Newsmaker
When a decision was made to have weight loss surgery, it was explicitly discussed that Multivitamin, Calcium and other supplements will be required life long. Some patients find it comforting that they have normal laboratory studies, yet they have not been compliant with their multivitamin, Calcium and other supplements. It is important to note that some of the nutritional markers have long half-life. Additionally, in certain cases, there is a large volume of reserve stored in the body. It may take a long time for deficiencies to show on the laboratory results.
Continue to take your Multivitamin, Calcium and other supplements as instructed regardless of your laboratory results.
Ara Keshishian, MD, FACS

Loss Of Sleep, Even For A Single Night, Increases Inflammation In The Body
Loss of sleep, even for a few short hours during the night, can prompt one’s immune system to turn against healthy tissue and organs.

A new article in the September 15th issue of Biological Psychiatry, by the UCLA Cousins Center research team, reports that losing sleep for even part of one night can trigger the key cellular pathway that produces tissue-damaging inflammation. The findings suggest a good night’s sleep can ease the risk of both heart disease and autoimmune disorders such as rheumatoid arthritis. Specifically, the researchers measured the levels of nuclear factor (NF)-κB, a transcription factor that serves a vital role in the body’s inflammatory signaling, in healthy adults. These measurements were repeatedly assessed, including in the morning after baseline (or normal) sleep, after partial sleep deprivation (where the volunteers were awake from 11 pm to 3:00 am), and after recovery sleep. In the morning after sleep loss, they discovered that activation of (NF)-κB signaling was significantly greater than after baseline or recovery sleep. It’s important to note that they found this increase in inflammatory response in only the female subjects.

These data close an important gap in understanding the cellular mechanisms by which sleep loss enhances inflammatory biology in humans, with implications for understanding the association between sleep disturbance and risk of a wide spectrum of medical conditions including cardiovascular disease, arthritis, diabetes, certain cancers, and obesity. John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, comments: “The closer that we look at sleep, the more that we learn about the benefits of sleeping. In this case, Irwin and colleagues provide evidence that sleep deprivation is associated with enhancement of pro-inflammatory processes in the body.” “Physical and psychological stress brought on in part by grinding work, school and social schedules is keeping millions of Americans up at night,” said Dr. Irwin, lead author and director of the Cousins Center for Psychoneuroimmunology at the Semel Institute. “America’s sleep habits are simply not healthy. Our findings suggest even modest sleep loss may play a role in common disorders that affect sweeping segments of the population.” In other words, sleep is vitally important to maintaining a healthy body. And as Dr. Krystal notes, “these findings provide a potential mechanistic avenue through which addressing sleep disturbance might improve health.”

Newsmaker
Some patients are asking us if they can see their primary care physician instead of following up with us. As we outline before an operation is performed, routine follow-ups are an integral part of a successful outcome. If however it is an extreme hardship we will on individual cases review your labs work on the phone. This is however not a substitute for an in office follow-up. To arrange for a review of your lab results, please make a request through our contact page on the website.
Ara Keshishian, MD, FACS

 

Vitamin D: New Way To Treat Heart Failure?
Strong bones, a healthy immune system, protection against some types of cancer: Recent studies suggest there’s yet another item for the expanding list of Vitamin D benefits. Vitamin D, “the sunshine vitamin,” keeps the heart, the body’s long-distance runner, fit for life’s demands.

University of Michigan pharmacologist Robert U. Simpson, Ph.D., thinks it’s apt to call vitamin D “the heart tranquilizer.” In studies in rats, Simpson and his team report the first concrete evidence that treatment with activated vitamin D can protect against heart failure. Their results appear in the July issue of the Journal of Cardiovascular Pharmacology. In the study, treatments with activated vitamin D prevented heart muscle cells from growing bigger – the condition, called hypertrophy, in which the heart becomes enlarged and overworked in people with heart failure. The treatments prevented heart muscle cells from the over-stimulation and increased contractions associated with the
progression of heart failure.

About 5.3 million Americans have heart failure, a progressive, disabling condition in which the heart becomes enlarged as it is forced to work harder and harder, making it a challenge even to perform normal daily activities. Many people with heart disease or poorly controlled high blood pressure go on to experience a form of heart failure called congestive heart failure, in which the heart’s inability to pump blood around the body causes weakness and fluid build-up in lungs and limbs. Many people with heart failure, who tend to be older, have been found to be deficient in vitamin D.

