Core Bariatrics
Welcome to Core Bariatrics, the podcast dedicated to walking your bariatric journey with you. Hosted by a bariatric surgeon and her very first bariatric patient. Their paths crossed as patient-doctor, but now they work and lead together. This podcast is your trusted source for valuable insights, expert advice, and inspiring stories that will empower you to make informed decisions about your health. In each episode, we explore the world of bariatric surgery, covering a wide range of topics such as different types of procedures, pre-surgery preparation, post-surgery care, nutrition, exercise, mental health and much much more.
But Core Bariatrics is more than just a podcast—it's a supportive community where you can connect with real people who have walked the same path you're on now. Listen to personal testimonials from individuals who have undergone bariatric surgery, sharing their challenges, triumphs, and the incredible impact it has had on their lives.
We will discuss the importance of post-surgery lifestyle changes, including healthy eating habits, regular exercise, and mental wellness strategies, ensuring your weight loss journey is sustainable and fulfilling.
Join us on Core Bariatrics as we foster a sense of community, providing a platform where you can find encouragement, motivation, and practical tips to navigate the challenges of obesity and achieve lasting weight loss success. Whether you're considering bariatric surgery, are in the post-surgery phase, or simply interested in learning more about this life-changing option, our podcast is here to support you every step of the way.
Remember, your path to a healthier, happier life starts here at Core Bariatrics. Subscribe now and embark on a transformative journey towards a better you.
Core Bariatrics
Episode 12: Beyond Restriction: The Full Spectrum of Bariatric Surgery
Are you ready to revolutionize your understanding of bariatric surgery? Prepare to have your misconceptions shattered and witness the unveiling of the metabolic miracle. Dr. Maria Iliakova, alongside Tammie Lakose, navigates the transformative journey that bariatric patients undertake. It's not a mere alteration of stomach size - it's a full-body metamorphosis. From discussing the nuanced realities of procedures like the gastric band to addressing how individual health histories shape surgical choices, this episode promises to challenge everything you thought you knew about weight-loss surgery.
Weight loss is just the tip of the iceberg when it comes to the profound hormonal and metabolic shifts post-surgery. Our conversation takes an in-depth look at how these changes can foster enhanced fertility, manage diabetes, and even alleviate PCOS symptoms. It's a path that requires unwavering dedication, akin to the prolonged commitment we see in other major life endeavors. We're peeling back the curtain on the myth that bariatric surgery is a shortcut, revealing the truth about the demanding journey of lifestyle transformation that follows.
As we close this insightful episode, we share our appreciation for your companionship on this educational voyage. Dr. Lamasters has illuminated the intricate details of our bodies' responses to bariatric procedures, and we extend an invitation to you to join the conversation. Your experiences and topics of interest are crucial to the fabric of our narrative, and we're committed to fostering a community rooted in evidence-based learning. Until the next episode, we leave you with a sense of belonging in our bariatric family, eager for the continued shared journey towards understanding and wellness.
Welcome to Core Bariatrics Podcast hosted by Bariatric Surgeon Dr Maria Iliakova and Tammy LaCoste, bariatric Coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric Podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it.
Speaker 2:Maria, I have not seen your face in so long and what beautiful faces we have. I'm excited to see yours. It's wonderful. Happy New Year.
Speaker 1:Happy New Year Was yours good.
Speaker 2:It was lovely.
Speaker 1:Do you stay out of trouble?
Speaker 2:Barely, but yes, did you yeah.
Speaker 1:Yeah, a mom of three and not fun.
Speaker 2:You already have had trouble in your past. That's how we get to three babies. So anyway, yes, no, happy New Year, and I have been reflecting a lot on this coming year and the past year and where we want to grow and where we want to build. Yes, so I'm excited to do this episode because I think I remember you actually mentioned having a light bulb moment when we were in Iowa City at a dinner that we had organized for some Bariatric groups and things like that. We brought together folks from all over Iowa and Dr Teresa Lamasters was talking and she is the leader of a Bariatric program and also a very well-recognized national leader in Bariatric surgery and weight management in general, and I remember you mentioned to me afterwards that your mind was blown by what you were learning from her.
