gastric bypass is typically recommended for individuals who: • Have a BMI of 40 or higher, or 35 and higher with obesity-related health conditions. • Are between the ages of 18 and 65, though this can vary depending on individual health conditions and risks. • Have tried other weight-loss methods without sufficient results. • Understand the commitment to lifestyle changes required for success. Gastric Bypass Surgery Success Stories and Patient Outcomes Studies have shown that gastric bypass patients can achieve significant weight loss that is often maintained for many years. Additionally, nearly 80% of patients experience remission or significant improvement in type 2 diabetes, and up to 90% see improvements in hypertension and other weight-related issues. However, success rates depend on each person’s adherence to dietary, activity, and follow-up guidelines. Conclusion Gastric bypass is a powerful tool for weight loss and health improvement in individuals struggling with obesity. However, it requires a strong commitment to lifestyle changes and regular medical follow-up. For those who meet the criteria and are prepared for the challenges, it can be life-changing—helping them achieve a healthier weight, improve related health conditions, and regain quality of life. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

13. 

    6 Nov 2024

    SIBO After Bariatric Surgery

    SIBO After Bariatric Surgery If you've undergone bariatric surgery, whether it's gastric bypass, sleeve gastrectomy, or another procedure, you may be at an increased risk of developing small intestinal bacterial overgrowth (SIBO). SIBO is a condition where there is an abnormal increase in the number and/or type of bacteria present in the small intestine. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. The Link Between Bariatric Surgery and SIBO Bariatric surgeries work by restricting the amount of food you can consume or by reducing the absorption of nutrients. While these changes help with weight loss, they can also disrupt the delicate balance of gut bacteria, leading to SIBO. Some of the ways bariatric surgery can contribute to SIBO include: 1. Altered Gut Anatomy: Procedures like gastric bypass and duodenal switch involve rerouting the intestines, which can create "blind loops" where bacteria can accumulate. 2. Decreased Stomach Acid: Reduced stomach acid production, a common side effect of bariatric surgery, can allow more bacteria to survive and thrive in the small intestine. 3. Nutrient Malabsorption: Decreased absorption of nutrients, such as iron and vitamin B12, can create an environment that favors the overgrowth of certain bacteria. Symptoms of SIBO After Bariatric Surgery Recognizing the symptoms of SIBO is crucial for getting the right treatment. Common symptoms include: - Bloating and gas - Abdominal pain or discomfort - Diarrhea or constipation - Unintentional weight loss - Nutrient deficiencies (e.g., vitamin B12, iron) If you experience any of these symptoms after your bariatric surgery, it's important to speak with your healthcare provider. Diagnosing and Treating SIBO To diagnose SIBO, your healthcare provider may order a breath test or a small intestinal aspirate and culture. These tests can help determine the type and amount of bacteria present in your small intestine. Once SIBO is diagnosed, the treatment typically involves a combination of antibiotics, dietary changes, and probiotics. Your healthcare provider will work with you to develop a personalized treatment plan based on your specific needs and the type of SIBO you have. Preventing SIBO After Bariatric Surgery While SIBO is a common complication after bariatric surgery, there are steps you can take to help prevent it: 1. Follow your healthcare provider's dietary recommendations, which may include limiting certain carbohydrates and increasing your intake of fiber-rich foods. 2. Take probiotics and digestive enzymes as directed by your healthcare provider. 3. Maintain good oral hygiene and avoid unnecessary antibiotic use, as these can disrupt the gut microbiome. 4. Stay hydrated and exercise regularly to support overall digestive health. Addressing SIBO after bariatric surgery is crucial for your long-term health and well-being. By working closely with your healthcare provider, you can manage your symptoms, restore gut health, and continue your journey to improved health and wellness. Thanks for reading Murat Ustun! This post is public so feel free to share it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

14. 

    5 Nov 2024

    Ozempic Alert!

