Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Intestinal sleeve for obesity placed by upper GI scope endoscopy

UGI scope or upper endoscopy and then eat whatever you want without checking calories. No need for weight loss surgery or drugs for weight control. No more overweight, obesity, and the diabetes gets cured! Too good to be true? Perhaps not....

The answer may be the Endobarrierunal bypass sleeve or endoscopic duodenal-jejunal bypass sleeve (DJBS) . DJBS is placed in the small intestine during endoscopy. It is designed to mimic  intestinal bypass effects of Roux-en-y gastric bypass without the need for any surgery stapling etc. and is designed to produce weight loss in morbidly obese. The technical feasibility has been tested in pigs.

It has actually been placed in a woman with BMI of 45. The Endobarrierunal bypass sleeve device was placed while the obese subject was under anesthesia. After 3 months, the device was removed by endoscopy again. The obese patient's weight loss was a total of 9 k over this period. Remember, this weight loss occurred over this short period and even a modest weight loss in overweight patients can have substantial health benefits

Sure seems easy treatment of obesity using this device. If this works out, this may be an easy treatment for this curse of obesity and its ssociated diseases like diabetes, heart disease etc.

What do you think about this treatment? Would you want to get this device even if you slightly overweight? please share your thoughts.

Fructose sweetener, appetite and obesity

Use of fructose as artificial sweetener has been subject of media reports recently. Some have advised against using fructose because of potential for increased appetite and weight gain. However, multiple studies using fructose in humans have failed to support effect of fructose and the association may be weak at best.

Fructose and glycemic index: Dr. Bantle in a recent review article, “Is fructose the optimal low glycemic index sweetener?” suggests that , there is not yet any convincing evidence that dietary fructose does increase energy intake.

Fructose and food intake and satiety: Soenen and colleagues from Netherlands found no differences in satiety or energy intake after high-fructose corn syrup, sucrose, or milk preloads.

Glucose fructose ratio and food intake, satiety: Similarly, Akhavan and Anderson from Canada studied the effects of glucose-to-fructose ratios in solutions on subjective satiety, food intake, and satiety hormones in young men. They found that sucrose, high fructose corn syrup, and G50:F50 (50:50 solution of glucose and fructose) solutions do not differ significantly in their short-term effects on subjective and physiologic measures of satiety, uric acid and food intake at a subsequent meal.

Bottomline about fructose: As always, moderation is the key. Just because there is paucity of evidence to support deleterious effects of fructose, does not mean that you should load up on fructose in your diet. Naturally occurring fructose in your daily consumption of fruits and vegetables should not be a problem.

Do you use sugar or artificial sweeteners? Do you have any prefered kind? Please share your thoughts about fructose and artificial sweeteners.

Do bacteria cause obesity?

Let us start the year 2007 on a cheerful note. There is an old saying, all sickness begins in gut. Obesity is no exception. And it is not just related to imbalance between ingestion of excess food and calorie expenditure. And of course obesity cuts down your life span also.

Now that you may have packed some extra-pounds during the holidays, you may be feeling guilty since taking them off is usually not that easy. Worry not! If you can't take them off, it may not be entirely your fault. Even viral infections have been implicated. According to two articles reported in the prestigious journal Nature (October 2006), the gut bacteria may be playing an important role.

Obesity alters the ecology of the trillions of bacteria present in the gut. Dr. Turnbaugh and colleagues from Washington University in St. Louis, Missouri studied the intestinal bacteria of lean and obese mice as well as humans.

There is an alteration in relative dominance of two types of bacteria (Bacteroidetes and the Firmicutes) in the gut of obese persons. For example, the relative proportion of Bacteroidetes is decreased in obese people as compared to their lean counterparts. This relative proportion increases with weight loss on low-calorie diet.

This altered bacterial flora results in the alteration of bacterial metabolism. For example, bacterial flora in obese facilitates extraction of greater amount of energy from the diet. Data also showed that it might not be a static phenomenon. For example, the transfer of the "obese" bacterial flora to the lean animals results in induction of obesity in the lean ones!

Above findings in no way diminish the fact that obesity is directly related to the net balance between in amount of calories ingested and the calories consumed by the body as energy expenditure. It just means that the pathogenesis of obesity has a bacterial component.

Do you have a weight problem? Do you have difficulty taking off excess body weight? Have you been on yo-yo diet? Your thoughts are welcome.

Drink water to lose weight

We have always been told that water, the liquid that sustains life, is good for overall health and well being. No matter what kind of health-advice book you read including obesity, "plenty of water" is always one of the important suggestions given for improving your health. However, there has been a paucity of data to back up such very plausible and intuitive claims.

It is indeed gratifying when such a study on "plenty of water" comes along proving that such traditional claims are not empty. And the current study tackles no small issue, but the huge problem of obesity affecting the world, no pun intended.

NAASO, The Obesity Society, is the largest conference in North America focuses on the cutting edge issues related to obesity research and treatment. A study presented at the annual Scientific in Boston (October 2006) showed how drinking water instead of beverages with sugar could help people lose weight.

Researchers studied 240 overweight women who were on one of the several diet plans restricting carbohydrate consumption.

They found that dieters who replaced completely abstained from sugar-laden drinks and consumed water instead lost 5 pounds per year more than the subjects who did not do the switch.

In addition, the subjects who drank more than four cups of water per day lost an additional 2 pounds as compared to those who did not.

One simple explanation is that those drinking water were consuming fewer calories. Intestinal bacteria have been linked to obesity. Perhaps plenty of water gets rid of obesity-related bacteria. However, it is also possible that increased water may alter some hitherto unknown aspects of energy metabolism and improve health.

Do you have an overweight problem? What do you think about this study? Do you drink water more than beverages or vice-versa? Feel free to share your thoughts.

Fermented soy prevents obesity

As the health care costs keep rising on account of the epidemic of obesity, scientists are looking at more and more unconventional strategies to combat the curse of extra weight.

Dr. Manzoni and colleagues from Brazil studied the effect of a soy product fermented by two probiotics (Enterococcus faecium and Lactobacillus jugurti) in rats. The rats were fed a chow diet or Soy diet as above. The results were published in the journal Nutrition (October 2005)

They found that the soy had beneficial effect on fat pads in the body. This was likely due to the fact that the fat cell size was significantly smaller in the rats fed fermented soy diet. In addition, the data showed that the fermentation of probiotic was responsible for enhancing the anti-fat effects of the soy diet on the fat cells.

The authors concluded that this fermeted soy diet might be another option to pursue for obesity prevention.

While this study was done in rats, the results look very promising. The soy products and probiotics have many beneficial effects on health and it would be a coup if these results can be duplicated in humans.

What are your thoughts on soy or probiotics? Do you take soy or any probiotics for any reason? Feel free to share your thoughts.