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Nathan Goodyear

JAMA Network | JAMA Surgery | Three-Year Outcomes of Bariatric Surgery vs Lif... - 0 views

archsurg.jamanetwork.com/article.aspx

diabetes obesity obese bariatric surgery lifestyle

shared by Nathan Goodyear on 06 Jul 15 - No Cached
  • Nathan Goodyear on 06 Jul 15
     
    new study finds that bariatric surgery outperforms lifestyle interventions in improving glucose control in obese individuals.  On the surface this seems interesting, but the lifestyle interventions were based on the Diabetes Prevention program.  The diabetes prevention program doesn't do well in glucose control in any clients (see increasing diabetes rates), so it should be no surprise that bariatric surgery outperforms a program that doesn't work
Nathan Goodyear

Bariatric Surgery Results in Cortical Bone Loss - 0 views

jcem.endojournals.org/...541.abstract

bariatric surgery bariatric surgery weight loss surgery overweight obesity

shared by Nathan Goodyear on 18 Feb 13 - No Cached
  • Nathan Goodyear on 18 Feb 13
     
    no surprise here.  Bariatric surgery was found to result in bone loss.  Disruption of the GI tract and absorption is going to result in malnutrition states and bone loss will be one of the side effects.
Nathan Goodyear

JAMA Network | Archives of Surgery | Death Rates and Causes of Death After Bariatric Su... - 0 views

archsurg.jamanetwork.com/article.aspx

Bariatric surgery overweight obese weight-loss death rates

shared by Nathan Goodyear on 02 Nov 12 - No Cached
  • Nathan Goodyear on 02 Nov 12
     
    Study reveals that death rate increased per year post-Bariatric surgery.  Up to 6.4% at 5 years.  This study did not follow up on additional procedures/surgeries.  The re-operation rate is 50%.
Nathan Goodyear

Testosterone replacement: Medical alternative to bariatric surgery? : Clinica... - 0 views

www.clinicalendocrinologynews.com/...9ebe07503b9647c5b63b63de0.html

Testosterone low T low Testosterone men male hormones obese obesity

shared by Nathan Goodyear on 14 Oct 14 - No Cached
  • Nathan Goodyear on 14 Oct 14
     
    Testosterone therapy aids weight loss in study of obese men.  The presentation of the potentially biased study (study was funded by the makers of the Testosterone used in the study) proposes Testosterone as a pharmacologic bariatric treatment.  That conclusion is ludicrous!  Testosterone therapy has been shown to improve insulin sensitivity, improve glucose uptake, reduces inflammation, improve muscle building, and reduce the parameters of metabolic syndrome--all of which underlies the obesity.  Thus, men with low T and obesity, Testosterone therapy is playing a causal role in the obesity and thus Testosterone therapy is treating the cause.  But to describe it as pharmacologic bariatric therapy is false and misleading. http://ow.ly/CKrje 
Nathan Goodyear

Nutrition Care for Patients with Weight Regain after Bariatric Surgery - 0 views

www.hindawi.com/...256145

bariatric surgery weight loss surgery obesity obese weight loss nutrition

shared by Nathan Goodyear on 05 Mar 15 - No Cached
  • Nathan Goodyear on 05 Mar 15
     
    Bariatric surgery has a regain of 25-30% of weight loss and a 25% failure to achieve successful weight loss.
Nathan Goodyear

Gonadal status and outcome of bariatric surgery in obese men - Aarts - 2013 - Clinical ... - 0 views

onlinelibrary.wiley.com/...full

low T Testosterone overweight obese bariatric surgery men male hormone hormones free testosterone

shared by Nathan Goodyear on 04 Feb 14 - No Cached
  • Nathan Goodyear on 04 Feb 14
     
    Small study of 13 men found that weight loss following bariatric surgery resulted in improved HPA function in 10/13.  Three men had resistant HPA dysfunction.  Free Testosterone was followed.
Nathan Goodyear

