Purium by Nature

Purium is just one of the latest fads in a long line of fad diets.  Originally, the company was named Organic by Nature when it was founded in 1993.  The mainstay of the program is a ten day transformation diet.  A Naturopath is employed by the company, and its products are distributed by a myriad of individuals who are compensated for their efforts.  In other words, it is a multilevel marketing company.

Naturopathy proposes that the body can heal itself if given the right tools and environment.  People who believe in naturopathy are convinced that this premise is true.  I partly believe in this hypothesis if you are dealing with conditions like allergies.  Remove the allergic source, and you will feel better and heal.  With the exception of specific instances like this, I’m not so sure that the philosophy applies to all medical/physical conditions.

The ten day transformation diet promises weight loss of 5 to 10 pounds.  The sign up cost at present is $290 which is a bit on the expensive side.  The ten day transformation program is unproven which is unsettling since you’re paying a premium for this diet.  During these ten days, your metabolism is supposed to be “reset”.  If Purium has found the secret to reset metabolism, I would be very impressed.  As far as I know, your metabolism is already set, and you can shock your system into losing weight but the shock is only temporary.  Once you go off the diet, your metabolism reverts to what it was, and so does your weight.  There aren’t any clinical studies to show that Purium’s program resets your metabolism.

Purium has over one hundred products.  It’s big business.  Members who sign up to distribute Purium get $50 dollar gift cards (at no charge to the member) which they give out to prospective clients.  Once the client redeems the gift card for a ten day transformation program, the member gets $50.  But it doesn’t end there.  The member gets more compensation if the client decides to also become a member.  This sounds like a pyramid scheme.

The side effects that can be expected with this program include the usual side effects associated with any caloric restriction diet.  These include nausea, emesis, diarrhea and irritability along with headaches.  I spoke with one member who finished the ten day program, and he informed me that he couldn’t go to the gym while he was on the program since he felt extremely weak.  Feeling weak and fatigued is a common occurrence in any caloric restriction program.  Purium will advise you not to exercise more than fifteen minutes a day, but given the fatigue, even fifteen minutes a day may be too much. As I have said in the past, anyone can lose weight if you limit your calories.  But this is only a temporary occurrence since the body will recognize its new starvation state, and will then start to hold on to calories.

Purium will tell you that you are losing fat, and not muscle.  Anyone familiar with caloric restriction diets knows that this claim is questionable.

The company has a D- rating with the Better Business Bureau.  I think this is one of those instances where the caveat “buyer beware” definitely applies.

If you are thinking of starting this diet, consult your physician before doing so.  If you decide to follow this diet, please let me know how it worked out for you.

Eating wisely and exercising still remain the best options in my opinion.  Wishing you success with your weight loss and maintenance.  Pablo.

The Story of Belly Fat

We have all seen those huge bellies that some people have.  And perhaps we are one of those people.  Some of the abdominal fullness is due to subcutaneous fat (fat underneath the skin), but some of the protuberance is due to belly or visceral fat (fat that accumulates in the mesentery and inside the abdominal cavity).  There are several reasons for the occurrence of a generous abdomen.

As we age, men and women will have a tendency to deposit visceral fat.  Part of the problem is hormonal.  With women, their estrogen and progesterone levels start to decline and then disappear with menopause.  Menopause for a woman in the United States is age 50 plus or minus two years.  There are exceptions, however, like premature menopause.  Hormone replacement with estrogen and progesterone is something that may help with the belly fat.  You have the option of using a commercially available preparation like premarin and provera or you can use bioidentical hormones.  You can talk to your provider about which modality to use.  If you don’t have a uterus, you can use estrogen alone.  If you have a uterus, you should use both estrogen and progestin to avoid overstimulation of the endometrial tissue which could lead to endometrial cancer.  If you have had breast cancer, you should be cautious about using hormones especially if the tumor tissue was positive for estrogen receptors.  Be aware that hormonal replacement may have negative effects on your lipid profile, and you could be more at risk for deep vein blood clots among other conditions.

