Protein

What is it? Why the heck is it so important? How do I find it? Proteins are made up of long chains of amino acids. There are 22 different types of amino acid and the body needs all of them to function properly. Amino acids are chemical compounds containing carbon, hydrogen, oxygen and nitrogen, which combine together into different structures to form the various types of protein that the body requires.

There are 14 non-essential amino acids. They are termed non-essential as they can be manufactured by the body and do not have to be derived from food. The body, on the other hand, cannot produce the remaining 8 essential amino acids itself, and therefore they must be derived from the food that we eat. Non-essential amino acids are just as important as essential amino acids, as without the other, new proteins that are needed by the body cannot be properly formed. It is therefore vital that a variety of foods are eaten in order to provide the body with all of the amino acids required.

OK, so that's the basic science behind protein. But there is much more to it. Why is it important when building muscle? Why is it so important when losing weight? Oh so many questions. And even more answers. Even the official answers on how much is enough vary depending on the source. The USDA says one thing while the World Health Organization says much less. Body builders are all about the protein and eat massive amounts of it. So why? Well, here's an attempt to answer that.

Our bodies use protein to build just about everything. Skin, hair, muscles, organs, even the hemoglobin in your blood is made of protein. And the list goes on: The enzymes that break down food and spark chemical reactions in the body are proteins. Our immune systems depend on protein to make antibodies. Protein molecules aid the transfer of messages between the neurotransmitters in our brains. And many hormones, including insulin and other metabolism regulating hormones, are proteins as well. In short, protein is pretty much what holds us together. 

People do have different protein requirements depending on their age, their size, their levels of activity and health. However, those requirements are not as high, and don't vary as much, as some of the popular hype around protein might lead one to believe. The U.S.D.A recommends 5.5 ounces of protein for women 19-30 years old. For all other women's age groups they recommend 5 ounces. For men, 6.5 ounces for 19-30 years old, 6 ounces for 31-50 years old, and 5.5 ounces for over 51. 5 ounces is about 142 grams. 6 ounces equals about 170 grams.

Some nutritionists, and the World Health Organization (W.H.O), believe the U.S.D.A standards are too high. The W.H.O recommends 8 grams of protein for every 20 lbs. for adults. By those standards, an adult woman weighing 130 lbs. would only need 52 grams of protein - less than half of what the U.S.D.A. suggests. An adult male of 180 lbs. would need 72 grams. Again, less than half. The discrepancies between the U.S.D.A and the W.H.O may reflect special interest pressures on those groups. At any rate, one might surmise that the U.S.D.A numbers are at the top end of any reasonable scale.

As a reference, the U.S.D.A offers the following guidelines as to what serving sizes equal an ounce of protein: "In general, 1 ounce of meat, poultry or fish, ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter, or ½ ounce of nuts or seeds can be considered as 1 ounce equivalent from the Protein Foods Group."

How much protein do athletes need? The current dietary reference intake (DRI) for protein for persons over 18 years of age, irrespective of physical activity status, is 0.8 g per kilogram of body weight per day (i.e., 80 g of protein for a 220-pound person).

However, many sports nutrition experts have concluded that protein requirements are higher for athletes(American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada (2000). Joint Position Statement: Nutrition and athletic performance. Med. Sci. Sports Exerc. 32:2130-2145).

The additional protein may be needed in order to promote muscle adaptation during recovery from exercise in several ways:

• Aiding in the repair of exercise-induced damage to muscle fibers.
• Promoting training-induced adaptations in muscle fibers (e.g., synthesis of new proteins that are involved in energy production and/or force generation).
• Facilitating the replenishment of depleted energy stores.

The American College of Sports Medicine (ACSM), American Dietetic Association (ADA) and Dieticians of Canada (DC) recommend that (see reference above):

• Protein recommendations for endurance athletes are 1.2 to 1.4 g per kilogram of body weight per day, whereas those for resistance and strength-trained athletes may be as high as 1.6 to 1.7 g per kilogram of body weight per day. 

Heavy resistance exercise increases the rates of both protein synthesis and breakdown in muscle for at least 24 hours after a workout. Unless a protein-containing meal is consumed during recovery, breakdown will exceed synthesis, resulting in the loss of muscle mass.

Studies (Tipton KD, Wolfe RR. (2004). Protein and amino acids for athletes. J Sports Sci. 22:65-79; Rasmussen RB, Phillips SM. (2003). Contractile and nutritional regulation of human muscle growth. Exerc. Sport Sci. Rev. 31:127-131.) have shown:

The amount of dietary protein needed to stimulate muscle recovery is surprisingly small, only 5 to 10 grams of amino acids (that's only 20 to 40 kcal of protein).

Essential amino acids are superior to non-essential amino acids for stimulating muscle growth. Foods such as fish, meat, eggs, and milk are rich in essential amino acids.

The "maximum effective dose" of amino acids (i.e., the single serving size that will maximally stimulate muscle protein accretion) is not known, however, one study showed that the amount of muscle protein gained was similar when subjects consumed 20 to 40 g of essential amino acids after weightlifting exercise. (Tipton KD, Ferrando AA, Phillips SM, Doyle D Jr, Wolfe RR. (1999). Postexercise net protein synthesis in human muscle from orally administered amino acids. Am J Physiol Endocrinol Metab 276:E628-E634.)

Thus, there seems to be a point of amino acid availability above which no further stimulation of muscle protein synthesis occurs. This suggests that consuming massive single doses of protein in hopes of further accelerating muscle growth (as often practiced by strength athletes) is futile.

The anabolic boost stimulated by a single dose of amino acids is transient and lasts only one to two hours. This means that ingesting repeated small doses of protein during recovery may be more effective in optimizing the rate of muscle protein gain, as opposed to eating just one large meal.

Carbohydrate added to a protein mixture does not markedly affect the muscle anabolic response, but does confer other benefits, most important being the resynthesis of muscle glycogen.

Two studies recently reported that consuming a protein and carbohydrate beverage during exercise increased performance as compared to carbohydrate alone. ( Ivy JL et al. (2003). Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity. Int J Sports Nutr Exerc Metab. 13:382-395; Saunders MJ et al. (2004). Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Med Sci Sports Exerc. 36:1233-1238.)

Both studies measured exercise time to fatigue in trained cyclists using a randomized double-blind repeated measures design. In each experiment, subjects ingested a 7.75 percent carbohydrate solution on one occasion and a drink that contained 7.75 percent carbohydrate plus an additional 1.94 percent protein (about 4 g of protein per 8-oz serving) on another occasion.

Results

In the first study, subjects cycled at 85 percent peak VO2max immediately after performing three hours of standardized cycle exercise. Results showed that the subjects:

• Rode 36 percent longer when ingesting the carbohydrate solution as compared to the placebo.
• Rode 55 percent longer when ingesting the carbohydrate + protein solution compared to placebo, and this was also significantly longer than the carbohydrate trial.

The best sources of complete protein are found in animal foods such as meat, fish, shellfish, poultry and dairy produce.

Eggs are the best source of protein as they contain the highest amount of essential amino acids. Fish is the next best source and is then followed by meat, milk, cereal eaten with pulses, soya beans, oatmeal, rice, peas, lentils, kidney beans and then wholemeal bread.

Try to consume a variety of protein-rich foods, including pulses, fish, vegetables, shellfish and lean meat, rather than just red meat or only dairy products, as some foods that contain high amounts of protein also contain high levels of saturated fat, which is extremely bad for the body.

It is also advisable to swap full-fat foods or foods that are high in saturated fats, for a low-fat version, for example change cheddar cheese to cottage cheese and full-fat milk to semi-skimmed or skimmed milk.

To help you make lower-fat protein choices —

• Choose meats that are leaner cuts and trim away any fat you can see. For chicken and turkey, remove the skin to reduce fat.
• Substitute pinto or black beans for meat in chili and tacos.
• Choose low-fat or fat-free milk and yogurt.
• Choose low-fat or fat-free cheese.
• Choose egg whites or pasteurized egg white products.

