Bariatric Journal

Welcome back to another episode of “Health Breakthroughs,” where we explore the latest in medical innovation. Today, we’re diving into something that could be a game-changer for millions of people living with type 2 diabetes – a new outpatient endoscopic treatment called ReCET.Rewiring the GutType 2 diabetes has traditionally been managed with medications – pills, injections, insulin – all targeting symptoms. But what if we could go to the source of the problem and start fixing things upstream?That’s exactly what ReCET – short for Re-cellularization via Electroporation Therapy – aims to do. It’s a cutting-edge, non-thermal endoscopic procedure that targets the duodenum, the first part of the small intestine. And no, it doesn’t burn or cut – it uses pulsed electrical fields to regenerate the tissue.So how does it work?* The entire procedure currently takes 30 to 60 minutes, but the goal is to bring it down to just 20 minutes in the future.* It’s outpatient, meaning you can go home the same day.* It’s designed to restore healthy signaling in the gut, which influences how your body manages sugar, insulin, and fat storage.Dr. Barham Abu Dayyeh, who presented this at Digestive Disease Week 2025, describes the duodenum as the “conductor of the metabolic orchestra.”Right now, diabetes treatments focus on fixing individual instruments – like the pancreas or liver. But what if the real solution is to get the conductor back in rhythm?Thanks for reading Bariatric Journal! This post is public so feel free to share it.What did the results show?In a recent clinical trial called REGENT-1, involving 51 people with type 2 diabetes:* HbA1c dropped significantly at 12 and 48 weeks – up to 1.7 percentage points in some patients.* Insulin sensitivity skyrocketed, improving by nearly 5-fold.* Beta-cell function – how well your pancreas makes insulin – also improved.* Weight loss occurred across all groups, especially those receiving higher energy doses.* No serious side effects linked to the device or the procedure.And here’s a shocker:Compared to medications like semaglutide or tirzepatide, ReCET showed better improvement in insulin sensitivity and overall metabolic function in some categories. That’s impressive.What’s the vision for the future?Dr. Abu Dayyeh sees this becoming as routine as a colonoscopy. Primary care doctors or endocrinologists might refer patients to a GI specialist, who performs the procedure and sends them back with a simpler treatment plan – maybe even fewer meds or no insulin at all.Importantly, ReCET isn’t meant to replace medication but to enhance and complement it – especially for those early in their diabetes journey or struggling with control.What’s next?* A large randomized, sham-controlled clinical trial is already underway, with results expected by late 2026.* If successful, ReCET could reshape how we think about type 2 diabetes – not just as a chronic condition to manage, but one we can possibly reverse or modify at its root.Final Thoughts:We’re entering an era where minimally invasive gut-based therapies might rival traditional medications. ReCET offers real hope – not just to lower blood sugar, but to tackle the deeper dysfunction behind type 2 diabetes.Stay tuned, because this is just the beginning of a fascinating new chapter in metabolic health.Thanks for listening. Until next time, stay healthy and stay curious. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

Hello and welcome to our podcast dedicated to exploring innovative solutions in weight management. Today, we’re delving into a groundbreaking procedure that’s making waves in the medical community: Gastric Fundus Mucosal Ablation, or GFMA. This non-surgical technique offers hope for those seeking effective weight loss without the invasiveness of traditional surgery.The Challenge of ObesityObesity is a chronic condition affecting millions worldwide. Traditional methods like diet and exercise often fall short, and while bariatric surgery has been effective, it’s not suitable for everyone due to its invasive nature and potential risks. This gap has led researchers to seek alternative solutions that are both effective and less invasive.Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.Introducing GFMAGFMA is an endoscopic procedure targeting the stomach’s fundus—the upper part responsible for producing the hunger hormone ghrelin. By ablating, or carefully destroying, the mucosal lining of the fundus, GFMA aims to reduce ghrelin levels, thereby decreasing appetite and promoting weight loss. The procedure is performed using an endoscope inserted through the mouth, eliminating the need for external incisions.How GFMA WorksDuring GFMA, a specialized device delivers controlled thermal energy to the fundus’s mucosal layer. This process reduces the number of ghrelin-producing cells, leading to a significant drop in hunger signals. Additionally, the ablation causes the fundus to become less expandable, meaning patients feel full with smaller food portions.Clinical Trials and FindingsRecent studies, including the ABLATE I and II trials, have shown promising results:* Weight Loss: Patients experienced an average total body weight loss of 8% within six months post-procedure.* Hormonal Changes: Ghrelin levels decreased by approximately 48%, correlating with reduced appetite.* Stomach Capacity: There was a 42% reduction in gastric capacity, contributing to earlier satiety.* Safety: The procedure demonstrated a strong safety profile, with most patients experiencing only mild, short-term discomfort.Combining GFMA with ESGEndoscopic Sleeve Gastroplasty (ESG) is another non-surgical procedure that reduces stomach volume. When combined with GFMA, the duo has shown enhanced results:* Weight Loss: Patients achieved up to 24% total body weight loss, comparable to surgical sleeve gastrectomy.* Appetite Control: The combination led to sustained reductions in hunger and improved portion control.* Safety and Recovery: Like GFMA alone, the combined procedure is minimally invasive with a quick recovery time.Advantages Over Traditional SurgeryGFMA, especially when combined with ESG, offers several benefits over traditional bariatric surgery:* Non-Invasive: No external incisions mean reduced risk of complications and scarring.