Iron is critical for the production and action of red blood cells. Deficiency of iron may have many causes. These include bleeding from the GI track, inadequate absorption, inadequate intake, and menstrual losses in females.

Regardless of the underlying cause, chronic deficiency of iron will lead to iron deficiency anemia (IDA).

Normal Iron Ranges:

It’s important to have at least yearly laboratory studies to surveil for abnormalities. Normal results of iron testing may be different for men, women, and children. Iron and TIBC are measured in micrograms per deciliter (mcg/dL). Normal results for iron are:

• 65 to 175 mcg/dL for men
• 50 to 170 mcg/dL for women
• 50 to 120 mcg/dL for children

Normal results for TIBC are 250 to 450 mcg/dL for men and women.

To correct or prevent IDA, iron supplementation is recommend in some patients. Iron absorption is very inefficient. It take a long time to develop IDA and as long if not longer to correct it with oral supplementation. This is why we recommend some patient condor getting iron infusion.

For most, oral supplements are adequate. There are different formulary of iron supplement with varying degree of absorption.

Heme iron  and  iron bisglycinate have been shown to have much better absorption than ferrous sulfate formulary.

This is why we recommend:

Heme Iron or 

Iron bisglycinate.

Endoscopic sleeve gastroplasty (ESG) differs from Laparoscopic sleeve gastrectomy (LSG).

ESG (Endoscopic Sleeve Gastroplasty)  is promoted and advocated as a low-risk, equal alternative to the Laparoscopic Sleeve Gastrectomy, but it is not.

Anatomically speaking:

Endoscopic Sleeve Gastroplasty is an endoscopic procedure performed under general anesthesia. During this procedure, a specialized endoscope is inserted through the mouth into the stomach. Multiple plastic “H”-type anchors are used to create a fold in the stomach, thereby reducing its size. No part of the stomach is removed. Initial limited weight loss occurs as the patient feels full after consuming small volumes of food. This effect resembles what happens with the lap band and gastric balloon, and we know how the story ends with those.

LSG is performed laparoscopically with incisions on the abdomen under general anesthesia. Seventy-five to eighty-five percent of the stomach, along its greater curvature, is removed, eliminating the part of the stomach that produces the Ghrelin hormone, which controls and modulates hunger. This is why patients feel fuller with a smaller volume of food and experience significantly reduced hunger.

Results:

Please read the fine print

The summary results indicate

“Our results suggest that ESG is safe and effective for the treatment of obesity, with durable

long-term results for at least up to 5 years after the procedure. “

When you look at the details of the results, however, it states:

“At 5 years, mean TBWL was 15.9% (95% CI, 11.7-20.5, p < .001) and 90 and 61% of

patients maintained 5 and 10% TBWL, respectively.”

This means that five years after ESG, 90% of the patients have only lost 10% of their TBWL (total body weight loss), and 61% would have lost 10% of their TBW (Total Body Weight).

Let’s do that math: If a patient weighs 250 lbs. and has ESG, five years later, they would have lost only between 5-10% of their TBW. This means that five years after ESG, the patient who started at 250 lbs will weigh between 225 lbs. (250 – 25, 10%) and 235.25 lbs. (250 – 12.5, 5%). Can anyone say why this makes sense? Comparatively the Laparoscopic Sleeve Gastrectomy (LSG) at 5 years after patients typically experience a mean total body weight loss (TBWL) of around a mean of 16% ( 90% of patients). 8% of LSG patients had lost 30% or more of their total body weight TBWL.

This serves as an illustration of how actual outcomes are obscured within the fine print, resulting in a lack of attention from individuals seeking the optimal outcome devoid of perceived risk. The same principle applies to the ongoing discourse regarding GLP-1 medications. The genuine risk associated with ESG and PLG-1 is that patients have undergone alterations to their anatomy and physiology without demonstrable results. Several years into contemplating a treatment promising sustained outcomes, we find that the alterations have increased the overall risk.

As a surgeon, I encourage people to always ask questions and demand that scientific proof be provided. I am not opposed to progress; considering the nature of our practice, we have witnessed and have unrgone significant evolution over the past 30 years, transitioning from performing open cases necessitating a hospitalization period of 4 to 6 days to performing the same cases  laparoscopically and robotically in some cases outpatient procedures.

There are no known contraindications from a weight-loss surgical perspective to prevent a post-surgical patient from getting the COVID vaccines.

A patient who has had a Duodenal Switch, Lap Sleeve Gastrectomy, RNY Gastric Bypass, or revisions to Weight Loss Surgery should have the COVID vaccine. The vaccination should be avoided for a few weeks after surgery. For other possible contraindications, please consult your PCP.

Here is a summary of the vaccines and the details of each one approved as of the publication date.

Physical activity in the U.S. varies based on geographic location, socioeconomic status and in comparison to other countries. It is important to know that physical activity is an important component of our well-being. However, this does not mean that going to the gym is the only way to be physically active.

Strain et al. Shows that different populations in different countries get their activity from different sources.

His research showed that the United States population ranked as a high-income country, ranks in the lower 1/3 of the number of countries surveyed with regards to the meeting minutes of moderate-to-vigorous physical activity (MVPA) per week.  This may be a contributing factor to the significant rise in obesity in the United States. Individually we should all aim to increase our moderate to vigorous activity significantly.

We are excited to announce we will be having a Zoom group meeting Tuesday, September 22, 2020 at 7:00 PM PST.  We hope to see you online!

Registration is required. Please follow the link to the meeting registration.