Bariatric Surgery: Impacting High Blood Pressure Through More Than Weight Loss

According to the Centers for Disease Control, about one in three U.S. adults has high blood pressure (hypertension). Risks include family history, advancing age, poor diet, consuming excessive amounts of alcohol, and being overweight or obese.

Lifestyle changes are a big part of controlling high blood pressure. The main tenets include:

  • Following a healthy diet, which may include reducing salt. The DASH (Dietary Approaches to Stop Hypertension) diet is often recommended. In addition to lowering salt intake, DASH is replete with fruits, vegetables, and low-fat or nonfat dairy. The diet emphasizes whole grains and is rich in potassium, magnesium, calcium and fiber.
  • Exercising regularly.
  • Maintaining a healthy weight.
  • Keeping stress levels at bay. (Stress can cause us to engage in unhealthy blood pressure-raising behaviors.)
  • Drinking only moderate amounts of alcohol.
  • Taking your medications as prescribed.

There are many types of prescription medications that can help control blood pressure and reduce the risk of heart attack or stroke. These medications may need to be taken for life to maintain their effect.

New research is showing, however, that bariatric surgery can allow obese people taking a lot of antihypertensive medications to cut way back on them. Study subjects’ blood pressure was maintained in the normal range with only one agent or even without drugs.

Within a year, those in a recent trial who had bariatric surgery were more than six times as likely to have cut back on their number of blood pressure (BP) medications by hypertension-867855__340about a third. Half of the surgical patients didn’t need any antihypertensive meds to maintain their BP at healthy levels. On the other hand, all of the “standard-care” patients in the study needed antihypertensive medications to keep BP that low, and half of them needed at least three different ones.

Interestingly, most patients in the gastric-bypass group achieved the primary end point in the first month of the postop period. That seems to indicate that something more is happening beyond just weight loss.

That something is likely to be related, at least in part, to the metabolic changes in the surgery group compared with the control group, which included significant improvements in fasting plasma glucose, HbA1c, LDL cholesterol, triglycerides, and high-sensitivity C-reactive protein in addition to the lowering of blood pressure.

If you live in the Las Vegas area and are wondering if bariatric surgery might be right for you, schedule an appointment at VIP Surg. Dr. Tsuda and his team can help find the right treatment for your unique situation.

 

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DASH Your High Blood Pressure Away

DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet is a lifelong approach to healthy eating that’s designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium, and magnesium.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just asparagus-2169305_960_720lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke, and diabetes.

The DASH diet emphasizes vegetables, fruits, and low-fat dairy foods — and moderate amounts of whole grains, fish, poultry, and nuts.

Here’s a look at the recommended servings from each food group for the 2,000-calorie-a-day DASH diet:

  • Grains: 6 to 8 servings a day — Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole-wheat bread, 1-ounce dry cereal, or 1/2 cup cooked cereal, rice or pasta.
  • Vegetables: 4 to 5 servings a day — Vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Examples of one serving include 1 cup raw leafy green vegetables or 1/2 cup cut-up raw or cooked vegetables.
  • Fruits: 4 to 5 servings a day — Like vegetables, fruits are packed with fiber, potassium and magnesium and are typically low in fat.
  • Dairy: 2 to 3 servings a day — Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure that you choose dairy products that are low fat or fat-free because otherwise they can be a major source of fat — and most of it is saturated. Examples of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, or 1 1/2 ounces part-skim cheese.
  • Lean meat, poultry and fish: 6 servings or fewer a day — Meat can be a rich source of protein, B vitamins, iron and zinc. Choose lean varieties and aim for no more than 6 ounces a day.
  • Nuts, seeds and legumes: 4 to 5 servings a week — Almonds, sunflower seeds, kidney beans, peas, lentils and other foods in this family are good sources of magnesium, potassium and protein. They’re also full of fiber and phytochemicals, which are plant compounds that may protect against some cancers and cardiovascular disease. Serving sizes are small and are intended to be consumed only a few times a week because these foods are high in calories. Examples of one serving include 1/3 cup nuts, 2 tablespoons seeds, or 1/2 cup cooked beans or peas.
  • Fats and oils: 2 to 3 servings a day — Fat helps your body absorb essential vitamins and helps your body’s immune system. But too much fat increases your risk of heart disease, diabetes and obesity. Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2 tablespoons salad dressing.
  • Sweets: 5 servings or fewer a week — You don’t have to banish sweets entirely while following the DASH diet — just go easy on them. Examples of one serving include 1 tablespoon sugar, jelly or jam, 1/2 cup sorbet, or 1 cup lemonade.