* Quick Recovery: Most patients return home the same day and resume normal activities shortly after.* Hormonal Balance: Targeting ghrelin production addresses the root cause of hunger, leading to more sustainable weight loss.* Flexibility: The procedure can be repeated or adjusted as needed, offering a customizable approach to weight management.Thanks for reading Bariatric Journal! This post is public so feel free to share it.Future Implications and Ongoing ResearchThe success of GFMA has spurred further research into its applications:* MAINTAIN Trial: Investigating GFMA’s role in maintaining weight loss after discontinuing GLP-1 medications like semaglutide.* REVAMP Trial: Exploring GFMA as a solution for patients who have regained weight after sleeve gastrectomy.These studies aim to solidify GFMA’s place in the spectrum of weight management options, offering hope to those seeking alternatives to surgery or long-term medication use.Conclusion:Gastric Fundus Mucosal Ablation represents a significant advancement in non-surgical weight loss treatments. By directly addressing the hormonal drivers of hunger, GFMA offers a promising solution for sustainable weight management. As research continues, this procedure may become a cornerstone in the fight against obesity, providing patients with effective, less invasive options for achieving their health goals.Thank you for joining us on this exploration of GFMA. Stay tuned for more insights into the evolving world of weight management solutions.Sources:* Istanbul Bariatric Center. (2025). Gastric Fundus Mucosal Ablation (GFMA) Latest News. Retrieved from Istanbul Bariatric Center* True You Weight Loss. (2024). Gastric Fundus Mucosal Ablation (GFMA). Retrieved from True You Weight Loss* Business Wire. (2024). True You Weight Loss Announces Two Clinical Trials Exploring Groundbreaking Non-Surgical Weight Loss Procedures. Retrieved from Business WireIf you have any questions or would like more information on GFMA or other weight management options, feel free to reach out to us. Your journey to better health is important, and we’re here to support you every step of the way. This is a public episode. 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In science and medicine, the most dramatic explanations often grab headlines – but they can sometimes be wrong. Two classic examples are the mid-20th-century diet-heart hypothesis and early psychoanalytic theory. In the 1950s–60s, researchers convinced the world that saturated fat was the villain behind heart disease, leading governments and food makers to push low-fat diets. Meanwhile, Sigmund Freud’s psychoanalysis – with its emphasis on childhood trauma and unconscious drives – dominated psychology, sidelining Alfred Adler’s more future-oriented ideas. In both cases, decades of public policy, clinical practice and cultural belief were shaped by a compelling but oversimplified cause. Over time we’ve learned these theories were misleading: sugar and other carbohydrates, not just fat, were fueling obesity and diabetes, and goal-driven therapies (like CBT and Adlerian “individual psychology”) often serve patients better than digging endlessly into the past. These stories remind us that early science can latch onto a single, dramatic cause and stay on it for decades, with far-reaching consequences.Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.1. The Fat Fallacy: Keys, Low-Fat Diets, and the Obesity SurgeIn the post-war era, heart disease was skyrocketing. A 1951 survey called body fat “America’s ‘primary public health problem’.” In 1952 President Eisenhower’s heart attack made heart disease a national crisis . Nutritionists scrambled to explain why. In 1958 Ancel Keys launched his famous Seven Countries Study – a large survey of heart disease risk factors – and emerged as the loudest voice blaming saturated fat. Keys famously concluded that “fat was to blame” for heart disease and that only a low-fat diet would reverse the trend . At around the same time, British researcher John Yudkin noticed that countries with high sugar intake also had high heart disease rates and argued that sugar (sucrose) was a major culprit .Initially Yudkin even admitted both fat and sugar might play roles . But Keys was adamant that fat alone drove the epidemic. Yudkin later accused Keys of “cherry-picking” data to support his low-fat view . By the 1960s–70s, the idea “fat = bad” had won the day: public health guidelines and doctors told everyone to slash butter, eggs and meat fat out of their diets. The food industry rushed to replace fat with cheap carbs; low-fat products were sweetened heavily with sugar to taste good . In a sense, the sugar industry got what it wanted: by promoting the fat hypothesis, sugar became the “hidden” culprit (even as fat got demonized).Over the same decades, obesity and related diseases exploded. US obesity rates more than tripled since the 1960s.Globally the picture was similar. World Health Organization reports show adult obesity nearly tripled from 1975 to 2016 . By 2016 some 650 million adults (≈13% of the world’s population) were obese . If trends continued, models predicted over a billion obese by 2025 . In the US today roughly 42% of adults are obese , up from ~13% in the early 1960s . During these decades many Americans dutifully followed low-fat advice – eating fat-free cookies and high-sugar cereals – while gaining weight.Why didn’t cutting fat stop the epidemic? Modern evidence suggests Keys’s theory was over-simplified. A growing body of research now points to refined carbohydrates and sugar (not fat) as major drivers of obesity, diabetes and heart disease. A 2023 review notes that clinical trials “could never establish a causal link” between saturated fat and heart attacks, and in fact concluded that saturated fats have “no effect on cardiovascular disease” or mortality . In other words, decades of guidelines capping fat intake are being re-evaluated. At the same time, sugar’s dangers have gained renewed attention. The