Tips for Vegetarians

• Build meals around protein sources that are naturally low in fat, such as beans, lentils, and rice. Don't overload meals with high-fat cheeses to replace the meat.
• Calcium-fortified soymilk provides calcium in amounts similar to milk. It is usually low in fat and does not contain cholesterol.
• Many foods that typically contain meat or poultry can be made vegetarian. This can increase vegetable intake and cut saturated fat and cholesterol intake. Consider:
• pasta primavera or pasta with marinara or pesto sauce
• veggie pizza
• vegetable lasagna
• tofu-vegetable stir fry
• vegetable lo mein
• vegetable kabobs
• bean burritos or tacos
• A variety of vegetarian products look (and may taste) like their non-vegetarian counterparts, but are usually lower in saturated fat and contain no cholesterol.
• For breakfast, try soy-based sausage patties or links.
• Rather than hamburgers, try veggie burgers. A variety of kinds are available, made with soy beans, vegetables, and/or rice.
• Add vegetarian meat substitutes to soups and stews to boost protein without adding saturated fat or cholesterol. These include tempeh (cultured soybeans with a chewy texture), tofu, or wheat gluten (seitan).
• For barbecues, try veggie burgers, soy hot dogs, marinated tofu or tempeh, and veggie kabobs.
• Make bean burgers, lentil burgers, or pita halves with falafel (spicy ground chick pea patties).
• Some restaurants offer soy options (texturized vegetable protein) as a substitute for meat, and soy cheese as a substitute for regular cheese.
• Most restaurants can accommodate vegetarian modifications to menu items by substituting meatless sauces, omitting meat from stir-fries, and adding vegetables or pasta in place of meat. These substitutions are more likely to be available at restaurants that make food to order.
• Many Asian and Indian restaurants offer a varied selection of vegetarian dishes.

Is too much protein bad for you?

Although the body needs a certain amount of protein, too much can be harmful for a person's health.

There is a significant risk of high cholesterol, due to the high amount of saturated fats in certain foods, which could in turn lead to heart disease and stroke.

Too much protein also puts a strain on the liver and kidneys. Foods that contain protein have high levels of nitrogen, which are harmful to the body and must be eliminated. The role of the kidneys is to filter out waste products and therefore an excess of protein will force the kidneys to work harder to remove the nitrogen waste from the body. This stress could ultimately lead to kidney disorders or damage to the body's filtering capacities.

Due to the inability of the body to store excess protein, any surplus protein that is consumed is then converted into glucose in the liver and either used up as energy or stored as fat.

Some protein-rich foods are high in nucleic acids, which when broken down, are converted into uric acid. Consequently, too much uric acid in the blood can lead to gout, an extremely uncomfortable condition that causes a person's joints to become inflamed, tender and agonizingly painful to move.

Finally, too much protein in the diet could also lead to osteoporosis (thinning of the bones), as an excess of protein promotes the loss of calcium in the bones through urine.

So you may be wondering at this point what all the high protein hype is about and if it's really all it's cracked up to be. Well, again, opinions range on that.

Participants in a study published in the American Journal of Clinical Nutrition reported greater satisfaction, less hunger, and weight loss when fat was reduced to 20% of the total calories in their diets, protein was increased to 30%, and carbs accounted for 50%. The study participants ate some 441 fewer calories a day when they followed this high-protein diet and regulated their own calorie intake.

Another study, reported in the Journal of Nutrition, showed that a high-protein diet combined with exercise enhanced weight and fat loss and improved blood fat levels. Researchers suggest that higher-protein diets help people better control their appetites and calorie intake.

Diets higher in protein and moderate in carbs, along with a lifestyle of regular exercise are often purported by experts to reduce blood fats and maintain lean tissue while burning fat for fuel without dieters being sidetracked with constant hunger.

Researchers don't understand exactly how protein works to turn down appetite. They surmise that it may be because a high-protein diet causes the brain to receive lower levels of appetite-stimulating hormones. It may be due to eating fewer carbs and/or the specific protein effect on hunger hormones and brain chemistry.

The American Heart Association has this to say about diets high in protein:

Most Americans already eat more protein than their bodies need. And eating too much protein can increase health risks. High-protein animal foods are usually also high in saturated fat. Eating large amounts of high-fat foods for a sustained period raises the risk of coronary heart disease, diabetes, stroke and several types of cancer. People who can't use excess protein effectively may be at higher risk of kidney and liver disorders, and osteoporosis.

That's why the American Heart Association guidelines urge adults who are trying to lose weight and keep it off to eat no more than 35 percent of total daily calories from fat and less than 7 percent of total daily calories from saturated fat and less than 1 percent of total daily calories from trans fat. On most high-protein diets, meeting these goals isn't possible.

Some high-protein diets de-emphasize high-carbohydrate, high-fiber plant foods. These foods help lower cholesterol when eaten as part of a nutritionally balanced diet. Reducing consumption of these foods usually means other, higher-fat foods are eaten instead. This raises cholesterol levels even more and increases cardiovascular risk.

High-protein diets don't provide some essential vitamins, minerals, fiber and other nutritional elements. A high-carbohydrate diet that includes fruits, vegetables, nonfat dairy products and whole grains also has been shown to reduce blood pressure. Thus, limiting these foods may raise blood pressure by reducing the intake of calcium, potassium and magnesium while simultaneously increasing sodium intake.

So I suppose, like most things, it really depends on who you ask and what your lifestyle is. I think the best plan is balance, but that's not always possible. And I do personally find that protein keeps me full much longer than most other things I eat. Though I am learning more about dietary fiber and the benefits it provides in overall health and also in feeling satisfied longer. But that's for another blog. 

What counts as an ounce equivalent in the Protein Foods Group?

In general, 1 ounce of meat, poultry or fish, ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut
butter, or ½ ounce of nuts or seeds can be considered as 1 ounce equivalent from the Protein
Foods Group.

The chart lists specific amounts that count as 1 ounce equivalent in the Protein Foods Group
towards your daily recommended intake:

		Amount that counts as 1 ounce equivalent in the Protein Foods Group		Common portions and ounce equivalents
Meats		1 ounce cooked lean beef		1 small steak (eye of round, filet) = 3½ to 4 ounce equivalents
		1 ounce cooked lean pork or ham		1 small lean hamburger = 2 to 3 ounce equivalents
Poultry		1 ounce cooked chicken or turkey, without skin		1 small chicken breast half = 3 ounce equivalents
		1 sandwich slice of turkey (4 ½ x 2 ½ x 1/8”)		½ Cornish game hen = 4 ounce equivalents
Seafood		1 ounce cooked fish or shell fish		1 can of tuna, drained = 3 to 4 ounce equivalents 1 salmon steak = 4 to 6 ounce equivalents 1 small trout = 3 ounce equivalents
Eggs		1 egg		3 egg whites = 2 ounce equivalents 3 egg yolks = 1 ounce equivalent
Nuts and seeds		½ ounce of nuts (12 almonds, 24 pistachios, 7 walnut halves) ½ ounce of seeds (pumpkin, sunflower or squash seeds, hulled, roasted) 1 Tablespoon of peanut butter or almond butter		1 ounce of nuts or seeds = 2 ounce equivalents
Beans and peas		¼ cup of cooked beans (such as black, kidney, pinto, or white beans) ¼ cup of cooked peas (such as chickpeas, cowpeas, lentils, or split peas) ¼ cup of baked beans, refried beans		1 cup split pea soup = 2 ounce equivalents 1 cup lentil soup = 2 ounce equivalents 1 cup bean soup = 2 ounce equivalents
		¼ cup (about 2 ounces) of tofu 1 oz. tempeh, cooked ¼ cup roasted soybeans 1 falafel patty (2 ¼”, 4 oz) 2 Tablespoons hummus		1 soy or bean burger patty = 2 ounce equivalents

Some good protein sources:

Beef

• Hamburger patty, 4 oz – 28 grams proteinSteak, 6 oz – 42 grams
• Most cuts of beef – 7 grams of protein per ounce

Chicken

• Chicken breast, 3.5 oz - 30 grams protein
• Chicken thigh – 10 grams (for average size)
• Drumstick – 11 grams
• Wing – 6 grams
• Chicken meat, cooked, 4 oz – 35 grams