“Heart failure will progress despite the best medications,” says Simpson, a professor of pharmacology at the U-M Medical School. “We think vitamin D retards that progression and protects the heart.”

The U-M researchers wanted to show whether a form of vitamin D could have beneficial effects on hearts that have developed or are at risk of developing
heart failure. They used a breed of laboratory rats predisposed to develop human-like heart failure. The researchers measured the effects of activated Vitamin D (1,25 dihydroxyvitamin D3, a form called calcitriol) in rats given a normal diet or a high-salt diet, compared to control group rats given either of the same two diets, but no vitamin D treatment. The rats on the high-salt diet were likely to develop heart failure within months.

The rats on the high-salt diet, comparable to the fast food that many humans feast on, quickly revealed the difference vitamin D could make. “From these animals, we have obtained exciting and very important results,” Simpson says.

After 13 weeks, the researchers found that the heart failure-prone rats on the high-salt diet that were given the calcitriol treatment had significantly lower levels of several key indicators of heart failure than the untreated high-salt diet rats in the study. The treated rats had lower heart weight. Also, the left ventricles of the treated rats’ hearts were smaller and their hearts worked less for each beat while blood pressure was maintained, indicating that their heart function did not deteriorate as it did in the untreated rats. Decreased heart weight, meaning that enlargement was not occurring, also showed up in the treated rats fed a normal diet, compared to their untreated counterparts. Simpson and his colleagues have explored vitamin D’s effects on heart muscle and the cardiovascular system for more than 20 years. In 1987, when Simpson showed the link between vitamin D and heart health, the idea seemed far-fetched and research funding was scarce. Now, a number of studies worldwide attest to the vitamin D-heart health link.

The new heart insights add to the growing awareness that widespread vitamin D deficiency—thought to affect one-third to one-half of U.S. adults middle-aged and older—may be putting people at greater risk of many common diseases. Pharmaceutical companies are developing anti-cancer drugs using vitamin D analogs, which are synthetic compounds that produce vitamin D’s effects. There’s also increasing interest in using vitamin D or its analogs to treat autoimmune disorders.

In more than a dozen types of tissues and cells in the body, activated vitamin acts as a powerful hormone, regulating expression of essential genes and rapidly activating already expressed enzymes and proteins. In the heart, Simpson’s team has revealed precisely how activated vitamin D connects with specific vitamin D receptors and produces its calming, protective effects. Those results appeared in the February issue of Endocrinology. Sunlight causes the skin to make activated vitamin D.

People also get vitamin D from certain foods and vitamin D supplements. Taking vitamin D supplements and for many people, getting sun exposure in safe ways, are certainly good options for people who want to keep their hearts healthy. But people with heart failure or at risk of heart failure will likely need a drug made of a compound or analog of vitamin D that will more powerfully produce vitamin D’s effects in the heart if they are to see improvement in their symptoms, Simpson says.

Vitamin D analogs already are on the market for some conditions. One present drawback of these compounds is that they tend to increase blood calcium to undesirable levels. Simpson’s lab is conducting studies of a specific analog which may be less toxic, so efforts to develop a vitamin Dbased drug to treat heart failure are moving a step closer to initial trials in people.

left: Heart muscle cells in untreated rats bred to develop heart failure show signs of disease: Cells are irregular in size and shape and show fibrotic lesions (areas in purple). Right: Heart muscle cells remain healthy in rats treated with calcitriol, the hormone that Vitamin D becomes in the body. (Credit: Image courtesy of University of Michigan Health System)

Exercise for Osteoporosis

Exercise for Your Bone Health
Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and leads to better overall health.

Why Exercise?
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn help to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.

The Best Bone Building Exercise
The best exercise for your bones is the weight-bearing kind, which forces you to work against gravity. Some examples of weight-bearing exercises include lifting weights, walking, hiking, jogging, climbing stairs, tennis, and dancing. Examples of exercises that are not weight-bearing include swimming and bicycling. While these activities help build and maintain strong muscles and have excellent cardiovascular benefits, they are not the best way to exercise your bones.

Exercise Tips
If you have health problems – such as heart trouble, high blood pressure, diabetes, or obesity – or if you are over age 40, check with your doctor before you begin a regular exercise program. According to the Surgeon General, the optimal goal is at least 30 minutes of physical activity on most days, preferably daily. Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. STOP exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.

If you have osteoporosis, ask your doctor which activities are safe for you. If you have low bone mass, experts recommend that you protect your spine by avoiding exercises or activities that flex, bend, or twist it. Furthermore, you should avoid high-impact exercise in order to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of people with osteoporosis.

