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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

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

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

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

Plasma Ghrelin Levels after Diet-Induced Weight Loss or Gastric Bypass Surgery - NEJM - 0 views

www.nejm.org/...NEJMoa012908

diet weight loss overweight weight-loss surgery ghrelin bypass

shared by Nathan Goodyear on 26 Oct 11 - No Cached
  • Nathan Goodyear on 26 Oct 11
     
    "diets" and weight-loss surgery effect ghrelin diferently
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

Impact of gastric bypass operation on survival: A population-based analysis - 0 views

www.journalacs.org/...abstract

gastric bypass impact weight loss obesity

shared by Nathan Goodyear on 11 May 11 - No Cached
  • Thirty-day mortality after gastric bypass is higher than previously reported and closely linked to surgeon inexperience
  • Nathan Goodyear on 11 May 11
     
    Understand: surgery is surgery.  The death rate from weight loss surgeries is higher than reported as this large study shows.  Another thought: what are the long-term health implications.  I can tell you from the clients that I see, it is not good
Nathan Goodyear

Testosterone and glucose metabolism in men: current concepts and controversies - 0 views

joe.endocrinology-journals.org/...R37.full

shared by Nathan Goodyear on 04 Feb 14 - No Cached
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      80% of E2 production in men, that will cause low T in men, comes from SQ adiposity.  This leads to increase in visceral adiposity.
  • Only 5% of men with type 2 diabetes have elevated LH levels (Dhindsa et al. 2004, 2011). This is consistent with recent findings that the inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion
  • ...32 more annotations...
  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • Consistent with the hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • Figure 4
  • Interestingly, a recent 16-week study of experimentally induced hypogonadism in healthy men with graded testosterone add-back either with or without concomitant aromatase inhibitor treatment has in fact suggested that low oestradiol (but not low testosterone) may be responsible for the hypogonadism-associated increase in total body and intra-abdominal fat mass
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      This does not fit with the research on receptors, specifically estrogen receptors.  These studies that the authors are referencing are looking at "circulating" levels, not tissue levels.
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • This is supported by observational studies showing that weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • Several observational and randomised studies reviewed in Grossmann (2011) have shown that weight loss, whether by diet or surgery, leads to substantial increases in testosterone, especially in morbidly obese men
  • This suggests that weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in those men in whom glycaemic control worsened, testosterone decreased
  • successful weight loss combined with optimisation of glycaemic control may be sufficient to normalise circulating testosterone levels in the majority of such men
  • weight loss, optimisation of diabetic control and assiduous care of comorbidities should remain the first-line approach.
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      This obviously goes against marketing-based medicine
  • In part, the discrepant results may be due to the fact men in the Vigen cohort (Vigen et al. 2013) had a higher burden of comorbidities. Given that one (Basaria et al. 2010), but not all (Srinivas-Shankar et al. 2010), RCTs in men with a similarly high burden of comorbidities reported an increase in cardiovascular events in men randomised to testosterone treatment (see section on Testosterone therapy: potential risks below) (Basaria et al. 2010), testosterone should be used with caution in frail men with multiple comorbidities
  • The retrospective, non-randomised and non-blinded design of these studies (Shores et al. 2012, Muraleedharan et al. 2013, Vigen et al. 2013) leaves open the possibility for residual confounding and multiple other sources of bias. These have been elegantly summarised by Wu (2012).
  • Effects of testosterone therapy on body composition were metabolically favourable with modest decreases in fat mass and increases in lean body mass
  • This suggests that testosterone has limited effects on glucose metabolism in relatively healthy men with only mildly reduced testosterone.
  • it is conceivable that testosterone treatment may have more significant effects on glucose metabolism in uncontrolled diabetes, akin to what has generally been shown for conventional anti-diabetic medications.
  • the evidence from controlled studies show that testosterone therapy consistently reduces fat mass and increases lean body mass, but inconsistently decreases insulin resistance.
  • Interestingly, testosterone therapy does not consistently improve glucose metabolism despite a reduction in fat mass and an increase in lean mass
  • the majority of RCTs (recently reviewed in Ng Tang Fui et al. (2013a)) showed that testosterone therapy does not reduce visceral fat
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      visceral and abdominal adiposity are biologically different and thus the risks associated with the two are different.
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      yet low T is associated with an increase in visceral adiposity--confusing!
  • testosterone therapy decreases SHBG
  • testosterone is inversely associated with total cholesterol, LDL cholesterol and triglyceride (Tg) levels, but positively associated with HDL cholesterol levels, even if adjusted for confounders
  • Although observational studies show a consistent association of low testosterone with adverse lipid profiles, whether testosterone therapy exerts beneficial effects on lipid profiles is less clear
  • Whereas testosterone-induced decreases in total cholesterol, LDL cholesterol and Lpa are expected to reduce cardiovascular risk, testosterone also decreases the levels of the cardio-protective HDL cholesterol. Therefore, the net effect of testosterone therapy on cardiovascular risk remains uncertain.
  • data have not shown evidence that testosterone causes prostate cancer, or that it makes subclinical prostate cancer grow
  • compared with otherwise healthy young men with organic androgen deficiency, there may be increased risks in older, obese men because of comorbidities and of decreased testosterone clearance
  • recent evidence that fat accumulation may be oestradiol-, rather than testosterone-dependent
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