Fish

• Most fish fillets or steaks are about 22 grams of protein for 3 ½ oz (100 grams) of cooked fish, or 6 grams per ounce
• Tuna, 6 oz can - 40 grams of protein

Pork

• Pork chop, average - 22 grams protein
• Pork loin or tenderloin, 4 oz – 29 grams
• Ham, 3 oz serving – 19 grams
• Ground pork, 1 oz raw – 5 grams; 3 oz cooked – 22 grams
• Bacon, 1 slice – 3 grams
• Canadian-style bacon (back bacon), slice – 5 – 6 grams

Eggs and Dairy

• Egg, large - 6 grams protein
• Milk, 1 cup - 8 grams
• Cottage cheese, ½ cup - 15 grams
• Yogurt, 1 cup – usually 8-12 grams, check label
• Soft cheeses (Mozzarella, Brie, Camembert) – 6 grams per oz
• Medium cheeses (Cheddar, Swiss) – 7 or 8 grams per oz
• Hard cheeses (Parmesan) – 10 grams per oz

Beans (including soy)

• Tofu, ½ cup 20 grams protein
• Tofu, 1 oz, 2.3 grams
• Soy milk, 1 cup - 6 -10 grams
• Most beans (black, pinto, lentils, etc) about 7-10 grams protein per half cup of cooked beans
• Soy beans, ½ cup cooked – 14 grams protein
• Split peas, ½ cup cooked – 8 grams

Nuts and Seeds

• Peanut butter, 2 Tablespoons - 8 grams protein
• Almonds, ¼ cup – 8 grams
• Peanuts, ¼ cup – 9 grams
• Cashews, ¼ cup – 5 grams
• Pecans, ¼ cup – 2.5 grams
• Sunflower seeds, ¼ cup – 6 grams
• Pumpkin seeds, ¼ cup – 8 grams
• Flax seeds – ¼ cup – 8 gramsSources:

SOURCES

• http://pilates.about.com/od/pilatesandweightloss/a/What-Is-Protein.htm
• http://www.active.com/nutrition/Articles/The_role_of_protein_in_exercise_recovery.htm
• http://www.helpwithcooking.com/nutrition-information/protein-guide.html
• http://www.cdc.gov/nutrition/everyone/basics/protein.html
• http://www.choosemyplate.gov/healthy-eating-tips/tips-for-vegetarian.html
• http://lowcarbdiets.about.com/od/whattoeat/a/highproteinfood.htm
• http://www.webmd.com/diet/guide/high-protein-diet-weight-loss
• http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/High-Protein-Diets_UCM_305989_Article.jsp

Bariatric Surgery 101

I get so tired of reading about and listening to peoples opinions on what bariatric surgery is, how it works and why people get it from people that have absolutely no idea what they are talking about. I don't know why it bothers me so much, I probably shouldn't let it, but it does. I get so sick of people talking about how "it's the easy way" and it's "cheating". Or that people with bariatric surgery don't put in the work.

Remember, most of what is below I did not write myself. I have sighted my sources at the bottom of the page.

As a treatment for severe obesity, weight loss surgery's popularity is growing. When diet and exercise fail the more than 60 million Americans considered obese, surgery, for some, can literally be lifesaving.

But it isn't for everyone. While generally safe, bariatric weight loss surgery (also called simply weight loss surgery) has risks. And losing weight after bariatric surgery is far from automatic; it takes commitment to lifelong changes in eating patterns and lifestyle.

Gastric bypass surgery is a type of bariatric surgery performed to help morbidly obese patients lose significant amounts of weight—without gaining it back. It is considered the "golden standard" for obesity surgery, with a success rate of over 80%. Most patients lose at least half of their excess weight and keep it off for more than five years, as long as they adhere to an active and healthy lifestyle after surgery.

Gastric bypass helps patients lose weight by restricting food intake and altering the digestive process. This is done by creating a small pouch that serves as the new stomach and bypasses a part of the small intestine. There are several different types of gastric bypass procedures, but the most popular is the Roux-en-Y procedure, which involves stapling the stomach and shaping the small intestine into a “Y” shape.

Two ways that surgical procedures promote weight loss are:

• By decreasing food intake (restriction). Gastric banding, gastric bypass, and vertical-banded gastroplasty are surgeries that limit the amount of food the stomach can hold by closing off or removing parts of the stomach. These operations also delay emptying of the stomach (gastric pouch).
• By causing food to be poorly digested and absorbed (malabsorption). In the gastric bypass procedures, a surgeon makes a direct connection from the stomach to a lower segment of the small intestine, bypassing the duodenum, and some of the jejunum.

In addition to the significant weight loss results this procedure often provides, gastric bypass may also help to:

• Lower blood pressure
• Lower blood sugar
• Decrease workload of the heart
• Lower cholesterol levels

The ideal candidate for gastric bypass surgery is someone who:

• Is at least 18 years old
• Has a BMI of 40 or higher (or 35 or higher with a related medical condition)
• Obstructive sleep apnea, severe arthritis, and diabetes are several conditions that may benefit from even a small weight loss. Weight loss surgery can dramatically reverse these health problems when caused by obesity
• Has been obese for at least five years
• Has tried other methods of weight loss with little to no success
• Is committed to changing his/her lifestyle by eating healthy and exercising regularly after surgery

Here is a list of the most common types of bariatric surgery: 

In Gastric Bypass surgery, part of the stomach is stapled and becomes unusable. Then the smaller portion of the stomach is connected to the intestine. Because their stomachs have a smaller capacity for food, patients who have a gastric bypass will not be inclined to eat as much as they did prior to their surgery; when they do eat, they feel full much sooner than previously. 

During the gastric bypass procedure, your surgeon uses suture-like staples to create a pouch in the top of the stomach. The pouch is then connected directly to a section of the stomach called the Roux limb. The smaller stomach pouch restricts the amount of food that can be digested at any time and limits the body's ability to absorb fat from food by bypassing the majority of the stomach and some of the large intestine. This combination of restrictiveand malabsorptive techniques makes the Roux-en-Y procedure one of the most successful gastric bypass surgeries.

The Adjustable Gastric Band, also known as the Lap-Band, is actually a band that is surgically inserted around the top part of the stomach to create a small pouch in the upper stomach. This procedure decreases the stomach’s capacity to take in food, and also reduces the patient’s desire for food. 

Vertical Banded Gastroplasty (VBG) is like other types of bariatric surgery, in that is separates the stomach into two parts, producing a smaller stomach area within the larger stomach. This procedure also restricts the food intake of the patient. Vertical Banded Gastroplasty also uses staples to make a “smaller stomach” in the upper part of the stomach. 

The advantage of gastric sleeve surgery include:

• 30 to 60% extra weight loss within the first 12 months of the procedure
• Less invasive than gastric bypass
• No cutting or, disconnection or alteration of the intestines
• No risk of “dumping syndrome” typically associated with gastric bypass
• No need for implementation of foreign devices in to the body such as a gastric band
• Less restrictive post-surgery diet
• Procedure may be followed by gastric bypass or duodenal switch for even better results for super obese patients (those with a BMI > 70)
• Can be performed laparoscopically on extremely obese patients

Disadvantages of the Gastric Sleeve

• As with any medical procedure of this nature, there is always the potential for adverse affects. The biggest potential drawback for some people with this procedure is that is irreversible and thus you must really understand all of the implications before proceeding with gastric sleeve surgery.

In addition the following potential drawbacks should be taken in to consideration:

• Since the gastric sleeve is a restrictive weight loss procedure and not malabsorptive, inadequate weight loss or weight regain is more likely to occur than would in a procedure involving intestinal bypass
• The newly created pouch has the potential to stretch over time
• Weight Loss only really noticeable with total change in diet combined with exercise
• Additional surgery may be required for follow-up procedures to combine methods
• Leakage may occur at the site of stapling
• Still no knowledge of long term results due to short history of procedure
• Insurance may not cover due to the short history of the procedure making the cost potentially prohibitive for many people.

The Fobi-Pouch is very similar to the gastric bypass surgery. This procedure is typically done on overweight patients who have had the vertical banded gastroplasty but have not lost a sufficient amount of weight.