    The UK's Medicines and Healthcare products Regulatory Agency (MHRA) has issued a warning about the potential side effects of weight-loss drugs known as glucagon-like peptide-1 receptor agonists (GLP-1RAs), urging healthcare professionals to inform patients of these risks. Meanwhile, the House of Lords food, diet, and obesity committee has declared a public health emergency due to the high rates of obesity and diet-related diseases in the UK. The committee advocates for a comprehensive approach to address this crisis, including a tax on unhealthy foods, a ban on junk food advertising, and greater regulation of the food system. While weight-loss drugs are acknowledged as a potential tool, the committee emphasizes the need for broader societal interventions to combat the root causes of obesity. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work. Background Information on GLP-1RAs GLP-1 receptor agonists (GLP-1RAs) are used to treat type II diabetes and obesity. Approved options in the UK include dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide. Specific brands, such as Wegovy (semaglutide), are also approved to reduce cardiovascular risk in patients with heart disease. Another product, Mounjaro (tirzepatide), combines GLP-1RA with a GIP RA. Growing interest in GLP-1RAs for weight loss has led to their use outside intended conditions, although benefits and risks for these applications remain unstudied. GLP-1RAs licensed for weight management are effective for patients with obesity or weight-related health issues but are intended only for those who meet these criteria. Reports of adverse reactions include gastrointestinal symptoms, especially at treatment initiation or following dose increases. Severe cases of dehydration have led to hospitalizations, particularly in individuals who may not meet prescribing criteria but have used these drugs for unapproved weight-loss purposes. By October 2024, the MHRA received reports of gastrointestinal issues in users of GLP-1RAs for weight management, with 68 cases resulting in hospitalization. Limitations in reporting data mean the actual frequency of such reactions remains uncertain. Adverse Drug Reaction Reporting Healthcare professionals are encouraged to continue reporting ADRs through the Yellow Card scheme. Include detailed information, such as the patient’s medical history, co-medications, treatment dates, and any signs of misuse. This data supports the safe and effective use of GLP-1RAs. Information for Patients • Prescription Use Only: GLP-1RAs are prescription medicines intended for medical supervision. They should only be prescribed by qualified healthcare professionals. • Risks and Benefits: Be aware that the risks and benefits of using GLP-1RAs for weight loss outside licensed indications have not been thoroughly studied. • Common Side Effects: The most frequent side effects are gastrointestinal (nausea, vomiting, diarrhea, constipation), affecting over 1 in 10 users. These can persist for several days and may cause dehydration, which, in severe cases, could lead to complications like kidney damage. • Staying Hydrated: To avoid dehydration, stay hydrated by drinking plenty of fluids, especially if you experience gastrointestinal side effects like vomiting or diarrhea. • Serious but Rare Side Effects: Less common but serious side effects include gallstone disease, pancreatitis, and severe allergic reactions. • Avoiding Counterfeit Products: If you receive a private prescription, ensure it’s filled by a legitimate pharmacy to avoid the risk of counterfeit products. • Reading and Following Instructions: Always follow the dosage and instructions provided in the Patient Information Leaflet. If you experience any side effects, consult a healthcare professional. Guidance for Healthcare Professionals • Informing Patients of Side Effects: Educate patients at the start of their treatment and when increasing doses on the common gastrointestinal side effects of GLP-1RAs, which affect over 1 in 10 patients. While often mild, these effects can occasionally lead to severe dehydration and even hospitalization. • Hypoglycemia Awareness: Recognize that hypoglycemia can develop in non-diabetic patients using GLP-1RAs for weight management. Ensure patients understand the signs and symptoms of hypoglycemia and encourage them to seek medical advice immediately if they experience these symptoms. • Warning Against Falsified Medications: Advise patients of the risks associated with obtaining GLP-1RAs from unregistered sources, as some counterfeit versions contain insulin. • Potential for Misuse: Be mindful of reports of unauthorized use of GLP-1RAs, including aesthetic weight loss, and consider the implications of such misuse in patient counseling. • Adverse Drug Reaction Reporting: Report any suspected adverse drug reactions (ADRs) through the Yellow Card scheme to improve the safety and understanding of GLP-1RAs in real-world use. Source: https://shorturl.at/ebTJ6 (https://shorturl.at/ebTJ6) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

15. 

