Obesity surgery-diabetes study shows pros and cons

Obesity surgery worked much better at reducing and even reversing diabetes than medication and lifestyle changes in one of the most rigorous studies of its kind. But the researchers and others warn that possible serious complications need to be considered.

The yearlong study indicates that the most common weight-loss surgery, gastric bypass, can effectively treat diabetes in patients with mild to moderate obesity - about 50 to 70 pounds overweight. Other studies have shown the operation can reverse diabetes in severely obese patients, although sometimes the disease comes back.

About a third of the 60 adults who got bypass surgery in the new study developed serious problems within a year of the operation, though some cases were not clearly linked with the surgery. That rate is similar to what's been seen in previous studies. But for the most serious complications - infections, intestinal blockages and bleeding - the rate was 6 percent, slightly higher than in earlier research.

The most dangerous complication occurred in one patient when stomach contents leaked from the surgery site, leading to an overwhelming infection, leg amputation and brain injury.  A journal editorial says such devastating complications are rare, but that "the frequency and severity of complications ... is problematic" in the study and that the best way to treat patients with both obesity and diabetes "remains unknown."

A research review in the journal said more long-term evidence on risks and benefits is needed to determine if obesity surgery is an appropriate way to treat diabetes in patients who aren't severely obese - at least 100 pounds overweight.

More than 20 million Americans have Type 2 diabetes; most are overweight or obese. Diabetics face increased risks for heart disease and strokes, and poorly controlled diabetes can damage the kidneys, eyes and blood vessels.

About 160,000 people nationwide undergo various types of obesity surgery each year. Bypass surgery, the type studied, involves stapling the stomach to create a small pouch and attaching it to a lower part of the intestines. The American Society for Metabolic & Bariatric Surgery says obesity surgery is safe and that the death rate is less than 1 percent, lower than for gallbladder and hip replacement surgery.

The study involved 120 patients at five hospitals in New York, Minnesota and Taiwan. All patients got medicines for diabetes, obesity, cholesterol and/or high blood pressure. They all were advised to cut calories and increase physical activity.

Sixty patients also had surgery, and the two groups were compared after one year.

The surgery group lost on average nearly 60 pounds and 75 percent lowered blood sugar levels to normal or near normal levels. The non-surgery group lost an average 17 pounds and just 30 percent reached the blood-sugar goal. The surgery group also needed less medication after the operation.

The researchers say the diabetes changes were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed. The surgery group showed a trend toward having less high blood pressure and elevated cholesterol - both major risk factors for heart disease, although those between-group differences could have been due to chance.

12 Possible Heart Symptoms Never to Ignore

Heart Disease
Heart disease is the No. 1 killer of U.S. men and women, accounting for 40% of all U.S. deaths. That's more than all forms of cancer combined.
Why is heart disease so deadly? One reason is that many people are slow to seek help when symptoms arise. Yes, someone gripped by sudden chest pain probably knows to call 911. But symptoms of heart problems aren't always intense or obvious, and they vary from person to person and according to gender.

Heart Disease Warning Signs
Because it can be hard to make sense of possible heart symptoms, doctors warn against ignoring any warning signs, toughing them out, waiting to see if they go away, or being quick to blame them on heartburn, muscle soreness, or other less serious, noncardiac causes. That's especially true for men and people over 65, as well as for people with other cardiac risk factors, such as high cholesterol or blood pressure, obesity, smoking, diabetes, or a family history of heart disease.

Heart Disease Risk Factors
'The more risk factors you have, the higher the likelihood that a symptom means something is going on with your heart,' says David Frid, MD, a cardiologist at the Cleveland Clinic. 'People often don't want to admit that they're old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It's better to go in and get it evaluated than to be dead

Anxiety - Heart attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of 'impending doom.