The Roux-en-Y Gastric Bypass is a form of gastric bypass surgery that separates the stomach into two parts. A smaller stomach pouch is created and connected to the intestine. Because a large part of the stomach is bypassed, food intake and fat absorption are both significantly reduced. The “Y” refers to the shape of the connection made with the stomach and intestines in this type of surgery.

Advantages of Gastric Bypass

• Typically most people will lose about 10 to 20 pounds in the first month after the surgery. Weight loss will continue but decrease over time. The people who see the best results are those who adhere to a strict diet and exercise routine, which is essential to keeping the weight off long term.

 In addition the following are benefits one can expect from gastric bypass surgery:

• Increased weight loss due to being a restrictive and malabsorptive surgery
• Verified long term success
• Insurance coverage is likely

Gastric bypass surgery not only has the obvious benefit of helping shed weight, but it can help improve a variety of medical conditions that are related to obesity.

• Type 2 Diabetes
• High Cholesterol
• High Blood Pressure
• Type 2 Diabetes
• Sleep Apnea
• Hypertension
• Joint Pain
• Asthma

Disadvantages of Gastric Bypass

• With any other major medical procedure, there is the potential for gastric bypass complications ranging from minor to major. It is understanding the potential for those risks and managing accordingly that will best help you get through anything that may come arise.
• Complex operation comes with risks including infection and bleeding
• "Dumping Syndrome" is associated with this procedure
• Potential for vitamin and nutrient deficiency due to malabsorptive component of this surgery

Restriction operations are the surgeries most often used for producing weight loss. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters from the esophagus. The pouch initially holds about 1 ounce of food and expands to 2-3 ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.

After an operation, the person usually can eat only a half to a whole cup of food without discomfort or nausea. Also, food has to be well chewed. For most people, the ability to eat a large amount of food at one time is lost, but some patients do return to eating modest amounts of food without feeling hungry.

Restriction operations for obesity include gastric banding and vertical banded gastroplasty. Both operations serve only to restrict food intake. They do not interfere with the normal digestive process.

Restrictive operations lead to weight loss in almost all patients. However, weight regain does occur in some patients. About 30 percent of persons undergoing vertical banded gastroplasty achieve normal weight, and about 80 percent achieve some degree of weight loss. However, some patients are unable to adjust their eating habits and fail to lose the desired weight. In all weight-loss operations, successful results depend on your motivation and behaviors.

A common risk of restrictive operations is vomiting caused by the small stomach being overly stretched by food particles that have not been chewed well. Other risks of VBG include erosion of the band, breakdown of the staple line, and, in a small number of cases, leakage of stomach juices into the abdomen. The latter requires an emergency operation. In a very small number of cases (less than 1 percent) infection or death from complications can occur.

Gastric bypass operations (Roux-en-Y gastric bypass,Extensive gastric bypass (biliopancreatic diversion ) that cause malabsorption and restrict food intake produce more weight loss than restriction operations (Gastric Banding,Vertical banded gastroplasty (VBG) ) that only decrease food intake. Patients who have bypass operations generally lose two-thirds of their excess weight within 2 years.

The risks for pouch stretching, band erosion, breakdown of staple lines, and leakage of stomach contents into the abdomen are about the same for gastric bypass as for vertical banded gastroplasty. However, because gastric bypass operations cause food to skip the duodenum, where most iron and calcium are absorbed, risks for nutritional deficiencies are higher in these procedures. Anemia may result from malabsorption of vitamin B12 and iron in menstruating women, and decreased absorption of calcium may bring on osteoporosis and metabolic bone disease. Patients are required to take nutritional supplements that usually prevent these deficiencies.

Gastric bypass operations also may cause "dumping syndrome," whereby stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming so weak and sweaty that the patient must lie down until the symptoms pass.

The more extensive the bypass operation, the greater is the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require not only close monitoring, but also life-long use of special foods and medications.

Benefits

• Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.
• Surgery improves most obesity-related conditions. For example, in one study blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had had diabetes for a long time.

Risks

• Ten to 20 percent of patients who have weight-loss operations require followup operations to correct complications. Abdominal hernias are the most common complications requiring followup surgery. Less common complications include breakdown of the staple line and stretched stomach outlets.
• More than one-third of obese patients who have gastric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery.
• Nearly 30 percent of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
• Many medications can be absorbed normally after gastric bypass surgery. But certain drugs, including some types of time-release medications, require careful monitoring in people who have had gastric bypass.
• Certain types of antidepressant drugs may also be affected by gastric bypass surgery. Following gastric bypass, some people may need to have their dose of antidepressant medication modified, or they may need to switch to a different type of antidepressant.
• In addition, medications designed to regulate a person's heartbeat and prevent an irregular heartbeat, called anti-arrhythmic drugs, need to be closely monitored in people who have had gastric bypass, as their absorption may change due to the surgery. The same is true for people who've had an organ transplant and are taking immunosuppressive drugs to prevent their bodies from rejecting the new organ. Their medication dosages should be followed closely.
• Even with drugs that require monitoring after gastric bypass, absorption should not be a major problem to overcome. In many cases, a change in dose or medication type is all that's needed.
• Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.

Sources:

• http://www.advancebariatric.com/gastric-bypass.php
• http://www.wlscenter.com/ResearchArticles/Gastric_Surgery_Article.htm
• http://articles.chicagotribune.com/2012-02-09/health/sc-health-0208-gastric-drugs-20120208_1_stomach-pouch-controlled-release-medications
• http://www.webmd.com/diet/weight-loss-surgery/what-is-gastric-bypass-surgery
• http://www.webmd.com/diet/guide/is-weight-loss-surgery-right-for-you
• http://thebariatricsurgeryresource.com/
• http://www.mayoclinic.com/health/gastric-bypass/MY00825
• http://www.yourbariatricsurgeryguide.com/gastric-bypass-risks/

All about ME

That's right, this one is all about me. Well hell, most of them are all about me, but this one's a tad different. I think I wrote something way back about how I ended up not only where I am but how I am. I suppose I could dig bag and look, but I'm not gonna. I'm just going to write a new one, of sorts.

As anyone who has read any of my mindless drivel is aware, I'm fat, broken down, depressed and pretty much a walking (when I can) mess. Yes, I've come a long, long way from a couple years ago. But I've still a long ways to go. I ask myself sometimes, just how the hell did this happen? How did I get so fat, so beat up.

Now one of the things, the important things, about depression is it lies. It is one lie telling mother fucker. It talks up a good ol' story. It tells you all kinds of things. And being the fib telling bastard that it is, it's very believable. It beats you down until you believe the lies. Until you can't see past them. It tells you things like "it's all your fault", "you're useless". You know, fun, cheery shit. It builds walls in your memory, skews the past, covers everything with a thick, dark fog. So when you think about the past, about how things happened and how you got to the point you're at all you can remember is the negative. I remember all the bad things really well, vividly in fact. I can remember strange little details that most people probably wouldn't. When it comes to the good, not so much. I have to struggle.

So I was sitting here on my arse earlier today wandering about the internet and my old photos and what not thinking about how I ended up here. At some point I looked at my facebook and a friend had posted a photo of a whale next to a boat with the caption of "on my bucket list" and I realized, wow, not only have I don't that once but I've done it so many times that it started to feel normal and boring. Another friend posted a photo of the northern lights and people responded the same way, oh that's on my bucket list, I would love to see that, so on and so on. I sat and looked at the picture and realized; wow, I've seen that, more than once. And a small appreciation for the life I've lived started to sink in.

Yes, I've beat the hell out of my body. And my mind. I'm very fat. I'm out of shape. I am in constant pain. All this is true. Also true is that I have seen and done things in my 38 years that most people only dream about. I've been places that others only hope to see. I've been more things than the average character actor. I've lived through things that would have killed most people. And I never really truly stopped to appreciate it.

I've been to SE Alaska. I've seen glaciers calve, even ridden the waves they make in a small rubber raft. I've seen the northern lights and Orcas in the morning. I've watched whales bubble net and breach. I've sailed a boat down the Florida keys, around the other side and up the gulf. I've spent a week on a sailboat in the Bahamas. I've traveled. I've played. I've lived. And none of that ever occurred to me, not really.