Speaker 1:Still, and what was it that? Bariatric surgery is not just a restrictive surgery. Everybody thinks that we're taking out 80% of your stomach, and so the whole point of that is to restrict what you're putting in Right and even same with the bypass, that there's not as much space to put food in. Apparently, that's not all. It does Not all it does.
Speaker 2:You're so right. I think that's super fun to realize for people, because there's a lot more under the hood than what a lot of people are led to believe. And so it's not just restriction. And actually that's a huge misconception even in our field, because I remember learning this, even as a fellow and things like that, and learning that bands and sleeves are restrictive whereas bypasses are metabolic and all this stuff and the division is actually not like that at all. It's not that clear. So we'll talk about that, and we'll talk also about the concept of the magic bullet and that surgery is not one. We'll talk about that, and then also the impact that Bariatric surgery has on other health conditions and then where we're going in the future. A lot of things we still don't know and there's a lot of things that we want to know. So we're going to talk about those things too.
Speaker 1:So sounds good.
Speaker 2:Yeah. So let's get started again, let's do it. So, yes, bariatric surgery is not just about restriction, and you had a really good way of describing that. When we're doing sleeves, we're taking out a certain percent of the stomach about 70 to 80 percent, makes it smaller. We prefer to that in the past as a tank, like a gas tank and a car, getting smaller. And then same thing for yeah, same thing for bypass and all of the other surgeries that we do. They all include some form of restricting, meaning making size smaller, making that tank smaller, definitely Right. There's one exception to that, actually. Do you know what? It is the band. So this is not that common. Oh yeah, yeah, so that's not that common anymore.
Speaker 1:It's just not a surgery anymore.
Speaker 2:So like I don't even, I mean it is, but we don't talk about it because it's not done this much Exactly, and what I'm talking about is a band that goes in around the top part of your stomach, and it is a restrictive surgery technically, because it makes the space smaller. It makes it feel smaller, but it doesn't actually change the size or shape of the stomach, because there's no cutting on the stomach, there's no rearranging of parts or anything. But what's interesting this is an interesting thing is, though, it's restricting and making that space feel smaller. In fact, a lot of times, one of the complications of bands that we're seeing down the road many years afterwards is it can actually cause the top part of your stomach to balloon, yeah, or even your esophagus right.
Speaker 1:Yeah, to get bigger, yes.
Speaker 2:Because that's like a storage place if you eat too much or too fast, exactly because sometimes bands are too tight, or sometimes if people haven't changed their eating habits and they're eating a lot still or eating really big volumes of things and it just sits there, basically, absolutely, you can make your esophagus that tube between mouth and stomach, and then the top part of the stomach, bigger, and that can be a really big problem. In fact, when I was a resident, I remember we had a patient who had had a band for a long time that was really tight and things like that, and they did actually end up expanding the top part of their stomach and their esophagus to the point where their esophagus didn't work anymore. The muscles were they're supposed to push things down. Yeah, didn't. And so the person actually needed part of their esophagus and stomach removed as a result of that and had to have a special kind of bypass done called an esophagectomy. Anyway, it was a really big deal and really bad and really hard and that was a humongous change in that person's quality of life and problems thereafter. Not all bands will cause that problem, certainly Right. I want to be super clear If you have a band, do not rush to your local surgeon to go take it out or anything like that.
Speaker 1:If it's working for you, yeah, I feel like everything that we say in our podcast is very just pick with a grain of salt. Everybody is different. Everybody's surgeon is different. Even if two people had a bypass and all things were pretty much similar, things can be different.