Gut bacteria may decrease weight loss from bariatric surgery -- ScienceDaily - 0 views

www.sciencedaily.com/...150306102604.htm

microbiome gut flora gut microbiota metabolism weight loss bariatric surgery obesity

shared by Nathan Goodyear on 31 Mar 15 - No Cached
  • Nathan Goodyear on 31 Mar 15
     
    Article not yet available.  Just maybe, the but and the population of the micro biome in the gut should be the place to start, along with nutrition and exercise, instead of bariatric surgery.  Functional medicine has been pushing the micro biome impact on metabolism for years. I gladly welcome traditional medicine to the forefront of learning.
Nathan Goodyear

JAMA Network | JAMA: The Journal of the American Medical Association | Early Mortality ... - 0 views

jama.jamanetwork.com/article.aspx

overweight obesity death rates bariatric surgery weight-loss mortality

shared by Nathan Goodyear on 02 Nov 12 - No Cached
  • Nathan Goodyear on 02 Nov 12
     
    death rate in medicare population higher that previously reported post-bariatric surgery.  Those 65 and higher had higher mortality rates compared to younger individuals.
Nathan Goodyear

Healthcare Utilization and Outcomes After Bariatric Surgery : Medical Care - 0 views

journals.lww.com/...tion_and_Outcomes_After.2.aspx

weight loss obesity surgery lap-band gastric bypass sleeve

shared by Nathan Goodyear on 11 May 11 - No Cached
  • ntrast to current bariatric studies, which report a 20% in-hospital complication rate, we find a significantly higher complication rate over the 6 months after surgery, resulting in costly readmissions and emergency room visits
  • Nathan Goodyear on 11 May 11
     
    complication rates for weight loss surgery start at 20% and go up from there.
Nathan Goodyear

Perinatal outcomes after bariatric surgery: nationwide population based matched cohort ... - 0 views

www.bmj.com/bmj.f6460

bariatric surgery weight loss obesity pre-term delivery SGA small for gestational age pregnancy

shared by Nathan Goodyear on 18 Nov 13 - No Cached
  • Nathan Goodyear on 18 Nov 13
     
    Weight loss surgery associated with increased rate of pre-term delivery and SGA.
Nathan Goodyear

Bone Loss in Adolescents After Bariatric Surgery -- , 10.1542/peds.2010-0785d -- Pediat... - 0 views

pediatrics.aappublications.org/...peds.2010-0785dv1

weight loss surgery obesity bone

shared by Nathan Goodyear on 15 Apr 11 - No Cached
  • Nathan Goodyear on 15 Apr 11
     
    Weight loss surgery in teens results in bone loss; long-term implications is very poor
Nathan Goodyear

Human gut microbiota in obesity and after gastric bypass - 0 views

dl-web.dropbox.com/...PNAS-2009-Zhang-0812600106.pdf

obesity weight loss inflammation metabolic endotoxemia bariatric surgery gastric bypass probiotics firmicutes gut flora microbiota

shared by Nathan Goodyear on 26 Jan 12 - No Cached
  • Nathan Goodyear on 26 Jan 12
     
    It is proposed that the balance of bacteria in the gut play a critical role in energy utilization and obesity. This study showed that bypass surgery altered the gut bacteria to favor weight loss: decrease in firmicutes species. But, do we really need gastric bypass to do that? Of course not. Probiotics will do the same.
Nathan Goodyear

JAMA Network | JAMA Surgery | Long-term Metabolic Effects of Laparoscopic Sleeve Gastre... - 0 views

archsurg.jamanetwork.com/article.aspx

obesity overweight bariatric surgery weight loss surgery

shared by Nathan Goodyear on 11 Aug 15 - No Cached
  • Nathan Goodyear on 11 Aug 15
     
    This study reveals what is wrong with a lot of the "standard practice" and literature in medicine today.  At 5 years, almost 50% of weight loss with gastric sleeve is regained--defined as excess weight loss (only 50% weight loss of excess weight).  That is a terrible 5 year outcome; not to mention the definition of success.  Even at 3 years, 31% had regained their "excess weight".  Add to that, the numbers of patients that followed up was terrible.  This poor follow up points to worse data outcomes than this study claims.
Nathan Goodyear

Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures, ... - 0 views

jama.ama-assn.org/...1903.short

weight loss surgeries complications obesity gastric bypass lap-band

shared by Nathan Goodyear on 11 May 11 - No Cached
  • Patients aged 65 years or older had a substantially higher risk of death within the early postoperative period than younger patients.
  • Nathan Goodyear on 11 May 11
     
    Age has direct impact on postoperative complication rate in weight loss surgeries
Nathan Goodyear

Testosterone levels improve in obese men following a common weight-loss operation: Slee... - 0 views

www.sciencedaily.com/...151005151204.htm

low Testosterone low T Testosterone men hormones bariatric surgery

shared by Nathan Goodyear on 11 Nov 15 - No Cached
  • Nathan Goodyear on 11 Nov 15
     
    The ignorance of this authors statements is unmeasurable.  Numerous other studies have shown weight loss in men with obesity is associated with increased Testosterone production.  My book highlights the mechanism by which adipose tissue decreased Testosterone production.  The author was quoted as pointed to no Testosterone replacement (even if levels are low????) despite the evidence that Testosterone will improve glucose metabolism, build muscle (reverse sarcopenia obesity), improve cholesterol metabolism,  and significantly aid Diabetes control just to name a few; yet the author says, give surgery instead.  I am sure the author is a surgeon and thus bias might, just might, be present.
Nathan Goodyear

Obesity Surgery, Volume 14, Number 2 - SpringerLink - 0 views

www.springerlink.com/...825740k3r2735308

Vitamin B B vitamins vitamin gastric bypass neuropathy peripheral neuropathy Bariatric surgery obesity

shared by Nathan Goodyear on 26 Jun 12 - No Cached
  • Nathan Goodyear on 26 Jun 12
     
    B vitamin deficiency following gastric bypass resulting in neuropathy.
Nathan Goodyear

Lowered testosterone in male obesity: Mechanisms, morbidity and management Tang Fui MN,... - 0 views