I've walked away from motorcycle wrecks, car wrecks, horse wrecks and many a bicycle wreck. I've been kicked in the head, the nads and all points in between. I almost drowned, twice. I've been shot at, had knives pulled on me and threatened with all sorts of nasty ends. I've been a farmer, a construction worker, a cook, a bouncer, a deck hand, engineer and mate. I've cut down trees and planted grass. Built trails, roads, bridges, houses and a couple cars. I've been in fights, I've been in pain and I've enjoyed many a pleasure. But I never really enjoyed it. Not then. Depression wouldn't ever let me. And the one constant in my life, through all the years, all the places, faces, jobs, moves, road trips, camping trips and occasional acid trips, was the depression.

So, as I sit here with my knees throbbing at me, I find myself wondering, why do I hurt. I didn't do anything to make my knees hurt. What's with this pain. And then I remember, yes I did, I lived. Until, at some point living turned to surviving. Or maybe it's always been that way. I survived, creatively. Well now it's time to start living. Before it's time to start getting ready to die.

Why now?

I've been asking myself this question a lot recently. Trying to figure out just what has changed with me to change so much the way I want to live. I have spent most of my life as a larger person. And most of that time I pretended I was fine with it, that it didn't bother me. And I suppose to some extent that was true. When you are buried under a blanker of depression you don't care about much of anything, certainly not personal health. When you struggle regularly to find reasons to keep getting out of bed, going on a diet seems rather pointless. When you are struggling to make in through the week you certainly don't worry about next year.

I think a large number of people who are obese also suffer some form of depression. Sometimes it's much more subtle than others, but it's still there. My depression was far from subtle, at least to people who knew what to look for. I faked it pretty well off and on over the years but in the end the depression would always come back and swallow me whole. And that is what has changed in me. That's the biggest part of it anyway. I have finally, after so many years, gotten a handle on the depression. Yes, it's still there and always will be, but it doesn't rule my life anymore. Living doesn't feel pointless and death welcome. I don't climb in bed and hope not to wake up. I actually want to live and enjoy life. I want to be able to do all those things I've put off for so many years because of my size and health. I've survived, now I want to live.

The first step, of many to come, is to get my body back. To get myself healthy again. To get to a weight that is sustainable and that allows me the mobility I so desperately miss. I wish it was easy for me, but it's a daily struggle. It's a struggle with pain, with staying motivated, with fighting the constant tug of depression. I have to focus on the goal, on what is I want and why I want it. I can't stay lost in the past and I can't succumb to the abyss of depression. Not again, not ever again.

So what did change in me? I decided that if I was going to kill myself I should just get it over with and if I wasn't then I needed to change things and get better. I took a good hard long look at my life and decided that, as miserable as I was at that point in time, I still wanted to live. I wanted to see my children grow up. I wanted to accomplish something. I wanted to see more and do more. So I took the first step in what is going to be a very very long walk.

I look at where I am and where I want to be and at times it seems so very far away. But then I look at where I was a couple years ago and realize just how far I've come from that dark place. If I can make it this far then I can keep going.

Life as a fat man in America

There are few people in this country that aren't considered off limits for open ridicule, jokes, prejudices and discrimination. If you judge a person based on color, ethnicity, country of origin, sex or a handicap you are automatically labeled with any number of negative stigmas. Racist, cracker, douche bag, what ever. But it's still perfectly acceptable to openly ridicule and humiliate the obese. Call them names, crack jokes, don't offer jobs; it's all ok because they're fat and, after all, it's their fault.

And I suppose to some extent it is. Our fault. There are so many causes of obesity, it's not nearly as simple as some would like to think. Body chemistry, genetics, socioeconomic standings, family history, schooling, all these things contribute to a persons lifestyle and choices. Some we have control over, others we don't. Contrary to what seems a popular belief most overweight people are not so by choice. For some it's just lack of knowing any better. For others it's physical and mental issues. And for others, no matter what they do they can't seem to lose weight or keep it off. And then there are the ones who are obese simply because they have made the choice to do nothing about it.

Those of us who live in the United States live in the most obese nation on earth. Obesity is creeping up on being the number one preventable cause of death in this country. That's pretty sad. Yet at the same time, large people are so shunned by the rest of society that some things are complex, even impossible for some us. Things thin people don't ever think about. Every day things. Chairs, we either can't fit or have to worry if it's going to collapse under us.

I have to be careful where I go because of this issue. I avoid certain places because I know that there is no place for me to sit that I will be comfortable. Movie theaters, restaurants, even houses of friends and family. Visiting the doctors office can be embarrassing as well as uncomfortable.

Traveling is an issue. Some cars I simply can not fit into. I usually need a seat belt extension. If I was to fly at my current size I'm pretty sure they'd make me purchase two seats. I take the bus and I have to sit in a handicap spot because I don't fit in the others. Even things as mundane as using the restroom. I can not fit in stall built for normal people. I've been in some so small I couldn't even get in the stall sideways.

I get stared at any time I'm around food. I hear the whispers when I go out to eat. I see the looks of disgust. I hear the snide comments when I have to take the elevator because my knees just won't do stairs. People aren't nearly as sly as they think. I've had remarkably stupid people yell out there car windows at me. People on the street make comments to me while in my own yard. I've heard it all. And they all think it's just fine because I'm a fat man in America. And there's just no excuse for that.

I must like being fat, I must be lazy and eat crap food all the time. I couldn't possibly care about my body or how I look or feel. I am fat after all and fat is a choice. Except for some of us, it's not. I hate being a fat man in America. I hate having to think about and worry about the things I do. I hate not being able to play with my kids because of the pain I'm constantly in. I hate being fat.

For some people losing weight it easy. Like many things. I smoked for 20 years, I fought tooth and nail to quit. I still slip on occasion. I know others who have been able to just stop. Never to pick one up again. I've seen people do a drug one time and fall into a life of addiction and I've seen people never touch them again. Alcohol the same. And food is no different. Starting to exercise is also no different.

Of course there is much more to it. The overall condition of my body. Medications. Genetics. Chronic pain. Depression. It's all played a part in my life. Leading me to where I am today. It didn't happen over night and it certainly wasn't a conscious decision. I did not wake up one day and decide I'd like to be fat and in pain. In fact it often feel like the exact opposite. Like I suddenly woke up one day morbidly obese and in constant pain, having no idea how I got to this point.

balance in all things

The Tai Chi symbol

In All Things, Seek balance:

I read that someplace once. I don't remember the exact location. I've seen similar phrases here and there while reading different things. Never has it made so much since in my life as it does now. The Chinese call it yin and yang which is a belief that there exist two complementary forces in the universe. One is Yang which represents everything positive or masculine and the other is Yin which is characterized as negative or feminine. One is not better than the other. Instead they are both necessary and a balance of both is highly desirable.

This is what that symbol above represents, a balance in all things. There is, of course, more to it. As with most of the Eastern medicines and theologies, there are many levels. Here's a little more on what each side, the yin and the yang, represent:

The black area represents yin with the following characteristics:

• Feminine
• Passive
• Intuitive
• Delusion
• Moon
• Dark
• Cold
• Submission
• Contracting
• Downward seeking
• Downward movement
• Night
• Soft
• Stillness
• Rivers
• The White Section

The white area represents the yang with the following characteristics:

• Male
• Active
• Logical
• Enlightenment
• Bright
• Sun
• Light
• Creation
• Dominance
• Upward movement
• Strong
• Hot
• Expanding
• Hard
• Movement
• Mountains

So, what you probably noticed is that for every yin there is a counteractive yang. For an up there must be a down, for a left a right must also exist. 

The concepts of Yin and Yang and the Five Agents provided the intellectual framework of much of Chinese scientific thinking especially in fields like biology and medicine The organs of the body were seen to be interrelated in the same sorts of ways as other natural phenomena, and best understood by looking for correlations and correspondences. Illness was seen as a disturbance in the balance of Yin and Yang or the Five Agents caused by emotions, heat or cold, or other influences. Therapy thus depended on accurate diagnosis of the source of the imbalance.