Speaker 2:Exactly, everything is different, exactly. So if you have a question about your band, that's more specific than if you have a question about your band. It was good, a good idea, to go to your surgeon and talk to them about it, or go to your program and talk to them about it. But anyways, restriction let's go back to this idea of restriction is a part of all of these surgeries. You have less, that's, less space to take in food. You have less space that's absorbing food and less space that's absorbing fluids. For all of these surgeries, that is true, but for all of these surgeries, there's also a part of your metabolism that's changing too, and we've talked about that on some of our prior episodes, about how your insulin, for instance, changes and how the release of insulin and what that does to your blood sugar changes. But there's so much more than just insulin. In fact, even how the long-term impacts can even impact how your stem cells in certain parts of your body are working, how your genes are being altered above the level of the genes so something called phosphorylation and hydroxylation, which is called epigenetic alteration and even how well your cells and genes are preserving themselves. So there's an impact long-term on what's called cell senescence, which is how long cells survive and cells last. So it's really interesting and I'm not going to go into the details on this episode. We will go into some more. Yeah, because I'm already um, yes, I know I'm like staring you, but yes, but we will. Just brings up the point that there's so much more, and we are going to deep dive in another episode where we go a lot more into the details on the genetics of weight and genetics of weight changes that happen after surgery. But I just want you to know that there is a lot happening under the hood for all of these surgeries. Whether it's a sleeve or whether it's a bypass, or whether it's a Sadie or even in a band, when you lose weight, some of these signaling pathways are changing even in that circumstance, so it's not just about restriction. Very importantly, though, what on earth does that mean for you as a person? Yeah right, you're like okay, cool, wonderful, my genes are changing. How they're getting regulated is changing, potentially like all this stuff, but what does that mean for me or for you? What that means is, if you're struggling, for instance, with weight changes or not seeing the kind of weight changes that you would expect, it may not be because your surgeon messed it up. It may not be because you are doing something wrong with how you're eating or moving. It may be something about how your metabolism is changing or not changing and how your signaling is changing or not changing. Those are good things to especially if you're off of a curve, if you're off of where you expect to be with your weight changes, or you're starting to regain weight. For instance, afterwards you're starting to oh my goodness, my blood pressure is creeping back up and I've been off of blood pressure meds for a long time now. That's a really good chance to talk with your team, with your health care team, and start to figure out what's going on. Right, your restriction may not have changed, but it's likely that something about your metabolism or some bigger picture signaling has changed. We've talked about this in prior episodes as to why menopause or why pregnancy or why other kinds of things in life can really change. Even if people are status quo, they haven't changed anything else, but all of a sudden they're going through these big hormonal changes. That is why that can trigger weight gain or weight changes or other things to change.
Speaker 1:Absolutely Be aware of that.
Speaker 2:Okay, that's important things. That's also actually why these surgeries have such a big impact on things like diabetes or PCOS, which is polycystic ovarian syndrome, and why these surgeries can actually be used as treatments or cures for some of these other conditions. For instance, in our program, even over the course of a year and a half, we had a few pregnancies. Yes, yes, those pregnancies are not happening because of restrictive changes. They're happening because of metabolic changes that are causing hormone levels to change in people's bodies.
Speaker 1:I like that you said that and said it out blatantly clear that it's not just because of the surgery or the structure of the surgery that is helping these things.
Speaker 2:Exactly, exactly. I think there's a lot of confusion sometimes as to, okay, weight loss surgery is just a vanity thing or it's all just for people to lose weight, but it's actually for people to have babies and for people to perform better in the bedroom. And no babies here. No babies here. Okay, no more babies here, I know, so be careful. Yeah, you really got to watch it, tammy, because that's a thing. But the other thing to think about is that's why people can actually come off of their medications for high blood pressure and diabetes and have a treatment for their fatty liver disease through these surgeries and for lots of other things too. So it's not just about restriction. It's massively because your metabolism and hormones and everything is changing too. Yeah, no, all right, let's also talk about the magic bullet. You have heard of this one a lot Magic bullet, right. How do you think of this? Like? How do you think in the general public or people when they're coming in? What do you think people think of surgery? Is it like one and done, is it? Oh, I'm going to have to work really hard at this, is it? What's your general thoughts on that?
Speaker 1:No, it's literally the easy way out. That's what everybody thinks it is.
Speaker 2:Yeah.