World Health Organization now recommends cutting “free sugars” to under 10% of calories (5% ideal) because excess sugar intake promotes obesity and heart disease . In short, the dramatic focus on fat led us to ignore the growing evidence on sugar – and millions consumed low-fat/high-sugar foods that may have worsened weight gain and metabolic health.This history wasn’t a conspiracy of ignorance – though industry influence played a role. In fact, internal documents reveal that the sugar industry actively paid for early research to downplay sugar’s risks. In the 1960s the Sugar Research Foundation funded Harvard researchers who published a landmark 1967 review in the New England Journal of Medicine, concluding that lowering cholesterol (by cutting fat) was the only dietary fix . That review conveniently dismissed evidence implicating sugar . More recently, uncovered archives show the industry had privately sponsored this work to protect its product . The result: public health messages and food policies were skewed. As one nutrition historian observes, the 1960s–70s saw an obsession with “single nutrient” explanations (good fat vs. bad fat) while “overall attention unquestionably focused on fat” , largely ignoring sugar.Thanks for reading Bariatric Journal! This post is public so feel free to share it.In summary, the Keys era pressed a simple, dramatic culprit (fat) for complex diseases, with huge fallout: low-fat nutrition guidelines, sugar-laden diets, and a continuing obesity epidemic. Only after decades did researchers start correcting course. Modern reviews now urge a balanced view: replace refined carbs with whole foods, and recognize that sugar is a prime factor in today’s health crisis . This reversal shows how a powerful but narrow theory can mislead for generations.2. Freud’s Empire and the Overlooked Adlerian WayAt roughly the same time diet fads were taking hold, psychology was under the sway of another grand narrative. Sigmund Freud (1856–1939), an Austrian neurologist, founded psychoanalysis and became one of the century’s most famous thinkers. His revolutionary idea was that unconscious drives and childhood experiences – especially repressed sexual and aggressive impulses – shape all behavior . In the late 1800s and early 1900s Freud developed techniques like free association and dream analysis to uncover these hidden conflicts . His model of the mind (id, ego, superego) and notions like the Oedipus complex became deeply influential. As a historian notes, Freud’s impact on psychology was so huge that “throughout his life… he worked fervently… His impact on shaping the theoretical and practical approaches to the human mind… cannot be understated” . By mid-century psychoanalysis was the go-to theory for mental illness: many therapists believed that resolving past traumas was the key to treating depression, anxiety, neuroses and more.But Freud was not alone. Among his early circle was Alfred Adler (1870–1937). Adler co-founded the Vienna Psychoanalytic Society with Freud, but in 1911 he broke away from Freud’s theories to form “Individual Psychology” . Adler rejected Freud’s emphasis on sexual drives and inner conflict. Instead, he saw people as primarily goal-directed and motivated to achieve significance and social connection. Adler focused on concepts like “striving for superiority” and “social interest,” believing that we compensate for feelings of inferiority by setting future goals and cooperating with others. For example, Adler stressed empowering children – helping them build confidence and tackle life tasks – rather than endlessly dissecting their childhood guilt or fear . He famously said that healthy growth comes from feeling connected and useful in a community, not from reliving past injuries.Despite Adler’s insights, Freud’s personality and followers dominated the field. In the 1920s–50s, psychoanalysis grew into a massive movement (with institutes, journals and popular culture references), while Adlerian ideas remained on the fringe. Adler’s own biography notes that when he lectured in the US in the 1930s, “his followers found substantial re… This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

We explore the increasing prevalence of reflux following bariatric surgery, such as sleeve gastrectomy and gastric bypass in this article. It details the multifaceted causes, encompassing behavioural factors like diet, physiological changes in the lower esophageal sphincter, and anatomical issues including hiatal hernias.The article outlines various diagnostic approaches, from endoscopy and imaging to manometry, and discusses a range of treatment strategies, from conservative management (dietary changes and medication) to surgical interventions and revisions. A personalised approach, considering individual patient factors and employing a multidisciplinary team, is emphasised for successful management. Finally, ongoing research and evolving treatment options are highlighted.Understanding and Managing Reflux After Bariatric SurgeryThe rise of obesity surgeries has led to more individuals experiencing reflux after these procedures. This post explores the complexities behind post-bariatric reflux and outlines strategies for managing it effectively.The Rising Incidence of Reflux Following Bariatric ProceduresBariatric surgery, including sleeve gastrectomy and gastric bypass, can lead to reflux. Studies show that rates of reflux can vary widely, from 6% to 28%. Understanding why this happens is key for successful patient care since managing reflux is not just about addressing heartburn.The Multifactorial Etiology of Post-Bariatric Reflux: Beyond Simple HeartburnReflux after bariatric surgery is often due to multiple factors:* Behavioral Factors: What patients eat and how they eat significantly impact reflux symptoms. Bulky carbs, carbonated drinks, and improperly chewed food can all contribute.* Physiological Changes: Alterations in the function of the lower esophageal sphincter (LES) and the stomach's receptive relaxation may lead to symptoms.