While the DASH diet is not a weight-loss program, you may indeed lose unwanted pounds because it can help guide you toward healthier food choices.

Remember, healthy eating isn’t an all-or-nothing proposition. What’s most important is that, on average, you eat healthier foods with plenty of variety — both to keep your diet nutritious and to avoid boredom or extremes. With the DASH diet, you can have both.

If you live in the Las Vegas area and are dealing with health issues that come with obesity, contact VIP Surg. Dr. Tsuda and his team can help you find the treatment that works best for you. Call 702-487-6000 today for an appointment.

 

Gallbladder Disease and Gallstones

Some people think of their gallbladder as being “expendable”. Not that anybody wants any of their organs to be removed, but since many people live a seemingly normal life after getting their gallbladder removed, many people don’t think their gallbladder plays an important role in their overall health. After all, how important can your gallbladder be if you can do just fine after it’s surgically removed? The gallbladder actually plays a very important role in your body. It is an essential part of the digestive system.

Your gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile ducts. That is usually a gallstone. Gallstones form when substances in bile harden. Rarely, you can also get cancer in your gallbladder. Many gallbladder problems get better with removal of the gallbladder. Fortunately, you can live without a gallbladder. Bile has other ways of reaching your small intestine.

In the United States, about a million new cases of gallstone disease are diagnosed each year, and some 800,000 operations are performed to treat gallstones, making it the most common gastrointestinal disorder requiring hospitalization.

Gallstone disease is the most common disorder affecting the body’s biliary system, the network of organs and ducts that create, transport, store, and release bile. Bile contains cholesterol, water, proteins, bilirubin (a breakdown product from blood cells), bile salts (the chemicals necessary to digest fat), and small amounts of copper or other materials. If the chemical balance of bile contains too much of any of these components, particularly of cholesterol, crystals form and can harden into stones.

In terms of size, gallstones can be as small as a grain of sand or as large as a golf ball. A person can form one large stone in his or her gallbladder, or hundreds! About 10 percent of the population has gallstones, but the vast majority experiences no symptoms and need no treatment. However, in 1 percent to 2 percent of these people, gallstones can cause problems by lodging in bile ducts, stopping the flow of bile or digestive enzymes, and leading to severe abdominal pain, vomiting, inflammation, and even life-threatening infection.

Gallstone attack has some classic symptoms: The most agonizing pain is experienced in the upper right part of the abdomen under the ribs. Usually it appears suddenly, sometimes an hour or two after eating a fatty meal. The pain may get worse quickly, and then last for several hours. Many times, the pain may radiate to the back between the shoulder blades or under the right shoulder. Inhaling deeply, or moving, often makes the pain worse. The primary therapy for gallstones that are causing pain, inflammation, or infection is removal of the gallbladder.

A number of factors put people at higher risk of gallstones:

  • Gender: Women between the ages of 20 and 60 are 3 times more likely to develop gallstones than are men in the same age group. By age 60, 20 percent of American women have gallstones.
  • Age: The incidence of gallstone disease increases with age.Tsuda 11-18
  • Genetics: Family history and ethnicity are critical risk factors in development of gallstones, though no gene responsible for gallstone formation has yet been discovered. African-Americans seem to have lower rates of gallstone disease than American Indians, whites, or Hispanics.
  • Obesity: Obesity is a significant risk factor, particularly for women. Obesity also slows down the emptying of the gallbladder.
  • Location of body fat: Belly fat, that spare tire around the middle, dramatically increases the chance of developing stones.
  • Diabetes: People with diabetes often have high levels of triglycerides in their blood, and these fatty acids tend to increase the risk of gallstones.