Chest Discomfort - Pain in the chest is the classic symptom of heart attack, and 'the No. 1 symptom that we typically look for,' says Jean C. McSweeney, PhD, RN, associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock and a pioneer in research on heart symptoms in women. But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart. Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. The pain has been likened to 'an elephant sitting on the chest,' but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. 'It's not unusual for women to describe the pain as a minor ache,' McSweeney says. 'Some women say the pain wasn't bad enough even to take a Tylenol.' Women, more so than men, can also experience a burning sensation in their chest, rather than a pressure or pain. 'Sometimes people make the mistake that the pain comes from a stomach problem,' says Nieca Goldberg, MD, clinical associate professor of medicine at the NYU Langone Medical Center in New York City and another expert on women's heart symptoms.

Cough - Persistent coughing or wheezing can be a symptom of heart failure -- a result of fluid accumulation in the lungs. In some cases, people with heart failure cough up bloody phlegm.

Dizziness - Heart attacks can cause lightheadedness and loss of consciousness. So can potentially dangerous heart rhythm abnormalities known as arrhythmias.

Fatigue - Especially among women, unusual fatigue can occur during a heart attack as well as in the days and weeks leading up to one. And feeling tired all the time may be a symptom of heart failure. Of course, you can also feel tired or fatigued for other reasons. How can you tell heart-related fatigue from other types of fatigue? 'If you don't feel well and all the wind is knocked out of your sails, don't try to figure it out on the Internet or from a book,' says Goldberg. 'Wasting time is dangerous.

Nausea or Lack of Appetite - It's not uncommon for people to feel sick to their stomach or throw up during a heart attack. And abdominal swelling associated with heart failure can interfere with appetite.

Pain In Other Parts of the Body - In many heart attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain -- just pain in these other body areas. The pain might come and go.
Men having a heart attack often feel pain in the left arm. In women, the pain is more likely to be felt in both arms, or between the shoulder blades.

Shortness of Breath - People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a heart attack or heart failure.
"Sometimes people having a heart attack don't have chest pressure or pain but feel extremely short of breath," Goldberg says. "It's like they've just run a marathon when they haven't even moved." During a heart attack, shortness of breath often accompanies chest discomfort, but it can also occur before or without chest discomfort.

Sweating - Breaking out in a cold sweat is a common symptom of heart attack. 'You might just be sitting in a chair when all of a sudden you are really sweating like you had just worked out,' Dr. Frid of the Cleveland Clinic says.

Weakness - In the days leading up to a heart attack, as well as during one, some people experience severe, unexplained weakness. 'One woman told me it felt like she couldn't hold a piece of paper between her fingers,' Dr. McSweeney says."