The earliest surviving medical texts are fragments of manuscript from early Han tombs. Besides general theory, these texts cover drugs, gymnastics, minor surgery, and magic spells. The text which was to become the main source of medical theory also apparently dates from the Han. It is the Yellow Emperor's Classic of Medicine, supposed to have been written during the third millennium BCE by the mythical Yellow Emperor

One of the basic concepts of weight loss is to expend more fuel than you consume, thereby creating a negative force in your body. Once you achieve the weight you desire balance is key. You must keep what consume equal to what you burn. If you aren't in balance you either gain weight or lose it. 

In my case, I have always gained. But then my life has long been out of balance. Way out. I have always gone to extremes. With most things any way. Jobs, emotions, moving. I am not on a journey toward balance. It's slow, because you have to find the other half of all those things. The counterweight to bring things back to the middle. 

My last blog is a good example of why balance is so important. Not enough cortisol is bad, to much cortisol is bad. The human body, while quite resilient, is also in many ways a delicate machine. We operate on so many small balances that are all interconnected, to throw off one is to throw off the entire machine. 

I have been depressed for most of my life. Depression throws many things off balance. I don't want to move or go outside, that affects my level of vitamin D absorption. Vitamin D is affected by cortisol levels, cortisol levels are affected by activity, diet, stress, pain, all things affected by depression. 

I tried for years to work on one or the other of my issues. Addressing one at a time and then wondering why I failed. Why things got so difficult I just couldn't go on. One "thing" would improve just a little and the others would get worse. I found it quite confusing. I would try and diet and the depression would increase. The depression increased and I ate. I did less, I slept. The weight piled on, I got depressed because of it. I ate more.

Chinese and "new age" medicine frequently talk of seeking balance. The yin and the yang, the shakra, the chi, even the mind and meditation. Acupuncture is largely centered around balance. Eastern philosophy teaches that if one part is out of balance so then is the whole. 

So here I am, seeking balance for the first time in my life. Balance of mind, of body. Of yin and yang. My mind has long been out of balance. Chemically and emotionally. I'm one of those lucky enough to be born with faulty wiring. So, over time I have had to learn to reroute that wiring. To jump some switches, in an effort to return to balance. Now I am working on my body, working toward balance. With the energy, with the in and the out. A balance of pain and lack of. Fuel in and energy out. 

In all things, seek balance.

Further reading:

• http://feng-shui.lovetoknow.com/Ying_Yang_Meaning
• http://www.absolutelyfengshui.com/fengshui/feng-shui-yin-yang.php
• http://www.sacredlotus.com/theory/yinyang.cfm
• http://fly.cc.fer.hr/~shlede/ying/yang.html

cortisol

Cortisol, also known more formally as hydrocortisone, is a steroid hormone, more specifically a glucocorticoid, produced by the zona fasciculata of the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids

Cortisol affects many different body systems. It plays a role in:

• Bone
• Circulatory system
• Immune system
• Metabolism of fats, carbohydrates, and protein
• Nervous system
• Stress responses

Conditions which change cortisol levels are:

• abnormal ACTH levels
• clinical depression
• extremes of ambient temperature
• psychological stress
• hypoglycemia
• trauma
• surgery
• pain
• physical exertion
• illness
• fever
• fear

Cortisol is a steroid hormone produced in the cortex of the adrenal glands. Cortisol assists you in regulating blood pressure, cardiovascular functions, and your body’s use of fats, proteins and carbohydrates. Cortisol is also involved in glucose metabolism, insulin release for blood sugar maintenance, and inflammatory response. Cortisol helps in responding to and coping with stress, trauma and environmental extremes. Normal levels of cortisol increases energy and metabolism and helps regulate blood pressure. Cortisol also enhances the integrity of blood vessels and reduces allergic and inflammatory responses. [Aeron Biotechnology, 2010]

Cortisol regulates energy by selecting the right type and amount of substrate (carbohydrate, fat or protein) that is needed by the body to meet the physiological demands that is placed upon it. Cortisol mobilizes energy by tapping into the body’s fat stores (in the form of triglycerides) and moving it from one location to another, or delivering it to hungry tissues such as working muscle. Under stressful conditions, cortisol can provide the body with protein for energy production through gluconeogenesis, the process of converting amino acids into useable carbohydrate (glucose) in the liver. Additionally, it can move fat from storage depots and relocate it to fat cell deposits deep in the abdomen. Cortisol also aids adipocytes (baby fat cells) to grow up into mature fat cells. Finally, cortisol may act as an anti-inflammatory agent, suppressing the immune system during times of physical and psychological stress.

Cortisol directly effects fat storage and weight gain in stressed individuals. Tissue cortisol concentrations are controlled by a specific enzyme that converts inactive cortisone to active cortisol. This particular enzyme is located in adipose (fat) tissues. Studies with human visceral (fat surrounding the stomach and intestines) and subcutaneous fat tissue have demonstrated that the gene for this enzyme is expressed more by obese conditions. It has also been demonstrated in research that human visceral fat cells have more of these enzymes compared to subcutaneous fat cells. Thus, higher levels of these enzymes in these deep fat cells surrounding the abdomen may lead to obesity due to greater amounts of cortisol being produced at the tissue level. As well, deep abdominal fat has greater blood flow and four times more cortisol receptors compared to subcutaneous fat. This may also increase cortisol’s fat accumulating and fat cell size enlarging effect.

Small increases of cortisol produce positive effects like improved memory, reduced sensitivity to pain, and increased sustained energy. However, elevated cortisol levels from prolonged or chronic stress can cause side effects such as suppression of thyroid function, cognitive impairment, increased blood pressure, decreased bone density, and blood sugar imbalances. High levels of cortisol can also lower your immunity and inflammatory responses, as well as slow down the wound healing process. [Cortisol and The Stress Connection. John R. Lee, M.D. and Virginia Hopkins Virginia Hopkins Health Watch, One-to-One Inc., 2009]

Cortisol has been termed the "stress hormone" because excess cortisol is secreted during times of physical or psychological stress, and the normal pattern of cortisol secretion (with levels highest in the early morning and lowest at night) can be altered. This disruption of cortisol secretion may not only promote weight gain, but it can also affect where you put on the weight. Some studies have shown that stress and elevated cortisol tend to cause fat deposition in the abdominal area rather than in the hips. This fat deposition has been referred to as "toxic fat" since abdominal fat deposition is strongly correlated with the development of cardiovascular disease including heart attacks and strokes.

Now if all of this wasn't enough to make you about your levels of cortisol and how it's affecting you, here's a little more. High levels of cortisol affect vitamin D absorption. You know, that feel good, have energy vitamin people in the south get from the sun and those of us in the north get from a doctor prescribed pill. 

A special class of hormones called glucocorticoids is known to decrease expression of vitamin D receptor. The most well known glucocorticoid is cortisol.

The Department of Medicine, Division of Geriatrics and Nutritional Science, Alzheimer's Disease Research Center, Washington University School of Medicine in St. Louis released a study showing that depressed patients were 11 times more likely to have low levels of Vitamin D. They also determined that low levels of Vitamin D were associated with low mood and also not being able to complete certain mental tests.

Other current research being done on Vitamin D is showing that a deficiency in this vitamin may also play a role in 17 varieties of cancer (including breast, colon and prostate cancer) heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects and periodontal disease. If you're interested, you can read some of the studies on Vitamin D research from the VitaminD Council   

Now I for one know how I feel when my vitamin D levels are low. So, you combine that with the negative effects of high cortisone levels and suddenly I begin to understand at least one of the reasons I have low energy and store most of my fat in my gut. I have lived a VERY high stress life. 

Cortisol isn't all bad. In fact it's very important for some things, essential even. There are a few things that this “stress hormone” does that are very positive. It helps to reduce inflammation, and chemical reproductions of this hormone are called hydrocortisone. Hydrocortisone can be used topically to treat inflammatory skin condition or it can be used in injectable form to reduce inflamed tissue. It’s a very beneficial treatment under many circumstances.

Additional benefits of cortisol include its ability to make sure needed sodium is not lost. It can also be helpful in increasing short-term memory. Another function of cortisol is to help the liver remove toxins from the body.