* Anatomic Factors: Problems like hiatal hernias and retained fundus can aggravate reflux.A thorough evaluation is necessary to guide treatment plans tailored to each patient’s unique circumstances.Reflux After Sleeve Gastrectomy: Identifying and Addressing Underlying CausesCommon Contributing Factors: Behavioral, Physiological, and AnatomicBehavioral Factors: Dietary Habits and Eating PatternsWhat patients consume affects their reflux. For instance, excessive intake of tough meats or not separating solids and liquids can worsen symptoms.Physiological Changes: Alterations in LES Function and Receptive RelaxationAfter a sleeve gastrectomy, patients may experience changes in LES function, leading to increased reflux.Anatomic Factors: Hiatal Hernia, Staple Line Migration, and Retained FundusHiatal hernias, issues with staple line positioning, or enlarged retained fundus can all play a role in reflux development.Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.Diagnostic Approaches and Imaging TechniquesEndoscopy: Visualizing Anatomic Abnormalities and Ruling Out Barrett's EsophagusEndoscopic evaluations help identify anatomical problems and exclude serious conditions like Barrett's esophagus.Upper GI Series and CT Scans: Identifying Subtle Hiatal Hernias and StenosisThese imaging techniques reveal hidden issues like hiatal hernias or obstructions not visible in standard tests.Manometry and pH Testing: Assessing Motility and Pathologic RefluxThese tests measure the pressure and acidity in the esophagus, providing insights into reflux causes.Treatment Strategies: From Conservative Management to Surgical RevisionConservative Management: Dietary Modification, PPI Trials, and Behavioral InterventionsLifestyle changes and medications, such as proton pump inhibitors (PPIs), can alleviate symptoms for many.Endoscopic Interventions: Seromyotomy for Long Segment StricturesFor strictures, endoscopic interventions may help restore normal function.Surgical Interventions: Hiatal Hernia Repair, Fundoplication, and Conversion to Gastric BypassIn persistent cases, surgical options like hiatal hernia repair or conversion to gastric bypass can be considered.Reflux After Gastric Bypass: A Different Approach to Diagnosis and ManagementUnique Challenges: The Role of Anatomic Factors and Surgical PathologyReflux following gastric bypass often involves unique challenges due to anatomic complications.Hiatal Hernia and Pouch-Related Issues: Size, Outlet Obstruction, and TorsionA large pouch can cause outlet obstruction, leading to reflux symptoms.Anastomotic Strictures and Gastrogastric Fistulas: Impact on Gastric Emptying and RefluxStrictures and fistulas at the surgical connection site can hinder gastric emptying, aggravating reflux.Roux Limb Length and Bile Reflux: Implications for Nutrient Absorption and Gastric ContentShort Roux limbs can lead to bile reflux, complicating the situation further.Diagnostic Workup: Prioritizing Anatomic EvaluationEndoscopy: Assessing Anastomotic Integrity, Pouch Size, and Bile RefluxEndoscopy is essential for examining the anastomosis to ensure there are no blockages or abnormalities.Imaging Studies: CT Scans to Visualize Pouch Size, Hernias, and ObstructionsCT scans help visualize potential issues that may contribute to reflux.Upper GI Series: Identifying Gastric Outlet Obstruction and Small Bowel IssuesThis test is useful for spotting blockages in the gastric outlet or small bowel.Management Options: Surgical Revision and Addressing Specific Anatomic ProblemsRevisional Surgery: Anastomotic Revision, Pouch Downsizing, and Roux Limb LengtheningRevising the surgical connection or adjusting the pouch size can address unresolved reflux issues.Endoscopic Interventions: Dilatation of Strictures, and Management of Gastrogastric FistulasEndoscopic methods can help with strictures or fistulas, improving the situation.Addressing Bile Reflux: Roux Limb Lengthening and Bilio-Pancreatic Limb ReimplantationIn cases of bile reflux, lengthening the Roux limb or re-implanting the digestive limb may be necessary.The Role of Endoscopy in Diagnosing and Managing Post-Bariatric RefluxThe Importance of Endoscopic Evaluation in Both Sleeve and Bypass PatientsEndoscopy plays a crucial role in diagnosing reflux and any accompanying complications.Identifying Anatomic Abnormalities and Surgical Pathology During EndoscopyDuring these evaluations, surgeons can address specific anatomical issues contributing to reflux.The Rising Importance of Endoscopic Surveillance for Barrett's EsophagusRegular surveillance can catch early signs of Barrett's esophagus, a potential precursor to cancer.The Algorithm for Managing Reflux After Bariatric Surgery: A Step-by-Step ApproachInitial Evaluation: Comprehensive History, Dietary Assessment, and Symptom JournalingA thorough assessment, including dietary logs, helps identify potential triggers and patterns.Diagnostic Testing: Tailored Approach Based on Clinical Presentation and Initial FindingsTesting must be customized based on initial patient findings to ensure effective diagnosis.Treatment Strategy: Conservative Measures Versus Surgical Intervention, Based on DiagnosisTreatment options vary from dietary changes to surgical interventions, guided by specific diagnoses.Conclusion: Personalized Approach to Post-Bariatric Reflux ManagementReflux after bariatric surgery requires a careful, individualized approach.Key Takeaways: Comprehensive Evaluation, Multidisciplinary Approach, and Surgical Options for Intractable CasesPatients must undergo thorough evaluations, with a team-based approach for lasting success.Future Directions: Ongoing Research and Evolving Treatment StrategiesAs research continues, new treatment strategies may emerge, enhancing patient care and outcomes. 