Speaker 1:It's. One of the reasons why I wanted to do this with you is because I want people to know it's not just the easy way out. Again, like I have said in a previous episode, it just gives you the tools, just like a hip replacement gives you the tools to live a better life and not be in as much pain, but you still have to work, yeah. If a person beats the crap out of their hip replacement and not do the things they're told they're going to go backwards.
Speaker 2:If you think about it, anytime you're doing a knee surgery or hip surgery, you've probably, if you've had that surgery before, you've seen somebody else go through it. They go through rehab afterwards. Right, they go through PT, physical therapy, they do exercises, and really you're supposed to do those for forever. I don't know if anybody actually does them for forever, but these kinds of surgeries are the same in that way. It's basically you do the surgery but then there's rehab afterwards. Maybe we should call it that or something, because you are changing right Some things to think about, because you're changing everything about your life. You're changing how you're eating, you're changing how you're drinking, you're changing when you're doing those things. You're paying attention to vitamins, which you never really did before. If you're most people right Calling you out, yeah, never Calling you out. Yes, I'm still learning. Yes, and honestly, I think that's the best way to do it. Because I think that's the best way to do it. I really feel it, because I have a difficult time drinking water on a regular basis and I'm the person that's supposed to be living it, and it's hard to tell other people to do something that you yourself find difficult to do on a regular basis. But, yeah, these surgeries are super not not magic bullets. They're really effective, meaning that they work really well for losing weight and really well for treating a lot of other medical conditions. But it's not. They're not one and done Right. And so you got to still put in the effort over time to make sure that you're moving your body, you're eating and drinking well and you're really taking care of your body overall. Yeah, no, to be honest, it's a lifelong thing. It's a lifelong thing and I really do think that getting the most out of these surgeries and making sure that you're not just having surgery and then, all of a sudden, several years down the road, you're like why did I do that in the first place? That really wasn't helpful or that really didn't work very well. It is the lifelong commitment which is hard to do, because we don't actually. We do take on lifelong commitments, like marriage can be a lifelong commitment. Or kids certainly are lifelong commitment. What kids are? Yeah, certainly kids. Yeah, but even bosses can come and go. Yeah, you're right. You're right, spaces can come and go. But I think of how many things we do in life not even necessarily realizing their lifelong commitment, like our choice of what we do for work or choice of what kind of education we get, really sets us up on certain tracks, and I think that may be the best way to think of it is like this kind of a surgery or going through this process sets you up on a certain kind of track. You can totally get off track. Things can push you off track Just trains on a track. You can also crash into something. I do think that there's. It would be helpful to think of it as a journey, like you've said before. And yeah, and to be honest, I do think we're really missing out as an industry, as and I don't say industry meaning like a word, like money. Yeah, you're making money. We're Titans of industry doing railroads or something. No, but I mean about an industry like healthcare. Right, I think we are actually missing out on that concept of rehab afterwards, because we make it super obvious in certain like for certain things, recovering from any surgery. But I think maybe we need to make it super obvious after these kinds of surgeries to you're always on to something. You're always on to something too, tammy, okay, but I do want to say so. Now we're going to start talking about some medical conditions too, because this is where you get really jazzed about specifically bariatric surgery, because it's so freaking effective at helping people treat what is otherwise extremely difficult to treat, like diabetes. Right, and actually this kind of surgery is the most effective treatment for diabetes, the most effective treatment for hypertension, high blood pressure, the most effective treatment for polycystical variant syndrome, PCOS and many other things, and I don't think people would ever be like surgery can help me treat diabetes until you go to get yourself.
Speaker 1:No, that's not your first thought. Your first thought is I need meds?
Speaker 2:No, it isn't. And I'm going to say something. I may regret this 20 years down the road, but I actually think we're going to start using these surgeries to treat those things, even if people are not overweight, down the road.
Speaker 1:Potentially. Because I think that's how effective and how important these things are, and it would really help us take the focus off of weight, which I actually listen to a podcast that had a I think it was a plastic surgeon that there was research being done, that they had two mice again. I don't know, I don't like that, but they took the fecal matter out of the skinny mouse.
Speaker 2:Yes.