    4 Nov 2024

    Dark Side of the Medical Tourism

    The British Assosciation of Aesthetic Plastic Surgeons and the British Bariatric and Metabolic Surgery Society have issued a joint declaration last year on surgical health tourism due to increasing complication rates. In the report, it was pointed out that the increasing number of people going abroad for aesthetic and bariatric surgery has increased the rates of serious complications and even death. Aesthetic and Bariatric Surgery Associations stated that they published this joint declaration to draw attention to patient safety and health. Both associations warned about the risks of health tourism. Against this, economic pressures and advertising bombardment are leading to an increasing number of British patients choosing to travel abroad for surgery. Health professionals point out that an increasing number of patients are presenting with complications following operations performed outside the UK. The management of these complications has the potential to place a heavy burden on the already strained NHS budget. Therefore, a measure could be introduced to ensure that these costs are paid by the patient. Also the recent YouTube video "Türkiye'deki güzellik sektörünün karanlık tarafı" (The dark side of the beauty market in Turkey) by DW Türkçe explores the dark side of Turkey's booming aesthetic surgery industry, specifically highlighting the dangers faced by British citizens seeking cosmetic procedures there. The video investigates the cases of Morgan Ribeiro, a young woman who tragically died after a botched gastric sleeve surgery in Istanbul, and Sara Platt, who endured numerous complications after a tummy tuck and breast augmentation. Both women had been lured to Turkey by advertisements for affordable procedures, but ultimately fell victim to unscrupulous clinics and unqualified surgeons. The video also examines the role of medical tourism agencies in facilitating these procedures, raising concerns about their lack of transparency and accountability. The report concludes by advocating for stricter regulations in the industry and increased awareness among potential patients of the risks involved. Dangers of Unregulated Clinics Unregulated clinics pose significant risks to patients seeking medical care. These clinics often operate without proper licensing, oversight, or adherence to medical standards, leading to harmful consequences. In this chapter, we delve into the potential dangers associated with these establishments and provide examples from various sources to illustrate our points. Substandard Conditions Unregulated clinics often have substandard conditions that can compromise patient safety and care. These conditions may include: * Lack of proper sanitation, leading to the spread of infections and diseases * Outdated or malfunctioning medical equipment, increasing the risk of complications during procedures * Inadequate staff training, resulting in poor patient care and potentially life-threatening mistakes In the video, a journalist visits an unregulated cosmetic surgery clinic, where they find dirty instruments, rusty equipment, and unqualified staff, posing significant risks to patients undergoing procedures. Unqualified Staff Unregulated clinics may employ unqualified or inadequately trained staff, which can result in improper diagnoses, incorrect treatments, and patient harm: * Unlicensed practitioners may administer treatments or perform procedures outside their scope of expertise * Inadequately trained staff may not recognize or respond appropriately to patient complications or emergencies A former patient of an unregulated clinic shares their story of receiving treatment from an unlicensed practitioner who misdiagnosed their condition, leading to unnecessary and harmful treatments. Performed Procedures Unregulated clinics may perform procedures without proper oversight or adherence to medical standards, increasing the risk of complications and poor outcomes, such as: * Performing unnecessary or inappropriate procedures, potentially causing harm and increasing healthcare costs * Failing to obtain informed consent or provide adequate pre- and post-procedure instructions * Lack of follow-up care or inadequate response to patient complications The video shows undercover footage from an unregulated clinic, where practitioners are seen performing invasive procedures without proper equipment, safeguards, or patient consent. Unregulated clinics put patients at risk by operating without proper oversight, licensing, or adherence to medical standards. By cutting corners in areas such as staff training, facility maintenance, and procedure performance, unregulated clinics expose patients to potential harm, substandard care, and poor outcomes. It is crucial for both patients and regulatory bodies to ensure that medical clinics are held to the highest standards, to protect public health and safety. What We Offer to Our Patients? 1-When you decide to walk with us in your fight against obesity, you will be consulted by a UK citizen bariatric surgeon and informed in full detail. 2-Selection of the operation is completely tailored to you in the light of international criteria. Using the ACS NSQIP Surgical Risk Calculator, the most appropriate and lowest risk method is selected for you. Complication and risk estimates for all possible methods, detailed scientific analyses on targeted success rates are presented to you as a report. 3-The method to be applied to you is decided together in medical consultation, and all your postoperative examination and surgery reports, including images such as endoscopy, ultrasound, leak test, etc. are delivered to you. We would also like to inform you that our practice of delivering the surgery video to the patient without editing is a standard. 4- Your surgery is performed by internationally accredited surgeons who are world-renowned in the field of bariatric surgery. Follow-up processes are also carried out by a team with SRC International Accreditation. 5-The medical history, medications and embolism risks of all bariatric surgery candidates are evaluated at the time of surgery decision. If necessary, changes in medications or the use of blood thinners are decided in communication with your GP. 6-After the surgery, your regular and mandatory controls are carried out by our bariatric dietitians even if you do not request it. In order to avoid any vitamin and mineral deficiency, your regular blood tests will be followed up in co-operation with your GP. 7- In case you need any support in the UK, the necessary support is provided by local bariatric surgery specialists and other consultants. Your health is your most valuable asset, cost should never be your priority when deciding on surgery abroad. You can contact us to reach UK quality health service with much more reasonable package prices compared to UK figures. Sources: Fly to Cure Healthcare 🇬🇧 (https://www.flytocure.com/blog/medical-tourism-under-the-scrutiny) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