With a man, his testosterone level starts to decline after age 30-35.  Testosterone supplementation in men, however, is not as medically accepted as hormonal replacement in women.  There are not really set guidelines for testosterone replacement.  Ideally, there should be a low testosterone level on blood work, but even though some men have signs of “andropause” like fatigue, loss of libido, and declining mental acuity, a low testosterone blood level is not always found.  I believe that there is a lack of correlation between the symptoms of andropause and actual lab value confirmation just like there can be a lack of correlation in women between the symptoms of menopause (perimenopause) and actual lab confirmation of high follicular stimulating hormone (FSH) which can signal failed ovarian function.  It can take a few years for the lab correlation to catch up to the declining hormone levels in the blood work.  There are physicians who will provide testosterone replacement.  You just to look for them, as many mainstream physicians do not believe in andropause.

One of the issues with testosterone replacement that is mentioned for not providing testosterone supplementation is a possible increased risk of prostate cancer.  There is also the possibility of developing deep venous thrombosis (blood clots in the deep veins of the legs), alopecia (hair loss on the head), acne, and steroid rage among others.  What I found when I was in practice, however, was that administering 0.8cc of 200mg/ml testosterone cypionate IM (intramuscular) every two weeks helped the patient feel better without any of the above side effects.  I do recommend being followed closely by a physician if you decide to pursue this course of action.  Your provider may elect to run lab work on you every few months looking at your PSA (prostate specific antigen) to make sure that your prostate is in good health, and checking your liver enzymes among others.

Another medical condition that can influence belly fat is polycystic ovaries (PCO).  In this condition, there are a myriad of immature cysts on the ovaries that can help increase body weight and hirsutism (excessive facial and body hair growth).  Your provider can obtain lab work to check for this entity.  This condition requires medical treatment for improvement.

Since we’re talking about hormones, let us not forget cortisol.  Cortisol is secreted by your adrenal glands and causes you to hold on to fat.  Cortisol is often increased in stressful states which are increasingly common in our modern life.  Try to lower stress by meditating, and exercising.  The exercise will help to calm you down, and get rid of the nervous energy.

Studies have shown that sleeping five or less hours a night can cause an increase in belly fat as well.  The general recommended sleep time is seven to eight hours a night.  Try to get enough sleep every night.  Performing an aerobic exercise like walking or jogging for thirty minutes daily has been shown in clinical studies to help you get a good night’s sleep and to help stave off depression.

Diet can be a big factor in belly fat.  Avoid processed foods which are full of additives and unhealthy fats.  Foods like white bread, and those with refined white sugar are deadly for this condition.  If you are a big soda drinker, stop.  Drink water instead.

Exercise is one of the keys to losing belly fat and overall body fat.  Remember that the best exercise is a combination of weight bearing exercises (weights) and aerobic exercise (jogging, walking, spin class).  If you are already performing this exercise regimen and are not seeing results, you may consider increasing the intensity of the work outs.  You may be taking it too easy on yourself.  Situps can help your core, but may not necessarily help your belly fat.  Remember to include exercises to work out your oblique muscles and lower back along with your pelvis. Planks are a great exercise for your core along with your chest, arms, and legs.

Belly fat is more than physically unattractive.  An increased abdominal girth can be associated with type II diabetes mellitus, heart disease, and some cancers.

I hope you found the above suggestions helpful.  Wishing you continued success with your weight loss and maintenance.  Pablo.


Weight Loss With Liposuction

Liposuction is more of a body sculpting procedure than a weight loss procedure, but it can be used for weight loss to some extent.  You will definitely lose weight by having fat removed from your body, and you will also have a higher muscle to fat ratio at the end of the procedure which will help you lose weight since muscle burns more calories than fat.  Over the past few years, there have been several different forms of liposuction,  but the longest standing liposuction procedure has used tumescent solution.