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Sleep deprivation significantly impacts health, causing insulin resistance and metabolic dysfunction. Research reveals that insufficient sleep disrupts glucose metabolism, leading to pre-diabetic states and increased calorie consumption. Studies on animals and humans show physical damage within the brain, including cellular debris, even after recovery sleep. The complex interplay of these effects makes finding effective therapies besides sleep itself a considerable challenge.Sleep deprivationMillions of people who suffer sleep problems also suffer myriad health burdens. In addition to emotional distress and cognitive impairments, these can include high blood pressure, obesity, and metabolic syndrome. ‘In the studies we’ve done, almost every variable we measured was affected. There’s not a system in the body that’s not affected by sleep,’ says University of Chicago sleep researcher Eve Van Cauter. ‘Every time we sleep-deprive ourselves, things go wrong.’A common refrain among sleep scientists about two decades ago was that sleep was performed by the brain in the interest of the brain. That wasn’t a fully elaborated theory, but it wasn’t wrong. Numerous recent studies have hinted at the purpose of sleep by confirming that neurological function and cognition are messed up during sleep loss, with the patient’s reaction time, mood, and judgement all suffering if they are kept awake too long. In 1997, Bob McCarley and colleagues at Harvard Medical School found that when they kept cats awake by playing with them, a compound known as adenosine increased in the basal forebrain as the sleepy felines stayed up longer, and slowly returned to normal levels when they were later allowed to sleep.McCarley’s team also found that administering adenosine to the basal forebrain acted as a sedative, putting animals to sleep. It should come as no surprise then that caffeine, which blocks adenosine’s receptor, keeps us awake. Teaming up with Basheer and others, McCarley later discovered that, as adenosine levels rise during sleep deprivation, so do concentrations of adenosine receptors, magnifying the molecule’s sleep-inducing effect. ‘The brain has cleverly designed a two-stage defence against the consequences of sleep loss,’ McCarley says. Adenosine may underlie some of the cognitive deficits that result from sleep loss. McCarley and colleagues found that infusing adenosine into rats’ basal forebrain impaired their performance on an attention test, similar to that seen in sleep-deprived humans. But adenosine levels are by no means the be-all and end-all of sleep deprivation’s effects on the brain or the body.Over a century of sleep research has revealed numerous undesirable outcomes from staying awake too long. In 1999, Van Cauter and colleagues had eleven men sleep in the university lab. For three nights, they spent eight hours in bed, then for six nights they were allowed only four hours (accruing what Van Cauter calls a sleep debt), and then for six nights they could sleep for up to twelve hours (sleep recovery). During sleep debt and recovery, researchers gave the participants a glucose tolerance test and found striking differences. While sleep deprived, the men’s glucose metabolism resembled a pre-diabetic state. ‘We knew it would be affected,’ says Van Cauter. ‘The big surprise was the effect being much greater than we thought.’Subsequent studies also found insulin resistance increased during bouts of sleep restriction, and in 2012, Van Cauter’s team observed impairments in insulin signalling in subjects’ fat cells. Another recent study showed that sleep-restricted people will add 300 calories to their daily diet. Echoing Van Cauter’s results, Basheer has found evidence that enforced lack of sleep sends the brain into a catabolic, or energy-consuming, state. This is because itdegrades the energy molecule adenosine triphosphate (ATP) to produce adenosine monophosphate and this results in the activation of AMP kinase, an enzyme that boosts fatty acid synthesis and glucose utilization.‘The system sends a message that there’s a need for more energy,’ Basheer says. Whether this is indeed the mechanism underlying late-night binge-eating is still speculative. Within the brain, scientists have glimpsed signs of physical damage from sleep loss, and the time-line for recovery, if any occurs, is unknown. Chiara Cirelli’s team at the Madison School of Medicine in the USA found structural changes in the cortical neurons of mice when the animals are kept awake for long periods. Specifically, Cirelli and colleagues saw signs of mitochondrial activation – which makes sense, as ‘neurons need more energy to stay awake,’ she says – as well as unexpected changes, such as undigested cellular debris, signs of cellular aging that are unusual in the neurons of young, healthy mice.‘The number [of debris granules] was small, but it’s worrisome because it’s only four to five days’ of sleep deprivation,’ says Cirelli. After thirty-six hours of sleep recovery, a period during which she expected normalcy to resume, those changes remained. Further insights could be drawn from the study of shift workers and insomniacs, who serve as natural experiments on how the human body reacts to losing out on such a basic life need for chronic periods. But with so much of our physiology affected, an effective therapy − other than sleep itself – is hard to imagine. ‘People like to define a clear pathway of action for health conditions,’ says Van Cauter. ‘With sleep deprivation, everything you measure is affected and interacts synergistically to produce the effect.’ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

We would like to discuss the potential of weight loss injections, such as semaglutide and tirzepatide, as an alternative to obesity surgery. Whether these medications might eventually replace or diminish the role of surgery, discussing factors like patient suitability, cost, and long-term effectiveness. While these medications demonstrate promising weight loss results, particularly when compared to gastric band surgery, they still fall short of the effectiveness of procedures like sleeve gastrectomy and bypass. Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.The article highlights that surgery remains the preferred option for patients with extremely high BMIs, those requiring rapid weight loss, and those who have not responded well to medication. The article concludes that a combination of approaches, including lifestyle changes, medication, and surgery, may be necessary for sustainable weight management.Effectiveness: While GLP-1 analogs like semaglutide and tirzepatide are effective for weight loss, obesity surgery generally results in greater weight reduction. Tirzepatide, for example, can lead to an average weight loss of 23%, while sleeve gastrectomy or bypass surgery can achieve 30%-35% weight loss. However, GLP-1 analogs are comparably effective to gastric band surgery.Sustainability: Weight loss achieved through surgery is considered more sustainable than weight loss from medication.This is because medications only work as long as they are taken, while surgical alterations are more permanent. With drug therapy, sustainability relies on continued medication use combined with lifestyle changes. However, the long-term sustainability (10-20 years) of GLP-1 analogs is still unknown as these medications haven't been available for that long.Patient suitability plays a significant role in determining the best approach. For individuals with a BMI over 50 or those requiring rapid weight loss for medical reasons, surgery may be more appropriate.Cost is another factor to consider. While bariatric surgery is usually covered by insurance in Germany, GLP-1 analogs are not, making surgery a more accessible option for many patients.Combination therapy is possible. GLP-1 analogs can be used before surgery to reduce surgical risks and after surgery to minimise weight regain.Ultimately, the choice between GLP-1 analogs and obesity surgery depends on individual patient characteristics, needs, and circumstances.To read the article: Could weight loss medications replace bariatric surgery?Advantages and Disadvantages of Using GLP-1 Analogs Before Bariatric SurgeryThe sources offer some insights into the potential advantages and disadvantages of using GLP-1 analogs prior to bariatric surgery.Advantages:Reduced Surgical Risks: The sources suggest that using GLP-1 analogs like semaglutide before bariatric surgery can be beneficial in reducing surgical risks by facilitating weight loss before the procedure.Improved Surgical Outcomes: Although not explicitly stated in the sources, weight loss achieved through GLP-1 analogs before surgery may potentially lead to improved surgical outcomes. This is because a lower BMI often correlates with fewer complications and better recovery.Patient Preparation and Motivation: While not mentioned in the sources, initiating GLP-1 analog treatment prior to surgery could provide patients with an opportunity to adjust to lifestyle modifications necessary for long-term weight management, thus potentially enhancing their preparedness and motivation for post-surgery success.Disadvantages:Cost and Access: The sources highlight that access to GLP-1 analogs is limited, particularly in Germany, where health insurance does not cover the costs. This financial barrier might make pre-surgical use of these medications inaccessible for many patients.Delayed Surgery: Initiating GLP-1 analog treatment before surgery would inevitably delay the surgical procedure. This delay might be detrimental for patients requiring rapid weight loss for urgent medical reasons.Potential for Inadequate Response: It's important to consider that not all patients respond equally well to GLP-1 analogs. For some, the weight loss achieved through medication alone might be insufficient to warrant delaying surgery, particularly if they are good candidates for the procedure.Conclusion:Using GLP-1 analogs before bariatric surgery presents potential advantages, such as reduced surgical risks and potentially improved outcomes. However, disadvantages like cost barriers and potential treatment delays must be considered. The decision to use GLP-1 analogs pre-surgery should be made on a case-by-case basis, taking into account individual patient characteristics, needs, and access to these medications.Remember to consult a healthcare professional for personalised advice and guidance on this matter. Click for a free Consultation This is a public episode. 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SummaryA recent study by the Bariatric and Obesity Metabolic Surgery Society (BOMSS) has revealed that bariatric tourism, where individuals travel abroad for weight-loss surgery, is costing the UK's National Health Service (NHS) significantly more than the cost of performing the surgery itself. The study, which followed 35 patients who experienced complications after bariatric surgery abroad, found that the average cost of treating these complications was £16,006 per patient, a figure that could have funded 110 bariatric surgeries in the UK. This has prompted concerns about the NHS's role in providing care for patients who undergo surgery abroad, particularly given that many of these patients would not have qualified for surgery in the UK due to not meeting the National Institute for Health and Care Excellence (NICE) criteria. The BOMSS has issued a public warning about the risks of bariatric tourism, urging individuals to carefully consider the potential savings against the risks, and the Department of Health is working to develop advice to inform people about the potential challenges and risks associated with medical tourism.Financial and Healthcare Implications of Bariatric Tourism for the NHSThe sources highlight several financial and healthcare implications of bariatric tourism for the NHS:Increased costs: The NHS incurs significant costs treating complications arising from bariatric surgeries performed abroad. A study of 35 patients in five London hospitals found that the cost of treating complications was £16,006 per patient, totaling £560,234 in 2022. This amount could have funded approximately 110 bariatric surgeries within the UK.Strain on resources: Patients returning with complications from bariatric tourism require extensive medical care, including prolonged hospital stays, further surgeries, and revisional surgeries. The average hospital stay for the 35 patients in the study was 22 days, and five patients required feeding tubes. This influx of patients needing complex care puts additional strain on NHS resources and staff.Ethical considerations: The sources raise ethical questions regarding the