16. 

    2 Nov 2024

    Great News! IFSO Endorsed ESG

    As obesity rates continue to rise worldwide, the medical community is increasingly focusing on finding effective, minimally invasive solutions for weight management. Traditional surgical approaches, while effective, are not suitable for everyone due to the risks, recovery times, and certain health requirements. To bridge this gap, Endoscopic Sleeve Gastroplasty (ESG) has emerged as a promising option for those looking for less invasive weight-loss procedures. Recently, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) endorsed ESG as an effective method for managing obesity, especially for patients who cannot or prefer not to undergo traditional surgery. This endorsement follows a comprehensive review of ESG, reflecting its rising acceptance as a valuable addition to obesity care. Let’s dive into what ESG is, why it’s significant, and how the IFSO’s review supports its role in obesity treatment. What is Endoscopic Sleeve Gastroplasty (ESG)? ESG is a minimally invasive, endoscopic procedure designed to reduce the stomach’s volume, limiting food intake and helping individuals lose weight. Unlike traditional bariatric surgery, ESG does not require any cuts or large incisions. Instead, the procedure is performed using an endoscope—a flexible tube equipped with a camera and suturing device—that enters the stomach through the mouth. Once inside the stomach, the surgeon uses specialized tools to create a series of sutures along the stomach wall, reducing its overall size and forming a sleeve-like structure. This reshaping of the stomach reduces the amount it can hold, helping patients feel full after consuming smaller portions of food. Since ESG preserves the natural anatomy of the digestive system, it also reduces the risks associated with more invasive surgeries. The IFSO Review and Endorsement of ESG The recent endorsement of ESG by IFSO is based on a systematic review conducted by the IFSO Bariatric Endoscopy Committee. This review collected and analyzed data from various studies on ESG, with the aim of evaluating its safety, effectiveness, and role within obesity care. The review included findings from numerous case studies, cohort studies, and even a randomized controlled trial, encompassing a total of over 15,000 patients. The review’s findings provided evidence supporting ESG as a valuable option for weight loss, particularly for individuals with obesity who either cannot undergo or choose not to have more invasive procedures. Here are some of the key findings and conclusions from this IFSO-backed review: 1. Significant Weight Loss Outcomes: The review found that ESG led to meaningful and sustained weight loss across different study groups. Patients generally experienced a significant percentage of excess weight loss (EWL) and total body weight loss (TBWL) over periods extending up to five years. For example, average TBWL values remained between 14-18% over 24 to 36 months, indicating durable results. 2. Safety Profile: The review demonstrated that ESG has a favorable safety profile, with a serious adverse event rate of only 1.25%. This low rate of complications underscores ESG’s position as a safer alternative to more invasive weight-loss surgeries, especially for patients who might have higher surgical risks. 3. Quality of Evidence: Although most of the studies included in the review were observational, limiting the level of evidence, the findings from a randomized controlled trial (RCT) included in the review offered more robust support for ESG’s efficacy and safety. The RCT reinforced ESG’s status as a reliable option for weight management, providing a higher level of scientific evidence to back the positive outcomes observed in other study types. Why ESG is an Important Development in Obesity Treatment The IFSO’s endorsement of ESG signals a shift toward accepting less invasive methods as part of mainstream obesity treatment. Here’s why ESG’s position in obesity care is so important: • Alternative for High-Risk Patients: Many patients with obesity have health conditions that make them poor candidates for surgery. ESG provides a viable alternative for these patients, offering significant weight loss without the high risks associated with surgical interventions. • Options for Those with Lower BMI: Some individuals with a BMI below the threshold for traditional surgery still struggle with obesity-related health conditions, but they may not qualify for traditional metabolic and bariatric surgery (MBS). ESG fills this gap, providing an option for patients with class I and II obesity who may still benefit from medical intervention. • Reduced Healthcare Burden: Because ESG