A Complete Osteoporosis Program
Remember, exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss when you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your
bones strong.

Killer Stairs? Taking The Elevator Could Be Worse For Your Body

For years, scientists have been proclaiming the benefits of exercise. Studies showing that regular exercise benefits human health have exploded in number, examining many health problems ranging from cancer and diabetes to arthritis and pre-mature death. Now, a University of Missouri researcher has found direct evidence to support the claim of the Centers for Disease Control that a reduction in daily physical activity is an actual cause of many of the risk factors for chronic diseases, including diabetes and cardiovascular disease. The research team also found that it only takes about two weeks of reduced activity for individuals to start noticing the effects. “A low level of daily physical activity not only doesn’t help your current health status, it could be the reason you got sick in the first place,” said Frank Booth, professor of biomedical sciences in the MU College of Veterinary Medicine. “Our study looked at what happened when a group of individuals reduced their daily physical activity. Our findings indicated that if there is a lack of normal physical activity, a person greatly increases the chances of developing a chronic disease. Previously, we thought that not exercising just wasn’t healthy, but we didn’t think that a lack of activity could cause disease. That assumption was wrong.”

Booth and researchers at the University of Copenhagen conducted two different studies in Copenhagen. In the first study, participants were asked to reduce the amount of steps they took per day from 6,000 to 1,400 for three weeks. instead of walking or taking the stairs, participants were instructed to use motorized transportation, such as a car or elevator, in every situation possible. The second study asked participants who were more active, averaging 10,000 steps per day, to reduce their activity to 1,400 steps per day for two weeks.

The number of steps the average American adult takes per day is 7,473, although Americans who are inactive typically take about 2,100 steps each day. At the end of each study, participants were administered a glucose tolerance test or a fat tolerance test, or both. These tests measure how fast the body is able to clear glucose or fat from the blood stream. The researchers found that after two weeks of no exercise and very little activity, participants had much higher levels of glucose and fat and took a much longer time to clear the substances from their blood streams than before. The longer it takes the body to clear the blood stream of the substances, the higher the likelihood that a person will develop diabetes or other chronic diseases.

“We used to think that it is healthy to be physically active, but this study shows that it is dangerous to be inactive for just a couple of weeks,” said Bente Klarlund Pedersen, coauthor and lead investigator of the study and professor of internal medicine and director of Centre of Inflammation and Metabolism at the University of Copenhagen. “After 14 days of reduced stepping, subjects experienced accumulation of the dangerous abdominal fat, while also developing elevated blood-lipids, a sign of -prediabetes and cardiovascular disease. If you choose the passive mode of transport and abstain from exercise, than your risk of chronic disease is likely to increase markedly.”

“When the doctor says to go and exercise, they are not just telling patients to do that to improve their health; increasing daily stepping could actually reverse a cause of chronic disease,” Booth said. “When extra fats and sugars (glucose) don’t clear the bloodstream, they go where we don’t want them and cause problems for our bodies’ typical metabolic functions.”

The researchers also found that the total skeletal and muscle mass in the body decreased when activity decreased. Booth says that longer studies are needed to help answer more questions about the detrimental effects of long-term physical inactivity.

The study is being published in the Journal of the American Medical Association (JAMA) the week of March 18

Maintaining Aerobic Fitness Could Delay Biological Aging By Up To 12 Years, Study Shows

Maintaining aerobic fitness through middle age and beyond can delay biological ageing by up to 12 years and prolong independence during old age, concludes an analysis published ahead of print in the British Journal of Sports Medicine.

Aerobic exercise, such as jogging, improves the body’s oxygen consumption and its use in generating energy (metabolism). But maximal aerobic power starts to fall steadily from middle age, decreasing by around 5 ml/[kg.min] every decade. When it falls below aound18 ml in men and 15 ml in women, it becomes difficult to do very much at all without severe fatigue. In a typical sedentary man, the maximal aerobic power will have fallen to around 25 mil/[kg.min] by the age of 60, almost half of what it was at the age of 20.

But the evidence shows that regular aerobic exercise can slow or reverse the inexorable decline, even in later life. Research shows that relatively high intensity aerobic exercise over a relatively long period boosted maximal aerobic power by 25%, equivalent to a gain of 6 ml/ [kg.min], or 10 to 12 biological years. “There seems good evidence that the conservation of maximal oxygen intake increases the likelihood that the healthy elderly person will retain functional independence,” says the author. The other positive spin-offs of aerobic exercise are reduced risks of serious disease, faster recovery after injury or illness, and reduced risks of falls because of the maintenance of muscle power, balance, and coordination.