With the traditional tumescent solution liposuction procedure, the provider will introduce the tumescent solution into the area(s) that is (are) to be suctioned.  The tumescent solution consists of xylocaine (a local anesthetic), epinephrine (which constricts vessels to reduce bleeding), and sodium bicarbonate mixed in normal saline.  The provider will inject a small amount of xylocaine in the skin overlying the area he intends to suction, and will then make a small stab incision in the skin.  This will allow him to place a long, fine, blunt needle into the fat underlying the skin.  The provider will allow the tumescent solution to mix with the fat for a few minutes, and then introduce a cannula to suction the fat.  The cannulas come in different sizes and have different tips on the ends.  The provider will use the cannula suited to your body and to your expected results.  The procedure can be done under conscious sedation so general anesthesia can be avoided.

A variation on the traditional liposuction procedure is the ultrasound assisted liposuction which can be used to liquefy the fat.  The fat is then suctioned with a cannula.  Laser assisted liposuction can also be used which again liquefies the fat and prepares the fat for liposuction.

Of the above procedures, the traditional liposuction using tumescent solution is the least expensive, and has excellent results.  The stab incisions are left open at the end of the liposuction procedure so that the tumescent solution mixed with fat will continue to drain over the next few days.  Your provider may suggest using large plastic garbage bags or plastic sheets to cover your bed or car seat in order to avoid getting the drainage on these items.

There will be some bruising associated with the procedure.  This is an important point to note if you are having liposuction in the neck area as you may not want to immediately appear in public.  Bruising in other areas like the abdomen, back, legs, and arms can be covered with clothing.  Your provider will place you in a compression garment at the end of the procedure so that the skin will reattach itself to the underlying tissue.  You might consider having an extra compression garment so that you can wear one while washing the other.  Incidentally, hydrogen peroxide works quite well in removing blood stains.

LIposuction will immediately change your body contour, but the final results will not be visible for a few weeks.  It takes several weeks for the inflammation associated with the procedure to dissipate.

As with all surgical procedures, discuss the risks and benefits of liposuction carefully with your provider.  The traditional risks of hemorrhage, infection, injury to another organ system, and death apply although the risks are small with this procedure.  Still, I have heard of deaths occurring from liposuction due to bleeding.  In one case, a major vessel was penetrated.  Major vessels should not be affected with liposuction because liposuction is a relatively superficial procedure, but there is a slim possibility.  I have also heard of the intestines being perforated due to the cannula entering the abdomen.  Again, this should not happen.  There is also the risk of the skin overlying the liposuction area to slough off due to extensive interruption of the blood supply.  Again, this risk is rare.

Exercise and sensible eating are still the cornerstones for weight loss.  But liposuction may be convenient for those areas where the fat simply refuses to go away.

Wishing you continued success with your weight loss and maintenance, Pablo

New Game Changing Weight Loss Patch

Something very exciting is on the horizon.  Let me emphasize that this new weight loss patch is still in the experimental stages, and it’s unclear when it will be available for commercial use.  But if the hype is true, then this patch is well worth waiting for.  It will revolutionize the way that we lose fat, and it will provide an exciting glimpse into the future for other products that will serve the same purpose.

The weight loss patch changes white fat into brown fat.  Brown fat turns food into body heat as opposed to having the white fat turn more prolific after ingesting excess calories.  In nature, only babies and bears have brown fat.  And we have all seen how fast the “baby fat” goes away after the baby is born.  This patch will cause the transformed brown fat to burn off as quickly as the the baby fat.  The only way to eliminate fat quickly at the moment is to have a surgical procedure known as liposuction or to have a noninvasive procedure known as cold sculpting.  Liposuction and cold sculpting, however, are not weight loss procedures but are used, rather, to shape the body.  If the patch lives up to its promise, it could very well replace liposuction and give cold sculpture a run for their money.

