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.

 

Advertisements

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.
 

Rates of Obesity are on the Rise

The global obesity rate has nearly doubled since 1980, and there are now over 200Screen Shot 2017-09-27 at 11.51.03 AM million obese men and nearly 300 million obese women, according to the Harvard School of Public Health. In the United States, more than one third of adults (or 78.6 million people) are obese, according to the Centers for Disease Control and Prevention (CDC).

Obesity is usually defined by using a ratio of height to weight called body mass index (BMI), which usually correlates with a person’s level of body fat. According to the CDC, an adult with a BMI of 30 or higher is considered obese.

At a fundamental level, obesity occurs when people regularly eat more calories than they burn, but actually a number of factors can contribute to obesity, including:

  • lack of physical activity
  • lack of sleep
  • genetics and certain medications that slow calorie burn, increase appetite, or cause water retention, such as corticosteroids, antidepressants, or some seizure medications

Modern culture, conveniences, and other environmental factors also, in part, contribute to obesity. According to the National Heart, Lung, and Blood Institute, environmental factors that promote obesity include:

  • oversized food portions
  • busy work schedules that don’t allow for physical activity
  • lack of access to healthy foods at supermarkets
  • lack of safe places for physical activity

Because friends share similar environments and carry out activities together that may contribute to weight gain, obesity has also been found to “spread” socially among friends according to a 2011 study published in the American Journal of Public Health.

Certain health conditions also can lead to weight gain, including:

  • Hypothyroidism — an underactive thyroid gland that slows metabolism and causes fatigue and weakness
  • PCOS, or polycystic ovarian syndrome — which affects up to 10 percent of women of childbearing age and can also lead to excess body hair and reproductive problems
  • Cushing’s syndrome — which stems from an overproduction of the hormone cortisol by the adrenal glands and is characterized by weight gain in the upper body, face and neck
  • Prader-Willi syndrome– a rare condition in which people never feel full, and so they want to eat constantly, according to the Mayo Clinic

Although there are lots of fad diets, such short-term dietary changes are not the best way to maintain a healthy weight, the CDC says. Instead, 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 percent of your total body weight – can have health benefits, the CDC says.

For people who are still severely obese after attempting to lose weight through diet and exercise, other treatments, such as bariatric surgery, may be an option. Bariatric surgery is recommended for people with a BMI of 40 or more, or if they have a serious health problem related to their obesity and have a BMI of 35 or more. In many cases, people with a BMI of 30 or more are eligible for one type of bariatric surgery if they also have at least one health problem linked with obesity.

If you’re struggling with obesity and live in the Las Vegas area, schedule an appointment with VIP Surg. Our experts can help find the right treatment for you.

 

Bariatric Surgery Found to Help COPD

According to estimates, 6% of American adults have chronic obstructive pulmonary disease (COPD), and 35% of those COPD patients are considered obese. In addition to being common among COPD patients, studies have also suggested that obesity leads to a higher risk of acute exacerbations, indicating that obesity may be a risk factor. Now a U.S. study suggests that obese people with COPD who get weight loss surgery may go to the hospital less often with acute breathing problems after their operations. The study found that among obese adults with COPD, those who had bariatric surgery to lose weight, needed to go to the emergency room or have inpatient care half as often as before surgery.

The researchers examined data on 481 obese adults aged 40 to 65 who had COPD and underwent bariatric surgery in California, Florida and Nebraska. They followed patients from 2005 through 2011 to see how hospital and emergency room visits for COPD in the two years before weight loss surgery compared to the two years afterwards.

At the start of the study, when patients were 13 to 24 months away from getting their operations, 28 percent of them had an emergency department (ED) or hospital visit for acute COPD symptoms, researchers report in Chest. During the second year of the study, the 12 months right before surgery, these rates didn’t change much, but compared with that first year of the study, the chances of an ED or hospital visit dropped by 65 percentin the first year after bariatric surgery. Just 12 percent of patients had a COPD visit during that time. During the last year of the study, 13 to 24 months after surgery, the odds of an ED or hospital visit were 61 percent lower than in the first year of the study. These findings suggest that benefits of bariatric surgery may extend beyond remission of chronic health problems associated with obesity to include COPD and other respiratory conditions.

If you are considering bariatric surgery in the Las Vegas area, schedule a consultation at VIP SURG. Our expert team can help you find the right treatment for your unique situation.