Speaker 1:And put it into the overweight mouse lost weight. Yes, yes. So this is where we start looking into gut health. Yes, and like how it differs from places to places. Yeah, I'm digging into things you don't quite realize. I love it.
Speaker 2:What you're describing is called the fecal trans transplant and it sounds disgusting. Hold on, hold on. I love it. Right, put some poop in some other. No, anyway, but how it works is the yes, you take poop from one person or one animal and you actually clean it and you process it. It's not like you just take one piece of poo and put it in another person Just like blood.
Speaker 1:Exactly. Make sure it's a match. Yes.
Speaker 2:Yes, it's a blood donation versus a poop donation. Yay, but no, it's true, and you know what this is actually used for currently. This is an actual treatment that we use on real human beings. Do you know what we use it for? For C diff? Yes, we use it for C diff, yes, yes, and it's not like people that have C diff tend to get it over and over. That's right, and it's in part because it's gut bacteria that's out of whack with itself, and getting good bacteria and less bad bacteria basically into someone's gut through a fecal transplant can be a really good way to treat it. So this is a thing, it's a real thing. It's a real thing, it's a real thing. And so the idea basically being if we can do the same for people with weight or other metabolic issues, your gut health, the bacteria that's all throughout your body in fact, there's more bacteria on your body than there are cells of you, anyway. So, oh, yeah, in your stomach, yes, so, like stomach and small intestines and colon and everywhere, and they nasty, but they do good things, they do very important things. You're absolutely right. Fecal transplants, I think you're right, are going to also be used in bariatric care in the future. Yes, sorry, side track. I love it. There's always side tracks. This is a train on a track and then we've got all these little side tracks Always. So let's talk about one I really want to dive into, and that's diabetes, because I think diabetes is one of the things. First of all, it's really common in the US. Yes, somewhere close to a third of the population is either at risk, is pre diabetic or diabetic, which is one in three. That's crazy, that's a lot. Yeah, that's a lot, and that number is probably going to go up over time. Oh for sure, absolutely, yeah. So one in three, that's a lot of people. So if it's not you, it's not me. Then there's a third person.
Speaker 1:It might be that third person Right.
Speaker 2:So diabetes really common and really creates a lot of issues for people down the road. So it can affect everything from blood supply to your fingers and toes and how well your you perform sexually. It for effects fertility. Certainly. It affects how your heart and lungs work, how your kidneys work. Literally, there's no how your eyes work. You can go blind from diabetes. Yeah, so there's quite literally no body system that is not affected when diabetes is is your malady. It's also super expensive, so medications for diabetes can be hard to get can be totally. In fact, they're really fancy. Ozempic and manjarro and all those things that cost an arm and a leg are actually diabetes medications. And then we all are very familiar with the fact that insulin is very expensive too, Right Now this is side track again.
Speaker 1:Do you think that maybe down the road the value to diagnose diabetes is going to be different?
Speaker 2:Like lower. Yeah, I think so. I think you're right, because right now it's like what?
Speaker 1:eight or seven? You're a one seed.
Speaker 2:Your A1C is 6.5 and over 6.5 to diagnose.
Speaker 1:Okay, yeah, but you think that number might go down in the future.
Speaker 2:Right now we have this range that's funky called pre-diabetes, which is 5.7 to right before low 6.5 until you reach that threshold, and it's a risk, basically for diabetes it's not true diabetes, but you're at higher risk for developing this and it's more difficult to slow.
Speaker 1:These medications help with pre-diabetes?
Speaker 2:Yes, they do, but insurance are not free to pre-. No preventive care. What's the way? I'm looking for. Preventive care, yes, and honestly, that is a huge problem because we could do. It's always a pound of prevention, sorry, pound of yes. Prevention is worth an ounce of cure, right? If we could prevent diabetes, great, right? Exactly, yeah, we don't seem to do that very well, but OK. So let's talk about how surgery affects diabetes and there's different kinds of diabetes. Typically, we talk about a type 1, type 2, but there's a lot more nuance to it than that and we call it insulin-dependent or insulin-independent, but again, that's more terminology than really reality of how it works. But in general, what happens is you have insulin resistance. That happens so, even though insulin, which is trying to pull blood sugar into cells and help your cells use it for all kinds of activity that they're doing, what happens is your body doesn't really recognize the insulin, doesn't produce enough insulin. It just doesn't allow it to work very properly and so too much blood sugar stays in your bloodstream and has all of these downstream effects, quite literally on all your body organs? Yes, and the longer it happens. It's a bit of a feed forward mechanism, a downward spiral there, where your body just has some resistance and it keeps getting worse and worse until your body just really doesn't respond appropriately to blood sugar at all. It doesn't regulate it very well.