Not only will the new skin patch help eliminate fat, but it also has the potential to help with various metabolic conditions like diabetes and obesity.  The patch is being developed by researchers at Columbia University in New York and at the University of North Carolina in Chapel Hill.

The patch has microneedles that administer the medication rosiglitazone which browns the fat.  The patch is then placed on the skin over the areas where the fat loss is desired.  Some of you may be turned off by the idea of needles, but the needles are microscopic and the subject doesn’t feel the skin being penetrated.

So far, the patch has only been tested on mice.  The mice had patches placed on both sides of their bodies.  One patch was the weight loss patch, and the other patch was a placebo.  The patches were replaced every three days, and at the end of four weeks, the mice showed a 20% reduction in fat on the side treated with the weight loss patch.  Fasting glucose levels dropped as well which, again, is good news for diabetics.

The patch has not been tested on humans yet, but there is a lot of excitement about this new treatment modality.  We will have to wait for the final verdict, but I am excited about the possibilities for this new treatment.

The patch will not be a replacement for sensible eating and exercising, but it will be a wonderful adjunct.

Wishing you success in your weight loss and maintenance, Pablo.

Is Gluten a fad?

Gluten is a group of proteins that is found in most grains that we eat.  Wheat is the grain most commonly consumed that has gluten.  Gluten is what gives wheat its glue-like consistency when it is mixed with water.  Gluten can cause problems for people who have an allergy to wheat and people who have celiac disease.  For unknown reasons, the number of people with celiac disease has quadrupled since 1950.

Celiac disease is an autoimmune disease where gluten is attacked by the body when it is consumed.  Unfortunately, the gut lining is attacked as well when this happens.  This can cause nutrient deficiencies, and can also cause gastrointestinal (GI) symptoms such as bloating, diarrhea, and constipation.  The GI symptoms, however, are not always present in people with celiac disease.  Interestingly, most people with celiac disease don’t know they have this condition.

There is another group of people who have non-celiac gluten sensitivity.  A clear cut diagnosis of non-celiac gluten sensitivity does not exist, and the diagnosis is made after celiac disease and wheat allergies are eliminated.  The GI symptoms that this group of people have are very similar to those manifested by the celiac disease group.  This diagnosis is controversial, and some experts feel that the condition does not exist.  Furthermore, these experts feel that the symptoms manifested by the patients are due to another reason.

GI discomfort is the most common symptom with celiac disease.  Having trouble gaining weight, and anemia are other presentations for this condition.  You should consult your physician if you think you have this condition.  The diagnosis can be made with a blood test looking for the antibody  tTG-IgA.  If this is positive, then an intestinal biopsy is recommended.  A general surgeon or a gastroenterologist can perform the biopsy.  The other option is to eliminate gluten from the diet, and see what your symptoms do.  If the symptoms go away, then there is a good chance that you have celiac disease or non-celiac gluten sensitivity.  If the symptoms do not go away, then your symptoms are being caused by something else.

Having a gluten free diet can be difficult at first.  Many foods have wheat in them.  Most experts advise avoiding processed foods, and eating whole foods.  Read the labels on cans and containers to make sure that wheat had not been added.  Many foods do not contain gluten.  These foods include meat, eggs, vegetables, nuts, dairy products, and fruits among others.  The list of foods that are gluten free is steadily growing so people who have to avoid gluten have an increasing variety of choices.

There are short chain carbohydrates found in many foods called FODMAPs which can occur naturally or can be used as food additives.  FODMAPs include fructose, lactose, sorbitol, mannitol, FODMAPs can mimic the celiac disease and non-celiac gluten sensitivity conditions.  FODMAPs pull water into the intestine, and cause bloating.  The food then moves to the colon where the FODMAPs produce gas.  It’s likely that some people who think they have celiac disease actually have a problem with FODMAPs.  Finding FODMAP free food, however, is quite difficult.  Foods containing FODMAPs include artichokes, bananas, baked beans, figs, apples, apricots, onions, garlic, and pears to name a few.  There is a complete list of foods with FODMAPs on the internet.