Equipose 200

Boldenone Undecylenate has become a very popular steroid with athletes and bodybuilders due to the fact that it has very low side effects and has anabolic properties which promote a steady gain in quality muscle mass over time. GP Bold 200 (Boldenone Undecylenate) was tagged with the name Equipose® when it first became available as a veterinary steroid and was widely used in racehorses. Equipose 200 (Boldenone Undecylenate), as it is often called, can be effectively incorporated in both "cutting" and "bulking" cycles due to the well balanced effects of this anabolic substance. GP Bold 200 (Equipoise) aromatizes very little, and therefore produces almost no estrogenic side effects such as water retention or "gyno" (the development of female tissue under the nipples in males resulting in unattractive and often painful lumps in this area), and therefore is a favorite among bodybuilders who are looking to make solid gains without the extra bloat, or are nearing contest. Equipose 200 (Boldenone Undecylenate) also dramatically increases protein synthesis and red blood cell count meaning that nutrients are transported throughout the body much more effectively. Because of this, Equipose® is able to make much more use of less food, enhancing its capabilities as an effective hormone to use when "cutting" and a bodybuilder is trying to reduce calories to get into contest shape. Also, the increased red blood cell count caused by Boldenone Undecylenate also increases oxygen transportation throughout the body, thus giving athletes and bodybuilders much more endurance and the capability to endure cardio sessions for much longer periods of time, which obviously makes Equipose 200 (Boldenone Undecylenate) even more popular among those looking to shed bodyfat. Users of  Equipose 200 (Boldenone Undecylenate) also report a dramatic increase in vascularity, which can also be attributed to the oxidizing benefits of Equipoise. Bodybuilders using Equipose 200 (Boldenone Undecylenate)  in a cutting cycle often look to stack it with an oral steroid such as Stanozolole or Oxandrolone to further increase anabolic activity while keeping estrogenic side effects out of the picture. Equipose 200 (Boldenone Undecylenate) also has properties which make it very favorable amongst Bodybuilders looking to incorporate it into their bulking cycles. Users of Equipose 200 (Boldenone Undecylenate) often report an increase in appetite and the ability to eat more food easily when trying to gain weight in the offseason. The mild nature and steady gains produced by Equipose 200 (Boldenone Undecylenate) also make it very effective for those looking to do longer cycles (12-20 weeks ), where as most users note a continuous gain in muscle mass and strength over this time and credit the steroid with helping the muscles maintain a more defined, vascular tone throughout bulking . Bodybuilders looking for size often stack Equipoise with other anabolic drugs such as a testosterone preparation (GP Test Enanth 250, GP Test Cyp 250, GP Test Prop 100 etc.) and/or Deca-Durabolin . Bodybuilders looking to bulk might also incorporate an oral compound into this stack such as GP Oxan or GP Methan. Women bodybuilders are also fond of Equipoise due to its mild nature and low androgenic properties. The most often side effect of the drug being an increase in libido, women find that the drug rarely causes any masculizing side effects when kept in a reasonable dosage range. Male bodybuilders generally buy Equipose 200 (Boldenone Undecylenate) in doses of 300-800mg's a week for 8-20wks, depending on goals, while women bodybuilders often find a dosage of 50-100mg's a week to be very effective for making quality gains while keeping side effects to a minimum. Equipose 200 (Boldenone Undecylenate) has a long half life (7-10) days and is most commonly injected twice per week to keep blood concentrations as steady as possible.

Do Men's and Women's Hearts Burn Fuel Differently?

Researchers at the University of Illinois at Chicago College of Medicine will study gender differences in how the heart uses and stores fat  -  its main energy source - and how changes in fat metabolism play a role in heart disease.

When stressed, the heart changes how it uses fuel for energy. These changes may play a major role in the development of heart disease and are different in men and women, says E. Douglas Lewandowski, director of the UIC Center for Cardiovascular Research. The changes occur long before any symptoms, he said, and may be key to early diagnosis and treatment.

Lewandowski uses imaging techniques he developed to see fat molecules and the rate at which they are being burned in beating hearts. In healthy hearts, the balance between using fat for energy and storing it in tiny droplets within the cells is in a dynamic equilibrium. 

When a female heart is stressed, such as through chronic disease like hypertension, it becomes much less efficient at metabolizing fat, Lewandowski says. When a male heart is stressed, it starts using more sugar as fuel. These changes in the heart can also affect how fat is stored and used in other parts of the body.

"Because the heart is the body's number-one consumer of fat, when it starts using fat differently, there are consequences throughout the entire body," Lewandowski said. He thinks that changes in fat metabolism in the heart may send out signals to fat cells in other parts of the body to store more fat, and to insulin-producing cells in the pancreas that may trigger the onset of diabetes, which is often present along with heart disease.

Lewandowski will further investigate how gender differences in fat metabolism are related to the development of heart disease in men and women. He will also look at how higher levels of fat accumulation in heart cells may cause stiffness and lower the efficiency of heart muscle contraction. Understanding these changes may help identify targets for therapies, or lead to better diagnostic tests for heart disease.

No More Reflux!!!!

For years, Majed Khalifa's severe reflux prevented him from sleeping at night and, because of his disease, he couldn't even drink coffee to help him get through the day. He was taking medication for gastroesphogeal reflux disease (GERD), and when it stopped working, he decided to try something new.

Dr. Pat Reardon, surgical director of the Reflux Center at The Methodist Hospital in Houston, performed a new minimally-invasive outpatient surgery that ended years of severe discomfort in a matter of hours.