Speaker 1:I feel like we can use the example of antibiotics, right you? Don't want to use the antibiotics too much, because you could become resistant to them. I just want to.
Speaker 2:I love that. I don't want to dumb it down, but simple it. I love that. I love that. Yeah, so basically it's actually like alarm fatigue If you set your too many alarms or too many notifications I've been doing that more and you all of a sudden don't even register alarms or any of that anymore because there's so many of them. Think about email notifications or text notifications or whatever. Yeah, it's the same idea.
Speaker 1:Your body just goes. It goes off and I'm just like an Apple watch. It vibrates, but we get used to it Exactly.
Speaker 2:We get used to all of that and your body does the same thing. It gets used to that and it gets used to it being a problem, but it can't do anything about the problem and so it just gets worse and worse over time. So what happens with surgery which is interesting is you have a reprogramming going on of all of the signaling and, instead of having your entire pathway where the insulin and how it's accepted and all of the different things that help to make that work all of that working abnormally it starts to work more normally and it actually starts to get regulated in a positive way. You have signaling of certain kinds of genes changing as people lose weight and as people have these surgeries and their metabolism starts to change, where you actually have different cells that are helping to control inflammation and you're lowering the kinds of cells that actually encourage inflammation. So you have more balance in terms of less inflammation happening and being able to deal with it better, and that has an enormous impact on these signaling pathways that impact how blood sugar is stored in the cells and goes to the cells rather than stays in the bloodstream, and it even affects things like leptin, which is considered to be ingrelin, which are considered to be hormones of whether we feel full or hungry, and things like that, and these pathways are really specific. I'm going to talk about them more in our genetics podcast on bariatrics because they're complicated, but there's a lot and we'll actually be including some links in this podcast also that go into more of the details for people who are interested. But just for the scientists out there yeah, just for the scientists and the doctors out there and things like that. The specific pathways we're talking about are the insulin receptor substrate pathways, the PI3K pathways and MAP kinase pathways, as well as mitochondrial pathways that involve TNF-alpha and reactive oxide species, as well as pro-inflammatory and anti-inflammatory macrophages and beta cell dysfunction. So for anyone who wants to hear the actual mumbo jumbo, science jargon, that's it Just look at a little thing like that yes, big words, yes, exactly, but the crazy thing is that a lot of these kinds of pathways and a lot of this kind of damage is reversible through surgery, and so what happens is the beta cells that produce insulin actually start to work better after surgery. Your body starts to be less resistant to insulin if it had insulin resistance. It starts to be less resistant to leptin if it had developed resistance in the past, and between 35 and about 90% of people have diabetes. That goes into complete remission a year after surgery. Remission means cure. Essentially it goes completely away, meaning no meds, no monitoring, no, nothing, which I think is nuts, because there is absolutely no. Yeah, there's no medication out there that does that. There is no lifestyle change that does that. There's quite literally nothing out there that replicates that even close, and even the GLP-1 medications don't have that effect.
Speaker 1:No, because once you stop taking it.