Many experts feel that most people do not have to avoid gluten.  Dr. Peter Gibson from Australia, however, took a group of people with Irritable Bowel Syndrome (IBS) and placed them on a gluten free diet.  He found that the majority of people in the study had most of their symptoms improve with gluten free food.   So there is some controversy about the need of people who have not been diagnosed with celiac disease or non-celiac gluten sensitivy  to avoid gluten.  And remember that eating a gluten free food does not necessarily make it a healthy food.

My best advice, again, is to consult your physician if you feel that you have one of these conditions.

Wishing you success with your weight loss and maintenace, Pablo.

5 2 Diet Side Effects

The 5 2 in this diet refers to the five days where you eat whatever you like, and then you fast for two days.  During the two days of fasting, a woman is allowed to consume 500 calories while a man is allowed to consume 600 calories.  Then you repeat the cycle as many times as you want.  This diet fad has been around since 2012 and originated in the UK.  There aren’t any food restrictions.  You can eat whatever you want.  Obviously, the more sensibly you eat, the better the results.   People on this diet can expect to lose about a pound a week.  There is a report of a man who lost 50 pounds total.  Obviously, this is another calorie restricting diet.

One of the unpleasant effects for the participants is feeling hungry on the two fasting days.  Not surprisingly, participants complain of headache, low energy, and dizziness on the fasting days as well.  To minimize these side effects, proponents of the diet recommend not fasting on two consecutive days.  In addition, they recommend drinking plenty of fluids including water and tea.  Eating wisely during the fasting days is emphasized as well.  For example, you can eat salads without salad dressing or with minimal salad dressing during your fasting days which will make you feel full, but will have minimal calories.  Light exercising is encouraged, but strenuous exercise is discouraged especially on the days of fasting.  Exercise is generally not recommended on a calorie restricting diet due to feeling light headed and dizzy.

Everyone should consult their physician before starting a diet, but this is especially true for people with chronic illnesses like diabetes.

As of this date, there are few studies that have addressed this diet, so long term safety is unknown.  The benefit of this diet is that participants may be able to follow this diet for a long period of time as the fasting is confined to only two days a week.  The benefits that have been found, after following this diet, include a reduction in insulin and improvement in insulin sensitivity.  Other positive benefits include decreased triglycerides (a good thing), increased low density lipoproteins (another good thing), decreased C reactive protein (an indicator of inflammation in the body), and decreased leptin. This was in addition to losing weight as a result of fat loss while sparing muscle mass.

For the most part, dieters using this plan are happy with the results, and feel that the diet is not too stringent.  And, there are the positive side effects as mentioned above.  I should mention that the proponents of the diet recommend weighing once a week as opposed to weighing every day as weight can fluctuate on a daily basis.  Weighing once a week will provide a more accurate assessment of your progress.

The best diet is the diet that the dieter can follow long term and this appears to be such a diet.  I still recommend eating wisely and exercising instead of dieting, but some people prefer to diet.  If you decide to follow this diet, please leave a comment, and let me know how the diet worked for you.

Wishing you continued success in your weight loss and maintenance.  Pablo.


Gastric Sleeve Facts

Gastric sleeve surgery or vertical sleeve gastrectomy has been the fastest growing bariatric (weight loss) procedure in the United States.  This procedure removes 80% of the stomach. Gastric sleeve surgery  produces fast weight loss and has a relatively low complication rate.

Gastric sleeve surgery will diminish hunger in some individuals, but not all.  In addition, the patient will feel full sooner as the stomach is now smaller.  This procedure does not require rerouting of the intestines, and there is no dumping syndrome like there is with other bariatric procedures.  Unlike the lap band, there are not any adjustment procedures.  In addition, the majority of the weight is lost in the first year after the procedure compared to the lap band which takes three years.  Most patients will reach a plateau in weight loss after the first year.  Exercise and appropriate diet, however, can help with continued weight loss.  But the stomach can stretch over time due to over eating.