www.ajandrology.com/article.asp

Testosterone male obesity overweight men hormone hormones low T Low T

shared by Nathan Goodyear on 15 Jan 14 - No Cached
  • The number of overweight people is expected to increase from 937 million in 2005 to 1.35 billion in 2030
  • Similarly the number of obese people is projected to increase from 396 million in 2005 to 573 million in 2030
  • By 2030, China alone is predicted to have more overweight men and women than the traditional market economies combined
  • ...37 more annotations...
  • diacylglycerol O-acyltransferase 2 (DGAT2), mechanistically implicated in this differential storage, [10] is regulated by dihydrotestosterone, [11] suggesting a potential role for androgens to influence the genetic predisposition to either the MHO or MONW phenotype.
  • bariatric surgery achieves 10%-30% long-term weight loss in controlled studies
  • The fact that obese men have lower testosterone compared to lean men has been recognized for more than 30 years
  • Reductions in testosterone levels correlate with the severity of obesity and men
  • epidemiological data suggest that the single most powerful predictor of low testosterone is obesity, and that obesity is a major contributor of the age-associated decline in testosterone levels.
  • healthy ageing by itself is uncommonly associated with marked reductions in testosterone levels
  • obesity blunts this LH rise, obesity leads to hypothalamic-pituitary suppression irrespective of age which cannot be compensated for by physiological mechanisms
  • Reductions in total testosterone levels are largely a consequence of reductions in sex hormone binding globulin (SHBG) due to obesity-associated hyperinsulinemia
  • although controversial, measurement of free testosterone levels may provide a more accurate assessment of androgen status than the (usually preferred) measurement of total testosterone in situations where SHBG levels are outside the reference range
  • SHBG increases with age
  • marked obesity however is associated with an unequivocal reduction of free testosterone levels, where LH and follicle stimulating hormone (FSH) levels are usually low or inappropriately normal, suggesting that the dominant suppression occurs at the hypothalamic-pituitary level
  • adipose tissue, especially when in the inflamed, insulin-resistant state, expresses aromatase which converts testosterone to estradiol (E 2 ). Adipose E 2 in turn may feedback negatively to decrease pituitary gonadotropin secretion
  • diabetic obesity is associated with decreases in circulatory E 2
  • In addition to E 2 , increased visceral fat also releases increased amounts of pro-inflammatory cytokines, insulin and leptin; all of which may inhibit the activity of the HPT axis at multiple levels
  • In the prospective Massachusetts Male Aging Study (MMAS), moving from a non-obese to an obese state resulted in a decline of testosterone levels
  • weight loss, whether by diet or surgery, increases testosterone levels proportional to the amount of weight lost
  • fat is androgen-responsive
  • low testosterone may augment the effects of a hypercaloric diet
  • In human male ex vivo adipose tissue, testosterone decreased adipocyte differentiation by 50%.
  • Testosterone enhances catecholamine-induced lipolysis in vitro and reduces lipoprotein lipase activity and triglyceride uptake in human abdominal adipose tissue in vivo
  • in men with prostate cancer receiving 12 months of androgen deprivation therapy, fat mass increased by 3.4 kg and abdominal VAT by 22%, with the majority of these changes established within 6 months
  • severe sex steroid deficiency can increase fat mass rapidly
  • bidirectional relationship between testosterone and obesity
  • increasing body fat suppresses the HPT axis by multiple mechanisms [30] via increased secretion of pro-inflammatory cytokines, insulin resistance and diabetes; [19],[44] while on the other hand low testosterone promotes further accumulation of total and visceral fat mass, thereby exacerbating the gonadotropin inhibition
  • androgens may play a more significant role in VAT than SAT
  • men undergoing androgen depletion for prostate cancer show more marked increases in visceral compared to subcutaneous fat following treatment
    • Nathan Goodyear
      Nathan Goodyear on 16 Jan 14
       
      Interesting: low T increases VAT, yet T therapy does not reduce VAT, yet T therapy reduces SAT.
  • irisin, derived from muscle, induces brown fat-like properties in rodent white fat
  • androgens can act via the PPARg-pathway [37] which is implicated in the differentiation of precursor fat cells to the energy-consuming phenotype
  • low testosterone may compound the effect of increasing fat mass by making it more difficult for obese men to lose weight via exercise
  • pro-inflammatory cytokines released by adipose tissue may contribute to loss of muscle mass and function, leading to inactivity and further weight gain in a vicious cycle
  • Sarcopenic obesity, a phenotype recapitulated in men receiving ADT for prostate cancer, [55] may not only be associated with functional limitations, but also aggravate the metabolic risks of obesity;
  • observational evidence associating higher endogenous testosterone with reduced loss of muscle mass and crude measures of muscle function in men losing weight
  • genuine reactivation of the HPT axis in obese men requires more substantial weight-loss
  • A number of intervention studies have confirmed that both diet- and surgically-induced weight losses are associated with increased testosterone, with the rise in testosterone generally proportional to the amount of weight lost
  • men, regardless of obesity level, can benefit from the effect of weight loss.
  • inconsistent effect of testosterone on VAT
  • Nathan Goodyear on 15 Jan 14
     
    to be read
Nathan Goodyear

Testosterone level in men with type 2 diabetes mellitus and related metabolic... - 0 views

www.ncbi.nlm.nih.gov/...PMC4364844

low T low Testosterone Diabetes Testosterone men male hormones metabolic syndrome