COPD Chronic obstructive pulmonary disease health medical concept

Most Common Surgical Treatments for Clinically Severe Obesity

The obesity epidemic continues to grow in our country, and with obesity comes a whole host of additional health risks, like type 2 diabetes, heart disease, high blood pressure, osteoarthritis and stroke. Those looking to reduce these obesity-related health risks are turning to bariatric or medical weight-loss surgeries like gastric bypass.

With weight-loss surgery, your surgeon makes changes to your stomach or small intestine, or both. The procedure resolves diabetes 80 percent of the time, and patients lose an average of 70 percent of extra weight. However, gastric bypass isn’t the only choice. Learn about your options:

Laparoscopic Adjustable Gastric Band – The surgeon puts a small band around the top of your stomach. The band has a small balloon inside it that controls how tight or loose the band is. The band limits how much food can go into your stomach. This surgery is done using a laparoscope. Advantages include:

  • Minimally invasive with small incisions
  • Short hospital stay
  • Adjustable without additional surgery
  • Can support pregnancy
  • Removable at any time

Laparoscopic Gastric Sleeve – This surgery removes most of the stomach and leaves only a narrow section of the upper part of the stomach, called a gastric sleeve. The surgery may also curb the hunger hormone ghrelin, so you eat less. Advantages include:

  • No cutting, bypassing, or stapling of the intestine
  • Little concern about vitamin and calcium absorption
  • No adjustments or artificial devices put into place
  • Most foods are possible

Laparoscopic Roux-en-Y Gastric Bypass Surgery – The surgeon leaves only a very small part of the stomach (called the pouch). That pouch can’t hold a lot of food, so you eat less. The food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine. This surgery can often be done through several small incisions using a camera to see inside (laparoscope). Doctors can also perform a mini-gastric bypass, which is a similar procedure also done through a laparoscope. Advantages include:

  • Tiny incisions, resulting is less scarring and easier healing
  • Excellent cosmetic result
  • Little pain
  • Few wound complications
  • Fast recovery
  • Short hospital stay
  • Resuming physical activity soon
  • Little risk of hernia formation

Duodenal Switch- This is complicated surgery that removes most of the stomach and uses a gastric sleeve to bypass most of your small intestine. It limits how much you can eat. It also means your body doesn’t get as much of a chance to absorb nutrients from your food, which could mean you don’t get enough of the vitamins and minerals you need. Advantages include:

  • Results in greater weight loss than other methods, i.e. 60 – 70% percent excess weight loss or greater, at 5 year follow up
  • Allows patients to eventually eat near normal meals
  • Reduces the absorption of fat by 70 percent or more
  • Causes favorable changes in gut hormones to reduce appetite and improve satiety
  • Is the most effective against diabetes compared to other methods

If you’re considering bariatric surgery, schedule an appointment with Dr. Shawn Tsuda. He can help you decide which, if any, of these treatments is right for your unique situation.Fat man running

 

Gastric Bypass for a Longer Life

According to research by the Geisinger Health System, one of the largest health service organizations in the U.S., patients with severe obesity who have gastric bypass surgery reduce their risk of dying from obesity and other diseases by 48% up to 10 years after surgery, compared to similar patients who do not undergo the procedure. This is significant considering that the American Society for Metabolic and Bariatric Surgery estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40.

Researchers from the Geisinger Health System followed nearly 2,700 patients who had gastric bypass at the system’s nationally accredited bariatric surgery center between 2004 and 2014. Mortality benefits began to emerge within two years after surgery and were significant within four years. The biggest reduction in risk occurred in patients 60 years or older at the time of surgery and in patients who had diabetes before surgery.

“The long-term survival benefits these older patients and those with diabetes experience likely relate to improvements in long-term metabolic and cardiovascular health, among other risk factors,” said Michelle R. Lent, Ph.D., a Geisinger Obesity Institute researcher. “While this study did not evaluate specific-cause mortality, as expected, we did find significant improvements or remission in diabetes and high blood pressure.”

In the study, more than 60 percent of patients with diabetes before surgery experienced diabetes remission about five years after surgery. Previous studies have shown death from heart disease and even certain cancers are lower in gastric bypass patients than patients with severe obesity who do not have the operation.

People with obesity and severe obesity have higher rates of heart disease, diabetes, some cancers, arthritis, sleep apnea, high blood pressure and dozens of other diseases and conditions. Studies have shown individuals with a BMI greater than 30 have a 50 to 100 percent greater risk of premature death compared to healthy weight individuals.Live Longer

If you live in the Las Vegas area and are interested in learning what bariatric surgery can do for you, schedule an appointment with Dr. Shawn Tsuda. He and his team of experts can help you choose the best treatment for your unique situation.

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.