What are Amino Acids and why we need them?

Amino Acids are the building blocks of the body. Besides building cells and repairing tissue they fare involved in our immune system to fight infections. They are also the building blocks of the proteins. When protein is broken down by digestion the result is 22 known amino acids.

As the building blocks of protein, amino acids are vital to our wellbeing. Next to water, amino acids in the form of proteins make up the greatest portion of our body weight. They comprise tendons, muscles and ligaments; organs and glands; hair and nails; important body fluids, and are necessary part of every cell in your body.

The amino acids are separated into two categories Essential and Nonessential. Essential amino acids are those that cannot be manufactured by our body, hence, it is essential that you obtain tem from your diet. Our body can manufacture non-essential amino acids, however, it must have the correct combination of essential amino acids and supporting nutrients to optimize healthy protein maintenance, so supplementation may be desirable. 20 amino acids are needed to build the various proteins used in growth, repair and maintenance of body tissue.

Dieters and anyone consuming an inadequate number of calories may not be consuming adequate amounts of amino acids. In these cases, the body will break down the protein in muscle tissue and use those amino acids to meet the needs of more important organs or will simply not build more muscle mass despite increasing exercise.

Unlike carbohydrates and fats the body does not store protein to any significant degree and, it must be consumed on a daily basis.Drinking more than one soft drink daily — whether it’s regular or diet — may be associated with an increase in the risk factors for heart disease, Framingham researchers reported in Circulation: Journal of the American Heart Association.

“We were struck by the fact that it didn’t matter whether it was a diet or regular soda that participants consumed, the association with increased risk was present,” said a senior author of the Framingham Heart Study. “In those who drink one or more soft drinks daily, there was an association of an increased risk of developing the metabolic syndrome.”

Metabolic syndrome is a cluster of cardiovascular disease and diabetes risk factors including excess waist circumference, high blood pressure, elevated triglycerides, low levels of highdensity lipoprotein (HDL “good” cholesterol) and high fasting glucose levels. The presence of three or more of the factors increases a person’s risk of developing diabetes and cardiovascular disease.

Prior studies linked soft drink consumption to multiple risk factors for heart disease. However, this study showed that association not only included drinking regular calorie-laden soft drinks, but artificially sweetened Make no mistake- It does not matter if the soda is regular or diet! diet sodas as well, researchers said.

The Framingham study included nearly 9,000 person observations made in middle-aged men and women over four years at three different times.

In a “snapshot in time” at baseline, the researchers found that individuals consuming one or more soft drinks a day had a 48 percent increased prevalence of the metabolic syndrome compared to those consuming less than one soft drink daily.

In a longitudinal study of participants who were free of metabolic syndrome at baseline (6,039 person observations), consumption of one or more soft drinks a day was associated with a 44 percent higher risk of developing new-onset metabolic syndrome during a follow-up period of four years.

Diet and regular soft drinks linked to increase in risk factors for heart disease.

The researchers also observed that compared to participants who drank less than one soft drink daily, those who drank one or more soft drinks a day had a:

• 31 percent greater risk of developing new-onset obesity (defined as a body mass index [BMI] of 30 kilograms/meter2 or more)
• 30 percent increased risk of developing increased waist circumference
• 25 percent increased risk of developing high blood triglycerides or high fasting blood glucose
• 32 percent higher risk of having low HDL levels
• A trend towards an increased risk of developing high blood pressure that was not statistically significant.

Researchers then analyzed a smaller sample of participants on whom data on regular and diet soft drink consumption was available from food frequency questionnaires. Participants who consumed one or more drinks of diet or regular soda per day had a 50 to 60 percent increased risk for developing new-onset metabolic syndrome. It didn’t matter whether it was a diet or regular soft drink.

Results also were not driven by the dietary pattern of soft drink users, i.e, by other food items that are typically consumed along with soft drinks,” The researchers adjusted the analyses for saturated fat and trans fat intake, dietary fiber consumption, total caloric intake, smoking and physical activity, and still observed a significant association of soft drink consumption and risk of developing the metabolic syndrome and multiple metabolic risk factors.”

There are number theories as to what is the cause for this observation. Future studies will be needed to identify the causal relationship between soda consumption and its associated health issues.