can often be performed as an outpatient procedure, it reduces the time patients need to spend in healthcare facilities, lowers the risk of complications, and generally has a shorter recovery period compared to surgery. This can help reduce healthcare costs and increase accessibility for patients who need treatment. Detailed ESG Outcomes from the IFSO Review The IFSO review looked at weight loss outcomes and complication rates for ESG over time. Here are some of the specific results from the review: 1. Weight Loss: • 6 Months: Patients typically lost an average of 15.66% of their total body weight. • 12 Months: At the one-year mark, average weight loss increased to approximately 17.56%. • 18-24 Months: Patients continued to lose weight over time, with results peaking around 18 months at nearly 16.25%. • Long-Term Results: Even at 36 to 60 months, weight loss remained stable, with mean weight loss percentages staying between 14-15%. 2. Safety and Complications: • The review showed that serious complications were uncommon, with a rate of only 1.25%. • Mild side effects, such as nausea or abdominal discomfort, were more common but generally resolved quickly. 3. Quality of Evidence: • While observational studies were the primary source of data, a single RCT in the review provided a more moderate level of evidence for ESG’s safety and effectiveness. The RCT’s findings aligned with those of other studies, reinforcing the reliability of ESG as a weight-loss tool. How ESG Compares to Other Weight-Loss Procedures Compared to traditional bariatric surgeries like the gastric bypass or sleeve gastrectomy, ESG offers several distinct advantages: • Lower Risk: ESG has a much lower rate of complications than many traditional surgeries, as it doesn’t involve cutting or stapling parts of the stomach or intestines. • Quicker Recovery: Most patients can return to daily activities within a few days after ESG, whereas recovery from surgical options can take several weeks. • Reversibility: While not commonly reversed, ESG is theoretically reversible by removing the stitches, which is not an option with more permanent procedures like sleeve gastrectomy. However, ESG may also have limitations in comparison to traditional surgeries: • Less Drastic Weight Loss: While ESG is effective, the amount of weight loss may be slightly less than with traditional surgeries, especially for those with higher BMI levels. The Future of ESG in Obesity Management The IFSO endorsement of ESG is a pivotal development in the field of obesity treatment, as it highlights the potential for ESG to become a standard, widely accepted option within the broader spectrum of obesity care. As more studies are conducted, and additional RCTs build upon the existing data, the medical community will gain an even clearer picture of ESG’s long-term benefits and limitations. The IFSO’s endorsement encourages healthcare providers to consider ESG not as an alternative to surgery but as a complementary option. It opens up the possibility of using ESG as part of a multidisciplinary obesity treatment plan, giving doctors more tools to help patients achieve sustainable weight loss. Key Takeaways for Patients Considering ESG If you’re considering ESG as a weight-loss option, here are some essential points to discuss with your healthcare provider: 1. Eligibility: ESG is best suited for patients with a BMI between 30 and 40 who haven’t found success with diet and exercise alone. 2. Expected Outcomes: ESG offers significant weight loss, but results vary. Your doctor can help you set realistic goals based on your health profile. 3. Risks and Recovery: While ESG has a favorable safety profile, mild side effects are possible. Be sure to follow all post-procedure care instructions to minimize risks. 4. Commitment to Lifestyle Changes: Like all weight-loss procedures, ESG requires a commitment to healthy eating, exercise, and regular medical follow-up for the best long-term results. Conclusion The IFSO’s endorsement of Endoscopic Sleeve Gastroplasty marks an important step forward in making effective, minimally invasive obesity treatments more accessible. ESG fills a critical gap for patients who cannot or prefer not to undergo traditional surgery, offering a safe and effective way to achieve lasting weight loss. As the global health community faces rising rates of obesity, tools like ESG provide new hope. Backed by comprehensive evidence and the support of an influential organization like the IFSO, ESG is well on its way to becoming a cornerstone of obesity management. Source: Apollo Endosleeve (https://apolloendosleeve.com/blog/big-news--ifso-endorsed-esg) This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

