New recommendations from doctors take us even further in the wrong direction. Action Alert.
Three medical societies—the American Association of Clinical Endocrinologists, the Obesity Society, and the American Society for Metabolic and Bariatric Surgery—jointly announced last month that they were changing their guidance on who should get metabolic and bariatric surgery, and which methods should be used.
These new guidelines state that bariatric surgery should be expanded to include mildly to moderately obese people (class 1 obesity) who have diabetes or metabolic syndrome. Eligible patients would have a body mass index (BMI) of 30 or above; for a 5’9” adult, that’s a weight of 203 lbs. or higher—only 35 pounds over what is considered a healthy weight.
This recommendation comes with a disclaimer: “Current evidence is limited by the number of subjects studied and lack of long term data demonstrating net benefit.” It is further noted that there is currently insufficient evidence for recommending a bariatric surgical procedure specifically for glycemic control alone, fat reduction alone, or cardiovascular disease risk reduction alone, independent of BMI criteria.
In their press release, this statement is immediately followed up—with no irony whatsoever—with these words: “These clinical guidelines provide evidence-based recommendations and information to help surgeons, primary care doctors and other health professionals make the most informed decisions for the benefit of patients.” Evidence-based? How absurd! There’s no evidence at all for their recommendation, by their own admission!
This is not the first time conventional medicine has recommended reducing the threshold for bariatric surgery. In 2011 we told you about an FDA panel’s recommendation that lap-band surgery be made available to 12 million more people than before.
Gastric bypass surgery is not only a popular medical procedure; it is also an economic goldmine. Bariatric surgery has a 45% profit margin—larger than most procedures (by contrast, other money-making procedures like coronary artery bypass surgery have an estimated profit margin of only 30%). And it’s almost always covered by insurance.
Bariatric surgery can reduce weight—at least at first. But weight loss does not necessarily result from reducing stomach size or primarily from that. New research suggests that the weight loss that occurs after gastric bypass surgery may be the result of changes to stomach flora. This study is discussed in the May 2013 issue of Dr. David Williams’s Alternatives newsletter. It has been known for some time that after surgery, the gut changes in its chemistry, not just its size—but it wasn’t clear whether the chemical changes were produced by the weight reduction, or caused it. This study found that the chemical changes were the catalyst to weight loss.
The data isn’t conclusive for humans—the study used test animals—and much remains to be understood about the process involved. If chemical changes in the gut are what causes people to lose weight, not a change in stomach size, it is better by far to shift the gut bacteria using probiotics.
Bariatric surgery is far from routine. Studies show that 1% of patients die from the surgery, and complications affect up to 40% of patients, including vomiting, diarrhea, infections, hernias and respiratory failure; as well nutritional deficiency, potentially resulting in anemia, osteoporosis, and bizarre neurological problems. Seizures and paralysis have even been reported in extreme cases. One thing to worry about in particular is damage to the vagus nerve, which controls many important digestive functions including bile release and the movement of food.
Moreover, a study from the Journal of the American Medical Association shows that bariatric surgery does nothing to reduce a patient’s long-term health care expenses. On top of that, the surgery is considered a “success” if only 50% of one’s excess weight is lost—even though the patient would still be overweight or obese—and within ten years, as few as 20% of patients have maintained their weight loss. This may be because the chemical changes in the remaining gut do not persist—though they could be maintained with the right diet and supplements. Indeed, these ideal gut conditions could and should be created without the surgery in the first place.
Weight loss supplements are a hot topic right now. Not surprisingly, the FDA is considering completely banning weight loss claims for anything other than drugs. So far, they have hesitated because there aren’t many weight loss drugs and they often have horrifying side effects. But if you haven’t taken action by writing the FDA to tell them not to ban supplement weight loss claims, please do so now.
One supplement much discussed for weight loss now is Garcinia cambogia, an extract from the Malabar tamarind. Studies in the 1960s and ’70s showed that Garcinia cambogia contains hydroxycitirc acid (HCA), which inhibits the enzyme ATP citrate lyase, diverting the conversion of carbs from fat to energy production instead. Furthermore, fatty acids in the body’s “fat pool” continue to be released, contributing to overall fat loss.
As Dr. Harry G. Preuss, MACN, CNS, a member of our board, points out in his paper “Garcinia Cambogia: How to Optimize Effects,” the quality of the Garcinia extract is important—it must contain a minimum of 50% HCA, and must not be composed wholly of calcium salts as this would decrease bioavailability. Potassium and/or magnesium should be present (both increase bioavailability), and a product with low lactone content is recommended. It must also be taken on an empty stomach (at least 30 to 60 minutes before a meal), because otherwise it will bind to components in the meal and be inactivated. (This is called the “food effect,” and it can reduce bioavailability of many different supplements besides HCA).
Garcinia provides an object lesson in using supplements wisely. It is never as simple as just taking a pill. The formulation is important; the co-factors are important; and your individual body chemistry is important. Always consult a knowledgeable professional.
Besides Garcinia cambogia, there are curcumin and cinnamon, which control blood sugar levels; magnesium, chromium, amino acids, and green tea, which help with weight loss; and Irvingia gabonesis supplements (derived from a wild mango from central and western Africa), which has showed impressive weight loss effects in a recent ten-week RCT.
For more suggestions, including the importance of good fats, the right kind of exercise, and metabolic typing, see our earlier article, “Natural Solutions for Losing Weight.”