Even if you’re not at risk for gallstones, it is wise to maintain a healthy body weight, by among other things, sticking to a diet that is low in fat and cholesterol and high in fiber.

If you are in the Las Vegas area and suffering with gallstones or gallbladder disease, schedule a consultation at VIP Surg.

Metabolic Syndrome: The New Silent Killer

For decades, American waistlines have been expanding, and there is increasing cause for alarm. Experts are saying metabolic syndrome is the new “silent killer,” like hypertension in the 1970s. As it turns out, the “love handle” can be fatal.

What is Metabolic Syndrome?

Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Metabolic syndrome is a cluster of metabolic disorders. When a patient presents with these conditions together, the chances for future cardiovascular disease is greater than any one factor presenting alone.

What are Metabolic Risk Factors?

Risk factors are traits, conditions, or habits that increase one’s chance of developing a disease. The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

  • A large waistline. This also is called abdominal obesity or “having an apple shape.” Screen Shot 2017-10-24 at 11.41.55 AMExcess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
  • A high triglyceride level (or you’re on medicine to treat high triglycerides).
  • A low HDL cholesterol level (or you’re on medicine to treat low HDL cholesterol).
  • High blood pressure (or you’re on medicine to treat high blood pressure).
  • High fasting blood sugar (or you’re on medicine to treat high blood sugar).

Your risk for heart disease, diabetes, and stroke increases with the number of metabolic risk factors you have. The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical activity.

Insulin resistance also may increase your risk for metabolic syndrome. Genetics (ethnicity and family history) and older age are other factors that may play a role in causing metabolic syndrome.

Can Metabolic Syndrome be Treated?

Metabolic syndrome is becoming more common due to a rise in obesity rates among adults, but it is possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. A healthy lifestyle is a lifelong commitment. Successfully controlling metabolic syndrome requires long-term effort and teamwork with your health care providers.

When changes in lifestyle alone do not control the conditions related to metabolic syndrome, your health practitioner may prescribe medications to control blood pressure, cholesterol, and other symptoms. Carefully following your practitioner’s instructions can help prevent many of the long-term effects of metabolic syndrome. Every step counts, and your hard work and attention to these areas will make a difference in your health.

If you live in the Las Vegas area and are looking for answers to obesity and metabolic syndrome problems, schedule a consultation with VIP Surg. Dr. Tsuda and Dr. Ryan and their team of experts can help find the right treatment for you.
 

Overcoming Genetics with Bariatric Surgery

Many of us have struggled with our weight. Whether it’s those 30 pounds of baby weight that have stubbornly hung around long after the baby was born or the 50 pounds gained after a back injury, weight gain is for many a constant struggle and a sensitive subject.

However, inactivity and poor diet are not the only causes of obesity. Research estimates that genetics determines at least 40 to 50 percent of our weight. Unfortunately, the specific genes are not well understood.

How can one overcome genetics? If everyone in your family is heavy, isn’t it a foregone conclusion that you will be heavy also? Not necessarily. Fortunately, we can level the genetics playing field with weight-loss surgery.

The most popular weight loss procedure in the United States is the laparoscopic sleeve gastrectomy. The surgery is minimally invasive, takes about an hour and requires an overnight stay in the hospital for most patients. The stomach, which regularly can hold about the volume of a football, is stapled and divided so that it is the shape and size of a banana.

Weight loss is achieved because the patient can no longer eat a large volume of food, and calories are proportionately decreased. The pylorus, the muscular valve at the outlet of the stomach, is left intact in this surgery. This also helps patients who have this procedure stay full.