17. 

    1 Nov 2024

    Endoscopic Sleeve Gastroplasty Frequently Asked Questions

    This podcast summarizes key information from the article published on the website of Dr. Murat Ustun, a leading bariatric surgeon in Turkey. The article focuses on Endoscopic Sleeve Gastroplasty (ESG), a minimally invasive procedure for weight loss. What is ESG? ESG is a non-surgical procedure where an endoscope is inserted through the mouth into the stomach. Special sutures are then used to reduce the stomach's volume, helping patients feel full faster and consume less food. Who is ESG suitable for? The procedure is generally suitable for individuals with a Body Mass Index (BMI) between 30 and 40 who have struggled to lose weight through traditional methods like diet and exercise. It can also be an alternative for patients who are high-risk for open surgical procedures. Procedure and Advantages: Performed under general anesthesia, the procedure takes approximately 1-2 hours. Recovery is generally quick with a low risk of complications, highlighting the advantages of ESG as a minimally invasive procedure. The article emphasizes the benefits of ESG over gastric balloons: “Although the basic mechanism of both is to reduce stomach volume, there are significant differences between them and gastric balloons. First, in a gastric balloon, a foreign body made of silicone or polypropylene, i.e., a gastric balloon, is placed into the stomach and filled with serum. In endoscopic sleeve gastroplasty, volume restriction is achieved only by placing sutures.” The article highlights the comfort and long-term effectiveness of ESG compared to the temporary nature of gastric balloons. Expected Weight Loss and Long-Term Care: Patients can expect to lose 15-20% of their excess weight within the first six months. However, maintaining this weight loss requires commitment to lifestyle changes, including: * Eating smaller portions regularly * Adopting a healthy and balanced diet * Engaging in regular physical activity * Attending periodic health check-ups * Seeking support from nutritionists and psychologists if needed Risks and Reversibility: While generally low, risks associated with ESG include nausea, vomiting, temporary abdominal pain, and rare occurrences of infection, bleeding, or suture opening. Importantly, ESG is reversible, as the sutures can be removed endoscopically if needed, restoring the stomach to its original size. ESG in Turkey and Cost: The article notes that Dr. Murat Ustun pioneered ESG in Turkey in 2014 and continues to perform the procedure with a team of gastroenterologists and bariatric surgeons. The cost of ESG in Turkey ranges from 7,000 to 10,000 USD, making it more expensive than traditional bariatric surgery methods due to the specialized equipment required. Conclusion: ESG is presented as a promising non-surgical alternative for weight loss, especially for individuals with a BMI between 30 and 40. The procedure boasts several advantages, including minimal invasiveness, quick recovery, and reversibility. However, long-term success depends heavily on patients adopting and maintaining healthy lifestyle changes. For more information: www.apolloendosleeve.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com (https://drmuratustun.substack.com?utm_medium=podcast&utm_campaign=CTA_1)

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