In contrast, the lap band requires diet and lifestyle changes which the gastric sleeve does not.  This explains why some patients do not lose weight with the lap band.

You will receive a preoperative evaluation prior to your surgery.  This includes a complete blood panel, and a chemistry panel. You will, most likely, also get an EKG, chest X-ray, and possibly a sleep study to check for sleep apnea.  Your provider will place you on a special two week diet prior to the surgery.  It is highly recommended that you stop using tobacco products.  And try to lose as much weight as possible on your own.  The larger patients have a higher surgery complication rate than the smaller patients.

The actual procedure takes about one to two hours.  It is done through the laparoscope which is a long tube with two lens and a light at the end which allows your surgeon to look inside your abdomen.  Anywhere from one to five small incisions will be made on the abdomen.  This leaves a “sleeve” that connects your esophagus to the intestines.  This procedure can be done on anyone from children to senior citizens.

Many of the medical problems associated with obesity are helped with this procedure.  Type II diabetes mellitus, hypertension, sleep apnea, and arthritis are a few of these conditions.

You will remain in the hospital for about two days.  Recovery at home will be about two weeks.  There will be a slow transition from a liquid diet to solid foods.  Slowly start to exercise.  There may be some nausea and abdominal discomfort, but these issues should resolve over time.

Remember that the gastric sleeve surgery is a way to start your weight loss, but proper diet and exercise will be required over time to maintain lasting results.  You will be required to take life long vitamin and mineral supplements.

Keep in mind, however, that there are risks with any surgical procedure.  These include hemorrhage, infection, injury to another organ system and death.  There can also be leaks from the stomach staple line which will require further surgery.  Strictures of the stomach site can also occur.

Long term side effects include gastroesophageal reflux (GERD) or heart burn, gallstone formation, sagging skin, gaining the weight again, vitamin and mineral deficiency, and intolerance to certain foods.

This is a brief overview of gastric sleeve surgery.  Consult your bariatric surgeon for more details.  This surgery is not for everyone and you have to be a certain BMI to qualify for the surgery.

Wishing you success in your weight loss and management.  Pablo.

The Truth About Protein Supplements

Protein is composed of building blocks called amino acids.  Protein supplements supply these amino acids to your body that are then used to feed your muscles.  Whey protein has all nine essential amino acids which makes this a good protein supplement.  In addition, whey protein is the fastest absorbing protein available.  Like everything else, there is the possibility of overdoing the protein supplements.  High doses of protein can cause nausea, bloating, cramps, headaches, and loose bowel movements.  Remember that your body needs vitamins and minerals in addition to the protein.  So be careful when you’re on your protein supplement.  Don’t neglect your vitamins and minerals.  Whey protein is good for building muscle and also as an aid to losing weight.  You have to be careful, however, as excess intake of whey protein will cause you to gain weight in the form of fat.

Whey protein is made during the cheese making process.  When making cheese, certain enzymes are added to milk causing a solid component called curd.  The curd is used in making cheese.  The liquid that is left over from this process has the whey protein.  There is another protein, casein, which also comes from milk.

Sometimes, the whey protein will make people ill.  This could be due to the sugar alcohols which are used to sweeten the supplement.  Sugar alcohols are used to keep the calories low.  Examples are sorbitol and isolated fructose.  So you may want to switch protein supplements if your present supplement is making you sick.

A condition that can make you ill from taking the protein supplements is lactose intolerance.  You can try changing your supplement to whey isolate which does not contain fat or lactose. This could solve the lactose intolerance.   There is a third form of protein known as whey protein hydrolysate which has undergone partial hydrolysis and doesn’t require as much digestion as the two other forms of whey protein.  This may help eliminate stomach discomfort if this is a symptom that you are experiencing.

Amazingly, protein supplements have not been approved or regulated by the US Food and Drug Administration.  Research has shown that protein has positive effects on muscle building, but there is concern within the agency about potential negative side effects.