Functions and health benefits of cortisol

Cortisol is very important for keeping humans alive. Cortisol is responsible for maintaining our ability to process sugars, maintain our blood pressure and react to stress and illness. Cortisol helps the body respond to stress. During times of stress, cortisol levels increase and accelerate the breakdown of proteins to provide the fuel to maintain body functions. It acts as a physiological antagonist to insulin by promoting breakdown of carbohydrates, lipids, and proteins and so mobilizing energy reserves. In addition, immune and inflammatory cells have their responses to stress attenuated by cortisol. Cortisol is known to stimulate gluconeogenesis (creation of glucose) to ensure an adequate fuel supply. It also makes fatty acids available for metabolic use. It increases mobilization of free fatty acids, making them a more available energy source, and decreases glucose utilization, sparing it for the brain. Cortisol stimulate protein catabolism to release amino acids for use in repair, enzyme synthesis, and energy production. Cortisol also act as an anti-inflamatory agent. It depresses immune reactions, and increases the vasoconstriction caused by epinephrine. Cortisol reduces the reserves of protein in all body cells except cells of the liver and gastrointestinal tract.

As an oral or injectable drug, cortisol is also known as hydrocortisone. Hydrocortisone relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Hydrocortisone is also used to treat certain types of cancer. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients who need steroid treatment but cannot take oral medication, and peri-operatively in patients on long-term steroid treatment to prevent an Addisonian crisis. Hydrocortisone may be applied to the skin to treat mild to severe inflammation and itching that results from conditions such as diaper rash, insect bites, allergic reactions, eczema, and psoriasis. Hydrocortisone lessens the body's response to an allergen, reducing swelling, redness, itching, and other symptoms.

I've read a saying in multiple different places, I have no idea who said it first. In all things seek balance. I suppose levels of cortisol are no exception. We all know stress is bad for us. Unfortunetly for many it is an an unavoidable side effect of life. Seek balance. 

Sources:

1. Cortisol Connection: Tips on Managing Stress and Weight by Christine A. Maglione-Garves, Len Kravitz, Ph.D., and Suzanne Schneider, Ph.D.
2. http://cortisol.com/the-cortisol-stress-connection/
3. http://www.aeron.com/new_page_27.htm
4. http://www.medicinenet.com/script/main/art.asp?articlekey=53304
5. http://www.3fatchicks.com/how-cortisol-causes-weight-gain/
6. http://www.life-with-confidence.com/benefit-of-vitamin-d.html
7. http://bodyecology.com/articles/vitamin-d-deficiency-are-stress-and-high-cortisol-depleting-you#.UEPiJxV6MkA
8. http://www.wisegeek.com/what-is-cortisol.htm
9. http://www.vitamins-supplements.org/hormones/cortisol.php
10. 
    

is it genetic?

1936

About 200 hundred television sets are in use world-wide.
1969

July 20, first TV transmission from the moon and 600 million people watch.

1972

Half the TVs in homes are color sets.

1973

Giant screen projection TV is first marketed.

1954
Ray Kroc became the first franchisee appointed by Mac and Dick McDonald in San Bernardino, California

1959
The 100th McDonald's opened in Chicago..

1955
Ray Kroc opened his first restaurant in Des Plaines, Illinois (near Chicago), and the McDonald's Corporation was created.

By 1975, sales of microwave ovens would, for the first time, exceed that of gas ranges. The following year, a reported 17% of all homes in Japan were doing their cooking by microwaves, compared with 4% of the homes in the United States the same year. Before long, though, microwave ovens were adorning the kitchens in over nine million homes, or about 14%, of all the homes in the United States. In 1976, the microwave oven became a more commonly owned kitchen appliance than the dishwasher, reaching nearly 60%, or about 52 million U.S. households. America's cooking habits were being drastically changed by the time and energy-saving convenience of the microwave oven. Once considered a luxury, the microwave oven had developed into a practical necessity for a fast-paced world.

So you may be wondering what my point is. It isn't so much a point as a long, complicated question with multiple answers. What's the question? Why are we fat? It's a world wide epidemic. Which is quite ironic given the number of hungry people also living day to day life on this rock. 

There have always been fat people in the world. There is no question about that. Some cultures considered it a sign of great wealth and fortune. In times of good fortune it was the desired norm to be chubby. But obesity at it's current levels was not an issue. The epidemic of fatness is new to the last century. The later half of it more specifically. 

As I said, there have always been fat people in the world. Why is that? I've asked myself many times why I'm fat, how I got to this point. I've also asked myself why there are people in the world who can eat twice what I do, not exercise and not gain an ounce. Just doesn't seem fair to someone who gains 5 pounds at the smell of a donut. 

It's such a complicated question that so many people attempt to over simplify. Some like to say it's a simple matter of calories in being more than calories out. And yes, there is some truth to this. Except, what about that friend who sits behind a desk all day eating thousands of calories, has never stepped foot in a gym and never gains anything? Oops, there goes the calorie in and out theory. 

Obesity is a very complex issues. People become overweight for more reasons than I could list. The Mayo clinic has the following to say about it:

Although there are genetic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity usually results from a combination of causes and contributing factors, including:

• Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities.
• Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, drinking high-calorie beverages and eating oversized portions all contribute to weight gain.
• Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Lack of sleep. Getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
• Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
• Medical problems. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function.

http://www.mayoclinic.com/health/obesity/DS00314/DSECTION=causes

But weight there's more:

Obesity occurs when you eat and drink more calories than you burn through exercise and normal daily activities. Your body stores these extra calories as fat. Obesity usually results from a combination of causes and contributing factors, including:

• Genetics. Your genes may affect the amount of body fat you store and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. Even when someone has a genetic predisposition, environmental factors ultimately make you gain more weight.
• Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn off through exercise and normal daily activities.
• Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.
• Family lifestyle. Obesity tends to run in families. That's not just because of genetics. Family members tend to have similar eating, lifestyle and activity habits. If one or both of your parents are obese, your risk of being obese is increased.
• Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to a weight gain of as much as several pounds a week for several months, which can result in obesity. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke.
• Pregnancy. During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Lack of sleep. Not getting enough sleep at night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.
• Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.
• Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't control what you eat as you age, you'll likely gain weight.
• Social and economic issues. Certain social and economic issues may be linked to obesity. You may not have safe areas to exercise, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight — you're more likely to become obese if you have obese friends or relatives.
• Medical problems. Obesity can rarely be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function.

Here is a fascinating article from the CDC website:

Genomics and Health

Behavior, environment, and genetic factors all have a role in causing people to be overweight and obese

Obesity results from the energy imbalance that occurs when a person consumes more calories than their body burns. Obesity is a serious public health problem because it is associated with some of the leading causes of death in the U.S. and worldwide, including diabetes, heart disease, stroke, and some types of cancer.

Do Genes Have a Role in Obesity?

In recent decades, obesity has reached epidemic proportions in populations whose environments promote physical inactivity and increased consumption of high-calorie foods. However, not all people living in such environments will become obese, nor will all obese people have the same body fat distribution or suffer the same health problems. These differences can be seen in groups of people with the same racial or ethnic background and even within families. Genetic changes in human populations occur too slowly to be responsible for the obesity epidemic. Nevertheless, the variation in how people respond to the same environment suggests that genes do play a role in the development of obesity.

How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in its environment. Studies of resemblances and differences among family members, twins, and adoptees offer indirect scientific evidence that a sizable portion of the variation in weight among adults is due to genetic factors. Other studies have compared obese and non-obese people for variation in genes that could influence behaviors (such as a drive to overeat, or a tendency to be sedentary) or metabolism (such as a diminished capacity to use dietary fats as fuel, or an increased tendency to store body fat). These studies have identified variants in several genes that may contribute to obesity by increasing hunger and food intake.

Rarely, a clear pattern of inherited obesity within a family is caused by a specific variant of a single gene (monogenic obesity). Most obesity, however, probably results from complex interactions among multiple genes and environmental factors that remain poorly understood (multifactorial obesity).