For a free brochure about the American Heart Association’s diet and nutrition recommendations called “Making Healthy Food and Lifestyle Choices: Our Guide for American Adults,” call 1-800-AHA-USA1.

Re-Introduction!
It has been a very long time since we have published our newsletter. The delay has in part been caused by unexpected circumstances that were brought on our staff, surgeons and the practice. I would like to take this opportunity to thank you for your understanding and patience. There are a number of new and very interesting developments that we are incorporating in our practice. Some of the more obvious ones are the changes in our newsletter and our website. We are incorporating an interactive media section, which will contain video of operations that we perform. There is also a new “Frequently Asked Question” section being added to our website. We have also started offering the Lap Band®, and StomaphyX as an alternative weight loss surgical procedures. I would like to thank Dawn Keshishian, yes my lovely wife, for her incredible work for raising our twin boys, in addition to her contribution to the newsletter. I would also like to acknowledge and thank the effort and work that Vicki Blackburn has placed for compiling much valuable information.
Ara Keshishian, MD, FACS

New Surgical Procedures

We have started offering Lap Band® and StomaphyX as additional surgical procedures for treatment of morbid Obesity. Each one of these procedures in addition to the Duodenal Swtich operation that we perform, provide a wide spectrum of options for patients. Each procedure has its own risks and benefits. Each patient will be closely examined and individual recommendation be made in each in case.

Moderate Exercise Yields Big Benefits

Moderately strenuous exercise, about 30 minutes a day, can lead to enormous benefits in terms of your mood, health, weight and the ability to live an independent and fulfilling life. The exercise doesn’t need to be athletic or difficult. Studies have shown that simply walking at a brisk pace for 30 minutes or more on most days can lead to significant health improvements. Add simple strengthening exercises two or three times a week and the benefits are even greater. The January issue of Mayo Clinic Health Letter lists some of the benefits of 30 minutes of exercise a day:

• Lower blood pressure: A reduction of 5 to 10 millimeters of mercury (mm Hg) is possible. In some cases, that’s enough to prevent or reduce the need for blood pressure medications.
• Improve cholesterol: Exercise often increases the concentration of high-density lipoprotein (HDL or “good” cholesterol in the blood), especially when accompanied by weight loss. Exercise also helps reduce triglyceride levels.
• Prevent or manage type 2 diabetes: Exercise helps insulin work better, lowering blood sugar.
• Manage weight: Coupling exercise with a healthy diet is the best way to shed fat and maintain a healthier body composition.
• Prevent osteoporosis: Exercise may increase bone density and protect against bone mass decline, especially if weight-bearing activities are involved.
• Prevent cancer: Exercise has been shown to strengthen the immune system, improve circulation, reduce body fat and speed digestion. Each has a role in preventing cancer, particularly cancers of the colon, prostate, uterine lining and breast.
• Maintain mental wellbeing: Exercise may help reduce stress, improve mild-to-moderate depression and anxiety, improve sleep and boost moods.
• Increase energy and stamina: A lack of energy often results from inactivity, not age.

Moderate Exercise Can Improve Sleep Quality Of Insomnia Patients

An acute session of moderate aerobic exercise, but not heavy aerobic or moderate strength exercises, can reduce the anxiety state and improve the sleep quality of insomnia patients, according to a research abstract that will be presented on June 11 at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by Giselle S. Passos, of Federal University of Sao Paulo in Brazil, focused on 36 patients (eight men and 28 women) with primary chronic insomnia, who were divided into three experimental groups (moderate aerobic exercise, heavy aerobic exercise, and moderate strength exercise) and a control group.

According to the results, after the exercise session, reductions were shown in sleep onset latency (54 percent) and wake time (36 percent) in the moderate aerobic exercise group, while increases were shown in total sleep time (21 percent) and in sleep efficiency (18 percent). A significant increase in the total sleep time (37 percent) and reduction in the sleep onset latency (40 percent) were observed in the sleep log of volunteers of the moderate aerobic exercise group. Finally, a significant reduction (seven percent) in the anxiety state was also observed after moderate aerobic exercise session.

“These findings indicate that there is a way to diminish the symptoms of insomnia without using medication,” said Passos. “This study is the first to look at the importance of using physical exercise to treat insomnia, and may contribute to increased quality of life in people with one of the most important kind of sleep disorders around the world.”

Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder. About 30 percent of adults have symptoms of insomnia. It is more common among elderly people and women.

The above articles were from www.sciencedaily.com