shared by Nathan Goodyear on 30 Mar 15 - No Cached
  • defined by consistent symptoms and signs of androgen deficiency, and an unequivocally low serum testosterone level
  • the threshold serum testosterone level below which adverse clinical outcomes occur in the general population is not known
  • most population-based studies use the serum testosterone level corresponding to the lower limit, quoted from 8.7 to 12.7 nmol/L, of the normal range for young Caucasian men as the threshold
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      this equals 251 to 366 in serum Total Testosterone
  • ...57 more annotations...
  • Researchers tried to examine whether serum total or free testosterone would be a better/more reliable choice when studying the effect of testosterone. The results were mixed. Some reported significant associations of both serum total and free testosterone level with clinical parameters25, whereas others reported that only serum free testosterone26 or only serum total testosterone6 showed significant associations.
  • −0.124 nmol/L/year in serum total testosterone
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      this equates to a 4 ng/dl decline annually in total Testosterone.
  • In experimental studies, androgen receptor knockout mice developed significant insulin resistance rapidly
  • In mouse models, testosterone promoted differentiation of pluripotent stem cells to the myogenic lineage
  • testosterone decreased insulin resistance by enhancing catecholamine induced lipolysis in vitro, and reducing lipoprotein lipase activity and triglyceride uptake in human abdominal tissue in vivo
  • by promoting lipolysis and myogenesis, testosterone might lead to improved insulin resistance
  • testosterone regulated skeletal muscle genes involved in glucose metabolism that led to decreased systemic insulin resistance
  • In the liver, hepatic androgen receptor signaling inhibited development of insulin resistance in mice
  • independent and inverse association of testosterone with hepatic steatosis shown in a cross-sectional study carried out in humans
  • In short, androgen improves insulin resistance by changing body composition and reducing body fat.
  • Although a low serum testosterone level could contribute to the development of obesity and type 2 diabetes through changes in body composition, obesity might also alter the metabolism of testosterone
  • In obese men, the peripheral conversion from testosterone to estrogen could attenuate the amplitude of luteinizing hormone pulses and centrally inhibit testosterone production
  • leptin, an adipokine, has been shown to be inversely correlated with serum testosterone level in men
  • Leydig cells expressed leptin receptors and leptin has been shown to inhibit testosterone secretion, suggesting a role of obesity and leptin in the pathogenesis of low testosterone
    • Nathan Goodyear
      Nathan Goodyear on 31 Mar 15
       