The "Thrifty Genotype" Hypothesis

Any explanation of the obesity epidemic has to consider both genetics and the environment. One explanation that is often cited is the mismatch between today’s environment and "energy-thrifty genes" that multiplied in the distant past, when food sources were unpredictable. In other words, according to the "thrifty genotype" hypothesis, the same genes that helped our ancestors survive occasional famines are now being challenged by environments in which food is plentiful year round.

Can Public Health Genomics Help?

Currently, genetic tests are not useful for guiding personal diet or physical activity plans. Research on genetic variation that affects response to changes in diet and physical activity is still at an early stage. Doing a better job of explaining obesity in terms of genes and environment factors could help encourage people who are trying to reach and maintain a healthy weight.

What about Family History?

Health care practitioners routinely collect family health history to help identify people at high risk of obesity-related diseases such as diabetes, cardiovascular diseases, and some forms of cancer. Family health history reflects the effects of shared genetics and environment among close relatives. Families can’t change their genes but they can change the family environment to encourage healthy eating habits and physical activity. Those changes can improve the health of family members—and improve the family health history of the next generation.

How Can You Tell If You or Your Family Members Are Overweight?

Most health care practitioners use the Body Mass Index (BMI) to determine whether a person is overweight. Check your Body Mass Index with a BMI calculator.

Key References

• Bouchard C. The biological predisposition to obesity: beyond the thrifty genotype scenario. Int J Obes 2007; 31:1337-9.
• Bouchard C. Defining the genetic architecture of the predisposition to obesity: a challenging but not insurmountable task. Am J Clin Nutr 2010;  91:5-6.
• Choquet H, Meyre D. Genetics of obesity: what have we learned? Curr Genomics. 2011;12:169-79.

So, can you or I blame genetics for our obesity? Yes and no. There is some scientific evidence that certain people are more prone to run a little fluffy than others. But there is far more to it than that. It is not nearly as simple. 

Obesity is the result of chronic energy imbalance in a person who consistently takes in more calories from food and drink than are needed to power their body’s metabolic and physical functions. The rapidly rising population prevalence of obesity in recent decades has been attributed to an “obesogenic” environment, which offers ready access to high-calorie foods but limits opportunities for physical activity. The obesity epidemic can be considered a collective response to this environment.

Did you understand that? Let me summarize. We live in a society that makes it easy to be fat. We have a drive through on every corner and a convenience store on the other. We have microwaves and frozen dinners. We have computers, televisions with remote and 2000 channels. Our jobs have become less and less active. Our food has become more and more processed. We move less and we eat more. 

Lets talk about why I'm morbidly obese. I just recently figured all this out so it's a bit new to me. I am one of those people with the genetic predisposition. I get fat easy and I stay that way. My body loves to be covered in pound upon pound of excess fuel. After all, I may need it over the winter. Except that winter never comes so I don't burn it off, only store another winters worth on top. And so it goes. 

How do genes control energy balance?
The brain regulates food intake by responding to signals received from fat (adipose) tissue, the pancreas, and the digestive tract. These signals are transmitted by hormones—such as leptin, insulin, and ghrelin—and other small molecules. The brain coordinates these signals with other inputs and responds with instructions to the body: either to eat more and reduce energy use, or to do the opposite. Genes are the basis for the signals and responses that guide food intake, and small changes in these genes can affect their levels of activity. Some genes with variants that have been associated with obesity are listed in the Table.

Energy is crucial to survival. Human energy regulation is primed to protect against weight loss, rather than to control weight gain. The "thrifty genotype" hypothesis was proposed to help explain this observation. It suggests that the same genes that helped our ancestors survive occasional famines are now being challenged by environments in which food is plentiful year round.

I am also a product of my environment, like many of us. I never learned what food was really for. I never learned to look at food as a fuel. I looked at food as a comfort. As something to be horded. As my only friend. And to be completely honest, I developed an unhealthy love for food. It replaced the intimacy I was never able to develop with anyone or anything else. 

So the question becomes, how much of it is genetics, how much of it environmental and most importantly, how much of it is personal choice? Diet, while somewhat dependent on socioeconomic circumstances and environment, is also largely left to personal choice. Yes, it's cheap and easy to go to the store and buy junk. Cooking can be difficult, expensive or completely foreign. What if you never learned to cook? A product of your environment. What if you never learned what was and was not healthy? 

Some people grow up in highly active households. They learn this behavior and consider it normal. Other people grow up in households that revolve around the television and an active lifestyle is completely foreign to them. How much of obesity is nature and how much is nurture? I'm still not entirely sure. 

I do know a few things. It can't all be blamed on genetics, nor can it all be blamed on everything else. But it's not an absolute. If a mentally handicapped person can learn, if a physically handicapped person can win a race, row a boat, ride a bike and all the other things they do, then I can overcome my genetic predisposition and life a healthy lifestyle. I can relearn what many people already know how to do. I can make better choices in what I eat, I can increase my activity level. It may not be easy, but it's far from impossible.

Introduction: Rising rates of obesity seem to be a consequence of modern life, with access to large amounts of palatable, high calorie food and limited need for physical activity. However, this environment of plenty affects different people in different ways. Some are able to maintain a reasonable balance between energy input and energy expenditure. Others have a chronic imbalance that favors energy input, which expresses itself as overweight and obesity. What accounts for these differences between individuals?

What We Know:	What We Don’t Know:
Biological relatives tend to resemble each other in many ways, including body weight. Individuals with a family history of obesity may be predisposed to gain weight and interventions that prevent obesity are especially important.	Why are biological relatives more similar in body weight?  What genes are associated with this observation?  Are the same genetic associations seen in every family?  How do these genes affect energy metabolism and regulation?
In an environment made constant for food intake and physical activity, individuals respond differently.  Some people store more energy as fat in an environment of excess; others lose less fat in an environment of scarcity.  The different responses are largely due to genetic variation between individuals.	Why are interventions based on diet and exercise more effective for some people than others?  What are the biological differences between these high and low responders?  How do we use these insights to tailor interventions to specific needs?
Fat stores are regulated over long periods of time by complex systems that involve input and feedback from fatty tissues, the brain and endocrine glands like the pancreas and the thyroid.  Overweight and obesity can result from only a very small positive energy input imbalance over a long period of time.	What elements of energy regulation feedback systems are different in individuals?  How do these differences affect energy metabolism and regulation?
Rarely, people have mutations in single genes that result in severe obesity that starts in infancy.  Studying these individuals is providing insight into the complex biological pathways that regulate the balance between energy input and energy expenditure.	Do additional obesity syndromes exist that are caused by mutations in single genes?  If so, what are they?  What are the natural history, management strategy and outcome for affected individuals?
Obese individuals have genetic similarities that may shed light on the biological differences that predispose to gain weight.  This knowledge may be useful in preventing or treating obesity in predisposed people.	How do genetic variations that are shared by obese people affect gene expression and function?  How do genetic variation and environmental factors interact to produce obesity?  What are the biological features associated with the tendency to gain weight?  What environmental factors are helpful in countering these tendencies?
Pharmaceutical companies are using genetic approaches (pharmacogenomics) to develop new drug strategies to treat obesity.	Will pharmacologic approaches benefit most people affected with obesity?  Will these drugs be accessible to most people?
The tendency to store energy in the form of fat is believed to result from thousands of years of evolution in an environment characterized by tenuous food supplies.  In other words, those who could store energy in times of plenty, were more likely to survive periods of famine and to pass this tendency to their offspring.	How can thousands of years of evolutionary pressure be countered?  Can specific factors in the modern environment (other than the obvious) be identified and controlled to more effectively counter these tendencies?

 What It Means

1. For people who are genetically predisposed to gain weight, preventing obesity is the best course.  Predisposed persons may require individualized interventions and greater support to be successful in maintaining a healthy weight.
2. Obesity is a chronic lifelong condition that is the result of an environment of caloric abundance and relative physical inactivity modulated by a susceptible genotype.  For those who are predisposed, preventing weight gain is the best course of action.
3. Genes are not destiny.  Obesity can be prevented or can be managed in many cases with a combination of diet, physical activity, and medication.

Also worth a read:

http://www.tjclarkinc.com/d_genetic_obesity.htm

http://www.usatoday.com/news/health/story/2012-04-09/childhood-obesity-genes-variants/54082720/1

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1642700/