Soy protein powder has phytoestrogens which are plant based compounds that can mimic the body’s estrogen.  High levels of phytoestrogen could increase the risk of some cancers in men and women.  Specifically, breast cancer in women.  I should point out, however, that the cancer risk is unclear and research is ongoing to determine if this is the case.  For example, a report in Anticancer Research suggests that whey protein may actually help fight some cancers.

A study issued by Consumer Reports in 2010 showed that all the protein powders that were tested showed traces of heavy metals including lead, arsenic, and cadmium.  These metals can produce neurological symptoms, cancer, and death if taken in sufficient quantities.

Protein supplements are used widely especially among body builders.  Like everything else, use the protein supplements in moderation if you are going to use them at all.  Remember that you can get adequate protein from your everyday diet if you eat wisely.

Wishing you continued success with your weight loss and weight maintenance, Pablo.


Sushi Nutrition Facts

Sushi has become one of the most popular foods in our society.  To a large extent, sushi is seen as a healthy food.  Have you asked yourself how healthy sushi really is?  I’ll bet you haven’t because you’re like most people who assume that sushi is healthy because it’s fish and rice along with some vegetables.

A sushi roll has about a cup of white rice which has been mixed with vinegar.  The rice alone is about 240 calories so that it is possible to have a roll with 500 calories by the time you finish preparing it.  Most people will consume more than one roll.  You can see how it would be easy to have a caloric intake of 800-1000 calories in a single meal.  It makes sense to limit your sushi roll intake or to eat the sashimi (fish without the rice).  How healthy the sushi roll is will ultimately depend on the ingredients used, like mayonnaise, and how much of it you eat.  There is also the issue of tempura which is just a fancy way of saying that the sushi roll is fried.  As we know, fried foods are not necessarily the healthiest.   On the bright side, the raw fish contains plenty of protein and omega 3 fatty acids which are good for heart health by lowering cholesterol and blood pressure.

You need a 3500 calorie deficit to lose a pound of weight.  So a sushi roll is not necessarily what you want to eat all the time.  You can, however, eat a vegetable roll which does not have any carbohydrates or sugar, but still has one gram of healthy protein.  You can also opt to eat sushi (a portion of fish with rice) which has fewer calories than the roll.  There are 37 calories in one piece of sushi.  You can check the internet for a more complete list of calories in sushi, sushi roll, and sashimi.

Whether it’s white or brown rice, the rice has quite a bit of sodium in it so that you will have consumed half of your daily intake of sodium by the time you finish your meal.  And this is not taking into account the sodium that is present in the soy sauce.

We have all heard about the potential dangers of getting sick from eating under cooked or raw food.  Raw fish is no exception.  There is a condition known as gnathostomiasis which you can acquire from a protein source like raw fish.  Other potentially contaminated foods are chicken, pigs, snails and frogs.  This condition consists of tiny worms that burrow under the skin and, in rare cases, can get into the eye and brain.  The skin becomes swollen, itchy and painful with the migratory worms.  The worms move about a centimeter an hour.

The good news is that gnathostomiasis is a rare disease.  The bad news is that the condition can be fatal.  The worms can invade any body part besides the skin, eye and brain.  Most causes of death come from invasion of the brain.  The condition can last for as long as 10-12 years.

Treatment consists of surgically removing the worms if they are easily accessible.  Medical treatment consists of using albendazole or ivermectin.  Usually, a combination of surgery and medicine will be used.

Another parasite that can be present in freshwater raw fish is the fish tapeworm, Diphyllobothrium latum.  The tapeworm will attach itself to the small intestine, and create a vitamin B12 deficiency which will lead to a certain type of anemia known as megaloblastic anemia.  An oral medication known as praziquantel is used to treat the condition.  Unlike gnathostomiasis, the one time treatment with prazinquantel is enough to take care of the infestation.

