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Bariatric Journal

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You can listen different topics and current scientific studies about healthy weight, obesity, weightloss treatments and bariatric surgery in this podcast. drmuratustun.substack.com

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aflevering Can We Reverse Diabetes from the Duodenum? artwork

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]

12 mei 2025 - 12 min
aflevering Breaking New Ground: Understanding Gastric Fundus Mucosal Ablation (GFMA) artwork

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]

11 mei 2025 - 18 min
aflevering Scientific Blind Alleys: Dietary Fat, Sugar, Freud, and Adler artwork

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]

26 apr 2025 - 18 min
aflevering Post-Bariatric Reflux: Diagnosis and Management artwork

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]

21 jan 2025 - 32 min
aflevering Sleep Deprivation and Metabolic Imbalances artwork

Sleep Deprivation and Metabolic Imbalances

Sleep deprivation significantly impacts health, causing insulin resistance and metabolic dysfunction. Research reveals that insufficient sleep disrupts glucose metabolism, leading to pre-diabetic states and increased calorie consumption. Studies on animals and humans show physical damage within the brain, including cellular debris, even after recovery sleep. The complex interplay of these effects makes finding effective therapies besides sleep itself a considerable challenge. Sleep deprivation Millions of people who suffer sleep problems also suffer myriad health burdens. In addition to emotional distress and cognitive impairments, these can include high blood pressure, obesity, and metabolic syndrome. ‘In the studies we’ve done, almost every variable we measured was affected. There’s not a system in the body that’s not affected by sleep,’ says University of Chicago sleep researcher Eve Van Cauter. ‘Every time we sleep-deprive ourselves, things go wrong.’ A common refrain among sleep scientists about two decades ago was that sleep was performed by the brain in the interest of the brain. That wasn’t a fully elaborated theory, but it wasn’t wrong. Numerous recent studies have hinted at the purpose of sleep by confirming that neurological function and cognition are messed up during sleep loss, with the patient’s reaction time, mood, and judgement all suffering if they are kept awake too long. In 1997, Bob McCarley and colleagues at Harvard Medical School found that when they kept cats awake by playing with them, a compound known as adenosine increased in the basal forebrain as the sleepy felines stayed up longer, and slowly returned to normal levels when they were later allowed to sleep. McCarley’s team also found that administering adenosine to the basal forebrain acted as a sedative, putting animals to sleep. It should come as no surprise then that caffeine, which blocks adenosine’s receptor, keeps us awake. Teaming up with Basheer and others, McCarley later discovered that, as adenosine levels rise during sleep deprivation, so do concentrations of adenosine receptors, magnifying the molecule’s sleep-inducing effect. ‘The brain has cleverly designed a two-stage defence against the consequences of sleep loss,’ McCarley says. Adenosine may underlie some of the cognitive deficits that result from sleep loss. McCarley and colleagues found that infusing adenosine into rats’ basal forebrain impaired their performance on an attention test, similar to that seen in sleep-deprived humans. But adenosine levels are by no means the be-all and end-all of sleep deprivation’s effects on the brain or the body. Over a century of sleep research has revealed numerous undesirable outcomes from staying awake too long. In 1999, Van Cauter and colleagues had eleven men sleep in the university lab. For three nights, they spent eight hours in bed, then for six nights they were allowed only four hours (accruing what Van Cauter calls a sleep debt), and then for six nights they could sleep for up to twelve hours (sleep recovery). During sleep debt and recovery, researchers gave the participants a glucose tolerance test and found striking differences. While sleep deprived, the men’s glucose metabolism resembled a pre-diabetic state. ‘We knew it would be affected,’ says Van Cauter. ‘The big surprise was the effect being much greater than we thought.’ Subsequent studies also found insulin resistance increased during bouts of sleep restriction, and in 2012, Van Cauter’s team observed impairments in insulin signalling in subjects’ fat cells. Another recent study showed that sleep-restricted people will add 300 calories to their daily diet. Echoing Van Cauter’s results, Basheer has found evidence that enforced lack of sleep sends the brain into a catabolic, or energy-consuming, state. This is because itdegrades the energy molecule adenosine triphosphate (ATP) to produce adenosine monophosphate and this results in the activation of AMP kinase, an enzyme that boosts fatty acid synthesis and glucose utilization. ‘The system sends a message that there’s a need for more energy,’ Basheer says. Whether this is indeed the mechanism underlying late-night binge-eating is still speculative. Within the brain, scientists have glimpsed signs of physical damage from sleep loss, and the time-line for recovery, if any occurs, is unknown. Chiara Cirelli’s team at the Madison School of Medicine in the USA found structural changes in the cortical neurons of mice when the animals are kept awake for long periods. Specifically, Cirelli and colleagues saw signs of mitochondrial activation – which makes sense, as ‘neurons need more energy to stay awake,’ she says – as well as unexpected changes, such as undigested cellular debris, signs of cellular aging that are unusual in the neurons of young, healthy mice. ‘The number [of debris granules] was small, but it’s worrisome because it’s only four to five days’ of sleep deprivation,’ says Cirelli. After thirty-six hours of sleep recovery, a period during which she expected normalcy to resume, those changes remained. Further insights could be drawn from the study of shift workers and insomniacs, who serve as natural experiments on how the human body reacts to losing out on such a basic life need for chronic periods. But with so much of our physiology affected, an effective therapy − other than sleep itself – is hard to imagine. ‘People like to define a clear pathway of action for health conditions,’ says Van Cauter. ‘With sleep deprivation, everything you measure is affected and interacts synergistically to produce the effect.’ 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 dec 2024 - 16 min
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