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

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

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

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

TBioMed | Full text | Arterial hypertension due to fructose ingestion: model based on i... - 0 views

www.tbiomed.com/27

fructose HCFS hypertension HTN. gastric bypass lap-band weight-loss surgery

shared by Nathan Goodyear on 25 Oct 11 - No Cached
  • Nathan Goodyear on 25 Oct 11
     
    fructose (HCFS) leads to increase in blood pressure.  Similar problem is also seen in post-gastric surgery for weight loss.
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

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.
wheelchairindia9

Cp Child Wheelchair - 0 views

www.wheelchairindia.com/...CP-Wheelchair

Wheelchair Offers New Vistas For Persons With Cerebral Palsy cerebellum and the cortex common causes of brain damage cause like chicken pox or measles neurological problems are properly managed

shared by wheelchairindia9 on 05 May 15 - No Cached
  • wheelchairindia9 on 05 May 15
     
    young children have a different set of needs than adults. Aesthetically, devices designed for kids are often sleek and colorful, and functionally, they are typically lightweight and adjustable. As any parent knows, young people don't stay the same size for long and since a wheelchair is a major purchase -- don't want a simple growth spurt to render it useless. Wheelchair category offers models that feature seat width and depth adjustability, elevating legrests, and other versatile features. As a weight-bearing activity is critical to proper physical and mental function-which is why children with cerebral palsy, who may sit for stretches in a wheelchair and typically are unable to stand on their own, can benefit greatly from pediatric standers as part of a comprehensive pediatric rehabilitation program. Pediatric standers are offered in passive, active and mobile formats: Passive standers stay in one place and feature a support surface, active standers allow reciprocal movement of the extremities while in a standing position, and mobile standers enable users to self-propel. Cerebral Palsy Wheelchair: Cerebral Palsy Wheelchair Description: The model designed for cerebral palsy child only. Ultra light weight aluminium alloy frame. Seat Width 38 cms (15"). Net Weight: 18.5 kgs. Epoxy powder coated frame. Detachable arm rest & foot rest provided. Elevated and swinging foot rest. Elevated foot rest provided to elevate leg angle. Height adjustable and detachable head rest. Hydraulic reclining high back for a comfortable posture. Hydraulic adjustable seat angle. Detachable back and seat pad. Extra cushion upholstery provided to under arm, head & calg Foldable. Lever and paddle brakes provided. Safety belt provided. Maintenance free rear solid wheels. Cloth look like water proof upholstery. Anti wheels for better safety and stability. Extra cushion upholstery provided to under arm, head & leg. Folding action. Lever and paddle brakes provide
Nathan Goodyear

Obesity - Abstract of article: Loss of Total and Visceral Adipose Tissue Mass Predicts ... - 0 views

www.nature.com/...oby2008542a.html

oxidative stress glutathione inflammation obesity weight loss overweight

shared by Nathan Goodyear on 02 Nov 11 - No Cached
  • Nathan Goodyear on 02 Nov 11
     
    obesity is known to increase inflammation. Now obesity, adipose tissue, is shown to increase oxidative stress and reduce glutathione levels.  The loss of glutathione is implicated the development of many chronic disease states.  
wheelchairindia9

Chair For Cerebral Palsy Child - 0 views

www.wheelchairindia.com/...Cerebral-Palsy-Wheelchair

cerebellum and the cortex common causes of brain damage cause like chicken pox or measles neurological problems are properly managed

shared by wheelchairindia9 on 12 May 15 - No Cached
  • wheelchairindia9 on 12 May 15
     
    Cerebral palsy (CP) is a group of conditions caused by medical abnormalities in the development of a fetus or the early life of a child. These lead to damage or delayed development in the brain. The disorder is permanent and, though it does not worsen with age, the level of functionality of a person with cerebral palsy varies widely: in some cases, effects may be very minor, while in others, movement is impaired to the extent that a wheelchair is required. Common complications associated with CP vary by the type of CP disorder but can include vision problems, seizures, learning disabilities, and issues speaking, writing, and performing other tasks. Cerebral palsy causes problems with muscle tone, movement, balance and/or coordination. Symptoms and effects range from mild to severe. In some infants, problems are evident soon after birth. In others, diagnosis comes in later infancy or toddlerhood. Cerebral Palsy Wheelchair Description: The model designed for cerebral palsy child only. Ultra light weight aluminium alloy frame. Seat Width 38 cms (15"). Net Weight: 18.5 kgs. Epoxy powder coated frame. Detachable arm rest & foot rest provided. Elevated and swinging foot rest. Elevated foot rest provided to elevate leg angle. Height adjustable and detachable head rest. Hydraulic reclining high back for a comfortable posture. Hydraulic adjustable seat angle. Detachable back and seat pad. Extra cushion upholstery provided to under arm, head & calg Foldable. Lever and paddle brakes provided. Safety belt provided. Maintenance free rear solid wheels. Cloth look like water proof upholstery. Anti wheels for better safety and stability. Extra cushion upholstery provided to under arm, head & leg Folding action. Lever and paddle brakes provided. Safety belt provided. Maintenance free rear solid wheels. Cerebral Palsy Wheelchair Recline system: Recline system provides kids with the most comfortable resting environment. It also allows stretching abdomin
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