All in all, sushi is a healthy food.  The major drawbacks to the healthy designation revolve around the additives like mayonnaise and the fact that some of the food is fried.  Also, there is the rare issue of parasites.

I eat sushi on a regular basis, and am quite fond of all of it.  I just know that I can’t eat it all the time.  Everything in moderation as the saying goes.

Remember to eat wisely and exercise regularly.  Wishing you continued success with your weight loss and maintenance, Pablo.

Duodenal Switch Side Effects

The duodenal switch is a weight loss procedure which consists of a restrictive and malabsorptive diet.  This is one of the most complicated weight loss surgeries.  The procedure keeps a small part of the small intestine known as the duodenum.  It also leaves a larger portion of the stomach intact including the pyloric valve compared to another procedure known as the biliopancreatic diversion.  About 20,000 people in the United States undergo this procedure annually.

The malabsorptive component of the procedure involves separating the blood flow from the bile and pancreatic juices so that the food and digestive enzymes only interact in the last 18 to 24 inches of the intestine.  It is this rerouting of the intestine which produces the malabsorption.  The patient will consume less food than that consumed prior to the surgery.  Some of the food will pass through the intestine undigested.

The procedure can be performed through a laparotomy (large abdominal incision) or through a laparoscope (several small incisions on the abdomen).

A BMI greater than 40 qualifies you for this procedure.  BMIs less than 40 can still qualify with certain related conditions attributed to obesity like diabetes.  The duodenal switch is a complex surgery, and only you and your doctor can ultimately decide whether this is the right surgery for you or not.  Remember that any surgery carries risks such as infection, hemorrhage, injury to another organ system, and death.  Particular risks associated with this surgery include leakage from the stitches in the bowel and inability to keep fluids ingested due to swelling in the gastrointestinal (GI) tract.   The swelling in the GI tract will subside, but the patient may require hospitalization for hydration while the swelling goes away.

You will have to undergo a preoperative protocol.  One of the steps in the protocol is to speak with a dietician about the diet that you will follow prior and after the surgery.  These diet changes involve a life long commitment.  An evaluation by a mental health professional will be performed.  Your doctor will most likely recommend an upper endoscopy to make sure that you do not have stomach conditions like ulcers.  Depending on your medical condition and age, your provider may order other tests such as an EKG, blood work, sleep study, and X-rays among others.  Finally, you will have a preoperative physical exam where your physician will go over your history and perform a physical exam.  At this time, be sure to inform your physician about any medications that you are taking including over the counter supplements and herbs.  Some herbs and supplements will impact your body adversely like prolonging your bleeding time.

You will be asked to make other lifestyle changes besides diet.  This includes quitting smoking if you are a smoker.  We all know that smoking increases your chances of developing some types of lung cancer.  In addition, there are other potential lung problems like chronic obstructive pulmonary disease (COPD).  You will also be asked to stop consuming alcohol prior to the surgery.  Losing some weight will help your postoperative recovery.

The surgery will last three to four hours if complications are not encountered.  You will be restricted to drinking fluids postoperatively followed by a pureed diet.  Solid foods will then be reintroduced into your diet.  There will be postoperative pain which will be controlled with different forms of pain killers.

The major weight loss will occur over 12 to 18 months after the surgery.  A patient can expect to lose 70% of their body weight during this time.  The patient will have to take minerals and vitamins daily as well due to the malabsorption caused by the surgery.  Bowel habits will change following the procedure.  Ingesting fatty foods will produce diarrhea and gas.

Other potential postoperative changes include osteoporosis (thin bones), chronic diarrhea, vitamin deficiencies, and chronic diarrhea.  Bad smelling stools may also occur.

The cost for this procedure is about $20,000.  Some insurances pay for this procedure.

Weight loss surgery is reserved for those people who are morbidly obese and cannot lose the weight.  It is also done on people who need to lose weight quickly due to a medical condition(s).

Consider your options carefully before undergoing any form of surgery.  Wishing you success in your weight loss and management, Pablo.