Speaker 2:Exactly, you're going back Exactly, and this is surgery. Again, surgery is not one and done. Surgery involves lifestyle changes and things to maintain it. But surgery plus those things, and between a third and almost all of people can very effectively treat or cure their diabetes with surgery Pretty cool and medications alone and prevent it and prevent and prevent it from getting in the way of the patients in the future having lower risk for life. Basically, as a result of that, and if you compare that to just medications that are used for diabetes management, the chances of treating or curing diabetes, especially going into remission at a year is less than 40%. Yeah, yeah, so it's less than. It's essentially the flip side. So one in three to all have a remission with surgery and less than 40% have a remission with medications alone. And one of the massive benefits of these surgeries is the impact it has on some of these other medical conditions that people have that are related, because it really is a much more complex approach than just restriction, like we talked about. It's making these metabolic changes and hormonal changes that are having impact on all these other medical conditions. And also one thing I want to mention is these changes oh, hello there, my husband's walking in. I love it. No, it's all good. You do live in a house, it is okay. Yeah, okay, you do have other people in this house, it's okay, don't worry. So the other thing I wanted to mention is that people sometimes wonder why a bypass is more effective than a sleeve at some of this treatment for diabetes. And that is true. So, even though with a sleeve you can treat or cure diabetes, it's more likely to happen if you have a surgery that actually rearranges body parts and that's a bypass, or like a ruin my bypass or a seedy or a doodial switch, and the reason is interesting because we don't know all of the reasons for it. But even the way that like bile salt which I don't know if you've ever heard of that, but that's what helps your body absorb fats and like more fats and things like that, and in what you're digesting, there's a difference in how those things actually get processed in your body. With those kinds of surgeries and some of those inflammatory markers and how the genes are being regulated, is even stronger of a change with a bypass or a seedy or any of those other things than with a sleeve. So that's, we think, why that's a more effective treatment when people have diabetes and other metabolic issues.
Speaker 1:Yeah, so I know that's a lot of jargon, no, but it makes sense for people that are really wanting to know why a powder tool works and very powerful.
Speaker 2:Yeah, I mean it's incredible because it's so cool. This is why I'm so jazzed about bariatric surgery and why I'm such a. I just think it's incredible, right, I think this is why we're such advocates of this is because it is a tool, that it's like a handyman tool for all the things potentially, and for so many more than just one thing, and it's really effective and it really works for people. Also, I wanted to touch on future directions. Where are we going with all of this? I mentioned that there's a lot of things we don't know and there's a lot of things that we're figuring out, like why, with every single thing in the medical field. Exactly and honestly, this field is a big one and you're noticing that, even if you don't care about it, because you're hearing about all these new medications that are coming out to help treat weight and things like that. So there's definitely development of medications. That's a big one and we're figuring out how we use medications, potentially with surgery sometimes, or just by themselves, or before and after surgery, like all kinds of things in combination. Potentially we're figuring out how to make medications more effective, because right now the medications we have are effective, but they're definitely nowhere near as effective as surgery. So there's that, even developing surgery techniques. So, for instance, we've talked about different kinds of bypasses and sleeves and things like that. We are totally just scratching the surface of how these surgeries work and what can we do to make them better. And how do we choose which surgery is the best option for which person, because there's guidelines on this stuff and there's good ways to choose, pick and choose with patients, but they're not perfect.
Speaker 1:Things have come a long way Already. A long way because I think I was incorrect me, if I'm wrong that back in the day they thought making the sleeve smaller will make people more successful, when in reality that's probably not the.
Speaker 2:There's definitely a limit to how small you can go. In fact, there's been some research into that not too long ago and it showed you make it too small and you actually give people a lot of complications, without benefits of weight loss or weight changes, and then you leave it too big and oftentimes, yeah, you won't have enough change too. So there's definitely like a size has an impact, but we're not exactly sure what the perfect size is. There's that, exactly, and not only that. But okay, so the bypass is for one quick second and again I'm going to go for the audience that is in healthcare or is interested in the stuff. I'm going to deep dive just for a second. So when we're talking about bypasses, we're actually rearranging the intestines and how they connect to the stomach, and so we're creating different limbs. We're literally creating different tracks, if you will like, different train tracks, and the length of those train tracks actually affects how well these surgeries work. But think of it this way we're rearranging the railroad, but we actually don't know each person you and me and anyone else will have different lengths of railroad in their bodies. And so when we do these kinds of surgeries and we actually create different tracks with different lengths and things like that. For one person, if you do a certain length, that will be a lot of their train track and if you do it in a different person, that won't be that much of their train track. And if you can imagine, the bigger the bypass for someone, the more effect. So I know this is getting into the weeds, but we don't even know necessarily what the perfect length is for everyone, because everyone's train track is different length. Hey, all right, so, yeah. So there's a lot of investigation and innovation going on there.