"I literally felt 100 percent better as soon as I got home," Khalifa said. "I haven't had a reoccurrence of reflux symptoms since the surgery and it's been more than a month."

GERD is a chronic, progressive disease that affects millions of people. It results when a bad valve at the lower end of the esophagus gets pulled open too easily from the pressure down below the stomach. The opening of the valve allows the contents of the stomach to wash back into the esophagus causing heartburn, regurgitation, loss of sleep and, in some cases, dietary restrictions.

The new LINX® Reflux Management System from Torax Medical was recently approved by the Food and Drug Administration (FDA) to combat GERD. The system, composed of a small implant made up of intertwined titanium beads with magnetic cores, is designed to prevent the bad valve at the end of the esophagus from opening. The magnetic attraction between the beads allows the food to go by when you eat. The magnets then snap back into place to prevent the valve from being pulled open from below by the stomach.

Coffee and green tea may help lower stroke risk

Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet.

• People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.
• People who drank two to three cups of green tea daily had a 14 percent lower risk of stroke and those who had at least four cups had a 20 percent lower risk, compared to those who rarely drank it.
• People who drank at least one cup of coffee or two cups of green tea daily had a 32 percent lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. (Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13 percent of strokes are hemorrhagic.)

Gene Regulates Heart's Ability to Regenerate After Injuries

 Researchers at UT Southwestern Medical Center have identified a specific gene that regulates the heart's ability to regenerate after injuries.

The function of the gene, called Meis1, in the heart was not known previously. The findings of the UTSW investigation are available online inNature.

"We found that the activity of the Meis1 gene increases significantly in heart cells soon after birth, right around the time heart muscle cells stop dividing. Based on this observation we asked a simple question: If the Meis1 gene is deleted from the heart, will heart cells continue to divide through adulthood? The answer is 'yes'," said Dr. Hesham Sadek, assistant professor of internal medicine in the division of cardiology, and senior author of the study.

In 2011, Dr. Sadek's laboratory showed that the newborn mammalian heart is capable of a vigorous, regenerative response to injury through division of its own cells. As the newborn develops, the heart rapidly loses the ability to regenerate and to repair injuries such as heart attacks.

The research team demonstrated that deletion of Meis1 extended the proliferation period in the hearts of newborn mice, and also re-activated the regenerative process in the adult mouse heart without harmful effect on cardiac functions. This new finding demonstrates that Meis1 is a key factor in the regeneration process, and the understanding of the gene's function may lead to new therapeutic options for adult heart regeneration. The findings also provide a possible alternative to current adult heart regeneration research, which focuses on the use of stem cells to replace damaged heart cells.

"Meis1 is a transcription factor, which acts like a software program that has the ability to control the function of other genes. In this case, we found that Meis1 controls several genes that normally act as brakes on cell division," Dr. Sadek said. "As such, Meis1 could possibly be used as an on/off switch for making adult heart cells divide. If done successfully, this ability could introduce a new era in treatment for heart failure."

Coronary thrombosis

    Coronary thrombosis is a form of thrombosis affecting the coronary circulation.
    A blood clot in the arteries supplying the heart, which can lead to a heart attack. Around 30 per cent are caused by smoking.

Cardiovascular disease

     Cardiovascular disease is one of the main cause of death due to smoking. Hardening of the arteries is a process that develops over years, when cholesterol and other fats deposit in the arteries, leaving them narrow, blocked or rigid.

     When the arteries narrow (atherosclerosis), blood clots are likely to form. Smoking accelerates the hardening and narrowing process in your arteries: it starts earlier and blood clots are two to four times more likely.

     Cardiovasular disease can take several forms depending on which blood vessels are involved, and all of thet forms are more common in people who smoke.

Smoking affects the life span

          Smoking reduces life duration by seven to eight years. More than 300 people dies every day in the UK as a result of smoking, many are comparatively young smokers.

         The number of people under the age of 70 who die from smoking-related diseases exceeds the total figure for deaths caused by breast cancer, AIDS, traffic accidents and drug addiction. Non-smokers and ex-smokers can also look forward to a healthier old age than smokers.