Besides the effects of the procedure on restricting food volume, there is increasing evidence that the mechanisms in the brain that cause hunger are permanently modified by the sleeve gastrectomy. People state that they no longer feel hungry and no longer crave some of the high-calorie foods they used to.

Weight-loss surgery is a powerful tool in the hands of the patient, but it is not an “easyfix.” Sleeve gastrectomy requires commitment to healthy food choices and exercise on the part of the patient. The exciting news is that those struggling with obesity are not doomed to a life of aches and pains, poor health, and a miserable quality of life. There is help, and there is hope.

If you are in the Las Vegas area and are considering bariatric surgery, schedule an appointment with VIP Surg. Dr. Tsuda, Dr. Ryan, and their expert team can help find the right treatment for you.

Overweight Woman is Overjoyed

 

Robotic Surgery Explained

Screen Shot 2017-10-10 at 12.35.38 PMRobotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. Utilizing this advanced technology, surgeons are able to perform a growing number of complex surgical procedures. Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including:

  • Less trauma on the body
  • Minimal scarring
  • Faster recovery times

If you’re facing general or bariatric surgery in the Las Vegas area, contact VIP SURG to learn about how we can help. Drs. Tsuda and Ryan specialize in minimally invasive procedures and are experts in robotic surgery. Call for a consultation at 702-487-6000.

Is Obesity a Disease?

Whether or not obesity should be considered a disease is a matter of debate. In 2013, the American Medical Association, the nation’s largest group of physicians, voted to recognize obesity as a disease. The decision was controversial to say the least.

The decision was meant to improve access to weight loss treatment, reduce the stigma of obesity, and underscore the fact that obesity is not always a matter of self-control. Others argue that calling obesity a disease automatically categorizes a large portion of Americans as “sick,” when they may not be. Instead, critics say obesity should be considered a risk factor for many diseases, but not a disease in and of itself.

Experts on one side of the issue say obesity, like alcoholism, depression, and anxiety, is a disease. There are definite medical patterns: hormone imbalances, neurotransmitter deficiencies, and nutritional exhaustion that all contribute to obesity. Many patients that are obese have underlying medical issues that need to be addressed.

On the other hand, with more than one third of the American population presently classified as obese, it is clear that there are many causes for excessive fat accumulation like genetic issues, too little exercise/physical activity, too much food, inappropriate food selection, eating while watching television, etc. In many cases, obesity is the result of a specific lifestyle which can typically be reversed (at least in the short term) by adopting a different lifestyle.

Obesity increases the risk of developing a number of serious health conditions, including:

  • Coronary heart disease
  • High blood pressure
  • Stroke
  • Type 2 diabetes
  • Cancer
  • Sleep apnea
  • Gallstones
  • Osteoarthritis
  • Infertility or irregular periods

The Center for Disease Control (CDC) says people should aim to make long-term changes, such as eating healthy on a regular basis, and boosting daily physical activity. Even small amounts of weight loss — such as 5% to 10% of your total body weight – can have health benefits.

For some, obesity as a disease invalidates the importance of discipline, proper nutrition, and exercise and enables individuals with obesity to escape responsibility. For others, obesity as a disease is a bridge to additional research, coordination of effective treatment, and increased resources for weight loss.

Ultimately, obesity is a complex entity that can have many causes; some are endocrine (like thyroid malfunction or hyperfunctioning of the adrenal gland or Cushing’s syndrome), but often the condition is from a combination of inactivity and overeating. For others, there are genetic factors that produce a tendency to be overweight even with the consumption of what would be for most people an appropriate number of calories. Whether the causes are hormonal, genetic, or reside in the brain is often difficult to determine.

If you’re in the Las Vegas area and looking for treatment for obesity and the life-threatening conditions that often accompany it, schedule an appointment with VIP Surg. Our experts can help you find the right treatment for your unique situation.