      So what is "unequivocal"?
  • Baltimore Longitudinal Study of Aging (BLSA) cohort made up of 3,565 middle-class, mostly Caucasian men from the USA, the incidence of low serum total testosterone increased from approximately 20% of men aged over 60 years, 30% over 70 years, to 50% over 80 years-of-age
  • 30–44% sex hormone binding globulin (SHBG)-bound testosterone and 54–68% albumin-bound testosterone
  • As the binding of testosterone to albumin is non-specific and therefore not tight, the sum of free and albumin-bound testosterone is named bioavailable testosterone, which reflects the hormone available at the cellular level
  • Serum total testosterone is composed of 0.5–3.0% of free testosterone unbound to plasma proteins
  • alterations in SHBG concentration might affect total serum testosterone level without altering free or bioavailable testosterone
  • listed in Table​T
  • A significant, independent and longitudinal effect of age on testosterone has been observed with an average change of −0.124 nmol/L/year in serum total testosterone28. The same trend has been shown in Europe and Australia
  • Asian men residing in HK and Japan, but not those living in the USA, had 20% higher serum total testosterone than in Caucasians living in the USA, as shown in a large multinational observational prospective cohort of the Osteoporotic Fractures in Men Study
  • subjects with chronic diseases consistently had a 10–15% lower level compared with age-matched healthy subjects
  • In Caucasians, the mean serum total testosterone level for men in large epidemiological studies has been reported to range from 15.1 to 16.6 nmol/L
  • Asians, higher values, ranging from 18.1 to 19.1 nmol/L, were seen in Korea and Japan
  • Chinese middle-aged men reported a similar mean serum testosterone level of 17.1 nmol/L in 179 men who had a family history of type 2 diabetes and 17.8 nmol/L in 128 men who had no family history of type 2 diabetes
  • The reduction of total testosterone was 0.4% per year in both groups
  • HK involving a cohort of 1,489 community-dwelling men with a mean age of 72 years, a mean serum total testosterone of 19.0 nmol/L was reported
  • pro-inflammatory factors, such as tumor necrosis factor-α in the testes, could locally inhibit testosterone biosynthesis in Leydig cells47, and testosterone treatment in men was shown to reduce the level of tumor necrosis factor-α
  • In Asians, a genetic deletion polymorphism of uridine diphosphate-glucuronosyltransferase UGT2B17 was associated with reduced androgen glucuronidation. This resulted in higher level of active androgen in Asians as compared to Caucasians, as Caucasians' androgen would be glucuronidated into inactive forms faster.
  • Compared with Caucasians, the frequency of this deletion polymorphism of UGT2B17 was 22-fold higher in Asian subjects
  • Other researchers have suggested that environmental, but not genetic, factors influenced serum total testosterone
  • The basal and ligand-induced activity of the AR is inversely associated with the length of the CAG repeat chain
  • In the European Male Aging Study, increased estrogen/androgen ratio in association with longer AR CAG repeat was observed
  • a smaller number of AR CAG repeat had been shown to be associated with benign prostate hypertrophy and faster prostate growth during testosterone treatment
  • In India, men with CAG ≤19 had increased risk of prostate cancer
  • the odds of having a short CAG repeat (≤17) were substantially higher in patients with lymph node-positive prostate cancer than in those with lymph node-negative disease or in the general population
  • assessing the polymorphism at the AR level could be a potential tool towards individualized assessment and treatment of hypogonadism.
  • In elderly men, there was reduced testicular response to gonadotropins with suppressed and altered pulsatility of the hypothalamic pulse generator
  • a significant, independent and longitudinal effect of age on serum total testosterone level had been observed
  • A significant graded inverse association between serum testosterone level and insulin levels independent of age has also been reported in Caucasian men
  • Low testosterone is commonly associated with a high prevalence of MES
  • most studies showed that changes in serum testosterone level led to changes in body composition, insulin resistance and the presence of MES, the reverse might also be possible
  • MES predicted a 2.6-fold increased risk of development of low serum testosterone level independent of age, smoking and other potential confounders
  • Other prospective studies have shown that development of MES accelerated the age-related decline in serum testosterone level
  • In men with type 2 diabetes, changes in serum testosterone level over time correlated inversely with changes in insulin resistance
  • weight loss by either diet control or bariatric surgery led to a substantial increase in total testosterone, especially in morbidly obese men, and the rise in serum testosterone level was proportional to the amount of weight lost
  • To date, published clinical trials are small, of short duration and often used pharmacological, not physiological, doses of testosterone
  • In the population-based Osteoporotic Fractures in Men Study cohort from Sweden, men in the highest quartile of serum testosterone level had the lowest risk of cardiovascular events compared with men in the other three quartiles (hazard ratio [HR] 0.70
  • low serum total testosterone was associated with a significant fourfold higher risk of cardiovascular events when comparing men from the lowest testosterone tertile with those in the highest tertile
  • Shores et al. were the first to report that low serum testosterone level, including both serum total and free testosterone, was associated with increased mortality
  • low serum total testosterone predicted increased risk of cardiovascular mortality with a HR of 1.38
  • low serum total testosterone increased all-cause (HR 1.35, 95% CI 1.13–1.62, P < 0.001) and cardiovascular mortality (HR 1.25
  • European Association for the Study of Diabetes 2013 suggested there was an inverse relationship between serum testosterone level and acute myocardial infarction
  • Diabetic men in the highest quartile of serum total testosterone had a significantly reduced risk of acute MI when compared with those in the lower quartiles
  • serum total testosterone level in the middle two quartiles at baseline predicted reduced incidence of death compared with having the highest and lowest levels
  • Nathan Goodyear on 30 Mar 15
     
    Nice review of Testosterone levels and some of the evidence linking Diabetes with low T.  However, the conclusion by the authors regarding what is causing the low T in men with Diabetes is baffling.  The literature does not point to one cause, it is clearly multifactorial--obesity, inflammation, high aromatase activity...I would suggest the authors continue their readings in the manner.
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