Speaker 1:And I just want to add that, because we're talking about all these surgeries, we will have a video that you made available for those that will be in our yes. Yes, I don't know if it'll be a Patreon. I don't know what it will be Discord Circle, any of that, but anybody that is in that community we're gonna make that video available to them to understand what each was.
Speaker 2:Yes.
Speaker 1:Because even as much research as I did you had to explain that to me.
Speaker 2:And it's a longer video and you do not have to watch it at all, but just know that we are just scratching the surface, thank you, but we're just scratching the surface of figuring out, like how these surgeries work and why and what we can do to make them better, or even totally different techniques. So I think it surprises some people when they learn that bypasses were originally used actually to treat reflux, not weight. So that's where that came from. And then we noticed that people asked for it. You know that either, right, and then sleeves only became part of the whole picture in the past, like less than 15 years. So the first, 2009 that the first sleeve was actually approved as a weight loss procedure by an insurance company, so that's less than 15 years ago. Yeah, crazy. And it used to be part of the duodenal switch and anyway, we don't need to go into all the details, but the whole idea is there. This is a newer field relative to a lot of others and there's still a lot that we don't know and a lot that we're investigating. Stay tuned.
Speaker 1:And you are good at investigating.
Speaker 2:Thank you. Cool Questions are good and we're curious. So stay curious, my friends. Yes, and then, lastly, just to mention at the very end of this that not every. There's some limitations to surgery, and I just want to breeze through these real quick, because this is going to be a completely different episode too at some point, but just for now. Not every surgery is right for everybody, okay, so just a sleeve is not the right choice for everyone. A bypass is not the right choice for everyone. A surgery is not the right choice for everyone, okay, very good. And not everyone will have the same outcome from the same surgery. You touched on it earlier, and there's lots of reasons both. Why, oh yeah, there's so many reasons, and so not everyone will have the same outcome, even if they have the exact same surgery as their friend or their family member or someone else. Okay, it also does not mean that you will lose weight and drop your weight below a BMI of 25. We can't do that. In fact, there's no healthy way to do that, for, whether with surgery or whether with meds or whether with anything, there just isn't a healthy way to do that.
Speaker 1:Your body will always determine where you'll be.
Speaker 2:Exactly, exactly, and there's safe places that we can go and there's not a lot beyond that Right, and pushing beyond that typically means doing some damage along the road. Exactly, and then these surgeries also can cause problems like being dehydrated or not getting your nutrition or having reflux or other things. So it is always very important to prepare for surgery, to know what those risks are before you get into it, and to be on the lookout for problems as you go after surgery and keep up on your labs and stuff, exactly.
Speaker 1:So your surgeon can mean mug you about not taking your vitamins.
Speaker 2:I love it. This is all actually an episode to mean mug you for 30 minutes. I love it, but no, so I'm really glad that we talked today about understanding bariatric surgery a little more and understanding that I learned more too, thank you. But understanding, there's one limitations. Two, we don't know everything and we're working on it and we'd love for everyone to help because we need that. Three, that this is a surgery, kind of surgery. They can have a really big impact on other medical conditions. That it's not a magic bullet and that it works in mysterious ways, some of which we know in some of the videos.
Speaker 1:It's not just restriction Exactly exactly. Thanks for explaining, thanks for letting me see your beautiful face, you too, tammy, and don't forget to follow us. Don't forget to comment if there's something you want us to talk about, or even you to come with us and talk about it.
Speaker 2:We are so open to having guests and patients and providers and all of that, yes, for this episode we will also have some links to some of the citations and materials, because I really want those folks who are interested in that to see that we're not just talking hot smoke, that this is very well supported in research and that we really want to share that with those folks who want to dive into it.
Speaker 1:Absolutely Well, until next time, maria Mwah. See you soon, bye, bye.