NHS's obligation to treat patients who develop complications after undergoing bariatric surgery abroad, particularly when those patients may not have met the criteria for surgery within the NHS. Over half of the 35 patients studied would likely have been ineligible for surgery on the NHS, and almost 60% did not meet the National Institute for Care and Excellent (NICE) criteria. This raises concerns about whether the NHS is inadvertently incentivising bariatric tourism by providing a safety net for patients who experience complications.The sources also outline the reasons behind the rise of bariatric tourism:Long NHS waiting lists: Patients may opt for surgery abroad due to lengthy wait times for bariatric surgery within the NHS.Lower costs: Bariatric surgery is significantly cheaper in countries like Turkey, where it can cost as little as £2,000, compared to £10,000-£15,000 for private surgery in the UK.While the sources acknowledge the NHS's duty to treat patients in need, they also emphasize the need for a broader public policy discussion on how to address the challenges posed by bariatric tourism This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

Summary:Syncope, or fainting, is a common complication after bariatric surgery. It details the risk factors contributing to syncope, including dehydration, electrolyte imbalances, cardiac arrhythmias, and the vasovagal response. The text also discusses the symptoms of syncope, ranging from lightheadedness and dizziness to more serious manifestations like seizures and loss of consciousness. Finally, it provides guidance on treatment and prevention, emphasising the importance of hydration, a healthy diet, avoiding triggers, regular exercise, and adherence to prescribed medications.Syncope After Bariatric SurgerySyncope, also known as fainting, is a temporary loss of consciousness (LOC) that is caused by a brief interruption of blood flow to the brain. It is a common complication after bariatric surgery, occurring in up to 10% of patients. Syncope can be a serious problem, as it can lead to falls, injuries, and even death.There are a number of factors that can contribute to syncope after bariatric surgery, including:* Dehydration: Bariatric surgery can lead to dehydration, which can decrease blood volume and blood pressure. This can make it more difficult for the heart to pump blood to the brain, leading to syncope.* Electrolyte imbalances: Bariatric surgery can also lead to electrolyte imbalances, which can disrupt the heart's electrical activity. This can also lead to syncope.* Cardiac arrhythmias: Bariatric surgery can increase the risk of cardiac arrhythmias, which are abnormal heart rhythms. Cardiac arrhythmias can lead to syncope by causing the heart to stop beating or by causing the heart to beat too slowly or too fast.* Vasovagal response: The vasovagal response is a reflex that causes the blood vessels to dilate and the heart rate to slow down. This can lead to a drop in blood pressure and syncope. The vasovagal response can be triggered by a number of factors, including pain, anxiety, and dehydration.Symptoms of SyncopeThe symptoms of syncope can vary depending on the severity of the episode. Mild episodes may only cause a brief loss of consciousness, while more severe episodes can cause a prolonged loss of consciousness and even seizures.The most common symptoms of syncope include:* Lightheadedness* Dizziness* Nausea* Vomiting* Blurred vision* Confusion* Weakness* Numbness or tingling in the arms or legs* Seizures* Loss of consciousnessTreatment of SyncopeThe treatment of syncope depends on the underlying cause. In most cases, treatment will involve addressing the underlying cause, such as dehydration, electrolyte imbalances, or cardiac arrhythmias.Treatment for syncope may include:* Intravenous fluids: Intravenous fluids can be used to treat dehydration and electrolyte imbalances.* Medications: Medications can be used to treat cardiac arrhythmias and vasovagal responses.* Lifestyle changes: Lifestyle changes, such as increasing fluid intake and avoiding triggers, can help to prevent syncope.Prevention of SyncopeThere are a number of things that can be done to prevent syncope after bariatric surgery, including:* Stay hydrated: Drink plenty of fluids, especially water, before and after surgery.* Eat a healthy diet: Eat a healthy diet that is rich in fruits, vegetables, and whole grains.* Avoid triggers: Avoid triggers that can cause syncope, such as pain, anxiety, and dehydration.* Get regular exercise: Get regular exercise to help improve your overall health and fitness.* Take medications as directed: Take your medications as directed by your doctor.ConclusionSyncope is a common complication after bariatric surgery, but it can be prevented and treated. By following the tips above, you can help to reduce your risk of syncope and improve your overall health and well-being. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) updated guidelines for bariatric surgery, marking a shift from the previous National Institute of Health (NIH) criteria set over 30 years ago. These updates aim to align patient eligibility and care standards with advancements in surgical techniques, patient safety, and new research findings on metabolic and bariatric surgery (MBS) outcomes.This research paper, a collaborative effort between the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders, presents a comprehensive review of the indications for metabolic and bariatric surgery (MBS). Using systematic reviews and a Delphi survey of experts, the paper examines the evidence supporting MBS for various patient populations, including those with different BMIs, age groups, and co-morbidities. The authors analyse the efficacy and safety of MBS in these groups, considering aspects such as weight loss, complications, and resolution of obesity-related conditions. Overall, the paper provides a strong foundation for evidence-based decision-making regarding the use of MBS in clinical practice.Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.Why Update the Guidelines?Since the original 1991 guidelines, bariatric surgery has evolved significantly:• Introduction of less invasive techniques, such as sleeve gastrectomy• Improved patient safety through accreditation and specialized MBS training• Enhanced follow-up care, reducing adverse events and promoting lasting health improvementsThe old NIH criteria, however, remained in use, limiting surgery access for certain patient groups who could benefit from modern bariatric options.Key Changes in the Guidelines1. Expanded Eligibility:• Lower BMI Thresholds: MBS is now recommended for those with a BMI of 30-34.9 if they have Type 2 diabetes or another obesity-related medical condition.• No Comorbidities Required for Higher BMI: Individuals with a BMI of 35-40 can now be considered for surgery even if they don’t have obesity-associated complications, provided they undergo a thorough multidisciplinary assessment.2. Inclusion of the Asian Population:• Given the increased metabolic risks at lower BMIs in Asian populations, the guidelines now recognize a BMI of 25 as a criterion for considering MBS in Asian patients.3. Older Adults:• There is no longer an upper age limit for eligibility, but a patient’s overall health, including frailty, should be assessed to balance surgery benefits against possible risks.Supporting Evidence for ChangesThe updated guidelines are supported by systematic reviews and expert consensus (Delphi surveys), covering:• Comparative studies on MBS outcomes across different BMI ranges• Evidence on remission rates for Type 2 diabetes, hypertension, and weight loss• Nutritional and post-operative complications, indicating specific risks for hypoabsorptive procedures but also clear benefits for most surgery typesOutcomes of Bariatric Surgery According to the New CriteriaThe findings emphasized consistent benefits across different surgical options (e.g., Roux-en-Y, sleeve gastrectomy) with weight loss outcomes meeting or exceeding expectations. The remission rates for Type 2 diabetes and hypertension post-surgery ranged widely, with studies reporting 33-100% and 28-100% remission, respectively.Conclusion: Bariatric Surgery as a Key Treatment for Obesity-Related ConditionsThese guidelines reflect an evolved understanding of obesity’s impact on health, positioning bariatric surgery as a preventative and therapeutic option for a broader patient population. While MBS remains a significant intervention, these guidelines ensure it’s more accessible for patients who can gain long-term health benefits.For a detailed read, refer to the original study in Obesity Surgery here. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com

Sleeve gastrectomy has become one of the most popular bariatric surgeries for treating obesity. Known for its relatively simple approach and effectiveness, this procedure has gained widespread adoption due to its success in helping patients achieve sustainable weight loss and improve overall health.Thanks for reading Bariatric Journal! Subscribe for free to receive new posts and support my work.What Is Sleeve Gastrectomy?In a sleeve gastrectomy, the surgeon removes approximately 80% of the stomach, leaving a tube-shaped “sleeve.” Unlike some other weight-loss surgeries, it doesn’t reroute the intestines, making it less complex and with a shorter surgery time. By reducing stomach capacity, patients feel fuller faster and consume fewer calories, which supports significant weight loss.Benefits of Sleeve Gastrectomy1. Significant Weight Loss: Patients can expect to lose 60-70% of their excess weight within the first 12-18 months.2. Improvement in Obesity-Related Conditions: Many patients see improvements in Type 2 diabetes, high blood pressure, sleep apnea, and more.3. Reduced Hunger: Sleeve gastrectomy decreases the production of ghrelin, a hormone that stimulates hunger, making it easier to manage cravings and adopt a healthier diet.Who Is a Candidate?Sleeve gastrectomy is typically recommended for individuals with a BMI of 40 or higher or a BMI of 35-40 with obesity-related health issues, such as Type 2 diabetes or hypertension. Candidates should also be ready for lifestyle changes that include healthier eating habits, regular exercise, and follow-up care.How the Surgery WorksThe procedure is performed laparoscopically, with small incisions and the aid of a camera. After creating a small “sleeve” of the stomach, the larger section is removed, and the new stomach is sealed. This minimally invasive technique allows for a quicker recovery, often with just 1-2 days in the hospital.Life After SurgeryAfter a sleeve gastrectomy, patients follow a structured diet, beginning with liquids and gradually reintroducing solid foods over several weeks. A key component of post-surgery life is a commitment to a balanced diet, physical activity, and regular medical follow-ups. Patients also need lifelong vitamin and mineral supplements, as their smaller stomachs may limit nutrient absorption.Potential RisksWhile the risks are lower than in more complex procedures, sleeve gastrectomy is still a major surgery with potential complications like infection, bleeding, or acid reflux. Additionally, patients may experience “dumping syndrome” if they consume high-sugar foods, leading to discomfort and nausea.Is Sleeve Gastrectomy Right for You?As with any weight-loss surgery, the decision should be made after a thorough consultation with a bariatric surgeon and understanding the commitment to long-term lifestyle changes. Sleeve gastrectomy is an effective tool, but its success depends heavily on the patient’s adherence to healthy habits and follow-up care. Contact us for a comprehensive evaluation and a free consultation via +44 7491068686Final ThoughtsSleeve gastrectomy can be transformative for individuals struggling with severe obesity, providing a pathway to improved health and well-being. However, it’s essential to approach this surgery as part of a broader commitment to a healthier lifestyle. With proper guidance and support, sleeve gastrectomy patients can enjoy a significantly improved quality of life and manage their weight more effectively over time. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit drmuratustun.substack.com